Is transcranial direct current stimulation (tDCS) effective to improve cognition and functionality after severe traumatic brain injury? A perspective article and hypothesis.

Severe traumatic brain injury (sTBI) is an important cause of disability and mortality and affects people of all ages. Current scientific evidence indicates that motor dysfunction and cognitive impairment are the main limiting factors in patients with sTBI. Transcranial direct current stimulation (tDCS) seems to be a good therapeutic option, but when it comes to patients with sTBI, the results are inconclusive, and some protocols have not yet been tested. In addition, there is still a lack of information on tDCS-related physiological mechanisms, especially during the acute phase. In the present study, based on current evidence on tDCS mechanisms of action, we hypothesized that performing tDCS sessions in individuals with sTBI, especially in the acute and subacute phases, together with conventional therapy sessions, could improve cognition and motor function in this population. This hypothesis presents a new possibility for treating sTBI, seeking to elucidate the extent to which early tDCS may affect long-term clinical outcomes.

Predictors of Mortality and Functional recovery after severe traumatic brain injury: protocol for a prospective cohort study

Introduction: traumatic brain injury is a global public health problem due to its severity and high rates of morbimortality worldwide. Identifying predictors associated with increased mortality and unfavorable functional outcomes after the traumatic brain injury event is crucial for minimizing morbidity and mortality rates. Therefore, this study aims to establish a protocol to investigate the predictors of mortality and functional recovery after severe traumatic brain injury in Brazil.Methods: The study will include all patients admitted for severe traumatic brain injury (Glasgow Coma Scale ≤ 8) at the State Hospital of Urgency and Emergency, which is the referral trauma hospital of Espirito Santo. The outcomes of interest are hospital mortality and functional recovery 24 months after hospital discharge. Subjects will be followed up at seventy-two hours, three months, six months, twelve months, and twenty-four months after the trauma. Morbidity will be determined by assessing: 1) the level of motor and cognitive disability, 2) functional impairment and quality of life, and 3) aspects of rehabilitation treatment. Additionally, the traumatic brain injury load, estimated by the years of life lost, will be calculated. Discussion: the results of this study will help identify variables that can predict morbidity and mortality, as well as diagnostic and therapeutic targets for patients with severe traumatic brain injury. Furthermore, the findings will have practical implications for: 1) the development of public policies, 2) investments in hospital infrastructure 3) understanding the socioeconomic impact of functional loss in the individuals.Study registration: the study received approval from the Ethics Committee of the Federal University of Espirito Santo under protocol number 4.222.002 on August 18, 2020.

Introdução: traumatismo cranioencefálico é um problema global de saúde pública devido à sua gravidade e altas taxas de morbimortalidade em todo o mundo. Identificar preditores associados ao aumento da mortalidade e desfechos funcionais desfavoráveis após o evento do traumatismo craniencefálico é primordial para minimizar as taxas de morbidade e mortalidade. Portanto, este estudo tem como objetivo estabelecer um protocolo para investigar os preditores de mortalidade e recuperação funcional após traumatismo cranioencefálico grave no Brasil. Métodos: este estudo tem como objetivo investigar os preditores de mortalidade e recuperação funcional em pacientes com traumatismo cranioencefálico, além de fornecer uma visão geral do traumatismo cranioencefálico no estado do Espírito Santo. O estudo abrangerá todos os pacientes internados por traumatismo cranioencefálico grave (Escala de Coma de Glasgow ≤ 8) no Hospital Estadual de Urgência e Emergência, o hospital de referência para traumas no Espírito Santo. Os desfechos de interesse incluem mortalidade hospitalar e recuperação funcional após 24 meses da alta hospitalar. Os participantes serão acompanhados em setenta e duas horas, três meses, seis meses, doze meses e vinte e quatro meses após o trauma. A morbidade será determinada pela avaliação de: 1) nível de incapacidade motora e cognitiva, 2) comprometimento funcional e qualidade de vida, e 3) aspectos do tratamento e reabilitação. Além disso, a carga de traumatismo cranioencefálico, estimada em anos de vida perdidos, será calculada. Discussão: os resultados deste estudo ajudarão a identificar variáveis que podem predizer a morbidade e a mortalidade após traumatismo cranioencefálico grave. Além disso, as descobertas terão implicações práticas para: 1) o desenvolvimento de políticas públicas, 2) investimentos em infraestrutura hospitalar e 3) compreensão do impacto socioeconômico da perda funcional nesses indivíduos. Registro do estudo: o estudo recebeu aprovação do Comitê de Ética da Universidade Federal do Espírito Santo sob o número de protocolo 4.222.002 em 18 de agosto de 2020

Transcranial direct-current stimulation over the motor cortex in patients suffering from anxiety and depression related to rheumatoid arthritis: Study protocol for a randomized, double-blind, placebo-controlled trial.

