Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial.

BACKGROUND: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN: A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION: This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION: ReBEC RBR-9B5DH7.

Influência da modalidade de reconto na avaliação do desempenho de escolares em compreensão leitora / Influence of retelling modality on reading comprehension assessment

Este estudo buscou estudar a influência da modalidade de reconto sobre a avaliação da compreensão leitora. Avaliaram-se 34 escolares do 2º ao 5º ano do Ensino Fundamental, sem queixas de leitura, agrupados em: 1) Grupo Reconto Oral: 19 crianças que recontaram oralmente texto narrativo e expositivo lidos; 2) Grupo Reconto Escrito: 15 que o fizeram por escrito. A análise dos recontos quantificou proposições de ideia central, detalhe, inferências e número de enlaces. Estabeleceu-se, também, o padrão de compreensão (3-0, do melhor para o pior desempenho). Resultados evidenciaram semelhanças entre as médias de desempenho dos grupos nas variáveis do reconto de texto narrativo. Para o expositivo, houve diferença para enlaces de primeiro nível (t = -2,114, p = 0,042), com maior média do Grupo reconto escrito. Concluiu-se, portanto, que a modalidade do reconto não influenciou a avaliação da compreensão de textos narrativos, mas o reconto escrito de textos expositivos favoreceu o aparecimento de enlaces entre ideias centrais.

The aim of the present study was to investigate the influence of the retelling strategy modality on the assessment of reading comprehension. Thirty-four 2nd-5th grade students (elementary school) without reading difficulties were evaluated and grouped as follows: Group 1. Oral retelling: students orally reconstructed narrative and expository texts they read (19 students); Group 2. Writing retelling: students retold these same stories in writing (15 students). The analysis conducted assessed retelling in terms of: proposition of central idea, details, inferences, and number of links. A performance reference standard (3-0) was also established from the best to the worst performance. The results obtained showed similarity between the average performance of the variables of the oral narrative text retelling groups. As for the expository texts, there were differences in the first level of links (t = -2.114, p = 0.042), and the highest average performance was found for the writing retelling group. It can be concluded that the retelling strategy modality did not influence the evaluation of the understanding of narrative texts, but the written retelling of expository texts influenced the connection of central ideas.