A Telemedicine Platform for Aphasia: Protocol for a Development and Usability Study.

BACKGROUND: Aphasia is a central disorder of comprehension and expression of language that cannot be attributed to a peripheral sensory deficit or a peripheral motor disorder. The diagnosis and treatment of aphasia are complex. Interventions that facilitate this process can lead to an increase in the number of assisted patients and greater precision in the therapeutic choice by the health professional. OBJECTIVE: This paper describes a protocol for a study that aims to implement a computer-based solution (ie, a telemedicine platform) that uses deep learning to classify vocal data from participants with aphasia and to develop serious games to treat aphasia. Additionally, this study aims to evaluate the usability and user experience of the proposed solution. METHODS: Our interactive and smart platform will be developed to provide an alternative option for professionals and their patients with aphasia. We will design 2 serious games for aphasia rehabilitation and a deep learning-driven computational solution to aid diagnosis. A pilot evaluation of usability and user experience will reveal user satisfaction with platform features. RESULTS: Data collection began in June 2022 and is currently ongoing. Results of system development as well as usability should be published by mid-2023. CONCLUSIONS: This research will contribute to the treatment and diagnosis of aphasia by developing a telemedicine platform based on a co-design process. Therefore, this research will provide an alternative method for health care to patients with aphasia. Additionally, it will guide further studies with the same purpose. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40603.

Neural Networks to Recognize Patterns in Topographic Images of Cortical Electrical Activity of Patients with Neurological Diseases.

Software such as EEGLab has enabled the treatment and visualization of the tracing and cortical topography of the electroencephalography (EEG) signals. In particular, the topography of the cortical electrical activity is represented by colors, which make it possible to identify functional differences between cortical areas and to associate them with various diseases. The use of cortical topography with EEG origin in the investigation of diseases is often not used due to the representation of colors making it difficult to classify the disease. Thus, the analyses have been carried out, mainly, based on the EEG tracings. Therefore, a computer system that recognizes disease patterns through cortical topography can be a solution to the diagnostic aid. In view of this, this study compared five models of Convolutional Neural Networks (CNNs), namely: Inception v3, SqueezeNet, LeNet, VGG-16 and VGG-19, in order to know the patterns in cortical topography images obtained with EEG, in Parkinson's disease, Depression and Bipolar Disorder. SqueezeNet performed better in the 3 diseases analyzed, with Parkinson's disease being better evaluated for Accuracy (88.89%), Precison (86.36%), Recall (91.94%) and F1 Score (89.06%), the other CNNs had less performance. In the analysis of the values of the Area under ROC Curve (AUC), SqueezeNet reached (93.90%) for Parkinson's disease, (75.70%) for Depression and (72.10%) for Bipolar Disorder. We understand that there is the possibility of classifying neurological diseases from cortical topographies with the use of CNNs and, thus, creating a computational basis for the implementation of software for screening and possible diagnostic assistance.

Non-immersive 3D virtual stimulus alter the time production task performance and increase the EEG theta power in dorsolateral prefrontal cortex.

AIM: The study investigated the cortical activity changes and time production task performance induced by changes in motion speed of a non-immersive 3D virtual stimulus. MATERIAL AND METHODS: Twenty-one individuals were participated in the crossover study with the visual-time reproduction task under three-speed conditions: original, slow and fast virtual stimulus. In addition, the electroencephalographic analysis of the theta band power in the dorsolateral prefrontal cortex was done simultaneously with time production task execution. RESULTS: The results demonstrated that in the slow speed condition, there is an increase in the error in the time production task after virtual reality (p < 0.05). There is also increased EEG theta power in the right dorsolateral prefrontal cortex in all speed conditions (p < 0.05). CONCLUSIONS: We propose that the modulations of speed of virtual stimulus may underlie the accumulation of temporal pulses, which could be responsible for changes in the performance of the production task of the time intervals and a substantial increase in right dorsolateral prefrontal cortex activity related to attention and memory, acting in cognitive domains of supraseconds.

Percolation theory for the recognition of patterns in topographic images of the cortical activity.

