Identifying biomarkers for tDCS treatment response in Alzheimer's disease patients: a machine learning approach using resting-state EEG classification.

Background: Transcranial direct current stimulation (tDCS) is a promising treatment for Alzheimer's Disease (AD). However, identifying objective biomarkers that can predict brain stimulation efficacy, remains a challenge. The primary aim of this investigation is to delineate the cerebral regions implicated in AD, taking into account the existing lacuna in comprehension of these regions. In pursuit of this objective, we have employed a supervised machine learning algorithm to prognosticate the neurophysiological outcomes resultant from the confluence of tDCS therapy plus cognitive intervention within both the cohort of responders and non-responders to antecedent tDCS treatment, stratified on the basis of antecedent cognitive outcomes. Methods: The data were obtained through an interventional trial. The study recorded high-resolution electroencephalography (EEG) in 70 AD patients and analyzed spectral power density during a 6 min resting period with eyes open focusing on a fixed point. The cognitive response was assessed using the AD Assessment Scale-Cognitive Subscale. The training process was carried out through a Random Forest classifier, and the dataset was partitioned into K equally-partitioned subsamples. The model was iterated k times using K-1 subsamples as the training bench and the remaining subsample as validation data for testing the model. Results: A clinical discriminating EEG biomarkers (features) was found. The ML model identified four brain regions that best predict the response to tDCS associated with cognitive intervention in AD patients. These regions included the channels: FC1, F8, CP5, Oz, and F7. Conclusion: These findings suggest that resting-state EEG features can provide valuable information on the likelihood of cognitive response to tDCS plus cognitive intervention in AD patients. The identified brain regions may serve as potential biomarkers for predicting treatment response and maybe guide a patient-centered strategy. Clinical Trial Registration: https://classic.clinicaltrials.gov/ct2/show/NCT02772185?term=NCT02772185&draw=2&rank=1, identifier ID: NCT02772185.

Does anodal transcranial direct current stimulation over left motor cortex show body side pain-related difference in fibromyalgia? / A estimulação transcraniana por corrente contínua anódica sobre o córtex motor esquerdo apresenta diferença na dor entre os hemicorpos na fibromialgia?

ABSTRACT BACKGROUND AND OBJECTIVES: Fibromyalgia (FM) is a chronic widespread musculoskeletal pain resulting in central sensitization of nociceptive signaling. Transcranial direct current stimulation (tDCS) over the left motor cortex (M1) is a non-invasive neuromodulation technique indicated for a broad range of chronic pain disorders, including FM. Studies suggest that left and right M1 (contralateral and ipsilateral hemisphere of tDCS stimulation) are modulated. But it is necessary to clarify the differences in clinical pain perception comparing the right and left side of the body. This study aimed to evaluate the pain-related difference between right-left side of the body after five sessions of anodal tDCS in women with FM. METHODS: A double-blinded, parallel, randomized, sham-controlled trial with 30 women with FM was performed. Five sessions of anodal C3 and cathodal supraorbital (Fp2) tDCS were conducted (2 mA for 20 min). Pain, impact of FM and anxiety were evaluated. No statistically significant three-way interaction between time, stimulation type and body side were found. RESULTS: Active-tDCS showed significant improvement in pain, but impact of FM and anxiety did not show significant improvement. CONCLUSION: Five sessions of anodal tDCS over the left M1 improves pain in women with FM, however there was no difference between right-left body sides.

RESUMO JUSTIFICATIVA E OBJETIVOS: A fibromialgia (FM) é uma dor musculoesquelética crônica generalizada que resulta na sensibilização central da sinalização nociceptiva. A estimulação transcraniana de corrente contínua (eTCC) sobre o córtex motor esquerdo (M1) é uma técnica de neuromodulação não invasiva indicada para uma ampla gama de distúrbios de dor crônica, incluindo a FM. Estudos sugerem a modulação do M1 esquerdo e direito (hemisfério contralateral e ipsilateral da eTCC). Mas é necessário esclarecer as diferenças na percepção clínica da dor comparando os lados direito e esquerdo do corpo. Este estudo teve como objetivo avaliar a diferença relacionada à dor entre o lado direito e esquerdo do corpo após cinco sessões de eTCC anodal em mulheres com FM. MÉTODOS: Foi realizado um estudo duplo-cego, paralelo, randomizado e controlado por sham com 30 mulheres com FM. Foram realizadas cinco sessões de eTCC anodais C3 e supraorbitais catodais (Fp2) (2 mA por 20 min). Foram avaliados a dor, o impacto da FM e a ansiedade. Não foi encontrada nenhuma interação de três vias estatisticamente significativa entre tempo, tipo de estimulação e lado do corpo. RESULTADOS: A eTCC-Ativa mostrou uma melhora significativa na dor, mas o impacto da FM e da ansiedade não mostrou uma melhora significativa. CONCLUSÃO: Cinco sessões de eTCC anodal sobre o M1 esquerdo melhoram a dor nas mulheres com FM, entretanto não houve diferença entre os lados direito e esquerdo do corpo.

