A non-expensive bidimensional kinematic balance assessment can detect early postural instability in people with Parkinson's disease.

Background: Postural instability is a debilitating cardinal symptom of Parkinson's disease (PD). Its onset marks a pivotal milestone in PD when balance impairment results in disability in many activities of daily living. Early detection of postural instability by non-expensive tools that can be widely used in clinical practice is a key factor in the prevention of falls in widespread population and their negative consequences. Objective: This study aimed to investigate the effectiveness of a two-dimensional balance assessment to identify the decline in postural control associated with PD progression. Methods: This study recruited 55 people with PD, of which 37 were men. Eleven participants were in stage I, twenty-three in stage II, and twenty-one in stage III. According to the Hoehn and Yahr (H&Y) rating scale, three clinical balance tests (Timed Up and Go test, Balance Evaluation Systems Test, and Push and Release test) were carried out in addition to a static stance test recorded by a two-dimensional movement analysis software. Based on kinematic variables generated by the software, a Postural Instability Index (PII) was created, allowing a comparison between its results and those obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to PD evolution. Although all tests were correlated with H&Y stages, only the PII was able to differentiate the first three stages of disease evolution (H&Y I and II: p = 0.03; H&Y I and III: p = 0.00001; H&Y II and III: p = 0.02). Other clinical tests were able to differentiate only people in the moderate PD stage (H&Y III). Conclusion: Based on the PII index, it was possible to differentiate the postural control decline among the first three stages of PD evolution. This study offers a promising possibility of a low-cost, early identification of subtle changes in postural control in people with PD in clinical practice.

Understanding voluntary human movement variability through data-driven segmentation and clustering.

Recently, we proposed a novel approach where movements are decomposed into sub-segments, termed movement elements. This approach, to date, provides a robust construct of how the brain may generate simple as well as complex movements. Here, we address the issue of motor variability during voluntary movements by applying an unsupervised clustering algorithm to group movement elements according to their morphological characteristics. We observed that most movement elements closely match the theoretical bell-shaped velocity profile expected from goal-directed movements. However, for those movement elements that deviate from this theoretical shape, a small number of defined patterns in their shape can be identified. Furthermore, we observed that the axis of the body from which the movement elements are extracted (i.e., medio-lateral, antero-posterior, and vertical) affect the proportion of the movement elements matching the theoretical model. These results provide novel insight into how the nervous system controls voluntary movements and may use variability in movement element properties to explore the environment.

A non-expensive bidimensional assessment can detect subtle alterations in gait performance in people in the early stages of Parkinson's disease.

Background: Gait is one of the activities most affected by the symptoms of Parkinson's disease and may show a linear decline as the disease progresses. Early assessment of its performance through clinically relevant tests is a key factor in designing efficient therapeutic plans and procedures, which can be enhanced using simple and low-cost technological instruments. Objective: To investigate the effectiveness of a two-dimensional gait assessment to identify the decline in gait performance associated with Parkinson's disease progression. Methods: One hundred and seventeen people with Parkinson's disease, classified between early and intermediate stages, performed three clinical gait tests (Timed Up and Go, Dynamic Gait Index, and item 29 of the Unified Parkinson's Disease Rating Scale), in addition to a six-meter gait test recorded by a two-dimensional movement analysis software. Based on variables generated by the software, a gait performance index was created, allowing a comparison between its results with the results obtained by clinical tests. Results: There were differences between sociodemographic variables directly related to the evolution of Parkinson's disease. Compared to clinical tests, the index proposed to analyze gait showed greater sensitivity and was able to differentiate the first three stages of disease evolution (Hoehn and Yahr I and II: p = 0.03; Hoehn and Yahr I and III: p = 0.00001; Hoehn and Yahr II and III: p = 0.02). Conclusion: Based on the index provided by a two-dimensional movement analysis software that uses kinematic gait variables, it was possible to differentiate the gait performance decline among the three first stages of Parkinson's disease evolution. This study offers a promising possibility of early identification of subtle changes in an essential function of people with Parkinson's disease.

Examining the neural mechanisms of rTMS: a naturalistic pilot study of acute and serial effects in pharmacoresistant depression.