Electroencephalogram (EEG) is one of the mechanisms used to collect complex data. Its use includes evaluating neurological disorders, investigating brain function and correlations between EEG signals and real or imagined movements. The Topographic Image of Cortical Activity (TICA) records obtained by the EEG make it possible to observe, through color discrimination, the cortical areas that represent greater or lesser activity. Percolation Theory (PT) reveals properties on the aspects of fluid spreading from a central point, these properties being related to the aspects of the medium, topological characteristics and ease of penetration of a fluid in materials. The hypothesis presented so far considers that synaptic activities originate in points and spread from them, causing different areas of the brain to interact in a diffusive associative behavior, generating electric and magnetic fields by the currents that spread through the brain tissue and have an effect on the scalp sensors. Brain areas spatially separated create large-scale dynamic networks that are described by functional and effective connectivity. The proposition is that this phenomenon behaves like a fluidic spreading, so we can use the PT, through the topological analysis we detect specific signatures related to neural phenomena that manifest changes in the behavior of synaptic diffusion. This signature must be characterized by the Fractal Dimension (FD) values of the scattering clusters, these values will be used as properties in the k-Nearest Neighbors (kNN) method, an TICA will be categorized according to the degree of similarity to the preexisting patterns. In this context, our hypothesis will consolidate as a more computational resource in the service of medicine and another way that opens with the possibility of analysis and detailed inferences of the brain through TICA that go beyond a simply visual observation, as it happens in the present day.

Movement automatization: motor interactions and electroencephalogram application / Automatização do movimento: interações motoras e aplicação do eletroencefalograma

The specificities of the motor system lead people to present skills to perform some movements in an automatic way after learning. Acquiring the automaticity of the movements is usually associated with reducing the demands of attention control. Thus, automatization represents a reduction in interference that undermines performance in dual task conditions. It was carried out a search on the databases of Pubmed, Scopus, SciELO e Lilacs, to understand the physiology of automaticity and analyze the use of electroencephalogram as a means of research in automatization. In this context, the study aims to verify the employment of the electroencephalogram as a resource in the analysis of the motor skills involved in the movement automatization.

As especificidades do sistema motor levam às pessoas há apresentarem habilidades para realizar alguns movimentos de maneira automática depois de aprendidos. Adquirir a automaticidade dos movimentos geralmente está associadaà redução das demandas de controle da atenção. Assim, a automatização representa uma redução da interferência que prejudica o desempenho em condições de tarefa dupla. Para este estudo foi realizado uma revisão integrativa de estudos indexados nas bases de dados Pubmed, Scopus, SciELO e Lilacs, para compreender a fisiologia da automaticidade e analisar a utilização do eletroencefalograma (EEG) como meio de investigação na automatização. Neste contexto, o estudo tem por objetivo verificar o emprego do eletroencefalograma como recurso na análise das habilidades motoras envolvidas na automatização do movimento.

Genetic polymorphisms associated with circadian rhythm dysregulation provide new perspectives on bipolar disorder.

OBJECTIVES: The objective of this study was to present a broad view of how genetic polymorphisms in genes that control the rhythmicity and function of circadian rhythm may influence the etiology, pathophysiology and treatment of bipolar disorder (BD). METHODS: A bibliographic search was performed to identify and select papers reporting studies on variations in circadian genes and BD. A search of Medline, Google Scholar, Scopus, and Web of Science was carried out to review the literature. RESULTS: Several studies provide evidence of contributions of variations in circadian genes to disease etiology, pathophysiological variations and lithium drug response. Dysfunction of the sleep-wake cycle, an important brain function regulator, is indicated as the primary means by which circadian gene variations act in mood disorders. CONCLUSIONS: Investigations of the effects of circadian genes have suggested that the chronotype offers hope for guiding and improving management of patients with BD. However, BD is a disease of a complex nature and presents multiple endophenotypes determined by different associations between genetics and the environment. Thus, new genomic studies to delimit variations that may help improve the clinical condition of these patients are extremely important.

Tuberculous meningitis in childhood: new aspects of neurologic complications / Meningite tuberculosa na infância: novos aspectos das complicações neurológicas

Tuberculous Meningitis (TBM) is a severe manifestation of tuberculosis that represents 1% of the cases of infection by Mycobacterium tuberculosis. Children are among the other age groups the most affected and when present, HIV-1 is responsible for poorer prognosis. It was carried out a search on the databases of Pubmed, Lilacs and Scielo, looking for articles that approach the principals news aspects of neurologic complications caused by TBM. The literature cite as major neurologic findings the hydrocephalus in approximately 80% patients, meningeal irritation, coma, seizures, intracranial pressure signs, cranial nerve palsy, hemiparesis and disorders in the movement. Neurologic sequelae occur in up to 50% of survivors and early diagnosis is crucial to reduce the occurrence of major functional losses. In this way, discussions presenting more specific methods for TBM as well as better assessment of the signs and symptoms of the disease is necessary for a better prognosis and lower mortality rate of these patients.

