Effects of transcranial LED therapy on the cognitive rehabilitation for diffuse axonal injury due to severe acute traumatic brain injury: study protocol for a randomized controlled trial.

BACKGROUND: Photobiomodulation describes the use of red or near-infrared light to stimulate or regenerate tissue. It was discovered that near-infrared wavelengths (800-900 nm) and red (600 nm) light-emitting diodes (LED) are able to penetrate through the scalp and skull and have the potential to improve the subnormal cellular activity of compromised brain tissue. Different experimental and clinical studies were performed to test LED therapy for traumatic brain injury (TBI) with promising results. One of the proposals of this present study is to develop different approaches to maximize the positive effects of this therapy and improve the quality of life of TBI patients. METHODS/DESIGN: This is a double-blinded, randomized, controlled trial of patients with diffuse axonal injury (DAI) due to a severe TBI in an acute stage (less than 8 h). Thirty two patients will be randomized to active coil helmet and inactive coil (sham) groups in a 1:1 ratio. The protocol includes 18 sessions of transcranial LED stimulation (627 nm, 70 mW/cm2, 10 J/cm2) at four points of the frontal and parietal regions for 30 s each, totaling 120 s, three times per week for 6 weeks, lasting 30 min. Patients will be evaluated with the Glasgow Outcome Scale Extended (GOSE) before stimulation and 1, 3, and 6 months after the first stimulation. The study hypotheses are as follows: (1) transcranial LED therapy (TCLT) will improve the cognitive function of DAI patients and (2) TCLT will promote beneficial hemodynamic changes in cerebral circulation. DISCUSSION: This study evaluates early and delayed effects of TCLT on the cognitive rehabilitation for DAI following severe acute TBI. There is a paucity of studies regarding the use of this therapy for cognitive improvement in TBI. There are some experimental studies and case series presenting interesting results for TBI cognitive improvement but no clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03281759 . Registered on 13 September 2017.

Transcranial Direct Current Stimulation for Post-Concussion Syndrome: Study Protocol for a Randomized Crossover Trial.

BACKGROUND: Mild traumatic brain injury (MTBI) represents 70-80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI. METHODS/DESIGN: This is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2 mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement. DISCUSSION: There is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT02292589 (https://register.clinicaltrials.gov).

Repetitive Transcranial Magnetic Stimulation (rTMS) for the cognitive rehabilitation of traumatic brain injury (TBI) victims: study protocol for a randomized controlled trial.

BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) has been proposed as a new tool in neurological rehabilitation of victims of traumatic brain injury (TBI). However, its usefulness to treat this condition has never been tested rigorously. The primary goal is to conduct a study protocol to determine whether rTMS used to cognitive rehabilitation of victims of TBI with diffuse axonal injury (DAI) is a safe instrument and if it enhances cognitive function recovery. METHODS: Double-blind randomized controlled trial of patients with diffuse axonal injury. Thirty-six patients will be randomized to either an active coil group or sham group in a 1:1 ratio. rTMS protocol: 10 sessions of high-frequency rTMS (10 Hz) over the left dorsolateral prefrontal cortex (DLPFC). Cortical Excitability measures will be obtained. Neuropsychological evaluations will be performed 1 week before, 1 week and 3 months after rTMS. There are 2 study hypotheses: (1) rTMS over the left DLPFC in patients with DAI will improve cognitive function and (2) whether rTMS is safe in TBI patients. DISCUSSION: This study evaluates the immediate and delayed effects of rTMS over the DLPFC on the cognitive domain of patients with DAI following TBI. rTMS has shown good results in treating major depression and may be promising for patients with TBI. As such, the results of this study can greatly modify the cognitive rehabilitation strategies. TRIAL REGISTRATION: This trial was registered in clinicaltrials.gov ( NCT02167971 ) on 17 June 2014.