Introduction: Previous studies have demonstrated the effectiveness of therapeutic repetitive transcranial magnetic stimulation (rTMS) to treat pharmacoresistant depression. Nevertheless, these trials have primarily focused on the therapeutic and neurophysiological effects of rTMS following a long-term treatment course. Identifying brain-based biomarkers of early rTMS therapeutic response remains an important unanswered question. In this pilot study, we examined the effects of rTMS on individuals with pharmacoresistant depression using a graph-based method, called Functional Cortical Networks (FCN), and serial electroencephalography (EEG). We hypothesized that changes in brain activity would occur early in treatment course. Methods: A total of 15 patients with pharmacoresistant depression underwent five rTMS sessions (5Hz over the left dorsolateral prefrontal cortex, 120%MT, up to 4,000 pulses/session). Five participants received additional rTMS treatment, up to 40 sessions. Resting EEG activity was measured at baseline and following every five sessions, using 64-channel EEG, for 10 minutes with eyes closed. An FCN model was constructed using time-varying graphs and motif synchronization. The primary outcome was acute changes in weighted-node degree. Secondary outcomes included serial FFT-based power spectral analysis and changes in depressive symptoms measured by the 9-Item Patient Health Questionnaire (PHQ-9) and the 30-item Inventory of Depressive Symptoms-Self Report (IDS-SR). Results: We found a significant acute effect over the left posterior area after five sessions, as evidenced by an increase in weighted-node degree of 37,824.59 (95% CI, 468.20 to 75,180.98) and a marginal enhancement in the left frontal region (t (14) = 2.0820, p = 0.056). One-way repeated measures ANOVA indicated a significant decrease in absolute beta power over the left prefrontal cortex (F (7, 28) = 2.37, p = 0.048) following ten rTMS sessions. Furthermore, a significant clinical improvement was observed following five rTMS sessions on both PHQ-9 (t (14) = 2.7093, p = 0.017) and IDS-SR (t (14) = 2.5278, p = 0.024) and progressed along the treatment course. Discussion: Our findings suggest that FCN models and serial EEG may contribute to a deeper understanding of mechanisms underlying rTMS treatment. Additional research is required to investigate the acute and serial effects of rTMS in pharmacoresistant depression and assess whether early EEG changes could serve as predictors of therapeutic rTMS response.

Analysis of intermunicipal journeys for cardiac surgery in Brazilian Unified Health System (SUS): an approach based on network theory.

INTRODUCTION: The transformation of data into information is important to support decision making and, thus, to induce improvements in healthcare services. The regionalized organization of healthcare systems is necessary to ensure the integrity of citizen care. From this perspective, the creation of mechanisms to guide and assess the behavior of a healthcare services network becomes necessary. However, these mechanisms must consider the interaction between different municipalities. The objective of this study is to apply network analysis as a supporting tool in the Brazilian Unified Health System (Sistema Único de Saúde-SUS) management. METHODS: The stages of the proposed method are described and applied in a real situation, analyzing the intermunicipal interaction network for cardiovascular surgery in the municipality of Vitória da Conquista, Bahia, Brazil, from 2008 to 2020. The metrics analyzed were journeys indices, flow of patients and distance of the journeys, considering the journeys from and to the municipality in focus. RESULT: There was an increase of the incoming flow and in-degree indices combined with a decrease in outgoing flow, showing the growing importance of this municipality as a provider of these services. CONCLUSION: The method used in the study has potential to be adopted as a management tool to assess the behavior of the interactions network of the selected service, aiding the regionalized organization of the healthcare system.

Brain instability in dynamic functional connectivity in schizophrenia.