Rheumatoid arthritis is up to three times more prevalent in women. It is often associated with anxiety and depression, comorbidities causing psychic suffering and potentiating pain perception. It is also related to a higher risk of suicide among diagnosed patients. The high rates of discontinuation of conventional pharmacological treatments are the predominant factor in the search for new therapeutic approaches for the treatment of anxiety and depression. Transcranial direct-current stimulation (tDCS) is a promising, safe and low-cost technique that is very associative with other therapies. When applied to the primary motor cortex (M1) it can induce long-term changes in the synaptic level leading to the improvement of neuroplasticity. The primary aim of this study is to evaluate the effect of tDCS on the symptoms of anxiety and depression. The secondary aim is to evaluate the interference of tDCS on the inflammatory profile, cardiac autonomic behavior and quality of life of patients with rheumatoid arthritis. This is a randomized, double-blind, placebo-controlled clinical trial. The intervention consists of 10 consecutive sessions (once a day) applying tDCS with a 2mA current for 20 minutes. The electrode assembly on the scalp is in accordance with the International Electroencephalogram System 10-20 (EEG) and the anodal electrode is placed over the area of the primary motor cortex (M1 - C3 or C4) and the cathodal electrode on the supraorbital contralateral area (SO - Fp1 or Fp2). The analysis of continuous variables will be described by mean and standard deviation for parametric data and median and interquartile interval for nonparametric data. The evaluation of the effect of tDCS on the inflammatory profile, heart rate variability and quality of life will be obtained by the ANOVA two-way test. tDCS is expected to have a greater effect on reducing anxiety and depression symptoms compared to the placebo, being able to decrease inflammation and improve the quality of life of volunteers.

Home-based is as effective as centre-based rehabilitation for improving upper limb motor recovery and activity limitations after stroke: A systematic review with meta-analysis.

OBJECTIVE: This systematic review aimed to examine the effects of home-based exercises in comparison with centre-based exercises for improving the paretic upper limb after stroke. DATA SOURCES: AMED, MEDLINE, EMBASE CINAHL, Cochrane, PsycINFO, and PEDro databases. REVIEW METHODS: Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention was home-based exercises compared with centre-based exercises. Outcome data related to strength, motor recovery, dexterity, activity, and participation were extracted from the eligible trials and combined in meta-analyses. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Eight trials, involving 488 participants, were included. Most trials (63%) delivered semi-supervised interventions (amount of supervision 3-43%), and three trials provided full supervision. Random-effects meta-analyses provided moderate- to high-quality evidence that home- and centre-based exercises provide similar effects on motor recovery (MD 1.4 points; 95% CI -0.9 to 3.8), dexterity (MD -0.01 pegs/s; 95% CI -0.04 to 0.05), upper limb activity performance (SMD -0.04; 95% CI -0.25 to 0.18), and quality of movement (0.1 points; 95% CI -0.2 to 0.4). Effects on strength were also similar but the quality of the evidence was rated as low. No trials examined effects on participation. CONCLUSION: Effects of home-based prescribed exercises on upper limb motor recovery, dexterity, and activity are likely to be similar to improvements obtained by centre-based exercises after stroke.

Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review.

QUESTIONS: Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? DESIGN: A systematic review with meta-analyses of randomised clinical trials. PARTICIPANTS: Ambulatory adults with a clinical diagnosis of Parkinson's disease. INTERVENTION: tDCS combined with walking training. OUTCOME MEASURES: Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. RESULTS: Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. CONCLUSION: The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. REGISTRATION: PROSPERO CRD42020162908.

Giovanni Aldini and his contributions to non-invasive brain stimulation.

Giovanni Aldini was an Italian physicist interested in propagating Galvanism. With his uncle, Luigi Galvani, he learned techniques of electrical stimulation in humans and helped him to develop them. He later developed his own ideas and created transcranial electric stimulation. This paper presents some of Aldini's personal and professional traits, showing his trajectory and how his performance was important for the development of non-invasive brain stimulation techniques as a whole. Through research on animals and, later, on cadavers, his fundamental discoveries at the beginning of the treatment proposals are used so far.

