Avaliação da estimulação da medula espinhal como modelo de tratamento da doença de parkinson no primata Callithrix jacchus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Avaliação por ressonância magnética funcional e estimulação magnética transcraniana da intervenção única da terapia espelho em pacientes após acidente vascular cerebral isquêmico

Mirror therapy (MT) is being used as a rehabilitation tool in various diseases, including stroke. Although some studies have shown its effectiveness, little is known about neural mechanisms that underlie the rehabilitation process. Therefore, this study aimed at assessing cortical neuromodulation after a single MT intervention in ischemic stroke survivors, by means of by functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). Fifteen patients participated in a single thirty minutes MT session. fMRI data was analyzed bilaterally in the following Regions of Interest (ROI): Supplementary Motor Area (SMA), Premotor cortex (PMC), Primary Motor cortex (M1), Primary Sensory cortex (S1) and Cerebellum. In each ROI, changes in the percentage of occupation and beta values were computed. Group fMRI data showed a significant decreased in the percentage of occupation in PMC and cerebellum, contralateral to the affected hand (p <0.05). Significant increase in beta values was observed in the following contralateral motor areas: SMA, Cerebellum, PMC and M1 (p<0,005). Moreover, a significant decrease was observed in the following ipsilateral motor areas: PMC and M1 (p <0,001). In S1 a bilateral significant decrease (p<0.0005) was observed.TMS consisted of the analysis of Motor Evoked Potential (MEP) of M1 hotspot. A significant increase in the amplitude of the MEP was observed after therapy in the group (p<0,0001) and individually in 4 patients (p <0.05). Altogether, our results imply that single MT intervention is already capable of promoting changes in neurobiological markers toward patterns observed in healthy subjects. Furthermore, the contralateral hemisphere motor areas changes are opposite to the ones in the ipsilateral side, suggesting an increase system homeostasis.

Avaliação do desempenho funcional de crianças com paralisia cerebral de acordo com níveis de comprometimento motor

Contextualization: Several studies have examined the mobility of this group of children, however little is known about the impact of motor function in activities of daily living, considering the seriousness of their neuromotor damage. Objective: Identify the functional differences of children with Cerebral Palsy with different levels of motor dysfunction and correlate these differences with the areas of mobility, self-care and social function in functional ability and caregiver´s assistance of these children. Methods: An l analytical cross-section search was developed, which were part 70 children / families aged from 4 to 7.5 years, in the Rehabilitation Center for Children. As tools were used the Pediatric Evaluation Disability Inventory (PEDI) and the Gross Motor Function Classification System (GMFCS). Data analysis was performed by ANOVA and Pearson's correlation tests. Results: The results show the functional variability of children CP in different severity levels of motor disfunction This variation was observed in the areas of mobility, self-care and social function. The results also showed a strong correlation between the domains mobility and self-care, mobility and social function. Conclusions: The variability shown by the children with CP, suggests the use of PEDI and GMFCS as this association appears to increase the understanding of how the gross motor functions are related to activities of daily living, describing the best commitments and their degree of impact on functional activities. This correlation demonstrates how mobility is crucial to evaluate the performance and guide the therapeutic practice, to develop the children´s potencial, and guide the caregiver in stimulation

Efeito da estimulação transcraniana por corrente contínua anódica sobre o controle do movimento em para-halterofilistas

Introduction: The sport practiced by people with disabilities has been growing in recent years. Consequently, advances in assessment and training methods have emerged. However, the paralympic sport keeps in tow these advances, with few specific studies that consider disability as intervening factor. The transcranial direct current stimulation (tDCS) is a technique that has proven to be capable of modulating brain function. Studies show beneficial effects of tDCS on muscle strength, power and fatigue during exercise. Objective: Investigate de the effect of tDCS on movement control in para-powerlifters. Methods: Eight subjects underwent two sessions of motion capture, which previously applied the anodic tDCS or sham sessions in the cerebellum. Three movements were performed with increasing load between 90-95% of 1MR. The movements were recorded by an 10 infrared cameras system which reconstructed the 3D trajectory of markers placed on the bar. Results: There have been changes between the anodic and sham conditions over bar level (initial, final, maximum during the eccentric and concentric phase) and in the difference between the final and initial bar level. Moreover, there was difference in bar level (final and during the eccentric phase) comparing athletes amputees and les autres. Conclusion: The findings of this study suggest that tDCS applied prior to the exercise over the cerebellum in para-powerlifters acts differently according to disability