Schizophrenia is a severe psychiatric disorder associated with altered connectivity of brain functional networks (BFNs). Researchers have observed a profound disruption in prefrontal-temporal interactions, damage to hub regions in brain networks and modified topological organization of BFNs in schizophrenia (SCZ) individuals. Assessment of BFNs with dynamic approaches allow the characterization of new functional structures, such as topological stability patterns and temporal connectivity, which are not accessible through static methods. In this perspective, the present study investigated the physiological processes of brain connectivity in SCZ. A resting-state EEG dataset of 14 SCZ individuals and 14 healthy controls (HC) was obtained at a sampling rate of 250 Hz. Dynamic BFNs were constructed using time-varying graphs combined with the motifs' synchronization method and the indexes were evaluated in different scales: global averages, by hemispheres, by regions, and by electrodes for both groups. The SCZ group exhibited lower temporal connectivity, lesser hub probability, and fewer number of edges in right and left temporal lobes over time, besides increased temporal connectivity in the central-parietal region. Neither differences for the full synchronization time of BFNs were observed, nor for intra- and inter-hemispheric connections between groups. These results indicate that SCZ BFNs exhibit a dynamic fluctuation pattern with abrupt increases in connectivity over time for the regions studied. This elucidates an attempted interaction of the temporal area with other regions (frontal, central-parietal, and occipital) that is not sufficient to maintain a connectivity pattern in schizophrenia individuals similar to that of healthy subjects. Our results suggest that changes in interaction of dynamic BFNs connections in SCZ can be better approached by dynamic analyses that enable a thorough glance at brain changes over time.

Scaling Exponent of Human Gait: A Scoping Review.

Nonlinear analysis such as detrended fluctuation analysis (DFA) and power spectrum density are often used to describe the gait motor behavior. This is an interdisciplinary effort to understand and evaluate human movement by the complexity field lenses. However, there are conflicting interpretations about the measures. For instance, the same alpha value could be a better adaptation or sign of pathology. Therefore, the purposes of this scope review are: to map scientific production in the application of the scaling exponent for gait and running analysis, identify the scaling methods used in these studies and the results interpretation, and identify knowledge gaps for future studies. Eleven methods and six metrics associated with them were found. Most of the papers use DFA and explain the results through hypotheses about the supraspinal influence and origin of long-range correlations, adaptability and stability during gait and running. Comparing studies and interpretations, we found a broad designation of terms for the same metric. This reflects the lack of agreement and language uniformity in this literature.

Ephaptic entrainment in hybrid neuronal model.

In recent decades, there has been a growing interest in the impact of electric fields generated in the brain. Transmembrane ionic currents originate electric fields in the extracellular space and are capable of affecting nearby neurons, a phenomenon called ephaptic neuronal communication. In the present work, the Quadratic Integrated-and-Fire model (QIF-E) underwent an adjustment/improvement to include the ephaptic entrainment behavior between neurons and electric fields. Indeed, the aim of our study is to validate the QIF-E model, which is a model to estimate the influence of electric fields on neurons. For this purpose, we evaluated whether the main properties observed in an experiment by Anastassiou et al. (Nat Neurosci 14:217-223, 2011), which analyzed the effect of an electric field on cortical pyramidal neurons, are reproduced with the QIF-E model. In this way, the analysis tools are employed according to the neuronal activity regime: (i) for the subthreshold regime, the circular statistic is used to describe the phase differences between the input stimulus signal (electrode) and the modeled membrane response; (ii) in the suprathreshold regime, the Population Vector and the Spike Field Coherence are used to estimate phase preferences and the entrainment intensity between the input stimulus and Action Potentials. The results observed are (i) in the subthreshold regime the values of the phase differences change with distinct frequencies of the input stimulus; (ii) in the supra-threshold regime the preferential phase of Action Potentials changes for different frequencies. In addition, we explore other parameters of the model, such as noise and membrane characteristic-time, in order to understand different types of neurons and extracellular environment related to ephaptic communication. Such results are consistent with results observed in empirical experiments based on ephaptic phenomenon. In addition, the QIF-E model allows further studies on the physiological importance of ephaptic communication in the brain, and its simplicity may open a door to simulate the ephaptic response in neuronal networks and assess the impact of ephaptic communication in such scenarios.

A social network approach for the study of leprosy transmission beyond the household.

BACKGROUND: Mycobacterium leprae was the first microorganism directly associated with a disease, however, there are still important gaps in our understanding of transmission. Although household contacts are prioritized, there is evidence of the importance of extrahousehold contacts. The goal of this article is to contribute to our understanding of the transmission of leprosy ex-household. METHODS: We compare co-location data of 397 leprosy cases and 211 controls drawn from the Centro de Dermatologia Sanitária D. Libânia in Fortaleza, Brazil. We collected lifetime geolocation data related to residence, school attendance and workplace and developed novel methods to establish a critical distance (Rc) for exposure and evaluated the potential for transmission for residence, school and workplace. RESULTS: Our methods provide different threshold values of distance for residence, school and workplace. Residence networks demonstrate an Rc of about 500 m. Cases cluster in workplaces as well. Schools do not cluster cases. CONCLUSIONS: Our novel network approach offers a promising opportunity to explore leprosy transmission. Our networks confirm the importance of coresidence, provide a boundary and suggest a role for transmission in workplaces. Schools, on the other hand, do not demonstrate a clustering of cases. Our findings may have programmatic relevance.