Giovanni Aldini and his contributions to non-invasive brain stimulation / Giovanni Aldini e suas contribuições para a estimulação cerebral não invasiva

ABSTRACT Giovanni Aldini was an Italian physicist interested in propagating Galvanism. With his uncle, Luigi Galvani, he learned techniques of electrical stimulation in humans and helped him to develop them. He later developed his own ideas and created transcranial electric stimulation. This paper presents some of Aldini's personal and professional traits, showing his trajectory and how his performance was important for the development of non-invasive brain stimulation techniques as a whole. Through research on animals and, later, on cadavers, his fundamental discoveries at the beginning of the treatment proposals are used so far.

RESUMO Giovanni Aldini era um físico italiano interessado em propagar o Galvanismo. Com seu tio, Luigi Galvani, aprendeu técnicas de estimulação elétrica em humanos e pode ajudá-lo a desenvolvê-las. Mais tarde, desenvolveu suas próprias ideias e criou a estimulação elétrica transcraniana. Este artigo apresenta alguns traços pessoais e profissionais de Aldini, mostrando sua trajetória e como seu desempenho foi importante para o desenvolvimento de técnicas não invasivas de estimulação cerebral como um todo. Através de pesquisas em animais e, posteriormente, em cadáveres, suas descobertas fundamentais no início das propostas de tratamento utilizadas até o momento.

Does neuromodulation transcranial direct current stimulation (tDCS) associated with peripheral stimulation through exercise to walk have an impact on falls in people with Parkinson's disease?

Parkinson's disease (PD) is one of the most prevalent neurodegenerative diseases in the world, with a high degree of disability. Among the various therapeutic possibilities, brain stimulation appears in a promising approach, with deep brain stimulation (DBS) being the best described and successful, yet it has the limitation of being invasive. In this context we present transcranial direct current stimulation (tDCS), a non-invasive treatment that brings a new perspective when thinking about treatment of neurological diseases. It is easy to handle, low cost, few side effects and good adherence to patients. TDCS presents good evidence for clinical practice, but when it comes to PD the results obtained are inconclusive and some protocols have not yet been tested. In this hypothesis we propose that the use of tDCS applied in the supplemental motor areas, together with a gait training, can facilitate the motor learning and modulate the neurons for better potentiation of the exercises together with patients with walking difficulties due to PD.

Epidemiological and functional profile of patients diagnosed with multiple sclerosis in Manaus, Amazonas / Perfil epidemiológico e funcional de pacientes com diagnóstico de esclerose múltipla em Manaus, Amazonas

Multiple sclerosis (MS) is an immune-mediated, inflammatory disease characterized by repeated episodes of demyelization. Objective: The present study aimed to trace the epidemiological and functional profile of patients with Multiple Sclerosis treated at a Reference Hospital in Manaus-AM. Method: 80 charts were selected for screening and subsequent application of the Functional Independence Measure (MIF) scale. Results: 32 patients were included in the study, 23 females (74%), whose mean age was 35 (± 12) years, with a relationship between females and males of 2.5. The mean diagnostic time for men was 7.8 years and for women of 5.3 years. The mean score on the Total MIF scale was 110.9 (± 17.5). Conclusion: Epidemiological characteristics are in line with most similar studies, but lack further studies aimed at assessing the functionality of individuals with MS.

A esclerose múltipla (EM) é uma doença imuno-mediada, inflamatória, caracterizada por repetidos episódios de desmielinização. Objetivo: Traçar o perfil epidemiológico e funcional dos pacientes com Esclerose Múltipla atendidos em um Hospital de Referência de Manaus-AM. Método: Foram selecionados 80 prontuários para triagem e posterior aplicação da escala de Medida de Independência Funcional (MIF). Resultado: Foram incluídos no estudo 32 pacientes, 23 do sexo feminino (74%) cuja média de idade era de 35 (± 12) anos verificando uma relação entre mulheres e homens de 2.5. O tempo de diagnóstico médio para os homens foi de 7.8 anos e para as mulheres de 5,3 anos. A média do escore na escala de MIF Total foi de 110,9 (± 17,5). Conclusão: As características epidemiológicas estão em consonância com a maioria dos estudos semelhantes, mas carecem de mais estudos voltados para a avaliação da funcionalidade de indivíduos com EM.

