Análise da Coordenação Motora da Marcha em Idoso com Artroplastia Total do Joelho: Estudo de Caso

Bárbara Tavares; Inês Leal; Cristiana Mercê; Marco Branco

doi:10.25746/ruiips.v12.i1.33420

Autores

Bárbara Tavares Escola Superior de Desporto de Rio Maior https://orcid.org/0009-0005-4081-7706
Inês Leal Instituto Politécnico de Santarém, Escola Superior de Desporto de Rio Maior https://orcid.org/0009-0003-5124-2392
Cristiana Mercê Instituto Politécnico de Santarém, Escola Superior de Desporto de Rio Maior https://orcid.org/0000-0001-5146-6597
Marco Branco Instituto Politécnico de Santarém, Escola Superior de Desporto de Rio Maior https://orcid.org/0000-0001-5238-1069

DOI:

https://doi.org/10.25746/ruiips.v12.i1.33420

Palavras-chave:

Artroplastia Total, Joelho, Idoso, Coordenação Motora, Exercício Físico

Resumo

A avaliação da marcha é um fator crucial na medição dos resultados pós-operatório da Artroplastia Total do Joelho. A Artroplastia Total do Joelho (ATJ) é uma opção cirúrgica destinada a pacientes com estágios avançados de degeneração articular no joelho. O objetivo deste estudo consistiu em avaliar as assimetrias na coordenação motora na marcha de um indivíduo idoso com ATJ. O participante, com 68 anos e do sexo masculino, realizou uma única sessão de marcha onde foram captados os dados do giroscópio, através da aplicação Phyphox. O tratamento de dados foi realizado no Microsoft Excel. Através da análise da fluidez e dispersão das linhas, os resultados evidenciaram que entre os vários planos, o plano sagital apresentou a melhor coordenação motora. Verificou-se ainda uma menor rotação externa do membro inferior submetido a ATJ. De acordo com os resultados e, de forma a reduzir as assimetrias identificadas, recomenda-se que o participante realize exercícios de reforço muscular e propriocepção.

Referências

Beck, O. N., Azua, E. N., & Grabowski, A. M. (2018). Step time asymmetry increases metabolic energy expenditure during running. European Journal of Applied Physiology, 118(10), 2147–2154. https://doi.org/10.1007/s00421-018-3939-3

Bernstein, N. (1966). The co-ordination and regulation of movements. The co-ordination and regulation of movements. https://cir.nii.ac.jp/crid/1571698599600323072

Camomilla, V., Bergamini, E., Fantozzi, S., & Vannozzi, G. (2018). Trends Supporting the In-Field Use of Wearable Inertial Sensors for Sport Performance Evaluation: A Systematic Review. Sensors, 18(3), Artigo 3. https://doi.org/10.3390/s18030873

Crowther, R. G., Spinks, W. L., Leicht, A. S., Quigley, F., & Golledge, J. (2008). Intralimb coordination variability in peripheral arterial disease. Clinical Biomechanics, 23(3), 357–364. https://doi.org/10.1016/j.clinbiomech.2007.10.009

Fuchs, S., FLÖREN, M., SKWARA, A., & TIBESKU, C. O. (2002). Quantitative gait analysis in unconstrained total knee arthroplasty patients. International Journal of Rehabilitation Research, 25(1). https://journals.lww.com/intjrehabilres/Fulltext/2002/03000/Quantitative_gait_analysis_in_unconstrained_total.10.aspx

Harris, G. F., & Wertsch, J. J. (1994). Procedures for gait analysis. Archives of Physical Medicine and Rehabilitation, 75(2), 216–225. https://doi.org/10.1016/0003-9993(94)90399-9

Hatfield, G. L., Hubley-Kozey, C. L., Astephen Wilson, J. L., & Dunbar, M. J. (2011). The Effect of Total Knee Arthroplasty on Knee Joint Kinematics and Kinetics During Gait. The Journal of Arthroplasty, 26(2), 309–318. https://doi.org/10.1016/j.arth.2010.03.021