Velocidade de processamento da informação em adolescentes de escolas públicas e privadas / Speed of Information processing in adolescents from public and private schools / Velocidad de Tratamiento de la información en los adolescentes de escuelas públicas y privadas

A velocidade de processamento da informação se refere à atividade mental por certo período de tempo. O objetivo do estudo foi investigar esta velocidade de processamento em adolescentes de 14 anos de escolas públicas e privadas. Foram selecionadas 14 adolescentes (sexo feminino) que cursavam o 9º ano do Ensino Fundamental ou o 1º ano do Ensino Médio. Foram avaliadas por meio do IVP (Código, Procurar símbolos e Cancelamento) da WISC-IV e do Teste de Trilhas Coloridas Infantil (TTCI). O teste qui-quadrado apontou maior número de quase erros no TTCI em meninas que frequentavam escola privada. Nenhuma diferença foi encontrada entre os grupos no IVP. Embora o tipo de escola não pareça produzir diferenças entre os grupos no IVP, o número de quase erros, indicativo de distração, mostrou-se mais sensível para identificar essas diferenças. Sugere-se que o número de quase erros possa indicar diferenças mais sutis entre os grupos...

The speed of information processing refers to attainment of mental activity in a certain period of time. The aim of this study was investigate the speed of information processing in 14 years old girls, who attended public and private schools. We selected 14 girls who were in the 9th grade of elementary school or 1st year of high school. Half of them attended public school and the other half attended private school. They were evaluated by: Processing Speed Index - PSI (Coding, Symbol Search and Cancellation) of the WISC - IV and the Trail Making Test Colored Children (TTCI). The chi-square test showed a higher number of near-misses in CCTT in girls attending private school compared to girls attending public school. No difference was found between the two groups in the PSI. Although the type of school does not seem to produce significant differences between the groups in the PVI, the number of nearmisses showed a more sensitive measure to identify these differences. It is suggested that the number of near-misses may indicate subtle differences between groups...

La velocidad de procesamiento de información se refiere a la realización de actividad mental en un determinado período de tiempo. El objetivo de este estudio fue investigar la velocidad de procesamiento de información en adolescentes de 14 años que asisten a escuelas públicas y privadas. Fueron seleccionado 14 adolescentes, de sexo femenino que curzaban 9 º o 10º grado. La mitad asistia a la escuela pública y la otra mitad a la escuela privada. Fueron evaluadas utilizando las siguientes pruebas: IVP (Código, búsqueda y cancelación de símbolos) de la bacteria WISC-IV y test infantil de sequencias coloreadas (TISC). El t-test mostro un mayor número de casi errores en TISC en las niñas que asisten a las escuelas privadas. No se encontraron diferencias entre los dos grupos en las otro pruebas. Se sugiere que la medición de la cantidad de casi errores revelan una mayor sensibilidad en TTCI...

Velocidade de processamento da informação em adolescentes de escolas públicas e privadas / Speed of Information processing in adolescents from public and private schools / Velocidad de Tratamiento de la información en los adolescentes de escuelas públicas y privadas

A velocidade de processamento da informação se refere à atividade mental por certo período de tempo. O objetivo do estudo foi investigar esta velocidade de processamento em adolescentes de 14 anos de escolas públicas e privadas. Foram selecionadas 14 adolescentes (sexo feminino) que cursavam o 9º ano do Ensino Fundamental ou o 1º ano do Ensino Médio. Foram avaliadas por meio do IVP (Código, Procurar símbolos e Cancelamento) da WISC-IV e do Teste de Trilhas Coloridas Infantil (TTCI). O teste qui-quadrado apontou maior número de quase erros no TTCI em meninas que frequentavam escola privada. Nenhuma diferença foi encontrada entre os grupos no IVP. Embora o tipo de escola não pareça produzir diferenças entre os grupos no IVP, o número de quase erros, indicativo de distração, mostrou-se mais sensível para identificar essas diferenças. Sugere-se que o número de quase erros possa indicar diferenças mais sutis entre os grupos.(AU)