Impact of Pelvic Floor Muscle Training Isolated and Associated with Game Therapy on Mixed Urinary Incontinence: A Randomized Controlled Trial.

Objective: To verify whether pelvic floor muscle training (PFMT) associated with game therapy (GT) can potentiate improvements in PFM pressure, urinary loss, and perception of improvement in women with mixed urinary incontinence (MUI). Materials and Methods: A randomized and blinded trial was conducted with 32 women aged between 45 to 70 years presenting diagnosis of MUI. They were randomly divided into two groups: PFMT group and PFMT+GT group. Interventions occurred twice a week during 8 weeks. Primary outcome was PFM pressure, assessed by manometry, and secondary outcomes were 1-hour pad-test, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and patients global impression of improvement for incontinence (PGI-I). Two-way analysis of variance and post hoc Tukey analysis were performed. Results: Initially, no significant difference between groups was found in variables of age, body mass index, educational level, marital status, gynecological and obstetric variables, life habits, and sexual activity. Besides, at baseline clinical variables also showed similar results between groups for PFM pressure, 1-hour pad-test, and ICIQ-SF. Time-group interaction did not present statistically significant differences for PFM pressure (P = 0.56), 1-hour pad-test (P = 0.75), and ICIQ-SF (P = 0.30) in intergroup analysis. All women reported being "much better or better," considering the comparison of urinary complaints in the beginning and end of treatment. Conclusion: There were no statistically significant differences between groups for PFM pressure, 1-hour pad-test, and ICIQ-SF. However, both treatments proved to be effective for MUI symptoms. Perception of improvement was highly improved, according to women's report.

Modulating Anxiety and Functional Capacity with Anodal tDCS Over the Left Dorsolateral Prefrontal Cortex in Primary Dysmenorrhea.

BACKGROUND: Primary dysmenorrhea is a common and often debilitating condition affecting 40-90% of menstruating women. This condition reduces functionality, quality of life, and social activities. Transcranial direct current stimulation (tDCS) has been used in many chronic pain syndromes, with evidence of improved pain, functionality, and mood in women with primary dysmenorrhea. The objective of this study was to determine whether tDCS could offer clinical benefits on pain, anxiety, affectivity, and functionality in women with primary dysmenorrhea. METHODS: This parallel, sham, randomized, double-blind trial was conducted with 26 women randomized into sham tDCS and active tDCS. Anodal tDCS was applied for 5 consecutive days over F3 corresponding to the left dorsolateral prefrontal cortex (DLPFC) and the cathode electrode over Fp2 for 20 min with an intensity of 2 mA. A numeric rating scale (NRS) was used to assess pain, anxiety, positive and negative affect, and submaximal aerobic performance during two consecutive menstrual cycles. RESULTS: No significant interaction was found between intervention and time on the NRS [F(2,44) = 1.358, p = 0.26], and a significant main effect of time [F(2,44) = 4.446, p = 0.01] was found. The active group showed a significant reduction in anxiety (p = 0.03) with a mean difference of 5.12 (95% CI 0.79 to 11.05). No significant differences in positive and negative affect were found (p = 0.95 and p = 0.15, respectively). Submaximal aerobic performance was significantly greater in the active group [F(2,21) = 5.591, p = 0.02], with a mean difference of 70.87 (95% CI 8.53 to 133.21). CONCLUSION: Anodal tDCS over the DLPFC seems to be an effective therapeutic approach for improving anxiety and functionality in women with primary dysmenorrhea.

Effects of Transcranial Direct Current Stimulation for Treatment of Primary Dysmenorrhea: Preliminary Results of a Randomized Sham-Controlled Trial.

