Efeitos da Imersão nos Parâmetros Ventilatórios de Indivíduos com Distrofia Muscular de Duchenne

Abstract

Rev Neurocienc 2012;20(1):34-41 original 34 RESUMO Objetivo. Analisar os efeitos da imersão nos parâmetros ventilatórios de pacientes não deambuladores com Distrofia Muscular de Duchenne (DMD). Método. Estudo transversal, com casuística de 21 indivíduos, 8 com DMD e 13 formando o grupo controle (GC). Foram avaliados em solo e durante a imersão os seguintes parâmetros: saturação de oxigênio (SatO2), frequência cardíaca (FC), pressão inspiratória (PImax) e expiratória máximas (PEmax), volume minuto (VM), frequência respiratória (Fr), volume corrente (VC), capacidade vital forçada (CVF) e pico de fluxo de tosse (PFT). Resultados. O grupo DMD diminuiu a CVF no meio líquido. O GC diminuiu o PFT, a Fr e aumentou o VC após a imersão. Os valores de CVF em solo e no meio líquido obtiveram uma correlação positiva no grupo DMD e no GC, assim como os valores de PFT no grupo DMD. Conclusão. Como a correlação entre CVF e PFT foi positiva, sugere-se uma fórmula para estimar estes parâmetros ventilatórios em meio líquido a partir dos resultados obtidos em solo. Sendo este um importante parâmetro a ser considerado na indicação de fisioterapia aquática para pacientes com DMD. Unitermos. Distrofia Muscular de Duchenne, Imersão, Capacidade Vital Forçada. ABSTRACTObjective. To analyze the effects of immersion on the ventilatory parameters of non-ambulant patients with Duchenne Muscular Dystrophy (DMD). Method. Transversal study, with casuistry of 21 individuals, 8 with DMD and 13 forming the control group (CG). They were evaluated in ground and during immersion at the following parameters: oxygen saturation (SatO2), heart rate (HR), maximal inspiratory (PImax) and maximal expiratory (PEmax) pressures, minute volume (MV), respiratory rate (RR), tidal volume (TV), forced vital capacity (FVC) and cough peak flow (CPF). Results. The DMD group reduced the FVC in the water. The CG decreased the CPF, the RR, and increased the TV after immersion. The values of FVC in ground and in the water had a positive correlation between both groups, as like the values of PFT in group DMD. Conclusion. The positive correlations of FVC and CPF suggests a way to estimate these ventilatory parameters in immersion from the results obtained in ground. This is an important parameter to be considered in the indication of aquatic therapy for patients with DMD.

Fisioterapia aquática em indivíduos com distrofia muscular: uma revisão sistemática do tipo escopo

“…There was a predominance of investigation into the pulmonary system, postural control/functional performance and cardiac system. The cardiac system, in turn, was investigated only by the variable heart rate (HR) 13,17,19,20,24,29 .…”

“…There was a predominance of studies that investigated the effects of immersion on the pulmonary system 13,17,24,26,27,[29][30][31] and studies related to the postural control system and functional performance 18,21,22,[28][29][30]32,33 . According to the definition by Shumway-Cook and Woollacott 35 , musculoskeletal systems, internal representations, adaptive mechanisms, anticipatory mechanisms, sensory strategies, individual sensory systems and neuromuscular synergies contribute to postural control, terminology that was considered most suitable for this study.…”

“…The programs lasted 21 (±24) weeks (minimum 6 weeks, and maximum 89 weeks), on average, and only one study showed a two-year followup 22 . The average water temperature was 32.7 °C (±1.6) and immersion was at the seventh cervical vertebra level 13,24 , xiphoid process [18][19][20] , and varied levels 29,31 . The types of activities developed were strengthening 6,21,28,31 , passive and active stretching 6,21,26,29,31,34 , breathing exercises 17,18,21,27,31,34 , exercises for trunk control 6,18,21,28,31 , gait 6,17,29 , body balance exercises 6,29 , jumping 29 , running 29 , swimming 29,34 , diving 27 , transfer training 28 , wheelchair handling 18 , besides specific exercises (not described) of the Halliwick concept, Bad Ragaz Method and hydrokinesiotherapy 25 , adaptation activities to the aquatic environment 23,34 .…”

“…Twenty records were selected, published between 1998 and 2018, with a predominance of Brazilian studies 13,17-28 , followed by North American 29-31 , Portuguese 32,33 , one British 6 , and one from northern Cyprus 34 . The types of studies found were as follows: one case series 31 , one retrospective experimental 17 , one randomized controlled clinical trial 6 , three quasiexperimental 26,32,33 , five cross-sectional 13,17,19,20,24 and eight case studies 21,23,25,[27][28][29][30]34 . Objectives also found were effects of immersion on energy expenditure 19,20,28 , psychological aspects (selfperception, stress, pleasure and joy) 25,33,34 , quality of life 30,31,34 and body mass index 33 .…”