Muscular weakness represents the main limiting factor of walk, functional independence and quality of life of myelopathy patients associated to HTLV-1

Abstract

HTLV-1-associated myelopathy is a progressive disabling disease associated with gait abnormalities. Objective To identify and quantify the main muscles affected by weakness and spasticity, their impact on gait, functional capacity and on quality of life of HTLV-1-associated myelopathy patients. Method We evaluated lower limbs muscular strength according to the Medical Research Council scale, spasticity according to the modified Ashworth scale, daily activities according to the Barthel Index and quality of life according to the Short-Form Health Survey-36 of 26 HTLV-1-associated myelopathy patients. Results The muscles most affected by weakness included the dorsal flexors and knee flexors. Spasticity predominated in the hip adductor muscles and in plantar flexors. Assistance for locomotion, minimal dependence in daily activities, limitations in functional capacity and physical aspects were the most common findings. Conclusion The impairment of gait, functional dependence and quality of life were predominantly a consequence of intense muscle weakness in HTLV-1-associated myelopathy patients.

Balance, functional mobility, and fall occurrence in patients with human T-cell lymphotropic virus type-1-associated myelopathy/tropical spastic paraparesis: a cross-sectional study

“…Human T-cell lymphotropic virus type-1 (HTLV-1)associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a neurological disorder caused by demyelination and axonal destruction of the spinal cord [1][2][3] . This health condition is more prevalent in women older than 40 years of age [2][3][4][5][6][7][8] . Patients with HAM/TSP have motor, sensory, and autonomic alterations, which may influence gait performance, balance maintenance, and functional mobility [2][3][4] .…”

“…Studies report that the earliest clinical presentations of HAM/ TSP are reduction of muscle strength 5,8,[12][13][14][15] and spasticity in the lower limbs 5,8,15 . Muscle weakness occurs mainly in the hip flexors and ankle dorsiflexors, and spasticity mainly affects hip adductors and ankle plantiflexes 8 , which may have repercussions on balance reactions and functional mobility.…”

“…Muscle weakness occurs mainly in the hip flexors and ankle dorsiflexors, and spasticity mainly affects hip adductors and ankle plantiflexes 8 , which may have repercussions on balance reactions and functional mobility. These alterations may lead to a reduction in functional capacity, especially in the scope of mobility 5 . Most of these patients evolve to locomotion with some type of assistance 5,8,12,14,16 .…”

The effect of home exercise on the posture and mobility of people with HAM/TSP: a randomized clinical trial

“…Exercises to improve functional performance have been suggested, because they present positive results in mobility 8,10,11 . A Pilates protocol improved cervical and trunk alignment, varus knee and knee flexion 12 and pain intensity, and positively impacted the quality of life 13 .…”

Using a new tool to evaluate the functional capacity of patients with HTLV-1 associated myelopathy/Tropical spastic paraparesis (HAM/TSP)

“…The motor capacity of patients with HTLV-1 is usually assessed using categorical scales, such as the Expanded Disability Status Scale (EDSS) 15 , the Osame Motor Dysfunction Scale (OMDS) 16 , the Barthel Index 17 and the Functional Independence Measure (FIM) 12 . However, a recent study questioned the ability of categorical scales to accurately describe the functional capacity of patients with HAM/TSP 18 .…”