Efeitos do treinamento de dupla tarefa no controle do equilíbrio dinâmico e estático de idosas pré-frágeis: um estudo piloto

The increasing world population of older individuals has become a subject of growing research for prevention and reversibility of the frailty because it is a major risk factor for the occurrence of falls, especially when it involves everyday situations of dual task. Some rehabilitation programs have already used the methods of dual-task with general exercises for improving gait and postural control, but has been reported that these interventions have little specificity with limited success to improve certain aspects of static and dynamic position during the performance of functional tasks. This study aimed to verify the measures of postural control in a group of elderly women with fragility phenotype after physical therapy intervention program based on dual-task treadmill training. We selected six pre-frail elderly subjects, with a minimum age of 65, female, living in the community and randomly assigned to two groups. The survey was conducted twice a week for 45 minutes, for four weeks. The simple task intervention consisted only in training on a treadmill and the dual task consisted of in treadmill training associated with visual stimuli. The assessments were made with the use of the Berg Balance Scale (BBS) and the Balance Master® computerized posturography, static and dynamically. The effects of retention were observed after one month, using the same instruments earlier used. The results showed a tendency toward improvement or maintenance of the balance after training on a treadmill, especially with respect to static equilibrium. Both groups showed the most notable changes in the variables related to gait, as the length and speed. The BBS scores and the baropodometric variables showed that the experimental group could keep all values similar or better even one month after completion of training unlike the control group. We concluded that the dual-task performance had no additional value in relation to the improvement of balance in general, but we observed that the effectiveness of visual stimulation occurred in the maintenance of short term balancevariables

Funcionalidade em pacientes após acidente vascular encefálico: relação com o sono e ritmo de atividade-repouso

It is known that sleep plays an important role in the process of motor learning. Recent studies have shown that the presence of sleep between training a motor task and retention test promotes a learning task so than the presence of only awake between training and testing. These findings also have been reported in stroke patients, however, there are few studies that investigate the results of this relationship on the functionality itself in this population. The objective of this study was to evaluate the relationship between functionality and sleep in patients in the chronic stage of stroke. A cross-sectional observational study was conducted. The sample was composed of 30 stroke individuals in chronic phase, between 6 and 60 months after injury and aged between 55 and 75 years. The volunteers were initially evaluated for clinical data of disease and personal history, severity of stroke, through the National Institute of Health Stroke Scale, and mental status, the Mini-Mental State Examination. Sleep assessment tools were Pittsburgh Sleep Quality Index, the Questionnaire of Horne and Ostberg, Epworth Sleepiness Scale, the Berlin questionnaire and actigraphy, which measures were: real time of sleep, waking after sleep onset, percentage of waking after sleep onset, sleep efficiency, sleep latency, sleep fragmentation index, mean activity score. Other actigraphy measures were intraday variability, stability interdiária, a 5-hour period with minimum level of activity (L5) and 10-hour period with maximum activity (M10), obtained to evaluate the activity-rest rhythm. The Functional Independence Measure (FIM) and the Berg Balance Scale (BBS) were the instruments used to evaluate the functional status of participants. The Spearman correlation coefficient and comparison tests (Student's t and Mann-Whitney) were used to analyze the relationship of sleep assessment tools and rest-activity rhythm to measures of functional assessment. The SPSS 16.0 was used for analysis, adopting a significance level of 5%. The main results observed were a negative correlation between sleepiness and balance and a negative correlation between the level of activity (M10) and sleep fragmentation. No measurement of sleep or rhythm was associated with functional independence measure. These findings suggest that there may be an association between sleepiness and xii balance in patients in the chronic stage of stroke, and that obtaining a higher level of activity may be associated with a better sleep pattern and rhythm more stable and less fragmented. Future studies should evaluate the cause-effect relationship between these parameters

Efeitos do treinamento de marcha sobre superfícies inclinadas em indivíduos com hemiparesia crônica: ensaio clínico controlado randomizado

