ABSTRACT
Postural instability is common in neurological diseases. Although transcranial direct current stimulation (tDCS) seems to be a promising complementary therapy, emerging evidence indicates mixed results and protocols' characteristics. We conducted a systematic review and meta-analysis on PubMed, EMBASE, Scopus, and Web of Science to synthesize key findings of the effectiveness of single and multiple sessions of tDCS alone and combined with other interventions on balance in adults with neurological disorders. Thirty-seven studies were included in the systematic review and 33 in the meta-analysis. The reviewed studies did not personalize the stimulation protocol to individual needs/characteristics. A random-effects meta-analysis indicated that tDCS alone (SMD = -0.44; 95%CI = -0.69/-0.19; p < 0.001) and combined with another intervention (SMD = -0.31; 95%CI = -0.51/-0.11; p = 0.002) improved balance in adults with neurological disorders (small to moderate effect sizes). Balance improvements were evidenced regardless of the number of sessions and targeted area. In summary, tDCS is a promising therapy for balance rehabilitation in adults with neurological disorders. However, further clinical trials should identify factors that influence responsiveness to tDCS for a more tailored approach, which may optimize the clinical use of tDCS.
Subject(s)
Nervous System Diseases , Stroke Rehabilitation , Stroke , Transcranial Direct Current Stimulation , Activities of Daily Living , Humans , Nervous System Diseases/therapy , Stroke Rehabilitation/methods , Transcranial Direct Current Stimulation/methodsABSTRACT
BACKGROUND: Parkinson's disease (PD) is a neurodegenerative and progressive disease marked by the presence of motor and non-motor symptoms, as psychological and cognitive impairment. Physical exercises have been prescribed as complementary therapy for PD, and the type of intervention and duration of the intervention should be taken into account. OBJECTIVE: We aimed to compare the effect of different exercise modalities (functional mobility, multimodal and cognitive) and length (4 and 8 months) on psychological and cognition in people with PD. This study followed the CONSORT extension for non-pharmacological trials. METHODS: In this randomized controlled trial, we assessed 107 participants between 2011 and 2013. At the end of 3 years, participants with PD (mild to moderate stages) who achieved the criteria were assessed considering 3 different groups of exercise: Multimodal (n=38), Functional Mobility (n=33) and Mental/Leisure (n=36). All 3 interventions were performed for 32 weeks, twice a week, with 60min for each session (64 sessions in total). Psychological and cognitive function were assessed at baseline and after 4 and 8 months. RESULTS: The Functional Mobility and Mental/Leisure training had a potential effect on maintaining cognitive function (executive function, attention and work memory). The Multimodal training did not show a benefit for cognitive features and was not even able to delay the progressive decline in cognitive functions; however, this modality had a positive effect on physical stress after 8 months of exercise. CONCLUSIONS: An intervention that requires high complexity and specific activities, such as locomotor and cognitive exercise, provides a maintenance effect against the degeneration in cognition associated with the progression of PD and thus can delay the progressive decline in cognitive function in PD.
Subject(s)
Cognitive Dysfunction , Exercise Therapy , Parkinson Disease , Cognition , Cognitive Dysfunction/etiology , Cognitive Dysfunction/therapy , Exercise Therapy/classification , Humans , Parkinson Disease/therapyABSTRACT
Objetivo: O chute Mae-Geri é empregado tanto em situação de kata como de luta. Este tipo de chute é praticado tanto por karatecas iniciantes como por experientes, o que indica a necessidade de analisar sua assimetria intermembros. Assim, questiona-se: indivíduos habilidosos e experientes apresentam assimetria intermembros na execução do chute Mae-Geri? Para responder este questionamento, o presente estudo objetivou comparar o desempenho no chute Mae-Geri entre o membro dominante e o membro não dominante. Método: Participaram deste estudo 10 karatecas experientes, que desferiram um chute frontal Mae-Geri do Karatê em direção a um alvo. Cada participante realizou 5 tentativas com cada membro, com a ordem de apresentação randomizada entre os participantes. Os movimentos dos participantes foram filmados por uma câmera analógica, com freqüência de 60 Hz, posicionada perpendicularmente à perna da frente quando na postura Zenkutsu-Dachi. Os chutes foram coletados no plano sagital dos participantes. As seguintes variáveis dependentes foram calculadas: velocidade máxima do chute, velocidade média do chute, duração do chute, duração da recuperação da perna, altura máxima atingida pelo joelho, amplitude horizontal do quadril, distância inicial do pé ao alvo, distância final do pé ao alvo e comprimento do passo. A comparação entre os membros dominante e não dominante para cada variável dependente foi realizada por meio de teste t de Student para amostras relacionadas (p<0,05). Resultados: As análises iniciais mostraram que não houve efeito de tentativa para nenhuma das variáveis dependentes. As comparações intermembros de cada variável dependente não mostraram assimetria entre os lados. Conclusão: A prática regular com ambos os lados desde as fases iniciais de aprendizagem promoveu simetria intermembros no chute Mae-Geri eliminando a especificidade de cada membro (estabilização e ação).
Objective: The kick Mae-Geri is used both in situations of kata as fighting. This type of kick is practiced both by beginners as for experienced karateka, which indicates the need for analyze their intermembros asymmetry. So the question is: skilled and experienced individuals intermembros asymmetry present in the execution of the kick Mae-Geri? To answer this questioning, the present study aimed to compare the performance kick Mae-Geri betweendominant member and the non-dominant limb. Method: The study included 10 karateka experienced, which dealt a front kick Mae-Geri Karate toward a target. each participant performed five trials with each member, with the order of presentation randomized among the participants. The movements of the participants were filmed by an analog camera, a frequency of 60 Hz, positioned perpendicular to the front leg when the posture Zenkutsu-Dachi. The kicks were collected in the sagittal plane of the participants. the following dependent variables were calculated: maximum speed of the kick, the average speed of the kick, duration of the kick, the leg length of recovery, maximum height reached by the knee, amplitude the end of horizontal hip, initial distance of the foot to the target, the distance to the target and foot length step. The comparison between the dominant and nondominant limbs for each dependent variable was performed by "t" Student's test for related samples (p <0.05). Results: Initial analyzes showed no effect of trial for any of the variables dependent. The intermembros comparisons of each dependent variable showed no asymmetry between the sides. Conclusion: Regular practice with both sides from the early stages of learning promoted intermembros symmetry in kick Mae-Geri eliminating the specificity of each member (stabilization and action).