The speed of information processing refers to attainment of mental activity in a certain period of time. The aim of this study was investigate the speed of information processing in 14 years old girls, who attended public and private schools. We selected 14 girls who were in the 9th grade of elementary school or 1st year of high school. Half of them attended public school and the other half attended private school. They were evaluated by: Processing Speed Index - PSI (Coding, Symbol Search and Cancellation) of the WISC - IV and the Trail Making Test Colored Children (TTCI). The chi-square test showed a higher number of near-misses in CCTT in girls attending private school compared to girls attending public school. No difference was found between the two groups in the PSI. Although the type of school does not seem to produce significant differences between the groups in the PVI, the number of nearmisses showed a more sensitive measure to identify these differences. It is suggested that the number of near-misses may indicate subtle differences between groups.(AU)

La velocidad de procesamiento de información se refiere a la realización de actividad mental en un determinado período de tiempo. El objetivo de este estudio fue investigar la velocidad de procesamiento de información en adolescentes de 14 años que asisten a escuelas públicas y privadas. Fueron seleccionado 14 adolescentes, de sexo femenino que curzaban 9 º o 10º grado. La mitad asistia a la escuela pública y la otra mitad a la escuela privada. Fueron evaluadas utilizando las siguientes pruebas: IVP (Código, búsqueda y cancelación de símbolos) de la bacteria WISC-IV y test infantil de sequencias coloreadas (TISC). El t-test mostro un mayor número de casi errores en TISC en las niñas que asisten a las escuelas privadas. No se encontraron diferencias entre los dos grupos en las otro pruebas. Se sugiere que la medición de la cantidad de casi errores revelan una mayor sensibilidad en TTCI.(AU)

Avaliação da velocidade de processamento em uma amostra de crianças de 7 a 10 anos com e sem hipótese diagnóstica de TDAH / Processing speed assessment in a sample of 7- 10 year-olds children

Comparamos o desempenho de crianças com hipótese diagnóstica de TDAH ao de crianças saudáveis nos testes de velocidade de processamento da Escala de Inteligência Wechsler para crianças, 4ª edição (WISC-IV). Foram selecionadas dezesseis crianças, sendo 8 com hipótese diagnóstica de TDAH (Grupo TDAH) e 8 saudáveis (Grupo controle), de ambos os sexos, com idade entre 7 a 10 anos, provenientes do ensino público da cidade de Itatiba/SP. A velocidade de processamento foi avaliada pelos seguintes testes: Código, Procurar Símbolos e Cancelamento. Os resultados mostraram que não houve diferença significativa entre os grupos. Concluímos que os resultados examinados por meio da escala SNAP-IV não apresentaram diferença estatística entre os grupos. Futuros estudos poderiam ampliar o número de participantes de modo a equilibrar o número de participantes por faixa etária(AU)

We compared the performance of children with diagnosis of ADHD to the healthy children on tests of the Wechsler Intelligence Scale for Children, 4th edition (WISC-IV) Processing Speed. We selected sixteen children, 8 with diagnosis of ADHD (ADHD group) and 8 healthy subjects (control group), of both sexes, aged 7-10 years, from the public schools of the city of Itatiba / SP. Processing speed was assessed by the following tests: Coding Browse Symbols and Cancellation. The results showed no significant difference between the groups we conclude that the results examined by SNAP-IV scale, no statistically significant difference between groups. Future studies could expand the number of participants in order to balance the number of participants of age(AU)

Correlação entre velocidade de processamento e atenção alternada em crianças saudáveis de seis anos / Correlation between processing speed and attention switching in healthy children aged six years

O presente estudo investigou a correlação entre a velocidade de processamento (VP) e a atenção alternada em crianças saudáveis de 06 anos de idade, por meio da aplicação de testes psicométricos específicos. Foram avaliadas 28 crianças em curso do 1º Ano do Ensino Fundamental, tanto de escola pública quanto privada e igualmente divididas entre os gêneros. Utilizou-se o teste Matrizes Progressivas Coloridas de Raven; os subtestes do Índice de Velocidade de Processamento (IVP): Código A, Procurar Símbolos A, Cancelamento da escala WISC-IV; e o Teste de Trilhas Coloridas Infantil - forma 2 (TCC2). Os resultados evidenciaram correlação moderada negativa entre o IVP e o TCC2, não havendo diferença significativa entre os gêneros. Diante dos resultados, observou-se que a rapidez de execução em tarefas que avaliam VP se relaciona com redução moderada do desempenho em tarefas de atenção alternada(AU)

