Dicas de aprendizagem auxiliam as crianças com TDC na aquisição de uma habilidade motora complexa?

O objetivo do estudo foi analisar se as dicas de aprendizagem auxiliam crianças com TDC na aquisição de uma habilidade motora complexa. Dez crianças com TDC e 14 de desenvolvimento típico, de 9 a 11 anos, foram divididas nos grupos TDC com dicas (TDCD), TDC sem dicas (TDCS), desenvolvimento típico com dicas (GDTD) e desenvolvimento típico sem dicas (GDTS). As crianças participaram de sete aulas, durante três semanas, para a aprendizagem do rolamento peixe, com o uso das dicas "empurre o chão", "coloque a mão o mais longe possível" e "queixo no peito". Os resultados não foram estatisticamente significantes entre os grupos, o que evidencia que as dicas não apresentaram efeito positivo na aprendizagem do rolamento peixe.

Cognitive Assessment and Rehabilitation of subjects with Traumatic Brain Injury

This thesis regards the study and the development of new cognitive assessment and rehabilitation techniques of subjects with traumatic brain injury (TBI). In particular, this thesis i) provides an overview about the state of art of this new assessment and rehabilitation technologies, ii) suggests new methods for the assessment and rehabilitation and iii) contributes to the explanation of the neurophysiological mechanism that is involved in a rehabilitation treatment. Some chapters provide useful information to contextualize TBI and its outcome; they describe the methods used for its assessment/rehabilitation. The other chapters illustrate a series of experimental studies conducted in healthy subjects and TBI patients that suggest new approaches to assessment and rehabilitation. The new proposed approaches have in common the use of electroencefalografy (EEG). EEG was used in all the experimental studies with a different purpose, such as diagnostic tool, signal to command a BCI-system, outcome measure to evaluate the effects of a treatment, etc. The main achieved results are about: i) the study and the development of a system for the communication with patients with disorders of consciousness. It was possible to identify a paradigm of reliable activation during two imagery task using EEG signal or EEG and NIRS signal; ii) the study of the effects of a neuromodulation technique (tDCS) on EEG pattern. This topic is of great importance and interest. The emerged founding showed that the tDCS can manipulate the cortical network activity and through the research of optimal stimulation parameters, it is possible move the working point of a neural network and bring it in a condition of maximum learning. In this way could be possible improved the performance of a BCI system or to improve the efficacy of a rehabilitation treatment, like neurofeedback.

Non-invasive brain stimulation in neglect rehabilitation: an update

Here, we review the effects of non-invasive brain stimulation such as transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) in the rehabilitation of neglect. We found 12 studies including 172 patients (10 TMS studies and 2 tDCS studies) fulfilling our search criteria. Activity of daily living measures such as the Barthel Index or, more specifically for neglect, the Catherine Bergego Scale were the outcome measure in three studies. Five studies were randomized controlled trials with a follow-up time after intervention of up to 6 weeks. One TMS study fulfilled criteria for Class I and one for Class III evidence. The studies are heterogeneous concerning their methodology, outcome measures, and stimulation parameters making firm comparisons and conclusions difficult. Overall, there are however promising results for theta-burst stimulation, suggesting that TMS is a powerful add-on therapy in the rehabilitation of neglect patients.

Virtual reality and the role of the prefrontal cortex in adults and children

In this review, the neural underpinnings of the experience of presence are outlined. Firstly, it is shown that presence is associated with activation of a distributed network, which includes the dorsal and ventral visual stream, the parietal cortex, the premotor cortex, mesial temporal areas, the brainstem and the thalamus. Secondly, the dorsolateral prefrontal cortex (DLPFC) is identified as a key node of the network as it modulates the activity of the network and the associated experience of presence. Thirdly, children lack the strong modulatory influence of the DLPFC on the network due to their unmatured frontal cortex. Fourthly, it is shown that presence-related measures are influenced by manipulating the activation in the DLPFC using transcranial direct current stimulation (tDCS) while participants are exposed to the virtual roller coaster ride. Finally, the findings are discussed in the context of current models explaining the experience of presence, the rubber hand illusion, and out-of-body experiences.