Análise do sono e da utilização de cartilhas educativas em pacientes com acidente vascular cerebral

O AVC é uma grande causa de mortalidade e uma das principais causas de incapacidade entre adultos. O presente estudo visa analisar o estado do sono e da utilização de cartilhas educativas em pacientes com AVC. No primeiro estudo foram abordados os fatores associados com os horários de dormir/acordar e no segundo estudo foi analisado o conhecimento e prática quanto às orientações sobre os hábitos de sono e estimulação cognitiva. No estudo 1 foram avaliados 50 pacientes sendo 28 homens, de faixa etária entre 25 e 90 anos que durante uma semana completaram um diário do sono e o registro de atividades através do Social Rhythm Metric (SRM) e do Indice de Nível de Atividades (ALI) e aplicação do questionário de cronotipo (MEQ). Utilizado o teste de correlação de Spearman verificou-se correlação significativa entre os horários de dormir/acordar com cronotipo e entre os horários de dormir/acordar com SRM e o ALI. No segundo estudo foram abordados 40 pacientes com idade média 56,1 ± 11,9 anos, sendo 15 homens e 25 mulheres; como instrumentos foram utilizados National Institute Health Stroke Scale (NIHSS) e em seguida os pacientes observaram cartilhas educativas sobre hábitos de sono e estimulação cognitiva respondendo se conheciam e se praticavam as orientações apresentadas. A análise estatística realizada através do teste de Fisher obteve como resultado, que das 10 orientações apresentadas sobre os hábitos de sono, 6 foram citadas como conhecidas e apenas 4 foram praticadas. Das 6 orientações cognitivas, não houve diferença significativa entre os que conheciam e não conheciam, mas em 5 delas a maior frequência foi dos pacientes que não praticaram. Os resultados dos estudos indicam a importância de avaliar o cronotipo antes do planejamento de reabilitação, e a necessidade de se estimular o ritmo social a fim de contribuir para a melhoria dos padrões de sono de pacientes. Verificou-se também que em relação ao conhecimento e prática de orientações apresentadas muitos pacientes não conheceram ou não praticaram orientações importantes a respeito de hábitos de sono e de estimulação cognitiva, mesmo na fase crônica da patologia, sugerindo que mais políticas de educação em saúde devem ser implementadas com intuito de causar mudança nos hábitos de vida dos pacientes com AVC

Efeitos do treino de marcha em esteira com adição de carga ao membro inferior não parético de indivíduos com acidente vascular cerebral: ensaio clínico controlado e randomizado