Brain Asymmetry in Pain Affective Modulation.

OBJECTIVE: The aim of this study was to characterize the dynamic brain networks underlying the affective modulation of pleasant, unpleasant, and neutral image perception due to painful stimulations in healthy subjects. METHODS: Forty volunteers, 20 men and 20 women, participated in this study. Brain activity was recorded by 64-channel electroencephalography. After data cleaning, brain functional networks were built through the use of the motif synchronization method. RESULTS: We found that increased cerebral connectivity in the left hemisphere under the pain condition broke the connection symmetry. Both women and men showed homophilic connections (intrahemispheric), but women were more homophilic than men. The pain condition increased homophily in the left hemisphere, and emotions could modulate pain. The frontal, central, and left temporal regions showed homophilic variation, depending on the emotional stimulus. CONCLUSIONS: Pain and emotions altered brain activity. There was increased connectivity and homophily in the left brain hemisphere for the painful experience. The emotions modulated brain activity in the pain condition. Overall, the brain presented homophilic characteristics; homophily changed, depending on emotion or pain. The left brain hemisphere seems to be related to pain processing.

Health care network model for older adults: a co-creation and participatory action research approach / Modelo assistencial à saúde do idoso em rede: uma abordagem de cocriação e pesquisa-ação participativa

OBJECTIVE: To develop a collaborative, multidisciplinary care model for older adults that improves interdisciplinary teamwork and increases access to specialized services for frail patients, helping solve management problems in the Brazilian Unified Health System. In the state of Bahia, the health care network for older adults requires better interaction and integration with the Unified Health System and the Unified System of Social Assistance to improve patient flow in the network. METHODS: We used a co-creation and participatory action research approach based on reflection, data collection, interaction, and feedback with participants and stakeholders. Data was collected from health professionals, representatives of health agencies, and older adults through collective and individual interviews, reflective diaries, and direct communication. RESULTS: An action plan involving members of the older adult care network was developed to put the new model into practice. A pilot study with a multidisciplinary team allowed adjustments and implementation of the model at our institution. CONCLUSIONS: The new model improved both the internal management of the State Reference Center for Older Adult Health Care (Centro de Referência Estadual de Atenção à Saúde do Idoso - CREASI) and its interaction with primary care, optimizing patient flow and establishing rules for shared management between CREASI and primary care institutions. In view of this, restructuring the care model reorganized relations between the agencies, expanding CREASI's role in the management and systematization of older adult health.

OBJETIVO: Desenvolver um modelo assistencial colaborativo, multiprofissional e centrado na pessoa idosa para melhorar o trabalho em equipe interdisciplinar e o acesso de idosos frágeis ao serviço especializado, ajudando na resolução de problemas com o gerenciamento do idoso no Sistema Único de Saúde (SUS). A rede de assistência à saúde do idoso na Bahia requer avanços na interação e na integração entre os órgãos do SUS e do Sistema Único de Assistência Social para melhorar o fluxo dos pacientes na rede. METODOLOGIA: Foi realizada uma pesquisa-ação participativa e cocriação baseadas na reflexão, coleta de dados, interação e feedback com participantes e partes interessadas. A coleta dos dados foi realizada com os profissionais de saúde, representantes dos órgãos de saúde e idosos por meio entrevistas coletivas e individuais, diários reflexivos e registros de comunicação direta. RESULTADOS: Foi elaborado um plano de ação com participação dos membros da rede de assistência ao idoso para colocar em prática o novo modelo. Realizou-se um piloto com uma equipe multidisciplinar que possibilitou ajustes e a implementação do modelo na instituição. CONCLUSÕES: O novo modelo favoreceu tanto o gerenciamento interno do Centro de Referência Estadual de Atenção à Saúde do Idoso (CREASI) como a interação com a atenção básica, otimizando o fluxo de pacientes e estabelecendo regras de gerenciamento compartilhado entre CREASI e atenção básica. Diante disso, a reestruturação do modelo assistencial representou uma reorganização das relações entre os órgãos, ampliando o papel do CREASI no gerenciamento e na sistematização da saúde do idoso.