Modulating presence and impulsiveness by external stimulation of the brain

BACKGROUND "The feeling of being there" is one possible way to describe the phenomenon of feeling present in a virtual environment and to act as if this environment is real. One brain area, which is hypothesized to be critically involved in modulating this feeling (also called presence) is the dorso-lateral prefrontal cortex (dlPFC), an area also associated with the control of impulsive behavior. METHODS In our experiment we applied transcranial direct current stimulation (tDCS) to the right dlPFC in order to modulate the experience of presence while watching a virtual roller coaster ride. During the ride we also registered electro-dermal activity. Subjects also performed a test measuring impulsiveness and answered a questionnaire about their presence feeling while they were exposed to the virtual roller coaster scenario. RESULTS Application of cathodal tDCS to the right dlPFC while subjects were exposed to a virtual roller coaster scenario modulates the electrodermal response to the virtual reality stimulus. In addition, measures reflecting impulsiveness were also modulated by application of cathodal tDCS to the right dlPFC. CONCLUSION Modulating the activation with the right dlPFC results in substantial changes in responses of the vegetative nervous system and changed impulsiveness. The effects can be explained by theories discussing the top-down influence of the right dlPFC on the "impulsive system".

Studying the neurobiology of social interaction with transcranial direct current stimulation--the example of punishing unfairness.

Studying social behavior often requires the simultaneous interaction of many subjects. As yet, however, no painless, noninvasive brain stimulation tool existed that allowed the simultaneous affection of brain processes in many interacting subjects. Here we show that transcranial direct current stimulation (tDCS) can overcome these limits. We apply right prefrontal cathodal tDCS and show that subjects' propensity to punish unfair behavior is reduced significantly.

Diminishing risk-taking behavior by modulating activity in the prefrontal cortex: a direct current stimulation study.

Studies have shown increased risk taking in healthy individuals after low-frequency repetitive transcranial magnetic stimulation, known to transiently suppress cortical excitability, over the right dorsolateral prefrontal cortex (DLPFC). It appears, therefore, plausible that differential modulation of DLPFC activity, increasing the right while decreasing the left, might lead to decreased risk taking, which could hold clinical relevance as excessively risky decision making is observed in clinical populations leading to deleterious consequences. The goal of the present study was to investigate whether risk-taking behaviors could be decreased using concurrent anodal transcranial direct current stimulation (tDCS) of the right DLPFC, which allows upregulation of brain activity, with cathodal tDCS of the left DLPCF, which downregulates activity. Thirty-six healthy volunteers performed the risk task while they received either anodal over the right with cathodal over the left DLPFC, anodal over the left with cathodal over the right DLPFC, or sham stimulation. We hypothesized that right anodal/left cathodal would decrease risk-taking behavior compared with left anodal/right cathodal or sham stimulation. As predicted, during right anodal/left cathodal stimulation over the DLPFC, participants chose more often the safe prospect compared with the other groups. Moreover, these participants appeared to be insensitive to the reward associated with the prospects. These findings support the notion that the interhemispheric balance of activity across the DLPFCs is critical in decision-making behaviors. Most importantly, the observed suppression of risky behaviors suggests that populations with boundless risk-taking behaviors leading to negative real-life consequences, such as individuals with addiction, might benefit from such neuromodulation-based approaches.

How Transcranial Direct Current Stimulation Can Modulate Implicit Motor Sequence Learning and Consolidation: A Brief Review

The purpose of this review is to investigate how transcranial direct current stimulation(tDCS)can modulate implicit motor sequence learning and consolidation. So far, most of the studies have focused on the modulating effect of tDCS for explicit motor learning. Here, we focus explicitly on implicit motor sequence learning and consolidation in order to improve our understanding about the potential of tDCS to affect this kind of unconscious learning. Specifically, we concentrate on studies with the serial reaction time task (SRTT), the classical paradigm for measuring implicit motor sequence learning. The influence of tDCS has been investigated for the primary motor cortex, the premotor cortex, the prefrontal cortex, and the cerebellum. The results indicate that tDCS above the primary motor cortex gives raise to the most consistent modulating effects for both implicit motor sequence learning and consolidation.

Detectores monolíticos y sensores compatibles con altos campos magnéticos para tomografía por emisión de positrones