This study investigated the correlation between processing speed (PS) and attention switching in healthy children 06 years old, through the application of specific psychometric tests. We evaluated 28 children in the course of the 1st year of elementary school, both private and public schools as equally divided between genders. We used the test of Raven Colored Progressive Matrices; subtest of Processing Speed Index (PSI): Code A, Symbol Search A, Cancellation of WISC-IV; and the Children´s Color Trails Test - form 2 (CTT2). The results showed moderate negative correlation between PSI and CTT2, with no significant difference between genders. Considering the results, it was observed that the speed of execution into tasks that assess PS relates to moderate reduction of performance in attention switching tasks(AU)

Características neurológicas e neuropsicológicas na epilepsia rolândica / Neurological and neuropsychological characteristics in rolandic epilepsy

A epilepsia rolândica (ER) corresponde de 15 a 25% de todas as epilepsias na infância antes do 15 anos de idade, caracterizada por crises parciais ou generalizadas, que ocorrem normalmente durante o sono ou durante o despertar. Sugere-se que a atividade epileptiforme eletrográfica possa causar deterioração cognitiva pela perturbação da formação das sinapses, assim como as drogas antiepilépticas, que podem ser uma das variáveis que corroboram um pior desempenho neuropsicológico. Apesar de normalmente não haver alterações no quociente intelectual global, essas crianças podem evoluir para dificuldades escolares, distúrbios de linguagem, funções executivas e coordenação motora. Esse artigo de revisão tem como propósito discutir diferentes achados na literatura acerca da evolução desse quadro clínico(AU)

Rolandic epilepsy (ER) corresponds to 15 - 25 percent of all childhood epilepsy prior to fifteen years of age, characterized by partial or generalized seizures, which typically occur during sleep or waking hours. It is suggested that the electrographic epileptiform activity may cause cognitive impairment by disturbing synopsis formation, as well as antiepileptic drugs, which may be one of the variables to corroborate a decrease in neuropsychological performance. In spite of the fact that typically, no changes are observed in the IQ; learning difficulties, language disorders, executive functions and a diminution in motor coordination are observed. This review purposes a discussion on the evolution of the clinical scenario(AU)

Avaliação do desempenho da memória de curto prazo em crianças de escola pública e particular / Performance evaluation of short-term memory in children from public and private schools

Nesta pesquisa buscamos observar as diferenças existentes no desempenho da memória operacional entre crianças de escola pública e particular de diferentes cidades brasileiras. Os dados foram obtidos através da análise do desempenho da memória de curto prazo em crianças de sete anos, avaliadas através de dois subtestes da Escala Wechsler de Inteligência para Crianças (WISC) e pela Escala Matrizes Progressivas Coloridas de Raven – Escala Especial. Participaram deste estudo cinquenta e seis crianças, entre sete anos e sete anos e onze meses de idade, sendo vinte e oito estudantes de escolas públicas e a outra metade de escolas particulares, das cidades de Campinas – SP, Pouso Alegre – MG, Recife – PE e Florianópolis – SC. Os resultados, a partir dos instrumentos utilizados, sugerem que a diferença encontrada entre esses tipos de ensino é pouco significativa(AU)

In this study we sought to observe the differences in working memory performance among children in public and private schools in different cities. Data were obtained through analysis of the performance of short-term memory in seven-year old children, as evaluated by two subtests, i.e., the Wechsler Intelligence Scale for Children (WISC), and the Scale Raven Colored Progressive Matrices - Special Scale. There were fifty-six children that participated in the study, between the ages of seven years, and seven years and eleven months old. Twenty-eight students were from public schools and the other half from private schools; encompassing the cities of Campinas - SP, Pouso Alegre - MG, Recife - PE , and Florianopolis - SC. The results from the instruments suggest that the difference found between these types of education is insignificant(AU)

