Objective: To evaluate the response of the tibialis anterior (TA) muscle following a five-week protocol with contralateral irradiation force through Proprioceptive Neuromuscular Facilitation (PNF) diagonals in patients with demyelinating polyneuropathy associated with Charcot-MarieTooth disease type 1A (CMT-1A). Methods: The study included 12 patients of both sexes. They were treated twice-weekly for 5 weeks. At each session, they performed the following diagonal patterns: chopping, extension-adduction with internal rotation (EAIR) and flexion-abduction with internal rotation (FAIR). The diagonals were repeated four times, in both upper and lower limbs, with each repetition lasting six seconds on average. During execution, the response of the TA muscle was recorded by a surface electromyograph disregarding the initial and final two seconds of each diagonal. The mean RMS values of the four repetitions were normalized in percentage. The initial and final data were analyzed through the t test for paired samples with significant p-values <0.05. Results: The contralateral force irradiation with the chopping diagonal to the left and to the right increased the percentage RMS values of the TA muscle in the last session when compared with the values of the first session (t=-3.94 and t=-3.87, respectively). Similarly, the EAIR diagonal increased the percentage RMS values of the TA muscle in the last session when compared with the values of the first session (t=-3.3 and t=-4.58, respectively). The only diagonal that did not produce higher values of contralateral force irradiation in the TA muscle, left and right, was the FAIR (t=-2.31 and t=-1.55). Conclusion: These results may justify the use of a treatment program with PNF diagonals in patients with CMT-1A who have difficulty activating the TA muscle.Key words: Charcot-Marie-Tooth Disease; proprioceptive neuromuscular facilitation technique; peripheral demyelination; electromyographic evaluation. ResumoObjetivo: Avaliar a resposta do músculo tibial anterior (TA) após um protocolo de cinco semanas com irradiação contralateral de força através de diagonais de facilitação neuromuscular proprioceptiva (FNP) em pacientes com polineuropatia desmielinizante associada à doença de Charcot-Marie-Tooth do tipo 1A (CMT-1A). Métodos: Participaram deste estudo 12 pacientes, de ambos os sexos. Eles foram tratados em uma frequência de duas vezes por semana, durante cinco semanas. Em cada sessão, foram utilizadas as diagonais de Chopping, extensão-adução com rotação interna (EARI) e flexão-abdução com rotação interna (FARI). As diagonais foram repetidas quatro vezes, em ambos os membros superiores e inferiores; cada diagonal tinha duração média de 6 segundos. Durante as execuções, a resposta muscular do TA foi registrada por um eletromiógrafo de superfície, desprezando-se os 2 segundos iniciais e finais de cada diagonal. A média dos valores de Root Mean Square (RMS) das quatro repetições foi normalizada em porcentagem. Os dados iniciais e finais foram submetidos ao teste em t par...
The purpose of this study was to evaluate the response of the tibialis anterior muscle (TAm) using surface electromyography in patients with Charcot-Marie-Tooth disease (CMT-IA), after ipsilateral proprioceptive neuromuscular patterns (PNF). Thirteen CMT-IA patients (both sexes) were treated twice a week, for 5 weeks, with bilateral PNF pattern, four times per treatment. During the execution of the patterns, we recorded the bilateral activation of the TAm in root mean square (RMS). We used the Student paired t-test for the first and last treatments, P-value set at <0.05. Clinical significance (CS) was obtained by subtracting the values of the first treatment from the last. Chopping pattern to the right side increased RMS for the right (t=−3.52, CS=52%), but not the left TAm (t= −3.35). Flexion-abduction with external rotation pattern to the right (t= −2.46, CS=55%) and left (t=−2.07, CS=53%) significantly increased RMS for TAm on both sides. Extension-adduction with internal rotation pattern to the right (t=−0.25) and left (t=−1.84) did not produce any changes in TAm. Ipsilateral PNF patterns selectively produce TAm overflow in peripheral polyneuropathy patients and can be successfully used as supportive therapy for foot drop.
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