tDCS does not add effect to foot drop stimulator and gait training in improving clinical parameters and neuroplasticity biomarkers in chronic post-stroke: randomized controlled trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) and foot drop stimulators (FDS) are widely used for stroke rehabilitation. However, no study has investigated if tDCS could boost the effects of FDS and gait training in improving clinical parameters and neuroplasticity biomarkers of chronic post-stroke subjects. OBJECTIVE: To investigate the effects of combining tDCS and FDS on motor impairment, functional mobility, and brain-derived neurotrophic factor (BDNF) serum levels. Also, to evaluate the effects of this protocol on the insulin-like growth factor-1 (IGF-1), insulin growth factor-binding proteins-3 (IGFBP-3), interleukin (IL) 6 and 10, and tumor necrosis factor-α (TNF-α) levels. METHODS: Thirty-two chronic post-stroke individuals were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent ten gait training sessions for two weeks using a FDS device and real or sham tDCS. Blood samples and clinical data were acquired before and after the intervention. Motor impairment was assessed by the Fugl-Meyer Assessment and functional mobility using the Timed up and Go test. RESULTS: Both groups improved the motor impairment and functional mobility and increased the BDNF levels. Both groups also increased the IL-10 and decreased the cortisol, IL-6, and TNF-α levels. No difference was observed between groups. CONCLUSION: tDCS did not add effect to FDS and gait training in improving clinical parameters and neuroplasticity biomarkers in chronic post-stroke individuals. Only FDS and gait training might be enough for people with chronic stroke to modify some clinical parameters and neuroplasticity biomarkers.

Coumestrol pre-treatment improves spatial learning and memory deficits following transient cerebral ischemia recruiting hippocampal GluR2 AMPA receptors.

Transient global ischemia is a leading cause of learning and memory dysfunction and induces a pattern of delayed neuronal death in the CA1 subfield of the hippocampus by down-regulating GluR2 mRNA AMPA receptors in this cerebral area. This study sought to investigate the neuroprotective effect of coumestrol against spatial memory impairment induced by global ischemia that leads to neural death by reducing the GluR2 receptors content in the hippocampal CA1 area. Our studies demonstrated that coumestrol administration prevented spatial memory deficits in mice. These findings suggest a cognitive enhancement role of coumestrol against cognitive impairment in ischemic events.

Proprioceptive neuromuscular facilitation induces muscle irradiation to the lower limbs - A cross-sectional study with healthy individuals.

INTRODUCTION: This study aimed to evaluate the effectiveness of proprioceptive neuromuscular facilitation (PNF) in promoting muscle irradiation to the lower limbs and to relate these findings with muscle activation during the sit-to-stand task. METHODS: Twenty-four healthy women were recruited via convenience sampling and submitted to four PNF patterns: upper limb pattern with flexion-abduction-external rotation (UL), lower limb pattern with flexion-adduction-external rotation with knee flexion (lower limb pattern 1 [LL1]), lower limb pattern with flexion-abduction-internal rotation with knee flexion (lower limb pattern 2 [LL2]), and lifting to the right. Electromyography was recorded from the gluteus maximus, gluteus medius, vastus medialis, vastus lateralis, and soleus during the PNF patterns and during the sit-to-stand task. RESULTS: The most recruited muscles during the sit-to-stand task were the vastus lateralis, vastus medialis, and soleus (p < 0.05). Lifting to the right induced the greatest activation of the gluteus maximus (p < 0.001). Lifting to the right and LL2 were better than UL at recruiting the gluteus medius (p < 0.05). Lifting to the right and LL1 were better than UL at recruiting the vastus medialis and lateralis (p < 0.05; p < 0.05). and Lower limb pattern 1 and 2 were better than UL at recruiting the soleus muscle (p < 0.05). CONCLUSION: PNF can be used to induce muscle irradiation to maintain or improve muscle activity to the muscles recruited during the sit-to-stand task. The best PNF pattern for inducing muscle irradiation to muscles recruited during the sit-to-stand task are lifting to the right, LL2, and LL1.

Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor.

The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.