Among the therapeutic approaches that can be used to achieve this goal is the gait training on sloping surfaces, but there are few scientific findings that elucidate the results of this practice. OBJECTIVE: To evaluate the effects of training on sloping surfaces on the gait of subjects with chronic hemiparesis. MATERIALS AND METHODS: A controlled, randomized, blinded clinical trial was conducted. Concluded the study twenty-four subjects with age between 40 and 70 years (54,91±9,3). Their neurological function, functional independence, motor function and balance assessed, besides the gait evaluation through kinemetry. The subjects were allocated into two groups: control group (CG) underwent gait training on treadmill with partial body weight support (PBWS) without inclination; and the experimental group (EG) submitted to gait training on treadmill with PBWS and inclination of 10%. Twelve training sessions were performed. The paired t Student test and Wilcoxon test were used in statistical analysis to compare findings before and after training for each group, and the t student test for independent samples and Mann-Whitney.test were used to compare the to groups. RESULTS: After training within-group changes were observed on balance recovery, motor function and functionality, in both experimental conditions. The EG showed changes after training on speed, stride length, step length of paretic and non-paretic side, paretic single support, double support time and non-paretic swing time. The CG the differences were detected on double support, paretic single support and hip range of movement. The EG showed better results when compared to CG on the variables: speed (p=0,034), non-paretic single support (p=0,02) and paretic swing time (p=0,02). CONCLUSION: gait training on sloping surfaces represents a promising strategy for gait training of subjects with chronic hemiparesis since it is can influence a greater number of gait variables, when compared with gait training on flat surface

Desempenho motor de pacientes com acidente vascular cerebral em um jogo baseado em realidade virtual

The Cerebral Vascular Accident (CVA) is the leading cause of motor disability in adults and elderly and that is why it still needs effective interventions that contribute to motor recovery. Objective: This study was aimed to evaluate the performance of stroke patients in chronic stage using a virtual reality game. Method: 20 patients (10 with injury to the left and 10 to the right side), right-handed, average age 50.6 ± 9.2 years, and 20 healthy subjects with average age of 50.9 ± 8.8, also right-handed participated. The patients had a motor (Fugl-Meyer) and muscle tone assessment (Ashworth). All participants made a kinematic evaluation of the drinking water activity and then underwent training with the table tennis game on XBOX 360 Kinect®, 2 sets of 10 attempts for 45 seconds, 15 minutes rest between sets, giving a total of 30 minutes session. After training the subjects underwent another kinematic evaluation. The patients trained with the right and left hemiparect upper limb and the healthy ones with the right and left upper limb. Data were analyzed by ANOVA, t Student test and Pearson correlation. Results: There was significant difference in the number of hits between the patients and healthy groups, in which patients had a lower performance in all the attempts (p = 0.008), this performance was related to a higher level of spasticity (r = - 0.44, p = 0.04) and greater motor impairment (r = 0.59, p = 0.001). After training, patients with left hemiparesis had improved shoulder and elbow angles during the activity of drinking water, approaching the pattern of motion of the left arm of healthy subjects (p < 0.05), especially when returning the glass to the table, and patients with right hemiparesis did not obtain improved pattern of movement (p > 0.05). Conclusion: The stroke patients improved their performance over the game attempts, however, only patients with left hemiparesis were able to increase the angle of the shoulder and elbow during the functional activity execution, better responding to virtual reality game, which should be taken into consideration in motor rehabilitation

Influência da adição de carga na marcha em esteira de crianças com paralisia cerebral hemiparética espástica

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Realidade virtual na atividade cerebral: um estudo comparativo entre estados emocionais de adultos jovens e idosos

The association of Virtual Reality (VR) to clinical practice has become common in the recent years, showing to be an additional tool on health care, especially for elderly. Its use has been related to higher therapeutic adhesion levels and well being sensation. Such emotional based aspects are often observed by subjective tools of relative validity. This study analyzed the immediate effects of varied VR contexts balance training over emotional behavior, which was observed under peaks of maximum expression of EEG waves. Methodology: 40 individuals, divided in two groups, both gender, 20 young and 20 elderly, were submitted to a 60 minutes intervention, including balance training under VR. The first 25 minutes referred to initial evaluation, general orientation and cognitive assessment by the use of Mini Mental. The next ten minutes were designated to the avatar creation and tutorial video presentation. Through the following 20 minutes, the individuals from both groups were exposed to the exact same sequence of games under virtual contexts, while submitted to electroencephalography by Emotiv EPOC® focusing Adhesion, Frustration and Meditation states. The virtual interface was provided by the Nintendo® game, Wii Fit Plus, with the scenarios Balance Bubble (1), Penguin (2), Soccer (3), Tight Rope (4) and Table Tilt (5). Finally, a questionnaire of personal impressions was applied on the 5 minutes left. Results: data collected showed 64,7% of individuals from both groups presented higher concentration of adhesion peaks on Balance Bubble game. Both groups also presented similar behavior regarding meditation state, with marks close to 40%, each, on the same game, Table Tilt. There was divergence related to the frustration state, being the maximum concentration for the young group on the Soccer game (29,3%), whilst the elderly group referred highest marks to Tight Rope game (35,2%). Conclusion: Findings suggest virtual contexts can be favorable to adhesion and meditation emotional patterns induction, regardless age and for both sexes, whilst frustration seems to be more related to cognitive motor affordance, likely to be influenced by age. This information is relevant and contributes to the orientation for the best choice of games applied in clinical practice, as for other studies regarding this topic

