RESUMEN
Patients with Parkinson's disease (PD) have difficulties while performing dual-task activities, a condition present in everyday life. It is possible that strategies such as transcranial Direct Current Stimulation (tDCS) can be associated with motor training enriched with dual-task training to improve the performance of two concurrent tasks. Currently, it is unclear whether specific tasks and clinical conditions of PD patients have different results after the intervention. Therefore, the proposed randomized controlled trial will examine task-dependency in enhancing the effects of tDCS-linked rehabilitation training on PD and the relationships between baseline outcomes in responders and non-responders to therapy. Fifty-six patients with Parkinson's disease will be recruited to participate in this controlled, double-blind randomized multicentric clinical trial. Patients in modified Hoehn & Yahr stage 1.5-3, age between 40 and 70 years will be included. Subjects will be randomly assigned to an experimental group (EG) and a control group (CG). The EG will perform treadmill gait training associated with dual task exercises+tDCS, while the CG will only engage in treadmill gait training+tDCS. Blinded testers will assess patients before and after 12 intervention sessions and after a 4-week follow-up period. All patients will undergo a screening and an initial visit before being assessed for primary and secondary outcomes. The primary outcome measure is functional mobility measured by Timed Up and Go Test. Secondary outcomes include cognitive function, participation, motor function and body function and structure. This study will evaluate the effectiveness of an intervention protocol with tDCS, dual-task training and gait training in patients with PD. The study will also highlight the clinical factors and variability between individuals that could interfere in the training of a specific task and influence the therapeutic effect. Clinical Trial registration: www.ClinicalTrials.gov, identifier NCT04581590.
RESUMEN
Objetivo: Analisar o perfil social e funcional dos usuários de Unidade Básica de Saúde/Estratégia Saúde da Família com Acidente Vascular Encefálico (AVE) em Santa Cruz, município do estado do Rio Grande do Norte. Material e Métodos: Tratase de um estudo transversal constituído por 39 indivíduos com diagnóstico clínico de AVE. Foram avaliados o perfil sociodemográfico e o comprometimento cognitivo, funcional e sensório motor através das escalas: Mini Exame do Estado Mental (MEEM), Medida de Independência Funcional (MIF), Escala de Equilíbrio de Berg (EEB), Protocolo de Desempenho Físico Fugl-Meyer (FM), Timed Up and Go (TUG) e a escala de Deambulação Funcional (FAC). Resultados: A idade média dos indivíduos foi 68,94±14,01 anos onde 56,41% eram mulheres, 58,97% casados, 58,97% pardos, 46,15% analfabetos, 41,03% agricultores, 71,79% aposentados e 84,62% residentes em casa própria. O hemisfério cerebral esquerdo (56,41%) e o tipo isquêmico (61,54%) mostraram-se mais prevalentes nesta população. O tempo de lesão após o AVE foi de 6,7±6,9 anos, onde 66,67% apresentaram um único evento. 97,40% dos avaliados apresentavam fatores de risco associados. A Hipertensão Arterial Sistêmica (HAS) (74,35%) foi o de maior destaque. No MEEM observou-se 82,05% da amostra com grave comprometimento cognitivo, 48,72% com pontuação da MIF indicando maior independência funcional, grave comprometimento motorna FM (46,88%) e equilíbrio pobre com significativo risco para quedas na pontuação da EEB (43,59%) e TUG (36%). Conclusão: O elevado acometimento do AVE está relacionado com as características epidemiológicas da região,assim como os déficits funcionais, cognitivos e sensório motores encontrados evidenciando um grave problema de saúde pública. (AU)
Objective: To analyze the social and functional profile of users with stroke assisted by the Primary Care Health Unit/ Family Health Strategy in the city of Santa Cruz, Rio Grande do Norte State, Brazil. Materials and Methods: This was a cross-sectional study including 39 individuals with a clinical diagnosis of stroke. The sociodemographic, cognitive, functional and sensory motor impairment profiles of the users were evaluated using the following tools: Mini-Mental State Examination (MEEM), Functional Independence Measure (MIF), Berg Balance Scale (EEB), Fugl-Meyer Assessment Scale (FM), Timed Up and Go (TUG) and Functional Ambulation Scale (FAC). Results: The mean age of individuals was 68.94±14.01 years, where 56.41% were woman, 58.97% married, 58.97% mixed race, 46.15% illiterate, 41.03% farmers, 71.79% retirees, and 84.62% living in their own house. The leftcerebral hemisphere (56.41%) was the most affected side and ischemic stroke (61.54%) the most prevalent condition in this population. The injury time after stroke was 6.7±6.9 years, and66.67% of the individual shad a single stroke; 97.4% of them presented as sociated risk factors, particularly systemic arterial hypertension (HAS) (74.35%). The MEEM indicated that 82.05% of the sample had severe cognitive impairment; 48.72% of the sample showed MIF score indicative of functional independence; 46.88% showed severe motor impairment in FM; and poor balance with significant risk for falls was found to be 43.59%and 36% based on EEB and TUG scores, respectively. Conclusion: The high prevalence of stroke is related with the epidemiological characteristics of the region as well as with functional, cognitive and sensory motor deficits, which indicates a serious public health problem. (AU)
