Case Report: Galvanic Vestibular Stimulation in the Chronic Spinal Cord Injury Patient.

The traumatic spinal cord injury can generate sequels with high clinical severity and dysfunction and limitations of irreversible character. Current studies seek to reverse the sequelae and gain functionality in these individuals. Galvanic vestibular stimulation (GVS) has shown to be beneficial in spinal cord function as an evaluation correlated to functionality and for stimulation with physiological and functional characteristics in disease and healthy people. The present study observed the effects of Noise Galvanic Vestibular Stimulation in a patient with chronic spinal cord injury with tetraplegia on postural and trunk control. The evaluations were the Functional Independence Measure (FIM), the American Spinal Injury Association (ASIA) evaluation, and the Clinical Posturography, using force platform to assess postural balance, in the sitting position, through Sensory Organization and Functional Reach Tests. Ten sessions of Noise Galvanic Vestibular Stimulation associated with customized vestibular and neurofunctional rehabilitation were performed. The effects observed were increments in all assessments and tests that include modifications in functional independence, motor and sensory levels, change in disability grade from A (complete) to C (incomplete), and improvements in postural balance and trunk control. The phenomenon of stochastic resonance has shown benefits in postural control in people without vestibular lesions and we could observe some of these phenomena in our patients. We emphasize the need for evaluation with larger populations to observe the phenomena and effects in this group of patients and potential benefits and limitations.

Estimulação elétrica neural transcutânea (tens) na paroxismia do tronco cerebral: relato de caso / Transcutaneous electrical nerve stimulation (tens) in brain stem paroxysms: case report

INTRODUÇÃO: A paroxismia de tronco encefálico, descrita em pacientes com esclerose múltipla (EM), caracteriza-se por episódios rápidos de vertigem e nistagmos evocados por movimentos cefálicos. A neuromodulação tem apresentado sucesso terapêutico em várias disfunções da EM, mas ainda não foi utilizada na paroxismia. OBJETIVO: Avaliar o efeito aditivo da neuromodulação por estimulação elétrica neural transcutânea (TENS) na musculatura periocular em paciente com EM e paroxismia de tronco encefálico não responsiva à reabilitação clássica associada à medicação. MATERIAL E MÉTODOS: Avaliação do nistagmo com videonistagmógrafo, da sensibilidade cutânea facial com estesiômetro, do blefaroclônus por gravação em vídeo e da sensação dolorosa de forma subjetiva (descrição pessoal da paciente); execução de 10 sessões consecutivas semanais de exercícios oculares associados à TENS na musculatura do oblíquo inferior e reto lateral direitos. RESULTADO: Melhora da algia, do blefaroclônus, da vertigem e do nistagmo ocular direito. CONCLUSÃO: A neuromodulação com TENS parece ser uma terapia complementar válida para pacientes com EM e paroxismia de tronco não responsivos aos demais tratamentos clínicos, porém mais estudos são necessários para confirmar esse achado.

INTRODUCTION: Brainstem paroxysmia has been described in patients with multiple sclerosis, characterized by rapid episodes of nystagmus and vertigo evoked by cephalic movements. Neuromodulation has shown therapeutic success for several dysfunctions of multiple sclerosis, but it has not yet been used in paroxysmia. OBJECTIVE: To assess the additive effect of neuromodulation by transcutaneous electrical neural stimulation (TENS) on the periocular musculature in a patient with multiple sclerosis and brain stem paroxysmia that is not responsive to classical rehabilitation associated with medication. MATERIAL AND METHODS: Nystagmus evaluation with video nystagmography, facial skin sensitivity analysis with esthesiometer, video recording of blepharoclonus, and pain sensation subjectively quantification (by a personal description of the patient); execution of 10 eyes consecutive exercises sessions associated with TENS in the right lower oblique and lateral rectus muscles. RESULT: Improvement in pain, blepharoclonus, and right eye nystagmus. CONCLUSION: Neuromodulation with TENS seems to be a valid complementary therapy for patients with brainstem paroxysmia unresponsive to other clinical treatments, but more studies are needed to confirm this finding.

