Abstract
Background: The HTLV-1 was the first retrovirus-associated with disease in human, being mainly associated with adult T-cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis/HTLV-1–associated myelopathy (TSP/HAM). In the predominant clinical condition of HAM/TSP, biomechanical, sensory and functional alterations are observed. Objective: To describe and correlate postural deviations and the type of predominant weight load. Methods: This is a cross-sectional descriptive study, conducted with patients at the Center for HTLV, Salvador – Bahia. Data collection was performed in two steps, first evaluating postural orthostatic through digital photos of the individual, following the protocol SAPO® to mark anatomical points, the second step was the Baropodometric evaluation. For correlation of weight load and postural changes we used Pearson or Spearman correlation tests (a<0.05). Results: We studied 31 individuals, predominantly female (54.8%), african descent (58.1%), with a mean age of 52.8 (+ 9.89) years. Analysis showed a predominance by an anteriorized position of the head (80.6%), trunk displaced posteriorly (64.5%), anteriorized body (96,8%), hip extension (77.4%), pelvic retroversion (61.3%), flexed knee (51.6%) with genu valgus (right 64.5%, left 74.2%) right hindfoot valgus (64.5%) and left varus (71.0%), and a reduction in the ankle angle (100%), discharge weight of the right foot and bilateral forefoot. It was observed a significant correlation between changes in anteriorized body, flexed knee and reduction in the ankle angle to the weight load of bilateral forefoot, and pelvic retroversion with the weight load of his right foot. Conclusion: Patients with tropical spastic paraparesis have significant postural changes that alter their weight discharge.
Highlights
Human T-cell lymphotrophic virus (HTLV-1) was the first retrovirus-associated disease in human being mainly associated with adult T-cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis/HTLV-1–associated myelopathy (HAM/TSP).(1,2,3) With regard to HTLV type 2, there are no clear indications associating it with well-defined clinical manifestations, there is evidence that suggests its association with a clinical condition similar to HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP).[4]
The HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is characterized as a demyelinating, slow and progressive chronic inflammatory disease of the central nervous system.[7]. The first manifestations of disease occur in the fourth decade of life, with a ratio of 2:1 female to male.[6]. The virus affects the spinal cord determining the appearance of severe clinical syndrome due to motor disabilities affecting the lower limbs and lumbar spine, together with the associated autonomic dysfunction
The sample were composed of 49 individuals with HTLV-1-associated myelopathy (HAM/TSP) from which eight (16.3%) were excluded due to the inability to maintain the standing position, 5 (10.2%) were excluded for presenting rheumatic or orthopedic diseases, 4 (8.1%) because they had other neurological afflictions and 1 (2.0%) due to peripheral vestibular dysfunction
Summary
Human T-cell lymphotrophic virus (HTLV-1) was the first retrovirus-associated disease in human being mainly associated with adult T-cell leukemia/lymphoma (ATLL) and tropical spastic paraparesis/HTLV-1–associated myelopathy (HAM/TSP).(1,2,3) With regard to HTLV type 2, there are no clear indications associating it with well-defined clinical manifestations, there is evidence that suggests its association with a clinical condition similar to HAM/TSP.[4]It is estimated that 15 to 20 million people are infected with HTLV-1 in the world, approximately 95% remain asymptomatic. In the predominant clinical condition of HAM/TSP, biomechanical, sensory and functional alterations are observed, characterized by the reduction in muscle strength of the pelvic girdle and lower limbs, low lumbar pain, gait disturbances, spastic hypertonia, muscle shortening and joint hypomobility, which predispose individuals to abnormal posture.[7,8,9]. In view of this context and due to the lack of studies with an objective postural assessment of individuals with HAM/TSP, it is necessary to describe and correlate postural deviations and the type of predominant weight load. Conclusion: Patients with tropical spastic paraparesis have significant postural changes that alter their weight discharge
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