ABSTRACT
The current priority of investigations involving transcranial direct current stimulation (tDCS) and neurorehabilitation is to identify biomarkers associated with the positive results of the interventions such that respondent and non-respondent patients can be identified in the early phases of treatment. The aims were to determine whether: (1) present motor evoked potential (MEP); and (2) injuries involving the primary motor cortex, are associated with tDCS-enhancement in functional outcome following gait training in children with cerebral palsy (CP). We reviewed the data from our parallel, randomized, sham-controlled, double-blind studies. Fifty-six children with spastic CP received gait training (either treadmill training or virtual reality training) and tDCS (active or sham). Univariate and multivariate logistic regression analyses were employed to identify clinical, neurophysiologic and neuroanatomic predictors associated with the responsiveness to treatment with tDCS. MEP presence during the initial evaluation and the subcortical injury were associated with positive effects in the functional results. The logistic regression revealed that present MEP was a significant predictor for the six-minute walk test (6MWT; p = 0.003) and gait speed (p = 0.028), whereas the subcortical injury was a significant predictor of gait kinematics (p = 0.013) and gross motor function (p = 0.021). In this preliminary study involving children with CP, two important prediction factors of good responses to anodal tDCS combined with gait training were identified. Apparently, MEP (integrity of the corticospinal tract) and subcortical location of the brain injury exerted different influences on aspects related to gait, such as velocity and kinematics.
ABSTRACT
Introdução: O controle postural depende da ação integrada dos sistemas sensoriais e motores, e uma maior demanda atencional em situações de dupla-tarefa possivelmente acarreta maior oscilação postural. Objetivo: comparar a influ-ência de tarefas cognitivas sobre o equilíbrio estático de indivíduos saudáveis. Materiais e métodos: estudo transversal realizado com 20 participantes adultos saudáveis. Os participantes foram submetidos a avaliação estabilométrica (olhos abertos e fechados) durante a execução de tarefas cognitivas (Stroop Test e contagem regressiva) e na situação controle (sem tarefa). Os deslocamentos do centro de pressão foram coletados e analisado. Resultados: Houve diferença significante dos efeitos obtidos na execução da tarefa matemática em comparação às demais situações (aumento da área de deslocamento e oscilações do centro de pressão). As demais comparações do tamanho do efeito não demonstraram significância. Conclusão: A execução de tarefas cognitivas influenciou o equilíbrio estático dos participantes. A tarefa matemática demonstrou maior influencia sobre o equilíbrio estático.
Introduction: The postural control depends on the integrated action of sensory and motor systems. Attention is also a requirement for the maintenance of postural control. The increase of attentional demand in dual-task situations possibly entails postural sway. Objective: Compare the influence of a visual cognitive task with a mathematical task on static balance in healthy subjects. Methods: Crosssectional study with a group of 20 healthy adults. The stabilometric evaluations (open and closed eyes) were performed during the execution of cognitive tasks (Stroop Test and countdown) and in the control situation (without cognitive task). Oscillations of the center of pressure were collected and analyzed in this study. Results: There was significant results in the effects achieved in the mathematical task compared to other situations (increased area and center of pressure sway). The other effect size comparisons didn´t show significant difference.