Diferenças funcionais das regiões hipocampais na formação da memória do tipo o quê", "quando" e "onde" em ratos

Episodic memory refers to the recollection of what, where and when a specific event occurred. Hippocampus is a key structure in this type of memory. Computational models suggest that the dentate gyrus (DG) and the CA3 hippocampal subregions are involved in pattern separation and the rapid acquisition of episodic memories, while CA1 is involved in memory consolidation. However there are few studies with animal models that access simultaneously the aspects ‗what-where-when . Recently, an object recognition episodic-like memory task in rodents was proposed. This task consists of two sample trials and a test phase. In sample trial one, the rat is exposed to four copies of an object. In sample trial two, one hour later, the rat is exposed to four copies of a different object. In the test phase, 1 h later, two copies of each of the objects previously used are presented. One copy of the object used in sample trial one is located in a different place, and therefore it is expected to be the most explored object.However, the short retention delay of the task narrows its applications. This study verifies if this task can be evoked after 24h and whether the pharmacological inactivation of the DG/CA3 and CA1 subregions could differentially impair the acquisition of the task described. Validation of the task with a longer interval (24h) was accomplished (animals showed spatiotemporal object discrimination and scopolamine (1 mg/kg, ip) injected pos-training impaired performance). Afterwards, the GABA agonist muscimol, (0,250 μg/μl; volume = 0,5 μl) or saline were injected in the hippocampal subregions fifteen minutes before training. Pre-training inactivation of the DG/CA3 subregions impaired the spatial discrimination of the objects (‗where ), while the temporal discrimination (‗when ) was preserved. Rats treated with muscimol in the CA1 subregion explored all the objects equally well, irrespective of place or presentation time. Our results corroborate the computational models that postulate a role for DG/CA3 in spatial pattern separation, and a role for CA1 in the consolidation process of different mnemonic episodes

Taxa de disparo e ativação de assembléias no hipocampo de ratos durante o processamento de uma memória aversiva

Hebb postulated that memory could be stored thanks to the synchronous activity of many neurons, building a neural assembly. Knowing of the importance of the hippocampal structure to the formation of new explicit memories, we used electrophysiological recording of multiple neurons to access the relevance of rate coding from neural firing rates in comparison to the temporal coding of neural assemblies activity in the consolidation of an aversive memory in rats. Animals were trained at the discriminative avoidance task using a modified elevated plus-maze. During experimental sessions, slow wave sleep periods (SWS) were recorded. Our results show an increase in the identified neural assemblies activity during post-training SWS, but not for the neural firing rate. In summary, we demonstrate that for this particular task, the relevant information needed for a proper memory consolidation lies within the temporal patters of synchronized neural activity, not in its firing rate

Aprendizado espacial-temporal em um ambiente complexo sem restrição alimentar em ratos

Timeplace learning is the capacity of organisms to associate both space and time with a biological relevant stimulus such as food. Experiments are usually done with food restricted animals due to the belief that food system activation is necessary for timeplace learning. Another line of thought suggest that, in addition to food system activation, response cost should be increased to effectively allow timeplace discrimination. The purpose of this experiment was to test whether a complex environment, which presumably implied in a heightened response cost, would facilitate timeplace association in satiated rats using a highly palatable food as reward. Nine rats were trained in a timeplace task for 30 nonconsecutive days. A large experimental box (1x1m) divided in four compartments was used. To access each compartment the animal had to overcome a series of obstacles such as ramps, staircases and mazes. Two feeders localized in opposite compartments were rewarded with sunflower seeds in two daily sessions. One feeder offered the reward during the morning sessions while the second feeder in afternoon sessions. After the 15th day of training, the animals began to show a preference for the correct feeder during the correct time of day expressed by increased frequency of visits as well as lower latency to access the feeders. These results suggest that satiated animals are also capable of learning a timespace task as far as the experimental context is complex enough to result in a higher response cost

Efeitos da alteração dos níveis de ansiedade no desempenho de ratos em uma tarefa de discriminação apetitiva