OBJECTIVE: The aim of this trial was to investigate the effects of five consecutive sessions of anodal transcranial direct current stimulation (tDCS) over the motor cortex (M1) on pain, mood, and physical performance in patients with primary dysmenorrhea (PDM). DESIGN: This is a double-blind randomized controlled trial. SUBJECTS: Twenty-two participants with PDM according to the No. 345-PDM Consensus Guideline were included. METHODS: Eleven active treatment and 11 sham stimulation patients received five applications over a one-week period. The primary outcome measures were pain evaluated by numeric rating scale (NRS) and McGill Questionnaire score. Secondary outcomes measures were responses to the Positive and Negative Affect Schedule (PANAS), Hamilton Anxiety Scale (HAM-A), grip strength, and six-minute walk test (6MWT). Baseline data were performed during the first menstrual cycle, and during the second menstrual cycle, participants were conducted to tDCS treatment, and postintervention data were collected. RESULTS: The intervention provided significant improvements on NRS in active tDCS, shown as an interaction between group intervention vs pre/postintervention vs days of menstrual cycle (Wald x2 = 10.54, P = 0.005), main effect of days of menstrual cycle (Wald x2 = 25.42, P < 0.001), and pre/postintervention (Wald x2 = 6.97, P = 0.008). McGill showed an interaction effect between pre/postintervention and group of stimulation (Wald x2 = 18.45, P = 0.001), with a large reduction in active tDCS (P < 0.001, d = 0.75). Psychological and functional outcomes did not differ between groups or pre/postintervention. CONCLUSIONS: tDCS could provide pain relief in subjects with PDM. These results provide some preliminary evidence for the potential role of tDCS as a contributor to the management of symptoms of PDM.

Low-level laser therapy improves pain in postcesarean section: a randomized clinical trial.

This study aimed to evaluate the effect of low-level laser therapy (LLLT) on immediate postpartum pain relief during cesarean section. A randomized, parallel controlled trial was carried out. In total, 88 women with immediate postpartum were divided into 4 groups: control group (n = 22), placebo group (n = 22), experimental group I (n = 22, dose of 4 J/cm2), and experimental group II (n = 22, dose of 2 J/cm2). The pain measured by Numeric Rating Scale (NRS), algometry, and Global Change Perception Scale (GCPS) was assessed at 12, 20-24, and 44-48 h postpartum. Two LLLT sessions were performed at 12 and 24 h postpartum. A significant interaction was observed between time versus group for NRS F (2.40) = 36.80, p < 0.001 and algometry F (1.70) = 27.18, p < 0.001. GCPS revealed a significant difference between the groups during second (p = 0.04) and third evaluation (p = 0.04). The NRS and algometry presented a large effect size for the experimental groups. LLLT is an efficient method to reduce pain and enhance the GCP in postcesarean section. No significant clinical differences were found between the laser doses.

Comparison of pelvic floor muscle training isolated and associated with weight loss: a randomized controlled trial.

PURPOSE: To analyze whether pelvic floor muscle training (PFMT) associated with weight loss (WL) is better than isolated PFMT to provide additional beneficial effects to urinary symptoms in women with MUI. METHODS: A randomized, simple-blind parallel controlled trial was performed and included women with MUI aged between 40 and 65 years and body mass index between 25 and 40 kg/m2. The sample was randomized into two groups: 11 PFMT + WL and 11 PFMT. Data collection was performed in baseline and after interventions. The primary outcome was to investigate the loss of urine. Secondary aim includes PFM pressure and quality of life. PFMT was performed with two sets of eight repetitions in the first 4 weeks, and with three sets of eight repetitions in the final 4 weeks. The weight loss program was based on the calculation of total energy value needs. Data analysis was performed by SPSS 20.0 software and one-way ANCOVA. RESULTS: 22 volunteers participated in the study. There was no intergroup significant difference in post-intervention ICIQ-SF F(1, 19) = 7.115, p = 0.87, partial η2 = 0.001; manometry F(1, 19) = 0.608, p = 0.44, partial η2 = 0.003; pad test 1 h F(1, 19) = 0.185, p = 0.67, partial η2 = 0.01; QoL F(1, 19) = 1.018, p = 0.32, partial η2 = 0.05; and weight F(1, 19) = 0.251, p = 0.62, partial η2 = 0.01. CONCLUSIONS: Weight loss did not provide additional beneficial effects to PFMT in women with overweight or obesity grade I with MUI symptoms.