Effective Self-Management for Early Career Researchers in the Natural and Life Sciences.

Early career researchers (ECRs) are faced with a range of competing pressures in academia, making self-management key to building a successful career. The Organization for Human Brain Mapping undertook a group effort to gather helpful advice for ECRs in self-management.

Age and Disease have a Distinct Influence on Postural Balance of Patients with COPD.

The postural imbalance is an extra-pulmonary condition, associated with chronic obstructive pulmonary disease (COPD). COPD affects older individuals and it is unclear whether balance abnormalities can be described as pathophysiological mechanism or aging. The present study aimed to evaluate the influence of age or disease on postural balance of patients with COPD. Patients with COPD over 50 years old were compared with age- and sex-matched healthy adults, and with sex-matched younger healthy adults (n = 30 in each group). The Modified Sensory Organization Test (mSOT) was performed in four different conditions fixed or sway-referenced surface both either with full or no vision. It was analyzed the center of pressure (CoP) variables: amplitude, velocity, root-mean-square and load asymmetry. Three-way ANOVA and post hoc analysis were performed been represented of age (older or COPD compared with younger healthy adults) or disease influences (COPD compared with older healthy groups). Main results were as follows: The CoP excursion was faster, with higher amplitude and variability progressively from COPD vs. older healthy vs. younger healthy adults (p < 0.05) showing age and disease influences (p < 0.05). Age and disease influences were also observed in the sway-referenced surface in both vision conditions. Impairment in postural balance was found related to aging and disease in patients with COPD older than 50 years.

Development of postural control and maturation of sensory systems in children of different ages a cross-sectional study.

OBJECTIVE: To evaluate the stability, postural adjustments and contributions of sensory information for postural control in children. METHODS: 40 boys and 40 girls were equally divided into groups of 5, 7, 9 and 12 years (G5, G7, G9 and G12). All children were submitted to dynamic posturography using a modified sensory organization test, using four sensory conditions: combining stable or sway referencing platform with eyes opened, or closed. The area and displacements of the center of pressure were used to determine stability, while the adjustments were used to measure the speed of the center of pressure displacements. These measurements were compared between groups and test conditions. RESULTS: Stability tends to increase with age and to decrease with sensory manipulation with significant differences between G5 and G7 in different measures. G7 differed from G12 under the conditions of stable and sway platform with eyes open. G9 did not differ from G12. Similar behavior was observed for adjustments, especially in anterior-posterior directions. CONCLUSION: Postural stability and adjustments were associated with age and were influenced by sensory manipulation. The ability to perform anterior-posterior adjustments was more evident and sensory maturation occurred firstly on the visual system, then proprioceptive system, and finally, the vestibular system, reaching functional maturity at nine years of age. Seven-year-olds seem to go through a period of differentiated singularity in postural control.

An fMRI-compatible force measurement system for the evaluation of the neural correlates of step initiation.

Knowledge of brain correlates of postural control is limited by the technical difficulties in performing controlled experiments with currently available neuroimaging methods. Here we present a system that allows the measurement of anticipatory postural adjustment of human legs to be synchronized with the acquisition of functional magnetic resonance imaging data. The device is composed of Magnetic Resonance Imaging (MRI) compatible force sensors able to measure the level of force applied by both feet. We tested the device in a group of healthy young subjects and a group of elderly subjects with Parkinson's disease using an event-related functional MRI (fMRI) experiment design. In both groups the postural behavior inside the magnetic resonance was correlated to the behavior during gait initiation outside the scanner. The system did not produce noticeable imaging artifacts in the data. Healthy young people showed brain activation patterns coherent with movement planning. Parkinson's disease patients demonstrated an altered pattern of activation within the motor circuitry. We concluded that this force measurement system is able to index both normal and abnormal preparation for gait initiation within an fMRI experiment.