The plus-maze discriminative avoidance paradigm has been used to study the relationship between aversive memory and anxiety. The present study aims to verify if the elevated plus-maze can provide information about appetitive memory and anxiety, through a task motivated by food reward. Animals were allowed to explore an elevated plus-maze and received reinforcement in one of the enclosed arms. In a test session performed 24h later, in the absence of reward, rats showed preference for the previously rewarded enclosed arm over the neutral enclosed arm. The administration of diazepam and pentylenetetrazole before training induced, respectively, anxiolytic and anxiogenic effects (as evaluated by open-arm exploration). Both drugs induced amnestic effects, i.e., lack of preference for the rewarded arm in the test session. The results suggest that appetitive memory can be influenced by anxiety levels as well. The plus-maze appetitive discrimination task seems to be a useful model to investigate the relationship between memory and anxiety

Expressão de zif-268 durante a aquisição, evocação e extinção de uma memória aversiva

In the behavioral paradigm of discriminative avoidance task, both short and long-term memories have been extensively investigated with behavioral and pharmacological approaches. The aim of the present study was to evaluate, using the abovementioned model, the hippocampal expression of zif-268 - a calcium-dependent immediate early gene involved with synaptic plasticity process - throughout several steps of memory formation, such as acquisition, evocation and extiction. The behavioral apparatus consisted of a modified elevaated plus-maze, with their enclosed arms disposed in "L". A pre-exposure to the maze was made with the animal using all arms enclosed, for 30 minutes, followed by training and test, during 10 minutes each. The between sections interval was 24h. During training, aversive stimuli (bright light and loud noise) were actived whenever the animals entered one of the enclosed armas (aversive arm). Memory acquisiton, retention and extinction were evaluated by the percentage of the total time spent exploring the aversive arm. The parameters evaluated (time spent in the arms and total distance traveled) were estimated with an animal tracking software (Anymaze, Stoelting, USA). Learning during training was estimated by the decrease of the time spent exploring the aversive arm. One hour after the beginning of each section, animals were anaesthetized with sodium-thiopental (i.p.) and perfused with 0.9% heparinized saline solution followed by 4% paraformaldehyde. Brains were cryoprotected with 20% sucrose, separeted in three blocks and frozen. The middle block, containing the hippocampus, was sectioned at 20 micro meters in the coronal plane and the resutant sections were submitted to zif-268 immunohistochemistry. Our results show an increased expression of zif-268 in the dentate gyrus (DG) during the evocation and extinction stages. There is a distinct participation of the DG during the memory evocation, but not during its acquisition. Inaddition, all hippocampal regions (CA1, CA3 and DG) presented an increased zif-268 expression during the process of extinction.

Antidepressivos modificam a extinção de uma memória aversiva em ratas

Treatment of major depression, posttraumatic stress disorder and other psychopathologies with antidepressants can be associated with improvement of the cognitive deficits related to these disorders. Although the mechanisms of these effects are not completely elucidated, alterations in extinction of aversive memories are believed to be present in these psychopathologies. Moreover, researches with laboratory animals usually focus on male subjects, and we have recently verified that extinction of an aversive task is reduced in female rats when compared to males. In the present study, female rats were long-term treated with clinically used antidepressants (fluoxetine, nortriptyline or mirtazapine) and tested in the plus-maze discriminative avoidance and forced swimming tests in order to evaluate learning, memory, extinction, anxiety and depression-related behaviors. All groups learned the task, but learning was somewhat faster in nortriptyline and mirtazapine-treated animals . Task retrieval was also showed by all experimental groups. Chronic treatment with fluoxetine, but not with the other antidepressants, increased extinction of the discriminative task. In the forced swimming test, animals treated with fluoxetine and mirtazapine showed decreased immobility duration. In conclusion, antidepressants interfere with learning and female rats treated with fluoxetine presented increased extinction of the aversive memory task. On the other hand, both fluoxetine and mirtazapine were effective in the forced swimming test, suggesting dissociation between the antidepressant effects and the extinction of aversive memories

Avaliação dos efeitos do biperideno, diazepam e neuropeptídeos S sobre a memória e a ansiedade na tarefa do labirinto em T elevado em camundongos