Introduction: Gait after stroke is characterized by a significant asymmetry between the lower limbs, with predominant use of the non-paretic lower limb (NPLL) over using the paretic lower limb. Accordingly, it has been suggested that adding load/weight to the NPLL as a form of restricting the movement of this limb may favor the use of the paretic limb, reducing interlimb asymmetry. However, few studies have been conducted up to this moment, which only investigated the immediate effects of this practice. Objectives: 1) Investigating whether there is an influence of adding load to the NPLL during treadmill training on cardiovascular parameters and on gait performance of individuals with stroke, compared to treadmill training without load addition; 2) Analyzing the effects of treadmill training with and without load added to the NPLL on kinematic parameters of each lower limb during gait; 3) Analyzing the effects of treadmill training with and without load added to the NPLL on measurements of functional mobility and postural balance of these patients. Materials and Methods: This is a randomized single blinded clinical trial involving 38 subjects, with a mean age of 56.5 years, at the subacute post-stroke phase (with mean time since stroke of 4.5 months). Participants were randomly assigned into an experimental group (EG) or control group (CG). EG (n= 19) was submitted to gait training on a treadmill with the addition of load to the NPLL by ankle weights equivalent to 5% of body weight. CG (n= 19) was only submitted to gait training on a treadmill. Behavioral strategies which included home exercises were also applied to both groups. The interventions occurred daily for two consecutive weeks (Day 1 to Day 9), being of 30 minutes duration each. Outcome measures: postural balance (Berg Functional Balance Scale – BBS), functional mobility (Timed Up and Go – TUG; kinematic variables of 180° turning) and kinematic gait variables were assessed at baseline (Day 0), after four training sessions (Day 4), after nine training sessions (Day 9), and 40 days after completion of training (Follow-up). Cardiovascular parameters (mean arterial pressure and heart rate) were evaluated at four moments within each training session. Analysis of variance (ANOVA) was used to compare outcomes between EG and CG in the course of the study (Day 0, Day 4, Day 9 and Follow-up). Unpaired t-tests allowed for intergroup comparison at each training session. 5% significance was used for all tests. Results: 1) Cardiovascular parameters (systemic arterial pressure, heart rate and derivated variables) did not change after the interventions and there were no differences between groups within each training session. There was an improvement in gait performance, with increased speed and distance covered, with no statistically significant difference between groups. 2) After the interventions, patients had increased paretic and non-paretic step lengths, in addition to exhibiting greater hip and knee joint excursion on both lower limbs. The gains were observed in the EG and CG, with no statistical difference between the groups and (mostly) maintained at follow-up. 3) After the interventions, patients showed better postural balance (higher scores on BBS) and functional mobility (reduced time spent on the TUG test and better performance on the 180° turning). All gains were observed in the EG and CG, with no statistically significant difference between groups and were maintained at follow-up. Conclusions: The addition of load to the NPLL did not affect cardiovascular parameters in patients with subacute stroke, similar to treadmill training without load, thus seemingly a safe training to be applied to these patients. However, the use of the load did not bring any additional benefits to gait training. The gait training program (nine training sessions on a treadmill + strategies and exercises for paretic limb stimulation) was useful for improving gait performance and kinematics, functional mobility and postural balance, and its use is suggested to promote the optimization of these outcomes in the subacute phase after stroke.

Sonic hedgehog signaling regulates mode of cell division of early cerebral cortex progenitors and increases

The morphogen Sonic Hedgehog (SHH) plays a critical role in the development of different tissues. In the central nervous system, SHH is well known to contribute to the patterning of the spinal cord and separation of the brain hemispheres. In addition, it has recently been shown that SHH signaling also contributes to the patterning of the telencephalon and establishment of adult neurogenic niches. In this work, we investigated whether SHH signaling influences the behavior of neural progenitors isolated from the dorsal telencephalon, which generate excitatory neurons and macroglial cells in vitro. We observed that SHH increases proliferation of cortical progenitors and generation of astrocytes, whereas blocking SHH signaling with cyclopamine has opposite effects. In both cases, generation of neurons did not seem to be affected. However, cell survival was broadly affected by blockade of SHH signaling. SHH effects were related to three different cell phenomena: mode of cell division, cell cycle length and cell growth. Together, our data in vitro demonstrate that SHH signaling controls cell behaviors that are important for proliferation of cerebral cortex progenitors, as well as differentiation and survival of neurons and astroglial cells.

Evuloção cognitiva e funcional de pacientes pós-acidente vascular cerebral - AVC

PURPOSE: Stroke is a high-incidence cerebrovascular disease with elevated morbidity that results in impairments such as functional disabilities. This study aimed to investigate the functional evolution of individuals in the first six months post-stroke. METHOD: Longitudinal study with 42 stroke patients. The functional independence measure (FIM) and The National Institutes of Health Stroke Scale (NIHSS) were used by multidisciplinary staff 3 times in each participant; the first application was at admission to rehabilitation and the others three and six months later. RESULTS: Sample predominantly female (57%), married (52%), mean age 65.26 ±10.72 years, elementary schooling level (43%), ischemic stroke (91%), and right cerebral hemisphere (74%). Motor FIM scores and NIHSS scale showed improvement in the 3 evaluations, with significant p-value (<0.001). There was a strong relation between motor FIM evolution and NIHSS evolution (r = - 0.69 p-value< 0.001). CONCLUSIONS: It was observed that functional evolution at 6 months post-stroke was significant and the smaller the evolution of clinical impairment in these patients, the larger the evolution of their functional independence. The study is important because it allows a more appropriate therapeutic planning according with functional evolution in stroke rehabilitation

