Avaliação motora de pacientes portadores de doenças neuromusculares: um estudo longitudinal

Abstract

Neuromuscular diseases (NMD) are genetic or acquired affections, which may affect the anterior horn of the spinal cord, peripheral nerves, the myoneural junction or the muscle. The estimate is that these diseases affect around 1 among each 3.500 individuals in the world. The search for an assessment method that can identify and monitor the evolution of the NMD patients muscular strength and function is frequent in the literature. With this purpose several assessment methods have been proposed, however they are complex or are often used for specific neuromuscular disease, which complicate their application in the clinical practice. In 2005, the scale named Motor Function Measure (MFM) was created and validated by a group of French researchers. This scale allows the motor function assessment and monitoring of patients aged over six years old, with different forms of neuromuscular diseases. The objective of this study was to assess the longitudinal motor function in patients with neuromuscular diseases, under medical assistance at the UFMG Hospital das Clinicas, Outpatient Clinic for Neuromuscular Diseases, using scales MFM, MRC, and goniometry, and to compare the results of the MFM with the MRC findings. This study included 34 children and adolescents with neuromuscular diseases. All patients underwent the muscular strength assessment through the Medical Research Council (MRC) scale, the degrees of the articular range, through goniometry, and the application of the Motor Function Measure (MFM). The evaluation was done in two times, initial and final, with six month interval. The average time spend for the application of the MFM scale was 20 minutes, with no significant variation between the initial and final times. The results were compared between the initial time and the final time. There was significant statistic loss of the proximal muscular strength of the upper members (t=-3,13, p= 0,04) and limbs (t=-2,47,p= 0,02). With regards to the goniometry, in the final time a higher percentage of patients had plantar flexion in the left (p=0,02). The MFM showed losses related to the dimension 1 of the scale (t=-2,81, p=0,01). In the patients group with Duchenne (DMD) muscular dystrophy, with 20 individuals, it was noted average strong correlation between the scores of muscular strength and the MFM dimension. This result indicates that in the clinical practice, DMD patients monitoring can be done only with the MFM. It was noted that in six months the patients with neuromuscular diseases had motor loss. Therefore, it is highlighted that the use of the MFM scale is useful for monitoring these patients as it allows the early identification and quantification of motor losses.