Influência da adequação postural em cadeira de rodas na função respiratória de pacientes com amiotrofia espinhal tipo II

Abstract

Este estudo visou determinar a influência da adequação postural em cadeira de rodas na função respiratória de pacientes com amiotrofia espinhal tipo II (AME). Doze pacientes (idades entre 7 e 24 anos) com diagnóstico de AME II, confirmado por achados clínicos e análise genética, participaram do estudo. Os parâmetros respiratórios - volume minuto (VM), volume corrente (VC), capacidade vital forçada (CVF), pressões inspiratória (PImáx) e expiratória (PEmáx) máximas e pico de fluxo expiratório (PFE) - na cadeira de rodas individual, com adaptações, e em uma cadeira de rodas padrão, isto é, sem reclinação ou inclinação. Os resultados mostram valores melhores estatisticamente significativos de todos os parâmetros respiratórios (VM, p=0,002; VC, p=0,003; CVF, p=0,017; PImáx, p=0,002; PEmáx, p=0,006; e PFE, p=0,007) nas medidas tomadas na cadeira adaptada para a postura adequada. Os resultados permitem concluir que a adequação postural em cadeira de rodas influencia positivamente a função respiratória de pacientes com AME tipo II.

Enhancing Function, Fun and Participation with Assistive Devices, Adaptive Positioning, and Augmented Mobility for Young Children with Infantile-Onset Spinal Muscular Atrophy: A Scoping Review and Illustrative Case Report

“…See Figure 1 for PRISMA flow chart outlining each phase of the process. Twelve articles were eliminated as they did either did not include or did not explicitly report data from individuals with SMA-1 [38][39][40][41][42][43][44][45][46][47][48][49].…”

“…Disabilities 2021, 1, 4 did either did not include or did not explicitly report data from individuals with SMA-1 [38][39][40][41][42][43][44][45][46][47][48][49]. Five articles met inclusion criteria and are included in Table 1; one described power mobility skill development in a case-series of six children including only one child diagnosed as SMA-1 [34]; another described results from an internet-based survey of 32 parents of children with SMA-1 regarding use of speech generating devices and other augmentative communication supports [33]; a third study reported results of a retrospective cohort describing orthotic, positioning and mobility equipment use including 14 children with SMA-1 [35]; a qualitative study explored parents experiences with wheelchair provision and included parents of one child diagnosed as SMA-1 and another described as SMA-1-2 [36]; while a fifth study included data on stander use in 152 children with SMA-1 [37].…”

“…No studies specific to positioning with SMA-1 were identified in the search, although a study of 12 individuals (mean 16.4; range 7-24 years) diagnosed with SMA-2 reported improved respiratory function when positioned in individually prescribed and fitted supportive seating in comparison to standard wheelchair seating [44]. The Delphi consensus [1] recommends tilted or reclined supportive sitting to enhance function and custom or molded seating systems as necessary.…”

Spinal Muscle Atrophy: Clinical Cases

“…Respiratory muscle weakness is frequent in neuromuscular diseases and is directly associated with morbidity and mortality of these patients. Several complications may affect patients with AME, such as postural alterations, decrease in the range adequacy system resulted in an increase of 16% in MV, 30% in VC, 25% in CFV, 46% in MIP, 37% in MEP and 19% in PEF 27 .…”

“…Adaptations made specifically for the patient in his wheelchair provide better positioning and trunk stabilization, unlike the standard chair without postural fit. It is believed that the best biomechanical alignment offered by this resource positively influences the performance of the structures involved in breathing, contributing to minimize the possibility of a worsening of the respiratory function resulting from the sitting posture with mechanical compensation and blockages to the chest and abdomen, since such patients are already affected by progressive deterioration of the strength of the muscles involved 27 .…”