Seleção de categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para avaliação do paciente com acidente vascular cerebral em reabilitação

Stroke represents the first cause of disabilities among adults. Although different professions work together in treatment of stroke patients, all they use different terminologies for the description of the patients problems and it can constitute an impediment in the communication between the staff members. Thus, the multidisciplinary and interdisciplinary work would be facilitated if using a reference common tool, as the new International Classification of Functioning, Disability and Health (ICF). However, the ICF is very extensive and complex and due to its complexity, it has been evidenced the necessity to select its categories to become it more practical. The aim of the study was to investigate which categories of the ICF are more suitable to evaluate and to describe the stroke patient in the view of teachers and municipal public health professionals. It was a descriptive research, which involved 5 professors and 11 professionals of Physiotherapy that have worked at the health public area in Natal / RN. It was used the Delphi Technique in 3 rounds and the Likert Scale to select the categories among the ICF components. As result, from the 362 IFC categories, 94 were selected. The selected categories correspond to rehabilitative characteristics of Stroke patients in the universe of the Physiotherapy performance. The methodology applied was suitable to the studied object emphasizing the necessity of future studies for validation of the chosen categories

Do olhar inquieto ao olhar comprometido: uma experiência de intervenção voltada para a atuação com alunos que apresentam paralisia cerebral

Compte tenu de l importance de la formation des enseignants pour répondre, de nos jours, aux besoins des élèves dont les caractéristiques marquantes sont la diversité et la différentiation, desquels nécessairement font partie , à un échelon croissant, des personnes atteintes d une déficience quelconque ; devant le constat que les actuelles politiques d éducation, en fonction de leurs limitations, peuvent être considérées comme un des principaux facteurs qui entravent la concrétisation d un vrai processus d inclusion de ces personnes ; compte tenu, encore, que le confront des situations éducatives concernant le processus d inclusion de ceux ayant des déficiences physiques, notamment lorsqu il s agit d élèves atteints de paralysie cérébrale, engendre chez les enseignants un état de troublante inquiétude du fait de ne se sentir convenablement préparés pour se confronter avec des situations pareilles, cette recherche, centrée sur cette problématique, a chosi comme objectif planifier, mettre en marche et analyser un programme d intervention pédagogique dans une école régulière de la ville de Natal/RN, auprès de quatre enseignants de l école fondamentale (7e Série) qui avaient reçu, dans leur classe, deux élèves atteints de paralysie cérébrale. S utilisant comme recours méthodologique de la recherche-action, le programme d intervention s est structuré autour de troix axes thématiques : l attitudinal, le pédagogique et le vécu en milieu scolaire, sous la forme de discussions théoriques et la mise en oeuvre de ces thématiques. Les données qui devraient être soumises à l analyse ont été collectées à partir des procédés d observation, d entretiens avant et après l intervention, du régistre de photos et d un questionnaire. Les interprétations faites, basées dans la comparaison du discours des sujets ont signalé que les enseignants ont progressé dans la maîtrise des savoirs scienfiques concernant la paralysie cérébrale et dans la connaissance des personnes atteintes par cette déficience. Par rapport aux valeurs et significations attribuées par les enseignants à ce programme d intervention à partir de leur choix des photos dans l ensemble du déroulement de ce processus formatif, elles s expriment par une prise de conscience très marquée, de la part des enseignants, par rapport :aux besoins éducatifs des élèves atteints de paralysie cérébrale ; à l importance et au vrai rôle que l école doit jouer face aux politiques d éducation inclusive ; aux difficultés vécues par ces personnes, qui réclament le plus profond respect de leurs ingularités ; la reconstruction d une nouvelle image concernant ces personnes ; la constatation qu il est possible aux enseignants d adapter et même de créer à l école des ressources et matériaux pédagogiques envisageant la qualité du processus d enseignement et apprentissage de l élève atteint de paralysie cérébrale ; finalement, la perception de l importance du travail en équipe, d un milieu scolaire accessible à ces personnes et de l appuis de la famille dans le contexte de l éducation inclusive. Les résultats obtenus, issus de ce programme d intervention, d après l évaluation finale des sujets, de part de témoigner de son efficacité, montrent que l intervention a été une excellente opportunité d habiliter ces enseignants et d améliorer le processus d enseignement à l école choisie comme le locus de cette recherche

