Center of gravity oscillations in HTLV-1-associated myelopathy/tropical spastic paraparesis

Abstract Introduction: Postural control in individuals with HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP) is usually compromised, which increases the risk of falls, makes it difficult to perform activities of daily living, and impairs the quality of life. The profile of the center of gravity oscillations in this population is unknown and may aid in clinical follow-up and research. Objective: To compare the stabilometric values between HAM/TSP and uninfected individuals and verify the existence of correlations between stabilometric variables and the Berg Balance Scale (BBS). Method: A cross-sectional observational study was performed with infected individuals, classified as defined and likely (WHO criteria), compared to accompanying persons and seronegative relatives. A baropodometry platform (Footwork®) was used to obtain the oscillation values of the body’s center of gravity in total oscillation area (TOA), anterior-posterior oscillation (APO) and lateral oscillation (LO). Mean values were correlated with BBS by Spearman’s Correlation (5% alpha). Approved by the ethical committee of Escola Bahiana de Medicina e Saúde Pública under Opinion 49634815.2.0000.5628. Results: An asymmetric distribution of all the stabilometric variables analyzed in the HAM/TSP population was found, different from the uninfected group (p < 0.05). It was also possible to verify strong to moderate and inverse correlations between the variables of center of gravity oscillation with the scores obtained in BBS, especially for TOA and LO. Conclusion: People with HAM/TSP presented higher values for the center of gravity oscillations and these were correlated with the BBS in the balance evaluation.

引言：人类T淋巴细胞病毒1型相关脊髓病/热带痉挛性截瘫（HAM/TSP）患者的姿势控制通常受损，这会增加跌倒风险、提升日常生活活动的完成难度，并降低其生活质量。目前该人群的重心摆动特征尚不明确，而该特征或有助于临床随访与相关研究。研究目的：比较HAM/TSP患者与未感染个体的姿势稳定参数，并验证姿势稳定变量与伯格平衡量表（Berg Balance Scale, BBS）得分之间的相关性。研究方法：本研究为横断面观察性研究，纳入符合世界卫生组织（WHO）标准的确诊及疑似HAM/TSP患者，并以其陪同人员及血清学阴性亲属作为对照。采用足底压力测试平台（Footwork®）采集受试者身体重心的摆动参数，包括总摆动面积（TOA）、前后摆动幅度（APO）及内外侧摆动幅度（LO）。采用斯皮尔曼相关性分析（显著性水准α=5%）对重心摆动参数与伯格平衡量表得分进行相关性分析。本研究经巴伊亚医学与公共卫生学院（Escola Bahiana de Medicina e Saúde Pública）伦理委员会审批，审批号为49634815.2.0000.5628。研究结果：HAM/TSP患者组的所有分析姿势稳定变量均呈非对称分布，与未感染对照组存在显著统计学差异（p<0.05）。此外，重心摆动参数与伯格平衡量表得分呈中至强的负相关，其中总摆动面积与内外侧摆动幅度的相关性尤为显著。研究结论：HAM/TSP患者的重心摆动参数水平更高，且该参数与平衡评估中的伯格平衡量表得分存在相关性。