Electromiography Study in the Respiratory Muscle Training in Human Lymphotropic Virus Type 1
Condition: HTLV-I Infections
MeSH terms: HTLV-I Infections
Study type: Interventional

Summary: 
      The main objective of the research will be to analyze, through surface electromyography, the
      impact of inspiratory muscle training before a supervised home training protocol in patients
      with human T-cell lymphotropic virus type 1 (HTLV-1). For this, a clinical, longitudinal,
      prospective, quantitative and single center trial will be carried out, aiming at home
      inspiratory muscle training lasting 5 weeks, 3 times a week, 30 minutes daily through the IMT
      Threshold, with 14 volunteers enrolled in the Laboratory of Studies in Functional
      Rehabilitation (LAERF) of the Federal University of Pará (UFPA). They will be classified as
      the manifestation of Tropical Spastic Paraparesis / Myelopathy (PET / MAH) for GP (PET / MAH
      probable) and GD (PET / MAH definitive) groups, obeying inclusion criteria. For
      characterization of expiratory flow rates and flows, as well as respiratory muscle strength,
      they will be submitted to spirometry and manovacuometry, pre, per, and post treatment,
      respectively. For the analysis of the electromyographic activity, the diaphragm, parasternal
      and sternocleidomastoid muscles will be counted in the follow-up during the analysis of
      inspiratory muscle strength, as well as once a week during the conduction of the inspiratory
      muscle training protocol. The collected data will be stored in a Microsoft Office Excel® 2010
      worksheet and then submitted to statistical analysis using the Bioestat 5.0® program,
      adopting a standard error of 5%. The theoretical support of the research will have a
      bibliographical survey of scientific articles collected during the design of the project, and
      the accomplishment of the research. It is expected to map, through the surface
      electromyographic study, the impact of respiratory muscle training at a distance on the
      inspiratory muscle strength of patients with HTLV-I virus with probable or definitive PET /
      MAH.
    

Detailed description: 
      Human T-lymphotropic viruses, HTLV (Human Lymphotrophic Virus T), are retroviruses, which
      stand out as type 1 (HTLV-1) and type 2 (HTLV-2), the former being the etiologic agent of
      serious organ diseases such as leukemia adult T-cell lymphoma (ATLL), a neurological
      disorder, Tropical Spastic Paraparesis / HTLV-I-associated myelopathy (PET / HAM) and other
      non-malignant ophthalmologic, dermatological, rheumatic and osteomyelitis non-malignant
      disorders. For HTLV-2 it has not yet separated with some disease.

      The highest prevalence of virus is found in countries of the Caribbean, South America,
      Melanesia Islands, West Africa and Japan. Brazil is an endemic country for infection and
      prevalence varies from state to state, being highest in Bahia, Pernambuco and Pará. The form
      of sexual transmission, hematologic for blood transfusions or accompanied by contaminated
      needles, mother-to-child verticalization, the passage of the lymphocyte infected by breast
      milk and also in the perinatal period.

      The mechanism of the disease comes from the infection of several types of cells, such as T
      and B lymphocytes, monocytes and fibroblasts. However, its tropism is by TCD4 + cells. The
      form of contamination is cell-cell, thus being transferred from infected material to
      uninfected cells, modifying the immune system, as well as cell cells.

      The main characteristic of HTLV infection is that in most cases the virus persists
      asymptomatic and undetectable by the immune system per year or until death in about 98% of
      the patients, while the hosts are able to transmit the virus. There are still no basic
      surveys on how severe forms of symptoms of graves occur in those infected.

      In this context, when the individual becomes symptomatic, he is affected by chronic infection
      that may be associated with disabling diseases that compromise quality of life, such as the
      neurological disease PET-MAH. The onset is insidious with frequent changes in gait and
      urinary symptoms, mainly affecting the lower limbs such as spasticity, hyperreflexia,
      sensory-motor dysfunctions such as neuropathic or nociceptive pain, paresis, paralysis and
      paresthesia, urinary bladder disorders, muscle weakness and low back pain. The early
      diagnosis of motor complications in the face of the onset of neurological disease also
      contributes to the prevention of the installation of motor sensory sequelae if the
      physiotherapeutic treatment is established early. According to this reference, one of the
      aspects of preventive care refers to the functional autonomy correlated with physical
      conditioning in order to increase the strength and / or endurance of the skeletal muscles.

      In this way, the possibility of morphological and functional changes in the respiratory
      system is also highlighted. With preventive therapeutic possibilities, the respiratory muscle
      training (TMR) appears to this indicator with reference to the maximum inspiratory and
      expiratory pressures (PiMáx and PeMáx). This procedure directly reflects on the patient's
      functionality, having as guideline the conduction of training protocols. The protocol should
      be conducted at least three days weekly frequently twice daily.

      One tool to evaluate muscular behavior during TMR is surface electromyography (EMGs), which
      consists of a non-invasive detection of the muscular electrical activity by which it is
      presented graphically. It is constituted by the transcription of the sum of the electrical
      activity of all the active muscle fibers, through the positioning of electrodes on the skin.
      Thus, in order to verify the muscular activity of the respiratory dynamics related to
      inspiration, the main groups are the diaphragm, parasternal intercostal, sternocleidomastoid,
      abdominal rectus.

      Therefore, the training requires time, availability and greater displacement of the patient
      to the outpatient treatment units, thus causing difficulties in adherence to the proposed
      therapy. To that end, it has been proposed ways that facilitate such conduction, such as home
      treatments, which, in most cases, the patient is supervised by the physiotherapist at least
      once a week presently followed by distance monitoring.
    

Intervention name(s): Rehabilitation
Intervention type(s): Other
Intervention description(s): The first training session each week will be held at the LAERF under the direct supervision of the investigator and the other two home-based training sessions under the supervisor's distance supervision. They will receive the Threshold® IMT linear loading device, and guidelines for handling, posture and asepsis. The initial training load for each participant will be adjusted to 25% of PiMáx. Participants will be trained and instructed to do the exercise program on their own at home. Once a week, during the return to the laboratory the researcher will determine the new values for load (1st week 25%, 2nd week 35%, 3rd week 40%, 4th week 45%, 5th week 50%).
Intervention model: Single Group Assignment
Intervention model description: Rehabilitation
Masking: None (Open Label)
Primary purpose: Treatment