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Master's Dissertation
DOI
10.11606/D.39.2017.tde-24102017-142956
Document
Author
Full name
Tatiana Beline de Freitas
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2017
Supervisor
Committee
Pasin, Camila Torriani (President)
Freudenheim, Andrea Michele
Gobbi, Lilian Teresa Bucken
Pompeu, José Eduardo
Title in Portuguese
Aprendizagem de uma tarefa de demanda de controle postural em ambiente virtual em indivíduos com doença de Parkinson
Keywords in Portuguese
Aprendizagem motora
Controle postural
Doença de Parkinson
Abstract in Portuguese
O déficit de controle postural é impactante em indivíduos com doença de Parkinson (DP), nesse sentido, a aprendizagem de tarefas que o envolvam é fundamental para esses indivíduos. Recentemente, estudos têm mostrado que indivíduos com DP são capazes de aprender tarefas com demanda de controle postural, no entanto, o intervalo de retenção destes estudos é muito curto considerando-se uma doença neurodegenerativa. Outra questão que se coloca é, em aprendendo tarefas de demanda de controle postural, poderia haver diminuição da instabilidade postural, porém ainda não existem evidências concretas para responder esse questionamento. Nesse sentido, o objetivo do presente estudo foi investigar a aprendizagem de tarefas que envolvam demanda de controle postural em ambiente de realidade virtual em indivíduos com DP quando comparados com idosos saudáveis em curto e longo prazo, além de verificar seu impacto na cognição e no controle postural dos mesmos. A amostra foi composta por 28 sujeitos, sendo 14, com DP idiopática no grupo experimental (GE) [64.28±6.35 anos; escala de Hoehn e Yahr modificada = 14.28% dos sujeitos 1; 14.28%, 1.5; 7.14%, 2; 21.42%, 2.5; 42.85%, 3; Montreal Cognitive Assessment (MoCA) = 22.42±3.41; e Mini Balance Evaluation Systems Test (MiniBEStest) = 20.78±6.54]. Foram incluídos também 14 idosos saudáveis no grupo controle (GC) [69.71±5.91 anos; MoCA = 23.64±3.17; e MiniBESTest = 27.35±2.67]. Foram realizadas 13 sessões com duração de uma hora, 2x/semana por sete semanas, no período on da medicação para a reposição dopaminérgica, sendo a primeira considerada pré-teste e a última, pós-teste. A prática consistiu em jogar quatro jogos do sistema Kinect, 5 tentativas por jogo. Foram realizados dois testes de retenção, sendo o primeiro após uma semana e o segundo após um mês. A avaliação da cognição, através da MoCA, e do controle postural, através do MiniBESTest, foi realizada antes, imediatamente após e um mês após a fase de aquisição. Indivíduos com DP foram capazes de aprender tarefas com demanda de controle postural, havendo retenção a curto e longo prazo, apesar do desempenho apresentar-se inferior aos idosos neurologicamente saudáveis. Além disso, aprender as tarefas propostas levou a melhora da cognição, especificamente na memória e nos aspectos reativos do controle postural de idosos e indivíduos com DP, além da melhora da estabilidade de marcha somente dos idosos
Title in English
Learning of a task of demand postural control in virtual environment in Parkinson´s disease individuals
Keywords in English
Motor learning
Parkinson´s disease
Postural control
Abstract in English
Postural control deficits are striking in individuals with Parkinson's disease (PD), making the learning of postural control tasks crucial for these individuals. Recent studies have shown that PD patients are able to learn tasks with postural control demand; however, the retention interval found in these studies was quite short due to the nature of this neurodegenerative disease. Hence, in the learning process of high demand postural control tasks, is there a decrease in PD patients' postural instability? Concrete data are needed to answer this question. Therefore, the purpose of this study was to investigate the learning of tasks involving a high demand for postural control in a virtual reality environment in individuals with PD when compared to healthy elderly. The learning process was investigated through both short- and long-term retention. The secondary purpose was to verify the learning process's impact on both cognition and postural control. The sample included 28 participants: 14 with idiopathic PD in the Experimental Group (EG) [64.28±6.35 years; Hoehn e Yahr modified scale = 14.28% 1; 14.28%, 1.5; 7.14%, 2; 21.42%, 2.5; 42.85%, 3; Montreal Cognitive Assessment (MoCA) = 22.42±3.41; and Mini Balance Evaluation Systems Test (MiniBEStest) = 20.78±6.54] and fourteen healthy elderly in the Control Group (CG) [69.71±5.91 years; MoCA = 23.64±3.17; e MiniBESTest = 27.35±2.67]. Thirteen one-hour sessions were performed two x/week for seven weeks, which was the on-medication period for dopaminergic replacement. The first session was considered as the pre-test, and the last session was considered as the post-test. The practice consisted of playing four Kinect system games, with five trials per game. Two retention tests were performed, with the first occurring after one week and the second occurring one month after the end of the acquisition phase. The assessment of cognition through MoCA and postural control through MiniBESTest were performed before, immediately after and one month after the acquisition phase. Individuals with PD learned tasks with a high demand for postural control and had both short- and long-term retention, despite their inferior performance compared to the neurologically healthy elderly. In addition, learning the proposed tasks led to an improvement in cognition, specifically in memory, and in the reactive aspects of postural control in the elderly and individuals with PD, as well as gait stability only in the elderly
 
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Publishing Date
2017-10-27
 
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