Análise da ativação muscular durante o movimento de alcance nas condições ativo, ativo-assistido e autoassistido em pacientes pós-AVE / Análisis de la activación muscular durante el movimiento de alcance en las condiciones activo, activo-asistido y auto-asistido en pacientes post-AVE / Analysis of muscle activation during reaching movement in active, active-assisted and self-assisted conditions in post-stroke patients

RESUMO O Acidente Vascular Encefálico (AVE) é uma patologia que frequentemente causa limitações motoras nos Membros Superiores (MMSS) gerando prejuízos funcionais nos movimentos de alcance. O objetivo do estudo foi analisar o recrutamento muscular do membro superior parético durante três condições de alcance: ativo, ativo-assistido e autoassistido, através de dados eletromiográficos das fibras anteriores do Músculo Deltoide (MD), Bíceps Braquial (BB) e Tríceps Braquial (TB). Estudo do tipo transversal que utilizou como testes clínicos o miniexame do estado mental, escala de equilíbrio de Berg, medida de independência funcional, escala modificada de Ashworth e escala de Fugl-Meyer - seção MMSS. A coleta dos dados eletromiográficos de superfície foi realizada utilizando-se o eletromiógrafo e eletrodos de configuração bipolar da EMG System do Brasil com três canais posicionados nos pontos motores do MD (fibras anteriores), BB e TB de ambos os membros superiores. As variáveis clínicas apresentaram resultados de comprometimento motor, cognitivo e funcional leves. Os dados eletromiográficos mostraram que o MD e TB durante o alcance ativo-assistido contraíram mais que no alcance autoassistido (p<0.05). Os MD e TB apresentaram diferenças significativas durante os movimentos de alcance, enquanto que o músculo BB não mostrou alterações. Entre os diversos tipos de alcance, o ativo-assistido foi o que proporcionou maior ativação muscular. Sugere-se que sejam feitos ensaios clínicos para verificar a eficácia dos treinamentos.

RESUMEN El Accidente Vascular Encefálico (AVE) es una patología que frecuentemente causa limitaciones motoras en los Miembros Superiores (MMSS) generando perjuicios funcionales en los movimientos de alcance. El objetivo del estudio fue analizar el reclutamiento muscular del miembro superior parético durante tres condiciones de alcance: activo, activo-asistido y auto-asistido, a través de datos electromiográficos de las fibras anteriores del Músculo Deltóide (MD), Bíceps Braquial (BB) y Tríceps Braquial (TB). Estudio del tipo transversal que utilizó como pruebas clínicas el mini-examen del estado mental, escala de equilibrio de Berg, medida de independencia funcional, escala modificada de Ashworth y escala de Fugl-Meyer - sección MMSS. La recolección de los datos electromiográficos de superficie fue realizada utilizando el electromiografo y electrodos de configuración bipolar de la EMG System de Brasil con tres canales colocados en los puntos motores del MD (fibras anteriores), BB y TB de ambos miembros superiores. Las variables clínicas presentaron resultados de compromiso motor, cognitivo y funcional leves. Los datos electromiográficos mostraron que el MD y el TB durante el alcance activo-asistido contrajeron más que en el alcance auto-asistido (p<0.05). Los MD y TB presentaron diferencias significativas durante los movimientos de alcance, mientras que el músculo BB no mostró alteraciones. Entre los diversos tipos de alcance, el activo asistido fue el que proporcionó mayor activación muscular. Se sugiere que se realicen ensayos clínicos para verificar la eficacia de los entrenamientos.

ABSTRACT A cerebrovascular accident (CVA) is a disease that often causes upper limb motor limitations and functional losses in reaching movements. The objective of this study was to analyze the muscle recruitment of the paretic upper limb during three reaching conditions: active, active-assisted and self-assisted, through electromyographic data of anterior fibers of Deltoid Muscle (DM), Biceps Brachii (BB) and Triceps Brachii (TB). Cross-sectional study that used as clinical trials the Mini-Mental State Examination, Berg balance scale, functional independence measure, the modified Ashworth scale, and the Fugl-Meyer assessment - upper limbs section. Surface electromyographic data were collected using the electromyograph and bipolar electrode configuration of the EMG System do Brasil with three channels positioned in the motor points of DM (anterior fibers), BB and TB of both upper limbs. Clinical variables showed mild motor, cognitive, and functional impairment. Electromyographic data showed that DM and TB contracted more during active-assisted than during self-assisted exercise (p<0.05). DM and TB presented significant differences during reaching movements, while the BB muscle showed no changes. Among the different reaching exercises, the active-assisted was the one that provided greater muscle activation. Clinical trials are suggested to verify the effectiveness of the training.