An Observational Study Comparing Fibromyalgia and Chronic Low Back Pain in Somatosensory Sensitivity, Motor Function and Balance.

Fibromyalgia (FM) and chronic low back pain (CLBP) have shared pathophysiology and have a considerable impact on patients' daily activities and quality of life. The main objective of this study was to compare pain impact, somatosensory sensitivity, motor functionality, and balance among 60 patients with FM, 60 patients with CLBP, and 60 pain-free controls aged between 30 and 65 years. It is essential to know the possible differences existing in symptomatology of two of the major chronic pain processes that most affect the population, such as FM and CLBP. The fact of establishing possible differences in sensory thresholds, motor function, and proprioceptive measures among patients with FM and CLBP could bring us closer to a greater knowledge of the chronic pain process. Through an observational study, a comparison was made between the three groups (FM, CLBP, and pain-free controls) evaluating functional performance, postural balance, kinematic gait parameters, strength, depression, fatigue, and sensitivity to pain and vibration. Patients with chronic pain showed worse somatosensory sensitivity (p < 0.001) and motor function (p < 0.001) than pain-free controls. Moreover, patients with FM showed greater pain impact (p < 0.001) and bigger somatosensory (p < 0.001) and motor deficiencies (p < 0.001) than patients with CLBP. Further research should explore the possible reasons for the greater deterioration in patients with FM in comparison with other chronic pain conditions. Our results, showing the multiple areas susceptible of deterioration, make it necessary to adopt interdisciplinary interventions focused both on physical and emotional dysfunction.

Scaling effect in COVID-19 spreading: The role of heterogeneity in a hybrid ODE-network model with restrictions on the inter-cities flow.

The new Covid-19 pandemic has left traces of suffering and devastation to individuals of almost all countries worldwide and severe impact on the global economy. Understanding the clinical characteristics, interactions with the environment, and the variables that favor or hinder its dissemination help the public authorities in the fight and prevention, leading for a rapid response in society. Using models to estimate contamination scenarios in real time plays an important role. Population compartments models based on ordinary differential equations (ODE) for a given region assume two homogeneous premises, the contact mechanisms and diffusion rates, disregarding heterogeneous factors as different contact rates for each municipality and the flow of contaminated people among them. This work considers a hybrid model for covid-19, based on local SIR models and the population flow network among municipalities, responsible for a complex lag dynamic in their contagion curves. Based on actual infection data, local contact rates ( ß ) are evaluated. The epidemic evolution at each municipality depends on the local SIR parameters and on the inter-municipality transport flow. When heterogeneity of ß values and flow network are included, forecasts differ from those of the homogeneous ODE model. This effect is more relevant when more municipalities are considered, hinting that the latter overestimates new cases. In addition, mitigation scenarios are assessed to evaluate the effect of earlier interventions reducing the inter-municipality flux. Restricting the flow between municipalities in the initial stage of the epidemic is fundamental for flattening the contamination curve, highlighting advantages of a contamination lag between the capital curve and those of other municipalities in the territories.

Estimating Upper-Limb Impairment Level in Stroke Survivors Using Wearable Inertial Sensors and a Minimally-Burdensome Motor Task.

Upper-limb paresis is the most common motor impairment post stroke. Current solutions to automate the assessment of upper-limb impairment impose a number of critical burdens on patients and their caregivers that preclude frequent assessment. In this work, we propose an approach to estimate upper-limb impairment in stroke survivors using two wearable inertial sensors, on the wrist and the sternum, and a minimally-burdensome motor task. Twenty-three stroke survivors with no, mild, or moderate upper-limb impairment performed two repetitions of one-to-two minute-long continuous, random (i.e., patternless), voluntary upper-limb movements spanning the entire range of motion. The three-dimensional time-series of upper-limb movements were segmented into a series of one-dimensional submovements by employing a unique movement decomposition technique. An unsupervised clustering algorithm and a supervised regression model were used to estimate Fugl-Meyer Assessment (FMA) scores based on features extracted from these submovements. Our regression model estimated FMA scores with a normalized root mean square error of 18.2% ( r2=0.70 ) and needed as little as one minute of movement data to yield reasonable estimation performance. These results support the possibility of frequently monitoring stroke survivors' rehabilitation outcomes, ultimately enabling the development of individually-tailored rehabilitation programs.

