Physiotherapy for human T-lymphotropic virus 1-associated myelopathy: review of the literature and future perspectives

Figures & data

Figure 1 This figure presents a typical body map, with the location of pain sites ordered by importance (not always pain severity) according to the patients, from A to E, pain frequency and intensity in the visual analog scale (VAS).

Notes: Patients with human T-lymphotropic virus 1 often present with pain complaints in the lower back and lower limbs. The figure shows also the frequency of its distribution and the average reported intensity described using a VAS, where 0 indicates no pain and 10 the most intense pain (Mendes et al²²). Note that the pain tends to be more severe and frequent in the lower back. In the lower limbs it follows many distinct patterns, including a longitudinal distribution, which may be related to neuropathic or musculoskeletal pain, as well as joint pain.

Table 1 Physiotherapeutic assessment and treatment of individuals with human T-lymphotropic virus 1 (HTLV-1)

Assessment item(s)	Assessment method(s)	General comments	Proposed physiotherapeutic intervention(s)/goal(s)
Sociodemographic data	General assessment should include at least sex, socioeconomic status, life habits, and physical activity	HTLV-1 is mostly prevalent in women of low socioeconomic status, and smoking, alcohol consumption, diet, job satisfaction and physical activity are general factors which impact on the disease	Educational programs, general exercises (eg, walking, running, swimming, biking, weight lifting) aimed at maintaining fitness, and cognitive-behavioral strategies to help change negative life habits
Sensory abnormalities	QSTs	QSTs should include at least the assessment of touch, pain, proprioception, and vibratory sensibility in the lower back and lower limbs, or affected areas of the body	Proprioceptive exercises
Pain	Body map, VAS, BRIEF, DN4, and behavior scales	HTLV-1 individuals may have six or more sites of different pain all over the body, and this may be highly prevalent even before onset of neurological symptoms. The pain may be neuropathic or nociceptive in origin, and may be from low to severe intensity	Specific and general exercises Neuromodulation (tDCS) Virtual therapy Hydrotherapy Manual therapy
Quality of life	WHOQOL SF-36	Even before the infection leads to neurological symptoms, quality of life will be seriously affected. Because this is a chronic disease, the expected outcome of any intervention is a positive impact on quality of life	Educational program General and specific exercises
Balance	Postural assessment, Berg Balance Scale, stabilometry	The neurological symptoms associated with HTLV-1 affect mainly the thoracolumbar spinal cord, with consequences for muscle tonus (spasticity) and proprioception of the lower limbs. Balance is highly affected, with impact on gait and an increased risk of falls	Proprioceptive exercises Virtual therapy
Movement	Gait (kinematic and kinetic assessment), EMG, anthropometry, goniometry, dynamometry, postural assessment, Ashworth Scale, TUG, FIM, OMDS	The gait and transferences are highly affected because there are many muscles, specially in the lower limbs, that are shortened, weakened, and/or spastic. Strengthening, stretching, and motor-control training are very important for functional independence and symptom relief	General and specific exercises, which can involve the use of virtual resources; Pilates; core exercises; electrotherapy; and cognitive-behavioral strategies
Urinary dysfunction	OMDS Physical assessment	Urinary dysfunction is highly prevalent in individuals with HTLV-1, and can precede neurological symptoms (HAM/TSP). It is usual to find detrusor-sphincter hyperreflexia and bladder sphincter dyssynergia, with urgency, urge incontinence, nocturia, urinary frequency, and symptoms of hesitancy, weak or intermittent stream, sensation of incomplete emptying, stress voiding, and urinary retention	Manual therapy Biofeedback Perineal exercises Electrotherapy Cognitive-behavioral strategies

Abbreviations: BRIEF, Brief Pain Inventory; DN4, Douleur Neuropathique 4 questionnaire; EMG, electromyography; FIM, Functional Independence Measure; HAM/TSP, HTLV-associated myelopathy/tropical spastic paraparesis; OMDS, Osame Motor Disability Score; QSTs, quantitative sensory tests; SF-36, Short-Form 36 Quality of Life Questionnaire; tDCS, transcranial direct current stimulation; TUG, Timed Up and Go test; VAS, visual analog scale; WHOQOL, World Health Organization of Quality of Life questionnaire.

MendesSMBaptistaAFSáKNPain is highly prevalent in individuals with tropical spastic paraparesisHealth Care2013134753

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