Reach and palmar grasp in tetraplegics with neuromuscular electrical stimulation / Alcance e preensão palmar em tetraplégicos com estimulação elétrica neuromuscular / Alcance y prensión palmar en tetrapléjicos con estimulación eléctrica neuromuscular

OBJECTIVE: To evaluate the movement strategies of quadriplegics, assisted by neuromuscular electrical stimulation, on reach and palmar grasp using objects of different weights. METHODS: It was a prospective clinical trial. Four chronic quadriplegics (C5-C6), with injuries of traumatic origin, were recruited and all of them had their reach and palmar grasp movement captured by four infrared cameras and six retro-reflective markers attached to the trunk and right arm, assisted or not by neuromuscular electrical stimulation to the triceps, extensor carpi radialis longus, extensor digitorum communis, flexor digitorum superficialis, opponens pollicis and lumbricals. It was measured by a Neurological and Functional Classification of Spinal Cord Injuries of the American Spinal Injury Association, Functional Independence Measure and kinematic variables. RESULTS: The patients were able to reach and execute palmar grasp in all cylinders using the stimulation sequences assisted by neuromuscular electrical stimulation. The quadriplegics produced lower peak velocity, a shorter time of movement and reduction in movement segmentation, when assisted by neuromuscular electrical stimulation. CONCLUSION: This study showed that reach and palmar grasp movement assisted by neuromuscular electrical stimulation was able to produce motor patterns more similar to healthy subjects. Level of evidence IV; Case series.

OBJETIVO: Avaliar as estratégias de movimento de quadriplégicos com o auxílio de estimulação elétrica neuromuscular sobre o alcance e a preensão palmar com objetos de diferentes pesos. MÉTODOS: Estudo clínico prospectivo. Quatro quadriplégicos crônicos (C5-C6) com lesões de origem traumática foram recrutados e todos tiveram o alcance e movimento de preensão palmar capturado por quatro câmeras infravermelho e seis marcadores retrorreflexivos fixados no tronco e braço direito, assistidos ou não por estimulação neuromuscular do tríceps, extensor radial longo do carpo, extensor dos dedos, flexor superficial dos dedos, oponente do polegar e músculos lumbricais. A medida foi feita com base na Classificação Neurológica e Funcional de Lesões Medulares da American Spinal Injury Association, na Medida de Independência Funcional e em variáveis cinemáticas. RESULTADOS: Os pacientes foram capazes de alcançar e realizar preensão palmar em todos os cilindros utilizando as sequências de estimulação auxiliadas por estimulação elétrica neuromuscular. Os quadriplégicos produziram menor velocidade de pico, menor tempo de movimento e redução na segmentação do movimento, quando foram auxiliados pela estimulação elétrica neuromuscular. CONCLUSÃO: Este estudo mostrou que o alcance e o movimento de preensão palmar assistidos por estimulação elétrica neuromuscular foi capaz de produzir padrões motores mais semelhantes aos dos indivíduos saudáveis. Nível de evidência IV; Série de casos.

OBJETIVO: Evaluar las estrategias de movimiento de cuadripléjicos, con el auxilio de estimulación eléctrica neuromuscular sobre el alcance y la prensión palmar con objetos de diferentes pesos. MÉTODOS: Estudio clínico prospectivo. Fueron reclutados cuatro cuadripléjicos crónicos (C5-C6) con lesiones de origen traumático y todos ellos tuvieron su alcance y movimiento de prensión palmar capturado por cuatro cámaras infrarrojas y seis marcadores retrorreflexivos fijados al tronco y al brazo derecho, asistidos o no por estimulación neuromuscular del tríceps, extensor radial largo del carpo, extensor de los dedos, flexor superficial de los dedos, oponente del pulgar y músculos lumbricales. La medición fue hecha con base en la Clasificación Neurológica y Funcional de Lesiones Medulares de la American Spinal Injury Association, en la Medida de Independencia Funcional y en variables cinemáticas. RESULTADOS: Los pacientes fueron capaces de alcanzar y realizar prensión palmar en todos los cilindros utilizando las secuencias de estimulación auxiliadas por estimulación eléctrica neuromuscular. Los cuadripléjicos produjeron menor velocidad de pico, menor tiempo de movimiento y reducción en la segmentación del movimiento, cuando fueron auxiliados por la estimulación eléctrica neuromuscular. CONCLUSIÓN: El presente estudio mostró que el alcance y el movimiento de prensión palmar asistidos por estimulación eléctrica neuromuscular fue capaz de producir patrones motores más similares a los individuos saludables. Nivel de evidencia IV; Serie de casos.