Transcranial direct current stimulation in the treatment of cerebellar ataxia: A two-phase, double-blind, auto-matched, pilot study.

OBJECTIVE: To assess the impact of tDCS on posture, gait and coordination of movements in subjects with cerebellar ataxia. PATIENTS AND METHODS: This is a two-phase, double blind, auto matched, pilot study. Seven people were selected to participate in the study aged from 14 to 57. tDCS and sham-tDCS were applied at different times to all participants for 40 min over five consecutive days so that they were blind to which of the two techniques was applied at any one time. The area stimulated was the bilateral motor cortex. Subjects were evaluated before and after the interventions using the Scale for Assessment and Rating of Ataxia (SARA) and specific tests to measure posture and balance were carried out using the Wii Fit platform and CvMob software. RESULTS: The study indicates a statistically significant improvement in respect of gait parameters and the total score of the SARA scale and Wii Fit platform after tDCS when compared with data obtained from sham-tDCS trials (p: 0,03). The adverse events relating to tDCS were all self-limiting and from mild to moderate intensity. CONCLUSION: Despite the small sample size, tDCS showed positive results in some motor parameters and could be considered a valuable new option for the treatment of cerebellar ataxias.

The use of Social Network Analysis in a study of intergroup relations between affirmative action and regular students in a public university / O uso de Análise de Redes Sociais no estudo das relações intergrupais entre cotistas e não cotistas de uma universidade pública

Higher education has joined affirmative action and promoted the coexistence between different social groups at universities. This study evaluated the interaction pattern between 926 affirmative action and regular students from 25 different undergraduate programs from a public university using an informal social networks questionnaire. Homophily was the parameter chosen to measure intergroup relations. This behavior was evaluated according to the student's term, yield rate (percentage of admitted students who enroll), field of knowledge and nature of relationship. The results showed a low degree of integration between groups in highly competitive undergraduate programs. The group of regular students showed a greater tendency for endogeneity. These results point to need to create a culture of inclusion that provides a distribution of resources between different social groups.

A adesão ao sistema de cotas no ensino superior promoveu a convivência entre grupos sociais distintos. O estudo avaliou o padrão de interação entre 926 estudantes cotistas e não cotistas de 25 turmas de uma universidade pública brasileira, utilizando um questionário de redes sociais informais. Homofilia foi o parâmetro escolhido para medir as relações intergrupais. Esse comportamento foi avaliado de acordo com o semestre, a concorrência, a área de conhecimento e a natureza da relação. Os resultados demonstraram baixo grau de integração entre os grupos nos cursos de alta concorrência, bem como maior tendência à endogenia no grupo de não cotistas. Tais resultados apontam a necessidade de se criar uma cultura inclusiva, que propicie a distribuição de recursos entre os diferentes grupos sociais envolvidos.

Towards the Ambulatory Assessment of Movement Quality in Stroke Survivors using a Wrist-worn Inertial Sensor.

Stroke is a leading cause of long-term disability that may lead to significant functional motor impairments in the upper limb (UL). Wrist-worn inertial sensors have emerged as an objective, minimally-obtrusive tool to monitor UL motor function in the real-world setting, such that rehabilitation interventions can be individually tailored to maximize functional performance. However, current wearable solutions focus on capturing the quantity of movement without considering the quality of movement. This paper introduces a novel approach to unobtrusively estimate the quality of UL movements in stroke survivors using a single wrist-worn inertial sensor during any type of voluntary UL movements. The proposed method exploits kinematic characteristics of voluntary limb movements that are optimized by the central nervous system during motor control. This work demonstrates that the proposed method could extract clinically important information during random UL movements in 16 stroke survivors, showing a statistically significant correlation to the Functional Ability Scale - a clinically validated score for movement quality.

