Respostas de um programa de reabilitação locomotora de caminhada nórdica e livre em variáveis fisiomecânicas da marcha de pessoas com doença de Parkinson: um ensaio clínico randomizado

Abstract

Introduction: Muscle performance patterns during gait are altered in people with Parkinson's disease. In addition, the analysis of the pendular mechanism is important because it reflects the reduction of muscular effort required to accelerate and raise the center of mass during walking. This inefficient gait pattern in people with Parkinson's disease (PwP) can result in increased energy expenditure during walking, requiring therapeutic interventions that can reduce these symptoms in order to provide greater mobility and quality of life to this population. Recent findings demonstrate that the pendular mechanism (Recovery) is greater with the use of poles, which allows to indicate the hypothesis that a neurofunctional locomotor Nordic walking (NW) rehabilitation program may induce greater adaptations in the pendular mechanism compared to free walking (FW) in individuals with PwP. Objective: To analyze the responses of a neurofunctional locomotor rehabilitation program with and without poles of NW on physiomechanical parameters of gait in PwP. Materials and Methods: This study was characterized as a longitudinal randomized controlled trial, in which we investigated volunteers who met the following eligibility criteria: clinical diagnosis of idiopathic Parkinson's disease, with staging between 1 to 4 on the Hoehn & Yahr (H&Y) scale, sedentary, over 50 years of age, of both sexes. The volunteers were randomized into two groups: NW (with poles) and FW (without poles), and performed the exercises for nine weeks. The evaluations of the physiomechanical parameters, more specifically, Recovery, Internal mechanical work (Wint), Internal mechanical work of the arm, trunk, and leg (Wint arm, Wint trunk, Wint leg, respectively), External mechanical work (Wext), vertical external work (Wext vertical) and horizontal (Wext horizontal), and Total mechanical work (Wtot) of PwP's gait were analyzed during a treadmill walk at a self-selected speed pre- and post-rehabilitation program. A three- dimensional kinematic analysis was performed, with a video capture system composed of six infrared cameras from the VICON Motion Capture System 3D kinematics (Oxford, United Kingdom), with a camera sampling rate of 100 Hz. Thirty-six reflective markers (Vicon Biomechanics Marker Accessories) in the form of a sphere, with a diameter of 14 mm, were used and located on both sides of the body and in the regions of interest. The collected data were analyzed in NEXUS software, tabulated, and organized into spreadsheets in Excel 2016 software. After these steps, mathematical routines were employed in the Matlab® software for calculating the study outcomes. Generalized Estimating Equations were used to compare between groups (NW and FW) at different time points (pre and post). We used H&Y and Froude number values of volunteers as covariates, so that the values were fixed in the statistical model at the following values: H&Y (1.5) and Froude number (0.07). For the analysis of Group, Time, and Group*Time interactions effects, Bonferroni post-hoc was used to identify differences between means in all variables. The effect size was calculated by Hedge's g, and an α=0.05 was adopted. Results: The final sample consisted of 20 volunteers (NW: n=13 and FW: n=7), with NW group (64.23 ± 10.52 years) and FW group (69.71 ± 6.82 years) mean age, NW group (80.07 ± 14.79 kg) and FW group (80.07 ± 14.79 kg) body mass, NW group (1.68 ± 0.07 m) and FW group (1.68 ± 0.06 m) height. Significant differences were found for the factor Time for the Recovery (p=0.04), Wext (p<0.001), horizontal Wext (p=0.04), and vertical Wext (p<0.001) variables. For the interaction Group*Time, significant differences were found for the Wext (p=0.03) and vertical Wext (p=0.02) variables, whereas for the other variables, the values remained similar or were not modified (p>0.05). Conclusion: We concluded that the Recovery was performed more efficiently after the locomotor rehabilitation intervention for both groups, therefore individuals with Parkinson's disease presented a more optimized pendular mechanism. The Wext of individuals with Parkinson's disease who walked with and without poles reduced after the intervention, but the FW group presented lower Wext, meaning less energy was required to move in the environment in relation to the center of mass. Both NW and FW groups reduced their vertical Wext after the rehabilitation program, but the FW group demonstrated lower post-intervention values, indicating that the volunteers did not show as much efficiency in raising their center of mass. Horizontal Wext increased for both groups after the rehabilitation program, demonstrating that both groups showed improvements in their acceleration with respect to projection forward after the intervention. Our findings indicate that the locomotor rehabilitation model with and without sticks can be used by healthcare professionals to rehabilitate locomotion, making the pendular mechanism more optimized and the gait more efficient for mild to severe PwD. Clinical Trials Registration Number: NCT03355521.