Influência da terapia de restrição e indução do movimento no desempenho funcional de pacientes com acidente vascular encefálico: um ensaio clínico randomizado / Repercusión de la terapia de restricción y inducción del movimiento en el rendimiento funcional de pacientes con accidente cerebrovascular: un ensayo clínico randomizado / Influence of constraint induced movement therapy on functional performance in stroke patients: a randomized clinical trial

RESUMO A terapia de restrição e indução ao movimento (TRIM) pode auxiliar na recuperação de pacientes com sequelas pós-acidente vascular encefálico. Objetivou-se avaliar se a TRIM modificada interfere no equilíbrio e na mobilidade funcional de indivíduos na fase crônica pós-AVE. Foi realizado um ensaio clínico, randomizado, cego, com 19 pacientes na fase crônica pós-AVE. O grupo 1, "sem restrição", foi submetido apenas ao treinamento específico do membro superior (MS) parético (shaping). O grupo 2, "com restrição", foi submetido ao treinamento específico do MS parético (shaping) e restrição no MS não parético. O treinamento foi realizado três vezes por semana, durante quatro semanas consecutivas. Os voluntários foram avaliados antes e imediatamente após as sessões com a Escala de Equilíbrio de Berg (EEB), Timed Up and Go (TUG), avaliação da velocidade da marcha e de subir e descer escada. O teste de Mann-Whitney mostrou que o equilíbrio (EEB) apresentou melhora significativa (p=0,014) no grupo que utilizou a restrição, na análise intragrupo. Houve melhora na velocidade da marcha (p=0,050) na análise intergrupos. Concluiu-se que a TRIM modificada influenciou no equilíbrio e na velocidade da marcha do grupo submetido ao treinamento específico do MS parético e restrição no MS não parético.

RESUMEN La terapia de restricción y inducción al movimiento (TRIM) puede auxiliar en la recuperación de pacientes con secuelas post-accidente cerebrovascular (ACV). Se objetivó evaluar se la TRIM modificada interfiere en el equilibrio y en la movilidad funcional de individuos en fase crónica post-ACV. Fue realizado un ensayo clínico, randomizado, ciego, con 19 pacientes en fase crónica post-ACV. El grupo 1, "sin restricción", fue sometido sólo al entrenamiento específico del miembro superior (MS) parético (shaping). El grupo 2, "con restricción", fue sometido al entrenamiento específico del MS parético (shaping) y restricción en el MS no parético. El entrenamiento fue realizado tres veces por semana, durante cuatro semanas consecutivas. Los voluntarios fueron evaluados antes y inmediatamente despues de las sesiones con escala de equilibrio de Berg (EEB), Timed Up and Go (TUG), evaluación de la velocidad de marcha y de subir y bajar por escaleras. La prueba de Mann-Whitney mostró que el equilibrio (EEB) presentó mejora significativa (p=0,014) en el grupo que utilizó la restricción en el análisis intragrupo. Hubo mejora en la velocidad de marcha (p=0,050) en el análisis intergrupos. Se concluyó que la TRIM modificada repercutió en el equilibrio y en la velocidad de marcha del grupo sometido al entrenamiento específico del MS parético y restricción en el MS no parético.

ABSTRACT The Constraint Induced Movement Therapy (CIMT) can assist in the recovery of patients with post cerebrovascular accident sequelae. The aim was to assess whether the modified CIMT interferes with the balance and functional mobility of individuals in the chronic phase post-CVA. We conducted a randomized, blinded, clinical trial with 19 patients in the chronic phase post-CVA. Group 1, "no constraint," was submitted only to the paretic upper limb (UL) specific training (shaping). Group 2, "with constraint," was submitted to the paretic UL specific training (shaping) and non paretic UL constraint. The training was carried out 3 times a week for 4 consecutive weeks. The volunteers were evaluated before and immediately after the sessions with the Berg Balance scale (BBS), Timed "up & go" (TUG), evaluation of gait speed and going up and down stairs. Mann-Whitney test showed that the balance (BBS) showed significant improvement (p=0.014) in the group that used the constraint in the intra-group analysis. There was improvement in the gait speed (p=0.050) in the intergroups analysis. It was concluded that the modified CIMT influenced in the balance and gait speed of the Group submitted to the paretic UL specific training and constraint in the non-paretic UL.