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Artigo sobre distrofia de Duchenne
Therapy Taping Method: Therapeutic Approach in Two Children with Duchenne Muscular Dystrophy Cristina Iwabe-Marchese1* and Nelson Morini Jr2 1Department of Neurology, Unicamp, Metropolitan College of Campinas/ Metrocamp/ DeVry, Campinas, São Paulo, Brazil.2Taping Therapy Association, São Paulo, Brazil. Authors’ contributions This work was carried out in collaboration between both authors. Author CIM managed the literature searches, designed the study and the experimental process. Authors CIM and NMJ analyses the study performed, wrote the protocol and wrote the first draft of the manuscript. Both authors read and approved the final manuscript. Article Information DOI: 10.9734/BJMMR/2016/24176 Editor(s): (1) Claudia Borza, Department of Pathophysiology, “Victor Babes” University of Medicine and Pharmacy, România. (2) Ricardo Forastiero, Professor of Physiology and Internal Medicine, Haematology, Favaloro University, Argentina.Reviewers:(1) Craig Campbell, Children’s Hospital of Western Ontario, Canada. (2) Maricela Rodriguez-Cruz, Hospital de Pediatria, Mexico. (3) Mario Bernardo-Filho, Universidade do Estado do Rio de Janeiro, Brazil. Complete Peer review History: http://sciencedomain.org/review-history/14262 Case Report ABSTRACT Received 7th January 2016 Accepted 30th March 2016 Published 20th April 2016 Objective: To assess the effect of elastic bandage through the Therapy Taping Method on the execution of motor functions of children with Duchenne Muscular Dystrophy (DMD). Methods: Two children with confirmed clinical diagnosis of DMD that visited the physiotherapy clinic at Metrocamp College were selected. Their degree of motor function was assessed by Motor Function Measure -20 Scale (MFM-20), performing then a month of physical therapy in the therapy pool without the use of bandage, in order to verify the primary functionality degree. After this period, the subjects were reassessed according to the mentioned scale, starting the application of the bandage technique in oblique muscles and quadriceps bilaterally, in conjunction with the treatment in hydrotherapy. The bandages were exchanged weekly, in a total of 24 weeks. The data was analyzed by comparing results before and after the treatment. Results: The scores of the MFM-20 scale remained the same as the initial assessment after the _____________________________________________________________________________________________________ *Corresponding author: E-mail: crisiwabe@hotmail.com; Iwabe-Marchese and Morini Jr; BJMMR, 15(3): 1-7, 2016; Article no.BJMMR.24176 Keywords: Duchenne muscular dystrophy; plasticity; bandage. hydrotherapy sessions without the use of bandage. However, there was an increase in scores after the combination of the use of elastic bandage with hydrotherapy. Conclusion: The elastic bandage using the Therapy Taping Method allowed increased execution capacity of the motor activities of these children with DMD, slowing the development of symptoms. 1. INTRODUCTION Duchenne Muscular Dystrophy (DMD) is the most common form of muscular dystrophy in children, due to a coding error of the dystrophin protein, with progressive loss of motor function and independency [1]. Typically diagnosed in patients around the age of five, it can also be suspected earlier due to delays in developmental motor milestones, such as walking or language [2]. In healthy muscles, the dystrophin is located underlying the sarcolemma, parallel to the length of all myofibrils, attached to filaments of actin [3], beta-dystroglycan and alpha syntrophin [4]. The function of the dystrophin, associated with the previously mentioned protein complex, promotes a strong mechanical and elastic bond between the intracellular cytoskeleton and extracellular matrix, in order to send mechanical signs to muscle contraction. In DMD, total or partial absence of dystrophin and its protein complex is observed, due to deletions, duplications, point mutations or other rearrangements [5], compromising the integrity of the sarcolemma structure, increasing the intracellular calcium entry, mitochondrial dysfunction, degradation of myofibrils, and apoptosis and necrosis, resulting in degeneration/regeneration [6]. Another pathophysiological hallmark of the disease is that the slower/more oxidative muscle fibers are more resistant to pathological processes of degeneration of dystrophin than the faster ones. The precise mechanism of this increased resistance is unknown, but factors such as differences in protein composition in the sarcolemma, oxygen transport and intracellular calcium dynamics can contribute to this important physiological phenomenon [7]. So far there is no cure for this disease, but drug treatments with the use of corticosteroids (slows the loss of muscle strength, stabilizes lung and motor functions and delays the onset of cardiomyopathy) [1,2] or adenosine monophosphate protein kinase (AMPK) which provides myogenesis to slow and oxidative fibers [8], and clinical trials such as gene therapy [9], allow a postponement of muscular degenerative process, with consequent maintenance and optimization of child functionality. The motor rehabilitation, despite not allowing the full return of the lost functionality and restoration of muscle strength, it allows the child with DMD, depending on the clinical stage in which physical therapy is started, maintain and even gain a better ability to execute motor activity in order to spare energy expenditure, thus prolonging the functional deterioration. Among the various methods and physical therapy techniques currently used, the use of therapeutic bandage may facilitate or inhibit a better motor response, according to the placement direction in relation to the muscle fibers [10,11], by stimulating mechanoreceptors present in the integument. They send sensory pressure information (static and dynamic) to regions of the somatosensory cortex, then plan a better motor response [12,13]. There are currently several brands of bandages, having as one of the first the Kinesio Taping®. The Therapy Taping Method (TTM) uses the Therapy Tex® bandage, recommending the use of the bandage for as much time as possible during 24 hours, which can influence motor behavior through neurophysiological effects, providing external support over the body or to an entire segment [14]. Thus, the purpose of this study was to investigate the influence of MTT in the execution of motor functions in children with DMD. 2. METHODS 2.1 Study Design Case study, longitudinal, descriptive. 2.2 Study Local Physical therapy clinic of the Metrocamp College. 2 2.3 Material Used Therapy Tex® bandage, Motor Function Measure scale – 20 (MFM-20) Portuguese version (MFM-20-P) [15] score sheet. 2.4 Population Characterization We selected two children with confirmed clinical diagnosis of DMD by muscle biopsy and genetic testing, that visited the physiotherapy clinic at Metrocamp College. Inclusion criteria was children without support of any addition, with the ability to understand simple orders (e.g. get up, pick up, sit down), aged up to six …