Poly (lactide-co-glycolide) (PLGA) Scaffold Induces Short-term Nerve Regeneration and Functional Recovery Following Sciatic Nerve Transection in Rats.

Peripheral nerve injury is an important cause of incapability and has limited available treatment. Autologous donor nerve implant is the golden standard treatment, however, may cause secondary deficits. Stem cells show positive results in preclinical settings, preserving tissue and function. We tested the efficacy of stem cells derived from human exfoliated deciduous teeth seeded in poly (lactide-co-glycolide) scaffolds in sciatic nerve transection model. Seventy-two adult male Wistar rats had 7-mm nerve gap bridge using scaffolds with (or without) stem cells. Animals were randomly divided into: sham-operated; sham-operated without scaffold; sham-operated + scaffold + stem cells; sciatic transection + no treatment; sciatic transection + acellular scaffolds; sciatic transection + scaffold + stem cells. Sciatic Functional Index and Ladder Rung Walking tests were performed before (-1), 14 and 28 days after surgery. Morphometric nerve measurement and muscle weights were assessed. Scaffolds with stem cells improved function in Sciatic Functional Index. Acellular scaffold was effective, promoting functional recovery and nerve regeneration following nerve injury. Scaffolds provide better nerve regeneration and functional recovery after sciatic transection. Despite cell therapy promoting faster recovery after sciatic transection in the Sciatic Index Score, stem cells did not improve functional and morphological recovery after nerve injury. This is the first study testing the potential use of scaffolds combined with stem cells in the early stages after injury. Scaffolds with stem cells could accelerate nerve recovery and favor adjuvant therapies, evidencing the need for further studies to increase the knowledge about stem cells' mechanisms.

Automated Mechanical Peripheral Stimulation Effects on Gait Variability in Individuals With Parkinson Disease and Freezing of Gait: A Double-Blind, Randomized Controlled Trial.

OBJECTIVE: To assess the effects of automated peripheral stimulation (AMPS) in reducing gait variability of subjects with Parkinson disease (PD) and freezing of gait (FOG) treated with AMPS and to explore the effects of this treatment on gait during a single task (walking) and a dual task (walking while attending the word-color Stroop test). DESIGN: Interventional, double-blinded, placebo-controlled, randomized trial. SETTING: Clinical rehabilitation. PARTICIPANTS: Thirty subjects were randomized into 2 groups: AMPS (n=15) and AMPS sham (n=15). INTERVENTIONS: Both groups received 2 treatment sessions a week for 4 consecutive weeks (totaling 8 treatment sessions). AMPS was applied by using a medical device (Gondola™) and consisted in mechanical pressure stimulations delivered by metallic actuators on 4 areas of the feet. Treatment parameters and device configuration were modified for AMPS sham group. MAIN OUTCOME MEASURES: Gait analyses were measured at baseline and after the first, fourth, and eighth treatment sessions. RESULTS: Interactions among groups and sessions were found for both conditions while off anti-Parkinsonian medications. AMPS decreased gait variability in subjects with PD and FOG for both single and dual task conditions. CONCLUSIONS: AMPS is an effective add-on therapy for treating gait variability in patients with PD and FOG.

Height of the Medial Longitudinal Arch During Classical Ballet Steps.

The purpose of this study was to evaluate the midfoot longitudinal arch height and correlate it with active hip external rotation (ER) in dancers during static postures and technical steps of classical ballet (i.e., first position, demi-plié, battement fondu à la seconde, pas jeté à la seconde, and grand jeté à la seconde). A 3D motion analysis system was used for kinematic analysis. The arch height was significantly reduced during the battement fondu à la seconde, pas jeté à la seconde, and grand jeté à la seconde when compared to standing (p = 0.000 for all comparisons), first position (p = 0.000, p = 0.000, and p = 0.001, respectively) and demi-plié (p = 0.015, p = 0.003, and p = 0.006, respectively). No significant correlation was found between arch height and active hip external rotation (p > 0.05). Hence, active hip external rotation does not seem to be related to midfoot pronation in this sample. Other factors, such as intrinsic and extrinsic foot muscle strength, may be related to the midfoot arch height. These findings contribute to a better understanding of ballet steps, but future studies are required to clarify this topic completely.