Physiomechanical parameters of locomotion, functional-motor and non-motor symptoms in people with parkinson's disease : a comparison between hyperkinetic and akinetic-rigid subtypes

Abstract

Diferentes combinações de sintomas motores são observadas na doença de Parkinson (DP), com as formas acinético-rígida (AK-R) e hipercinética (HYP) sendo as mais comuns. Alterações na biomecânica da marcha, sintomas funcionais-motores e não-motores afetam a autonomia funcional, a mobilidade e as atividades diárias, mas ainda não se sabe se esses sintomas variam entre os subtipos clínicos. Esta tese tem como objetivo caracterizar e comparar os parâmetros fisiomecânicos da locomoção, os sintomas funcionais-motores e não-motores em pessoas com DP dos subtipos AK-R e HYP. O Capítulo I apresenta uma visão geral do estudo, e o Capítulo II traz uma revisão da literatura sobre a fisiopatologia da DP, suas manifestações clínicas, os subtipos clínicos e os impactos da atividade física na patologia. As lacunas identificadas motivaram a realização de quatro estudos originais: 1) Estudo A, intitulado “Telerehabilitation based on dance, balance and locomotion for people with Parkinson's disease: A protocol for a non- randomized clinical trial”, que apresenta um protocolo de intervenção para avaliar os efeitos de exercícios físicos online nos sintomas motores e não-motores de pessoas com DP em isolamento social; 2) Estudo B, intitulado “Clinical-motor subtypes of Parkinson's disease: a narrative review on the rigid-akinetic and hyperkinetic forms”; 3) Estudo C, intitulado “Functional-motor and non-motor symptoms in people with Parkinson's disease: study of different clinical subtypes”, que compara os sintomas entre os subtipos AK-R e HYP; e 4) Estudo D, intitulado “Physiomechanical parameters of locomotion in people with Parkinson's disease: a comparison between hyperkinetic and akinetic- rigid subtypes”, que compara a biomecânica da marcha e o trabalho mecânico nos dois subtipos. Os resultados do Estudo A mostram dois modelos de treinamento e avaliação que podem ajudar a organizar programas de exercícios domiciliares para pessoas com DP. No Estudo B, observou-se que, embora existam evidências de diferenças fisiopatológicas entre os subtipos, poucos estudos abordam as diferenças no curso da doença e na resposta ao exercício físico. O Estudo C concluiu que o grupo AK-R apresentou maior comprometimento dos sintomas funcionais-motores. No Estudo D, o grupo AK-R apresentou piora nos parâmetros de marcha, com maior trabalho mecânico, menor recovery e maior tempo de apoio duplo, além de menor comprimento e altura do passo. Esses resultados são importantes para entender as diferenças na sintomatologia e no controle motor dos pacientes com DP, contribuindo para a prescrição de programas terapêuticos mais adequados.

Different combinations of motor symptoms are observed in Parkinson’s disease (PD), with the akinetic-rigid (AK-R) and hyperkinetic (HYP) forms being the most frequent. Changes in gait biomechanics, functional-motor and non-motor symptoms affect functional autonomy, mobility and activities of daily living, however it is not clear whether these symptoms are affected by the different clinical subtypes. Thus, this thesis aims to characterize and compare physiomechanical parameters of locomotion, functional-motor and non-motor symptoms in people with AK-R and HYP subtypes of PD. Chapter I presents a general presentation and contextualization of the study. Chapter II presents a literature review, with compiled information on the pathophysiology of PD, motor and non-motor manifestations, clinical subtypes, locomotion and the impacts of physical activity and inactivity on the pathology. The gaps identified in the literature motivated the writing of four original studies: 1) Study A, entitled “Telerehabilitation based on dance, balance and locomotion for people with Parkinson's disease: A protocol for a non- randomized clinical trial”, which aimed to present the intervention and evaluation measures protocol used in a clinical trial, whose objective will be to evaluate the effects of online interventions with physical exercise on motor and non-motor symptoms of people with PD in social isolation; 2) Study B, entitled “Clinical-motor subtypes of Parkinson's disease: a narrative review on the rigid-akinetic and hyperkinetic forms”; 3) Study C, entitled “Functional-motor and non-motor symptoms in people with Parkinson's disease: study of different clinical subtypes”. A cross-sectional study, which aimed to compare functional-motor and nonmotor symptoms of people with AK-R and HYP PD; and 4) Study D, entitled “Physiomechanical parameters of locomotion in people with Parkinson's disease: a comparison between hyperkinetic and akinetic- rigid subtypes”. A cross-sectional study, which aimed to characterize and compare the gait biomechanics and the mechanical work in people with akinetic-rigid and hyperkinetic PD. In study A, we present two training models and assessment methods that can assist trainers and therapists in organizing appropriate home-based exercise programs for people with PD who have difficulty participating in a face-to-face program. In study B, we observed that the literature presents evidence of different pathophysiological findings between the AK-R and HYP subtypes, but few studies have explored the differences in the course of the disease, the manifestation of functional- motor and non-motor symptoms and the response of each subtype to physical exercise. In study C, we concluded that the AK-R group presented greater impairment of functional-motor symptoms. Finally, in study D, we observed that the AK-R group presented worsening of gait parameters, reflected in greater mechanical work, longer double support time, and shorter step length and height. Our results are important to understand the differences in symptomatology and motor control of patients with different clinical manifestations of PD and thus assist in the prescription of more appropriate therapeutic programs.