Asunto(s)
Algoritmos , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Manejo de la Enfermedad , Antirreumáticos/administración & dosificación , Artritis Reumatoide/economía , Artritis Reumatoide/fisiopatología , Deducibles y Coseguros , Costos de los Medicamentos , Quimioterapia Combinada , Humanos , Isoxazoles/administración & dosificación , Isoxazoles/economía , Isoxazoles/uso terapéutico , Leflunamida , Medicare , Metotrexato/administración & dosificación , Metotrexato/economía , Metotrexato/uso terapéutico , Cooperación del Paciente , Atención Primaria de Salud , Calidad de Vida , Reumatología , Estados Unidos , Recursos HumanosRESUMEN
The gait of five patients with Charcot-Marie-Tooth(CMT) disease was analyzed using light-emitting diodes and a force plate. The flexion-extension motions of the hips, knees, and ankles, as well as their moments (vector sums of forces acting at the joints) in the flexion-extension and abduction-adduction planes, were quantified. The gait of the CMT patients showed abnormalities consistent with both distal weakness (ankle dorsi- and plantar-flexors) and weakness of the hip abductor muscles. The latter weakness appeared to produce asymmetric hip moments and truncal instability in the mediolateral plane during ambulation. However, the extent to which the gait was abnormal appeared not to be exclusively related to the severity of the sensorimotor conduction deficits in the peripheral nerves. In the four patients for whom nerve conduction velocity studies were available, decrease in the lower-extremity distal conduction velocities and evoked motor amplitude potentials did not correlate with the severity and extent of the gait abnormalities.
Asunto(s)
Enfermedad de Charcot-Marie-Tooth/fisiopatología , Marcha/fisiología , Fenómenos Biomecánicos , Humanos , Pierna/fisiología , Debilidad Muscular/etiología , Debilidad Muscular/fisiopatologíaRESUMEN
The gait of five patients with myotonic dystrophy was analyzed using light-emitting diodes and a force plate. When compared with the gait of control subjects, that of myotonics suggested weakness of the tibialis anterior and triceps surae muscles. Although the myotonics showed no evidence of lower-extremity myotonia (delayed muscle relaxation following contraction), or of weakness of the hip or knee musculature, all had striking abnormalities in their hip motion. In contrast to the smooth and consistent extension of the hip throughout stance phase observed during gait in control subjects, the hips of myotonics oscillated irregularly as they progressed through stance phase extension, with considerable variation between legs and during successive strides. Excessive use of hip musculature in an attempt to control the oscillatory hip motion may contribute to the chronic fatigue associated with myotonic dystrophy.