Complex Upper-Limb Movements Are Generated by Combining Motor Primitives that Scale with the Movement Size.

The hand trajectory of motion during the performance of one-dimensional point-to-point movements has been shown to be marked by motor primitives with a bell-shaped velocity profile. Researchers have investigated if motor primitives with the same shape mark also complex upper-limb movements. They have done so by analyzing the magnitude of the hand trajectory velocity vector. This approach has failed to identify motor primitives with a bell-shaped velocity profile as the basic elements underlying the generation of complex upper-limb movements. In this study, we examined upper-limb movements by analyzing instead the movement components defined according to a Cartesian coordinate system with axes oriented in the medio-lateral, antero-posterior, and vertical directions. To our surprise, we found out that a broad set of complex upper-limb movements can be modeled as a combination of motor primitives with a bell-shaped velocity profile defined according to the axes of the above-defined coordinate system. Most notably, we discovered that these motor primitives scale with the size of movement according to a power law. These results provide a novel key to the interpretation of brain and muscle synergy studies suggesting that human subjects use a scale-invariant encoding of movement patterns when performing upper-limb movements.

Treinamento de classe em circuito em água versus terra em pacientes pós-acidente vascular cerebral: um protocolo para um estudo controlado randomizado / Circuit Class Training in water versus land in Post-Stroke patients: a protocol for a randomized controlled trial

INTRODUÇÃO: Uma alta porcentagem de pacientes pós-AVC tem consequências permanentes, apesar da reabilitação convencional. O treinamento em circuito oferece uma maneira eficiente de realizar a prática estruturada de atividades relacionadas à tarefa durante a reabilitação do AVC. A terapia aquática é outra abordagem terapêutica que oferece uma grande variedade de opções para ser um ambiente altamente dinâmico, o que ajuda a melhorar a funcionalidade e recuperar a qualidade de vida e a independência das pessoas com deficiência. OBJETIVO: Desenvolver um protocolo para um estudo controlado randomizado. MÉTODOS: Quarenta participantes serão randomizados em dois grupos: treinamento em classe de circuito aquático (ACCT) e treinamento em circuito de terra (LCCT). Em ambos os grupos, a intervenção será uma terapia de classe de 7 semanas, 3 vezes por semana, dando um total de 20 sessões, 60 minutos cada. Os avaliadores cegos conduzirão avaliações, utilizando ferramentas padronizadas: linha de base, pós-intervenção e 20 dias de acompanhamento para a eficácia da terapia em termos de marcha, equilíbrio e função motora do membro superior. RESULTADOS / CONCLUSÃO: Este estudo examinará o efeito imediato e de médio prazo de um programa ACCT em comparação com um programa LCCT em pessoas com AVC. Tem o potencial de identificar intervenções que possam melhorar a reabilitação desses pacientes. Ambos os programas do CCT são baseados no modelo da Classificação Internacional de Função, Incapacidade e Saúde, com atividades voltadas para os níveis de deficiência, atividade e participação. [AU]

INTRODUCTION: A high percentage of post-stroke patients have permanent aftermathsdespite conventional rehabilitation. Circuit class training offers an efficient way to achieve structured practice of task-related activities during stroke rehabilitation. Aquatic therapy is another therapeutic approach that offers a great variety of options to be a highly dynamic environment, which helps to improving functionality and recover quality of life and independence in people with disabilities. OBJECTIVE: To develop a protocol for a randomized controlled trial. METHODS: Forty participants will be randomized in two groups: aquatic circuit class training (ACCT) and land circuit class training (LCCT). In both groups, the intervention will be a 7-week class therapy, 3-times weekly, giving a total of 20 sessions, 60 minutes each. Blinded assessors will conduct assessments, using standardized tools: baseline, post-intervention, and 20 days follow-up for the effectiveness of the therapy in terms of gait, balance and upper limb motor function. RESULTS/CONCLUSION: This trial will examine the immediate and medium term effect of an ACCT program as compared to a LCCT program in people with stroke. It has the potential to identify interventions that may improve rehabilitation of these patients. Both CCT programs are based in International Classification of Function, Disability and Health model with activities aimed at impairment, activity and participation levels. [AU]