Anxiety is an emotional phenomenon, and normally it is interpreted as an adaptative behavior front to adversities. In its pathological form, anxiety can severely affect aspects related to the personal and professional life. Studies have shown a close relationship between anxiety disorders and aversive memory processing. Considering that the pharmacotherapy of anxiety disorders is still limited, innovative anxiolytic agents are needed. In this regard, neuropeptides systems are interesting therapeutic targets to the treatment of psychopathologies. Neuropeptide S (NPS), a 20-aminoacid peptide, is the endogenous ligand of a G-protein coupled receptor (NPSR), which has been reported to evoke hyperlocomotion, awakefull states, besides anxiolysis and memory improvements in rodents. This study aimed to investigate the effects of biperiden (BPR; an amnesic drug), diazepam (DZP; an anxiolytic drug) and NPS at three distinct times: pre-training, post-training, and pre-test, in order to assess anxiety and memory process in the same animal model. The elevated Tmaze (ETM) is an apparatus derived from the elevated plus-maze test, which consists of one enclosed and two open arms. The procedure is based on the avoidance of open spaces learned during training session, in which mice were exposed to the enclosed arm as many times as needed to stay 300 s. In the test session, memory is assessed by re-exposing the mouse to the enclosed arm and the latency to enter an open arm was recorded. When injected pre-training, BPR (1 mg/kg) impaired learning and memory processing; DZP (1 and 2 mg/kg) evoked anxiolysis, but only at the dose of 2 mg/kg impaired memory; and NPS 0.1 nmol induced anxiolysis without affecting memory. Post-training injection of DZP (2 mg/kg) or BPR (1 and 3 mg/kg) did not affect memory consolidation, while the post-trainning administration of NPS 1 nmol, but not 0.1 nmol, improved memory in mice. Indeed, pre-trainning administration of NPS 1 nmol did not prevent memory impairment elicited by BPR (2 mg/kg, injected before training). In the open field test, BPR 1 mg/kg and NPS 1 nmol induced hyperlocomotion in mice. In conclusion, the proposed ETM task is practical for the detection of the anxiolytic and amnesic effects of drugs. The anxiolytic and memory enhancement effects of NPS were detected in the ETM task, and reinforce the role of NPS system as an interesting therapeutic target to the treatment of anxiety disorders

Mudanças endógenas e suprafisiológicas nos níveis de estrógeno: efeitos sobre a amnésia induzida pela escopolamina em ratas intactas

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O Tratamento com a fluoxetina (mas não com outros farmacos antidepressivo e ansioíiticos) reverte o déficit de memória aversiva causado por estresse agudo de contenção em camundongos

The physiologist H. Selye defined stress as the nonspecific response of the body to any factors that endanger homeostasis (balance of internal environment) of the individual. These factors, agents stressors, are able to activate the Hypothalamic-Pituitary-Adrenal (HPA) axis, thus resulting in the physiological responses to stress by the release of glucocorticoids that leads to psychophysiological changes, including effects on cognitive functions such as learning and memory. When this axis is acutely stimulated occurs a repertoire of behavioral and physiological changes can be adaptive to the individual. Notwithstanding, when the HPA axis is chronically stimulated, changes may favor the development of, such as anxiety disorders. Some drugs used in the clinic for the treatment of anxiety disorders these can exert effects on cognitive function, on the HPA axis and on the anxiety. In this context, the aim of our study was to investigate the effects of administration i.p. acute of diazepam (DZP, 2 mg/kg), buspirone (BUS, 3 mg/kg), mirtazapine (MIR, 10 mg/kg) and fluoxetine (FLU, 10 mg/kg) in male mice submitted to acute restraint stress, and evaluated using plus-maze discriminative avoidance task (PMDAT), which simultaneously evaluates parameters such as learning, memory and anxiety. Our results demonstrated that (1) the administration of DZP and BUS, but not FLU, promoted anxiolytic effects in animals; (2) administration mirtazapine caused sedative effect to animals; (3) in the training session, the animals treated with BUS, MIR and FLU learned the task, on the other hand DZP group showed impairment in learning; (4) in the test session, animals treated with DZP, BUS, and MIR showed deficits in relation to discrimination between the enclosed arms, aversive versus non-aversive arm, demonstrating an impairment in memory, however, animals treated with FLU showed no interference in the retrieval of this memory; (5) acute stress did not interfere in locomotor activity, anxiety, or learning on the learning task, but induced impairment in retrieval memory, and the group treated with FLU did not demonstrated this deficit of memory . These results suggest that acute administration of drugs with anxiolytic and antidepressant activity does not interfere with the learning process this aversive task, but impair its retrieval, as well as the acute restraint stress. However, the antidepressant fluoxetine was able to reverse memory deficits promoted by acute stress, which may suggest that modulation, even acutely serotonergic neurotransmission, by selectively inhibiting the reuptake of this neurotransmitter, interferes on the process of retrieval of an aversive memory