Trilhas da inclusão escolar percorridas por uma aluna com paralisia cerebral na EJA: concepções e práticas

On this qualitative study, it has been discussed the school inclusion paths done by a student with cerebral palsy, who we call Liz, and who was also the reference and indirect subject for this study. For the representation of landscapes found, it follows throughout historical, political and pedagogical paths, getting through the case study method references on the current Brazilian educational context, analyzing, which concepts are attributed to the inclusion and which practices are developed by educational managers and teachers in a regular school of the City of Natal/RN. The theory which based this research is supported on Vygotsky's central ideas (1991, 1997, 2004) and his followers. Furthermore, it was essential to bring to this investigative journey a literature which could dialogue with the most relevant aspects of the cultural-historical approach, emphasizing the assumptions of a progressive education tendency, which promotes the subject involvement of his/her work in the world and for the world. This way, it was necessary to seek for theoretical support on assistive technology and on alternative communication, in order to show the importance of establishing other communications, which is, to break away from the conventional pattern established by the school. On this journey it was used procedures for the data construction, such as: observation, conducting semistructured interviews and questionnaires; and document analysis that supported and legitimized the inclusion, besides the permanent field diaries record. On the access paths to this landscape it entered in the Youth and Adults Education (Educação de Jovens e Adultos - EJA), seeking to establish a dialogue among Youth and Adult Education and Special Education. It was verified that, still, there are large gaps in these policies articulation. Among the results obtained it was raised discussions on new scenery, in which Youth and Adults Education (EJA) emerges as prominent mode of the established relationships throughout the school inclusion process. There were target reflections on: the planning and evaluation systematic, the pedagogical articulation among the Youth and Adults Education (EJA) teachers and the multifunctional resource room teacher's actions and the continuous training importance of the educators involved. It was considered, therefore, that the necessary mediations for school inclusion may be sustained if the walkers are involved in a permanent contact with the nature of a proposal from the Special Education inclusive perspective

Estimulação transcraniana por corrente contínua e a flutuação de força em idosas durante exercício isométrico

The fluctuacion force has been increasingly used in studies with elderly as a good predictor of performance and functionality of the motor. However, most analyzes the fluctuation of force in one session. Thus, identifying the minimum amount of sessions needed for familiarization with the fluctuation strength in isometric exercise become relevant. Furthermore, to investigate the effects of applying transcranial direct current stimulation (tDCS) associated with regular exercise on rates fluctuation task force is extremely important. In the first experiment, volunteers were subjected to a protocol marked by a familiarization session to establish the parameters of VCM and eight sessions with intensity of 30% MVC in office. It was observed that two familiarization sessions are required so there is a fluctuation stabilizing force. In experiment II, subjects performed an isometric contraction before and after applying tDCS (cathode, anode and sham) applied to M1. ETCC anodic effectively contributed to reducing the fluctuation of force during isometric exercise in the elderly, while the cathodic caused the increased levels of strength fluctuation. It was concluded that there is a need to implement a familiarization protocol with at least two sessions to avoid possible misunderstandings of measurements in tests of fluctuacion force. Besides that tDCS interfered with the behavior of the oscillations of force, with cathodic promoting increased fluctuation strength and anodic contributed to greater stability, demonstrating the potential of this technique neuromodulation associated with exercise as rehabilitation tools

A influência da estimulação transcrâniana por corrente contínua nos parâmetros de dano muscular induzido pelo exercício