A meningite tuberculosa (MTB) é uma manifestação grave da tuberculose que representa 1% dos casos de infecção por Mycobacterium tuberculosis. As crianças estão as faixas etárias mais afetadas e quando presente, o HIV-1 é responsável pelo pior prognóstico. Foi realizada uma revisão de bancos de dados Pubmed, Lilacs e Scielo, à procura de artigos que abordem os principais aspectos das complicações neurológicas causadas pela MTB. Os principais achados neurológicos compreendem a hidrocefalia em aproximadamente 80% dos pacientes, irritação meníngea, coma, convulsões, sinais de pressão intracraniana, paralisia de nervo craniano, hemiparesia e distúrbios movimento. Sequelas neurológicas ocorrem em até 50% dos sobreviventes e o diagnóstico precoce é crucial para reduzir a ocorrência de perdas. Desta forma, as discussões apresentando métodos mais TBM, bem como uma melhor avaliação dos sinais e sintomas da doença é necessária para um melhor prognóstico e menor taxa de mortalidade desses pacientes.

Augmented movement strategies for postural control in patients with spinocerebellar ataxia type 3: a case-control study / Estratégias aumentadas de movimento para controle postural em pacientes com ataxia espinocerebellar tipo 3: caso-controle

INTRODUCTION: This study investigated the movement strategies for postural control in patients with spinocerebellar ataxia type 3 (SCA3). METHODS: This case-control study enrolled 5 patients with SCA3 (aged 41 to 51 years) and 5 healthy participants group-matched by age, body mass and body height.Participants performed 3 trials lasting 30 s each of postural tasks characterized by: feet apart or together; eyes open or closed. Center of pressure (CoP) data was quantified using three-dimensional (3D: number of high-density and high-speed regions, average and maximal distances among regions), two-dimensional (2D: elliptical area, average velocity) and one-dimensional (1D: standard deviation, velocity) parameters. RESULTS: Analysis of variance revealed significant interaction effect between group*task for 1D (F12,238=3.496, p<0.001), 2D (F6,184=11.472, p<0.001), and 3D parameters (F12,238=2.543, p=0.004). Significant univariate effects for postural task were observed for all parameters, with higher body sway values under visual and biomechanical constraints, either separated or combined. CONCLUSIONS: Patients with SCA3 presented augmented movement strategiescompared with healthy subjects, characterized by increasing body sway under more demanding biomechanical and/ or visual constraints. Three-dimensional kinematic mapping revealed either random movement strategies or a unique movement strategy characterized by a stochastic CoP distribution, with high CoP speed to correct for large body sway deviations.

INTRODUÇÃO: Este estudo investigou as estratégias de movimento para controle postural em pacientes com ataxia espinocerebelar tipo 3 (SCA3). MÉTODOS: Este estudo de caso-controle incluiu cinco pacientes com SCA3 (idade 41 a 51 anos) e cinco participantes saudáveis, agrupados por idade, massa corporal e altura corporal. Os participantes realizaram três ensaios 30 s cada uma das tarefas posturais caracterizadas por: pés separados ou juntos; olhos abertos ou fechados. Os dados do centro de pressão (CoP) foram quantificados usando tridimensional (3D: número de alta densidade e alta velocidade regiões, distâncias médias e máximas entre regiões), bidimensional (2D: área elíptica, velocidade média) e unidimensional (1D: Desvio padrão, velocidade). RESULTADOS: Análise de variância Revelou um efeito de interação significativo entre a tarefa * grupo 1D (F12.238 = 3.496, p <0.001), 2D (F6.184 = 11.472, p <0.001) e os parâmetros 3D (F12,238 = 2,543, p = 0,004). Efeitos univariados significativos foram observados para todos os parâmetros, com maiores valores de balanço corporal sob restrições visuais e biomecânicas, separadas ou combinados. CONCLUSÕES: Os pacientes com SCA3 apresentaram estratégias de movimento comparadas com indivíduos saudáveis, aumentando o balanço do corpo sob condições biomecânicas e / ou restrições visuais. O mapeamento cinemático tridimensional revelou estratégias de movimento aleatório ou uma estratégia de movimento caracterizada por uma distribuição estocástica de CoP, com alta velocidade de correção para os grandes desvios.