Heiderscheit, B. C., Hamill, J., & Emmerik, R. E. A. van. (2002). Variability of Stride Characteristics and Joint Coordination among Individuals with Unilateral Patellofemoral Pain. Journal of Applied Biomechanics, 18(2), 110–121. https://doi.org/10.1123/jab.18.2.110

Heinlein, B., Kutzner, I., Graichen, F., Bender, A., Rohlmann, A., Halder, A. M., Beier, A., & Bergmann, G. (2009). ESB clinical biomechanics award 2008: Complete data of total knee replacement loading for level walking and stair climbing measured in vivo with a follow-up of 6–10 months. Clinical Biomechanics, 24(4), 315–326. https://doi.org/10.1016/j.clinbiomech.2009.01.011

Howell, D. R., Lugade, V., Taksir, M., & Meehan, W. P. (2020). Determining the utility of a smartphone-based gait evaluation for possible use in concussion management. The Physician and Sportsmedicine, 48(1), 75–80. https://doi.org/10.1080/00913847.2019.1632155

Ioshitake, F. A. C. B., Mendes, D. E., Rossi, M. F., & Rodrigues, C. D. A. (2016). Reabilitação de pacientes submetidos à artroplastia total de joelho: Revisão de literatura. Revista da Faculdade de Ciências Médicas de Sorocaba, 18(1), 11–14. https://doi.org/10.5327/Z1984-4840201623374

Judd, D. L., Eckhoff, D. G., & Stevens-Lapsley, J. (2012). Muscle Strength Loss in the Lower Extremity Following Total Knee Arthroplasty. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, 91(3), 220–230. https://doi.org/10.1097/PHM.0b013e3182411e49

Kirschberg, J., Goralski, S., Layher, F., Sander, K., & Matziolis, G. (2018). Normalized gait analysis parameters are closely related to patient-reported outcome measures after total knee arthroplasty. Archives of Orthopaedic and Trauma Surgery, 138(5), 711–717. https://doi.org/10.1007/s00402-018-2891-3

Kodesh, E., Kafri, M., Dar, G., & Dickstein, R. (2012). Walking speed, unilateral leg loading, and step symmetry in young adults. Gait & Posture, 35(1), 66–69. https://doi.org/10.1016/j.gaitpost.2011.08.008

Latash, M. L. (2008). Synergy. Oxford University Press.

Luthi, F., Pereira, L. C., & Jolles, B. M. (2015). Os 12 pontos-chave da reabilitação após artroplastia total do joelho. Revista da Sociedade Brasileira de Clínica Médica, 13(4), Artigo 4.

Maier, M. W., Aschauer, S., Wolf, S. I., Dreher, T., Merle, C., & Bitsch, R. G. (2019). Three dimensional gait analysis in patients with symptomatic component mal-rotation after total knee arthroplasty. International Orthopaedics, 43(6), 1371–1378. https://doi.org/10.1007/s00264-018-4118-1

Milner, C. E. (2009). Is gait normal after total knee arthroplasty? Systematic review of the literature. Journal of Orthopaedic Science, 14(1), 114–120. https://doi.org/10.1007/s00776-008-1285-8

Ottoboni, C., Fontes, S. V., & Fukujima, M. M. (2002). Estudo Comparativo entre a Marcha Normal e a de Pacientes Hemiparéticos por Acidente Vascular Encefálico: Aspectos Biomecânicos. Revista Neurociências, 10(1), Artigo 1. https://doi.org/10.34024/rnc.2002.v10.8904

Pelegrinelli, A. R. M., Kowalski, E., Ryan, N. S., Moura, F. A., & Lamontagne, M. (2022). Lower limb inter-joint coordination in individuals with osteoarthritis before and after a total knee arthroplasty. Clinical Biomechanics, 100, 105806. https://doi.org/10.1016/j.clinbiomech.2022.105806