A estimulação transcraniana por corrente contínua (ETCC) é uma técnica não invasiva que apresenta características anti-fadigante e analgésica. Com o objetivo de testar seus efeitos sobre a diminuição da força e do aparecimento da dor muscular de início tardio (DMIT), apresentados após um evento de dano muscular induzido pelo exercício (DMIE), foi utilizado um estudo clínico de caráter experimental, controlado, randomizado e duplo-cego. A amostra foi composta por 24 jovens do sexo masculino, aparentemente saudáveis (19,7±1,8 anos; 23,6±3,65 IMC), os quais foram alocada, de forma aleatória e estratificada, nos seguintes grupos: G1: grupo controle; G2: grupo de estimulação após o dano e G3: grupo com estimulação antes e após o dano muscular. Os dados foram submetidos à estatística descritiva e análise de variância ANOVA, adotando-se um nível de significância de 5%. O aumento nos níveis séricos de CK (56.18%) e LDH (24,15%) comprovou a ocorrência do DMIE. Em contrapartida, após a análise de variância para comparação dos tratamentos aplicados, pode-se observar que não houve diferenças significativas nos níveis de CK (p= 0,3514) e força muscular (p= 0,9702). A DMIT transcorreu como esperado, mas sem diferença significativa entre os grupos (p= 0,4861). Estes dados demonstraram que a ETCC não foi capaz de modular a DMIT e a diminuição da força muscular após o DMIE em jovens aparentemente saudáveis

Uma contribuição crítica para o redesenho de cadeiras de rodas adaptadas para crianças e adolescentes com paralisia cerebral

This work was aimed at making a critical analysis of the product wheelchair, both for using four different models, which were objects of study of the dissertation of Cláudia Regina Cabral Galvão, entitled Critical Analysis of the Mobility Products Seated a wheelchair - Used by Children and Adolescents with Cerebral Palsy in Natal / RN and other municipalities of Rio Grande do Norte . This product is considered an instrument in the social rehabilitation of great importance for people with physical disabilities. This study aims to position the issue and develop comments on technical up grading of certain models according to the needs of the user. Describes features of four models in search searched through catalogs in order to know its advantages and disadvantages of use. Were presented the definitions of ergonomics and ergonomic aspects to be considered on a design, the study of anthropometry and its recommendations. Discussions the methodology of project design in two parts: the first, on the structuring of design problem (formulation, analysis, synthesis and evaluation.) And the second on the project (design and development, implementation and evaluation and solution). With that review will include the possibilities for a new redesign of the wheelchair, based on forms of adaptation in order to achieve the target that was compressed by the average population studied. Seeks to that this project makes an improvement in quality of life of people in wheelchairs by including these people in society but also the improvement of rehabilitation

Desenvolvimento de protótipo de cadeira de banho para indivíduos com paralisia cerebral tetraparética espástica

This study proposes to develop an equipment that attends the demands of tetraplegic people due to cerebral palsy and that promotes an adequate caregivers postural biomechanics during the shower activity of daily living. First, a bibliographic review was performed to define the terms refering to cerebral palsy, activity of daily living (specifically shower), and assistive technology, besides listing the wheelchairs made on the mainly national assistive technology companies. Therefore, this is a descriptive-exploratory study based on a literature review and on a based-field exploration research. On the field research a survey was adopted as a methodological procedure as it is related to a direct investigation related to a phenomenon, on the case, represented by the current shower situation of the people investigated in this study. Data were collected with the application of a form to the caregivers and consumers of the medical-therapeutic treatment and place used by the participants. Such form, which was made up of open and close questions, tried to identify, besides the personal data of evaluated users and consumers, the characteristics of the current shower activity, such as the place where it takes place in the house, the used equipmentS, in the case there is any, and how often it occurs. The form also was used to identify the caregivers and consumers desires and perceptions in relation to the present characteristics of the new dispositive besides the users and consumers anthropometric data. The evaluation of the results obtained through the form, together with the practice and clinical experience of the researchers and engineers involved in this study, made it possible to develop and make up a real shower chair prototype with the specific adjusts destined to adequate the equipment to be used according to the needs of each user and consumer