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

Katia N Sá, Maíra C Macêdo, Rosana P Andrade, Selena D Mendes, José V Martins, Abrahão F Baptista, Katia N Sá, Maíra C Macêdo, Rosana P Andrade, Selena D Mendes, José V Martins, Abrahão F Baptista

Abstract

Human T-lymphotropic virus 1 (HTLV-1) infection may be associated with damage to the spinal cord - HTLV-associated myelopathy/tropical spastic paraparesis - and other neurological symptoms that compromise everyday life activities. There is no cure for this disease, but recent evidence suggests that physiotherapy may help individuals with the infection, although, as far as we are aware, no systematic review has approached this topic. Therefore, the objective of this review is to address the core problems associated with HTLV-1 infection that can be detected and treated by physiotherapy, present the results of clinical trials, and discuss perspectives on the development of knowledge in this area. Major problems for individuals with HTLV-1 are pain, sensory-motor dysfunction, and urinary symptoms. All of these have high impact on quality of life, and recent clinical trials involving exercises, electrotherapeutic modalities, and massage have shown promising effects. Although not influencing the basic pathologic disturbances, a physiotherapeutic approach seems to be useful to detect specific problems related to body structures, activity, and participation related to movement in HTLV-1 infection, as well as to treat these conditions.

Keywords: HAM/TSP; HTLV-1; pain; physical therapy modalities; quality of life; sensory-motor dysfunction; urinary symptoms.

Figures

Figure 1
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.

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