Meningite aguda bacteriana na população infantojuvenil: principais agentes e métodos para diagnóstico - uma revisão da literatura / Acute bacterial meningitis in children and young population: main agents and methods for diagnosis - a literature review

A meningite bacteriana é uma afecção de grande significância devido a sua relação com alta mortalidade e morbidade na população neonatal a jovem. Devido a este fato é importante o conhecimento sobre esta doença e os seus principais agentes etiológicos. Com o objetivo de relatar os principais métodos de diagnóstico, assim como os principais agentes etiológicos envolvidos na fisiopatologia da meningite bacteriana em população jovem foi realizada uma busca por artigos publicados nos últimos 5 anos nas bases de dados Pubmed, Scielo, Bireme e Lilacs. A literatura atual aponta como microrganismos predominantes na incidência dessa doença a N. meningitidis S. pneumoniae, sendo as mais recorrentes na população de faixa etária entre 29 dias e 17 anos. Os fatores relacionados ao prognóstico estão intimamente relacionados com a distinção da classificação do agente etiológico em bacteriano ou viral, importante para a determinação da terapia adequada.

Bacterial meningitis is a highly significant disease due to its relationship with high mortality and morbidity in neonatal and young population. Due to this is important to know about this disease and its main etiological agents. In purpose to report the main diagnostic methods, as well as the main etiological agents involved in the pathophysiology of bacterial meningitis was conducted a search for articles published in the last five years in Pubmed, Scielo, Bireme and Lilacs. The current literature indicates N. meningitidis S. pneumoniae the most predominant microorganisms in the incidence of this disease between population aged between 29 days and 17 years. Factors related to prognosis are closely related to the classification distinction of the etiologic agent in bacterial or viral, important to determine the ap- propriate therapy.

Acute effects of neural mobilization and infrared on the mechanics of the median nerve.

[Purpose] This study analyzed the acute effects of infrared and neural mobilization on the median nerve on the range of elbow extension of the dominant limb. [Subjects and Methods] Forty participants from university, neurologically asymptomatic, 12 males and 28 females (22.8 ± 1.9 years), were randomly divided into four groups: Group 1 (control) rested for 25 minutes in the supine position; Group 2 received the specific neural mobilization for the median nerve; Group 3 received an application of infrared for 15 minutes on the forearm; Group 4 received the same application of infrared followed by neural mobilization. The goniometric parameters of elbow extension were evaluated after the intervention. [Results] Significant differences of extension value were observed between Group 1 and Group 3 (15.75 degrees), and between Group 1 and Group 4 (14.60 degrees), and the average higher in Group 3 (26.35 degrees). [Conclusion] This research provides new experimental evidence that NM in relation to superficial heat produces an immediate effect on elbow range of motion versus NM isolated.

Effects of vestibular rehabilitation in the elderly: a systematic review.

BACKGROUND: Aging is characterized by gradual physiological changes in body systems. Changes in the vestibular system can occur and cause dizziness, vertigo and imbalance, symptoms that are common in the elderly. Vestibular rehabilitation is a therapeutic resource that has been widely used to improve this condition. AIMS: To complete a systematic review of the effects of vestibular rehabilitation on the elderly. METHODS: A search for relevant publications was conducted in SCIELO, PUBMED, MEDLINE, COCHRANE and LILACS databases. Clinical trials and cohort studies that were written in the English language and published over the course of the last 10 years were selected. The methodological quality of the studies was assessed using the PEDro scale. A critical analysis of the studies was composed. RESULTS: Eight studies that involved subjects who were over the age of 60 were selected for inclusion in the systematic review. The most common vestibular dysfunction identified was complaints about dizziness and imbalance. The Dizziness Handicap Inventory was the most frequently used assessment instrument, and the treatment protocol that prevailed was that suggested by Cawthorne and Cooksey. DISCUSSION: The PEDro scale showed that only one article was of an acceptable methodological quality and presented satisfactory outcome measures. This was due, in part, to a lack of a hidden randomization, masking of the subject, evaluators and therapists, and lack of outcome measures, which can reduce the quality of the evidence presented in this study. CONCLUSION: Clinical trials indicate that vestibular rehabilitation represents an effective means of treating elderly patients with vestibular disorders; however, evidence of its effectiveness remains lacking.