Medo de altura: desempenho cognitivo e controle postural / Fear of heights: cognitive performance and postural control

Fobia específica de altura ou acrofobia é um transtorno de ansiedade caracterizado pelo medo intenso e desproporcional de locais altos, levando à esquiva de situações e capaz de gerar sofrimento. Os diversos tipos de fobias parecem estar ligados a diferentes mecanismos de aquisição de medos. Mais do que experiências de aprendizado ou condicionamento, existem evidências de que anormalidades no controle da postura possam estar envolvidas na gênese do medo de altura. Deficiências na função vestibular podem levar um indivíduo a depender mais de sua visão ou de sua propriocepção para manter o controle postural. (...)

... Lugares altos são um tipo de situação limite onde a falta de tais referências poderiam, em tese, desencadear reações de defesa e sintomas ansiosos. Além disso, o aumento de demanda por recursos cognitivos para a compensação do equilíbrio poderia deixar indivíduos acrofóbicos mais susceptíveis a interações entre o controle postural e atividades que demandem atenção. Esta dissertação testou a hipótese de que indivíduos com fobia específica de altura apresentam pior controle postural e maior interferência entre o controle do equilíbrio e o desempenho em tarefas que demandem atenção. Foram comparados 31 acrofóbicos (23 mulheres, 36,4±12 anos) e 34 controles não-fóbicos (22 mulheres, 32,4±12 anos). O desempenho da estabilidade postural em plataforma de posturografia dinâmica e o desempenho atencional foram simultaneamente avaliados através de teste em computador envolvendo o rastreio visual de um alvo em movimento imprevisível. Foram avaliadas as seguintes variáveis: ÁREA (área delimitada da excursão do centro de pressão em cm²); CPx e CPy (deslocamento total do centro de pressão na base de suporte em cm, na direção látero-lateral (eixo x) e ântero-posterior (eixo y)); VMx e VMy (velocidade média com a qual ocorre o deslocamento do centro de pressão em cm/s) e RMSx e ) RMSy (quadrado da média da raiz do deslocamento do centro de pressão, em cm, a partir da coordenada central (0,0) da base de apoio). O teste de atenção foi avaliado pela porcentagem de tempo em que o sujeito conseguia seguir anualmente o movimento do alvo. Indivíduos com acrofobia apresentaram uma pior estabilidade postural e um pior desempenho no teste atencional, além de uma maior interferência entre as tarefas. Estes resultados são compatíveis com a hipótese de que anormalidades do controle postural possam exercer um papel importante na gênese e na perpetuação dos sintomas de medo de altura

INTRODUCTION: Fear of heights or acrophobia, is one of the most frequent subtypes of specific phobia frequently associated to depression and other anxiety disorders. Previous evidence suggests a correlation between acrophobia and abnormalities in balance control, particularly involving the use of visual information to keep postural stability. This study investigates the hypotheses that (1) abnormalities in balance control are more frequent in individuals with acrophobia even when not exposed to heights; (2) acrophobic symptoms are associated to abnormalities in visual perception of movement; and (3) individuals with acrophobia are more sensitive to balance-cognition interactions. METHOD: Thirty-one individuals with specific phobia of heights (23 women, 36.4±12 years) and thirty one non-phobic controls (22 women, 32.4±12 years) were compared using dynamic posturography and a manual tracking task. RESULTS: Acrophobics had poorer performance in both tasks, especially when carried out simultaneously. Previously described interference between posture control and cognitive activity seems to play a major role in these individuals. DISCUSSION: The presence of physiologic abnormalities is compatible with the hypothesis of a non-associative acquisition of fear of heights, i.e., not associated to previous traumatic events or other learning experiences. Clinically, this preliminary study corroborates the hypothesis that vestibular physical therapy can be particularly useful in treating individuals with fear of heights