Efeito da mobilização das raízes nervosas lombares sobre a força e flexibilidade dos músculos do membro inferior / Effect of the mobilization in lumbar nerve roots on muscle strength and flexibility of the lower limb

Introdução: A mobilização neural é bastante aplicada na pratica clínica. Objetivo: Avaliar o efeito da mobilização neural das raízes lombares na força e flexibilidade dos músculos flexores e extensores do joelho. Métodos: Foram selecionados 14 homens (22,4±2,87 anos) saudáveis. A flexibilidade foi avaliada para flexão de joelho (FJD e FJE), extensão de quadril (EQD e EQE) e coluna lombar (FL). A força muscular foi avaliada para flexão e extensão do joelho. As avaliações foram realizadas antes da técnica (PRÉ), imediatamente após (PÓS1) e uma semana após (PÓS2). Resultados: Nas avaliações PÓS1 e PÓS2 foi observado aumento significativo da força muscular na FJE. Para a flexibilidade, na avaliação PÓS1, observou-se aumento significativo na FJE, EQD e EQE. Conclusão: A técnica de mobilização neural promoveu aumento da força dos músculos flexores de joelho esquerdo e da flexibilidade no movimento de flexão de joelho esquerdo, extensão de quadril direito e esquerdo em homens sedentários saudáveis.

Introduction: Neural mobilization is widely applied in clinical practice. Aim: To evaluate the effect of neural mobilization of the lumbar roots on the strength and flexibility of the knee and hip muscles. Methods: We selected 14 men (22.4 ± 2.87 years) healthy. Flexibility was evaluated during knee flexion movements (KFR and KFL), extension of the hip (HER and HEL) and for the lumbar spine (LS). Assessment of muscle strength was performed for the knee movements. The evaluations were performed before the neural mobilization (PRE), immediately after (POST1) and one week after (POST2). Results: In the POST1 and POST2 was a significant increase in muscle strength in KFL. For flexibility, the POST1 evaluation, it was observed significant increase in KFL, HER, and HEL. In the evaluation POST2, a significant increase flexibility in LS and reduction in KFL. Conclusion: The neural mobilization promoted increased strength of the flexor muscles of the left knee, increased flexibility in the KFL, HER, HEL and LS.

Estudo da acessibilidade de idosos ao centro da cidade de Caratinga, MG / Study of the accessibility of aged people to the city center of Caratinga, state of Minas Gerais, Brazil

Este estudo, ao abordar a questão da acessibilidade urbana dos idosos, traz à tona a discussão do planejamento do espaço urbano e a importância de se identificar as necessidades dos idosos em relação ao ambiente construído e em relação a seu deslocamento na cidade. Tendo como objetivo discutir a acessibilidade do idoso ao centro da cidade de Caratinga, localizada no Estado de Minas Gerais, realizou-se pesquisa exploratória, por meio da aplicação de um formulário de avaliação da usabilidade do espaço urbano a 255 idosos. Por meio da análise descritiva e univariada, o trabalho buscou oferecer uma contribuição científica à discussão da acessibilidade urbana aos idosos, caracterizando seus participantes e identificando os principais problemas de acessibilidade sob o ponto de vista dos mesmos. Os resultados mostraram que a maioria dos idosos entrevistados se locomove a pé (55,3%). Problemas como obstáculos nas calçadas (66,3%), aglomeração de pessoas (63,5%), dificuldades para atravessar a rua (55,3%) e história de quedas no centro (33%) foram queixas observadas com frequência. Os registros fotográficos e as sugestões levantadas por esses idosos deram visibilidade às irregularidades e problemas de acessibilidade urbana ao centro de Caratinga.

This study, while approaching the issue of the urban accessibility of the elderly, brings us the discussion of the urban space planning and the importance of identifying the needs of the elderly in relation to the constructed environment and their motion in the city. Aiming to argue the accessibility of the aged one to the center of Caratinga city, state of Minas Gerais, Brazil, an exploratory research was conducted, applying an evaluation form on the usability of the urban space to 255 aged ones. Through descriptive and univariate analysis, the study tried to offer a scientific contribution to the debate of urban accessibility to the elderly, characterizing the participants and identifying the main problems of accessibility in their viewpoint. Interviewed results showed that most interviewed elderly walk themselves on foot (55.3%). Problems as obstacles in the sidewalk (66.3%), agglomeration of people (63.5%), difficulties to cross the street (55.3%) and history of falls in the center (33%) were frequently observed complaints. The photographic registers and the suggestions raised by these aged gave visibility to the irregularities and problems of urban accessibility in the city center of Caratinga.