Avaliação das funções mnésticas e atencionais em uma amostra de idosos saudáveis engajados em atividade física regular / Assessment of mnestic and attentional functions in a sample of healthy elderly engaged in regular physical activity

Diversos estudos têm mostrado que o prejuízo cognitivo relacionado ao envelhecimento pode ser compensado positivamente por exercício físico. O objetivo deste estudo foi avaliar o desempenho de sujeitos idosos saudáveis engajados em atividade física regular em medidas de memória episódica e atenção, em comparação com sujeitos controles sedentários pareados por idade e escolaridade. Para isso, 14 sujeitos entre 60 e 85 anos de idade e entre 12 e 18 anos de escolaridade foram avaliados através de uma bateria de testes neuropsicológicos, um teste de cognição geral e uma escala de ansiedade e depressão, além de uma entrevista semidirigida. Sujeitos engajados em atividade física mostraram desempenho significativamente melhor em uma medida de memória episódica verbal (evocação imediata) em comparação com sujeitos sedentários (n=7 por grupo; p=0,004). Esse resultado está de acordo com achados anteriores que mostram um efeito positivo da atividade física sobre o funcionamento cognitivo de sujeitos idosos saudáveis(AU)

Several studies have shown that the cognitive impairment associated with aging may be positively compensated by physical exercise. The aim of this study was to evaluate the performance of healthy elderly subjects engaged in regular physical activity on measures of episodic memory and attention, compared with sedentary control subjects matched for age and education. For this, 14 subjects between 60 and 85 years old and between 12 and 18 years of education were assessed through a battery of neuropsychological tests, a test of general cognition and a scale of anxiety and depression, besides a semi-directed interview. Subjects engaged in physical activity showed significantly better performance on a measure of verbal episodic memory (immediate recall) compared with sedentary subjects (n=7 per group, p=0.004). This result is in agreement with previous findings showing a positive effect of physical activity on cognitive functioning in healthy elderly subjects(AU)

Avaliação da atenção sustentada e alternada em uma amostra de adultos saudáveis com alta escolaridade / Evaluation of alternating and sustained attention in a sample of healthy adults with high level of schooling

Este estudo objetivou avaliar o desempenho das funções atencionais sustentada e alternada em uma amostra da população brasileira adulta e com alta escolaridade. Foram avaliados 14 sujeitos entre 45 e 59 anos e com nível de escolaridade igual ou superior a 18 anos. A avaliação foi realizada através de entrevista semiestruturada, MEEM, escala de ansiedade e depressão e uma bateria de testes neuropsicológicos, com enfoque no Trail Making Test. Foi realizada uma análise descritiva, tanto no TMT A quanto no TMT B e os resultados situaram-se dentro do esperado às faixas etárias dos sujeitos. Tais dados corroboram estudos que apontam a influência do tempo de escolaridade sobre a realização e aprendizado de uma tarefa cognitivo-motora e podem contribuir às futuras comparações de desempenho entre as diversas faixas etárias, uma vez que ainda são escassos os achados que avaliam as faixas etárias intermediárias(AU)

This study aimed the evaluation of the alternating and sustained attentional functions performance in a sample of an adult Brazilian population with high level of schooling. Were evaluated 14 subjects between 45 and 59 years old with level of schooling equal or higher than 18 years. The evaluation was conducted through semistructered interview, MEEM, depression and anxiety scale and neuropsychological tests, with focus on Trail Making Test. A descriptive analysis was performed in the TMT A and the TMT B and the results were within the expected age of the subjects. These data corroborate with studies that show the influence of time of schooling on achievement and learning of a cognitive-motor task and may contribute to the future performance comparisons between different age groups, since there are just a few findings which evaluate the intermediate age groups(AU)