Pincivero, D. M., Heller, B. M., & Hou, S.-I. (2002). The effects of ACL injury on quadriceps and hamstring torque, work and power. Journal of Sports Sciences, 20(9), 689–696. https://doi.org/10.1080/026404102320219392

Registo Português de Artroplastias. (2010). R.P.A - Hospitais / Estatísticas. http://www.rpa.spot.pt/Main-Sections/Hospitals.aspx

Saari, T., Tranberg, R., Zügner, R., Uvehammer, J., & Kärrholm, J. (2005). Changed gait pattern in patients with total knee arthroplasty but minimal influence of tibial insert design. Acta Orthopaedica, 76(2), 253–260. https://doi.org/10.1080/00016470510030661

Seifert, L., Leblanc, H., Chollet, D., & Delignières, D. (2010). Inter-limb coordination in swimming: Effect of speed and skill level. Human Movement Science, 29(1), 103–113. https://doi.org/10.1016/j.humov.2009.05.003

Silsupadol, P., Teja, K., & Lugade, V. (2017). Reliability and validity of a smartphone-based assessment of gait parameters across walking speed and smartphone locations: Body, bag, belt, hand, and pocket. Gait & Posture, 58, 516–522. https://doi.org/10.1016/j.gaitpost.2017.09.030

Sousa, L. M. M., & Carvalho, L. (2017). Pessoa com osteoartrose na anca e joelho em contexto de internamento e ortopedia. http://repositorio-cientifico.uatlantica.pt/handle/10884/1067

Tibesku, C. O., Daniilidis, K., Skwara, A., Dierkes, T., Rosenbaum, D., & Fuchs-Winkelmann, S. (2011). Gait analysis and electromyography in fixed- and mobile-bearing total knee replacement: A prospective, comparative study. Knee Surgery, Sports Traumatology, Arthroscopy, 19(12), 2052–2059. https://doi.org/10.1007/s00167-011-1540-y

Todorov, E., & Jordan, M. I. (2002). Optimal feedback control as a theory of motor coordination. Nature Neuroscience, 5(11), Artigo 11. https://doi.org/10.1038/nn963

Vahtrik, D., Gapeyeva, H., Aibast, H., Ereline, J., Kums, T., Haviko, T., Märtson, A., Schneider, G., & Pääsuke, M. (2012). Quadriceps femoris muscle function prior and after total knee arthroplasty in women with knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 20(10), 2017–2025. https://doi.org/10.1007/s00167-011-1808-2

Valtonen, A., Pöyhönen, T., Heinonen, A., & Sipilä, S. (2009). Muscle Deficits Persist After Unilateral Knee Replacement and Have Implications for Rehabilitation. Physical Therapy, 89(10), 1072–1079. https://doi.org/10.2522/ptj.20070295

van den Akker-Scheek, I., Stevens, M., Bulstra, S. K., Groothoff, J. W., van Horn, J. R., & Zijlstra, W. (2007). Recovery of Gait After Short-Stay Total Hip Arthroplasty. Archives of Physical Medicine and Rehabilitation, 88(3), 361–367. https://doi.org/10.1016/j.apmr.2006.11.026

Van der Bracht, H., Van Maele, G., Verdonk, P., Almqvist, K. F., Verdonk, R., & Freeman, M. (2010). Is there any superiority in the clinical outcome of mobile-bearing knee prosthesis designs compared to fixed-bearing total knee prosthesis designs in the treatment of osteoarthritis of the knee joint? Knee Surgery, Sports Traumatology, Arthroscopy, 18(3), 367–374. https://doi.org/10.1007/s00167-009-0973-z

VanPutte, C., Regan, J., & Russo, A. (2016). Anatomia e Fisiologia de Seeley—10a Edição. McGraw Hill Brasil.

Wang, Y., Qie, S., Li, Y., Yan, S., Zeng, J., & Zhang, K. (2022). Intersegmental Coordination in Patients With Total Knee Arthroplasty During Walking. Frontiers in Bioengineering and Biotechnology, 10. https://doi.org/10.3389/fbioe.2022.839909