Esta tesis recoje un trabajo experimental centrado en profundizar sobre el conocimiento de los bloques detectores monolíticos como alternativa a los detectores segmentados para tomografía por emisión de positrones (Positron Emission Tomography, PET). El trabajo llevado a cabo incluye el desarrollo, la caracterización, la puesta a punto y la evaluación de prototipos demostradores PET utilizando bloques monolíticos de ortosilicato de lutecio ytrio dopado con cerio (Cerium-Doped Lutetium Yttrium Orthosilicate, LYSO:Ce) usando sensores compatibles con altos campos magnéticos, tanto fotodiodos de avalancha (Avalanche Photodiodes, APDs) como fotomultiplicadores de silicio (Silicon Photomultipliers, SiPMs). Los prototipos implementados con APDs se construyeron para estudiar la viabilidad de un prototipo PET de alta sensibilidad previamente simulado, denominado BrainPET. En esta memoria se describe y caracteriza la electrónica frontal integrada utilizada en estos prototipos junto con la electrónica de lectura desarrollada específicamente para los mismos. Se muestran los montajes experimentales para la obtención de las imágenes tomográficas PET y para el entrenamiento de los algoritmos de red neuronal utilizados para la estimación de las posiciones de incidencia de los fotones γ sobre la superficie de los bloques monolíticos. Con el prototipo BrainPET se obtuvieron resultados satisfactorios de resolución energética (13 % FWHM), precisión espacial de los bloques monolíticos (~ 2 mm FWHM) y resolución espacial de la imagen PET de 1,5 - 1,7 mm FWHM. Además se demostró una capacidad resolutiva en la imagen PET de ~ 2 mm al adquirir simultáneamente imágenes de fuentes radiactivas separadas a distancias conocidas. Sin embargo, con este prototipo se detectaron también dos limitaciones importantes. En primer lugar, se constató una falta de flexibilidad a la hora de trabajar con un circuito integrado de aplicación específica (Application Specific Integrated Circuit, ASIC) cuyo diseño electrónico no era propio sino comercial, unido al elevado coste que requieren las modificaciones del diseño de un ASIC con tales características. Por otra parte, la caracterización final de la electrónica integrada del BrainPET mostró una resolución temporal con amplio margen de mejora (~ 13 ns FWHM). Tomando en cuenta estas limitaciones obtenidas con los prototipos BrainPET, junto con la evolución tecnológica hacia matrices de SiPM, el conocimiento adquirido con los bloques monolíticos se trasladó a la nueva tecnología de sensores disponible, los SiPMs. A su vez se inició una nueva estrategia para la electrónica frontal, con el ASIC FlexToT, un ASIC de diseño propio basado en un esquema de medida del tiempo sobre umbral (Time over Threshold, ToT), en donde la duración del pulso de salida es proporcional a la energía depositada. Una de las características más interesantes de este esquema es la posibilidad de manejar directamente señales de pulsos digitales, en lugar de procesar la amplitud de las señales analógicas. Con esta arquitectura electrónica se sustituyen los conversores analógicos digitales (Analog to Digital Converter, ADCs) por conversores de tiempo digitales (Time to Digital Converter, TDCs), pudiendo implementar éstos de forma sencilla en matrices de puertas programmable ‘in situ’ (Field Programmable Gate Array, FPGA), reduciendo con ello el consumo y la complejidad del diseño. Se construyó un nuevo prototipo demostrador FlexToT para validar dicho ASIC para bloques monolíticos o segmentados. Se ha llevado a cabo el diseño y caracterización de la electrónica frontal necesaria para la lectura del ASIC FlexToT, evaluando su linealidad y rango dinámico, el comportamiento frente a ruido así como la no linealidad diferencial obtenida con los TDCs implementados en la FPGA. Además, la electrónica presentada en este trabajo es capaz de trabajar con altas tasas de actividad y de discriminar diferentes centelleadores para aplicaciones phoswich. El ASIC FlexToT proporciona una excelente resolución temporal en coincidencia para los eventos correspondientes con el fotopico de 511 keV (128 ps FWHM), solventando las limitaciones de resolución temporal del prototipo BrainPET. Por otra parte, la resolución energética con bloques monolíticos leidos por ASICs FlexToT proporciona una resolución energética de 15,4 % FWHM a 511 keV. Finalmente, se obtuvieron buenos resultados en la calidad de la imagen PET y en la capacidad resolutiva del demostrador FlexToT, proporcionando resoluciones espaciales en el centro del FoV en torno a 1,4 mm FWHM. ABSTRACT This thesis is focused on the development of experimental activities used to deepen the knowledge of monolithic detector blocks as an alternative to segmented detectors for Positron Emission Tomography (PET). It includes the development, characterization, setting up, running and evaluation of PET demonstrator prototypes with monolithic detector blocks of Cerium-doped Lutetium Yttrium Orthosilicate (LYSO:Ce) using magnetically compatible sensors such as Avalanche Photodiodes (APDs) and Silicon Photomultipliers (SiPMs). The prototypes implemented with APDs were constructed to validate the viability of a high-sensitivity PET prototype that had previously been simulated, denominated BrainPET. This work describes and characterizes the integrated front-end electronics used in these prototypes, as well as the electronic readout system developed especially for them. It shows the experimental set-ups to obtain the tomographic PET images and to train neural networks algorithms used for position estimation of photons impinging on the surface of monolithic blocks. Using the BrainPET prototype, satisfactory energy resolution (13 % FWHM), spatial precision of monolithic blocks (~ 2 mm FWHM) and spatial resolution of the PET image (1.5 – 1.7 mm FWHM) in the center of the Field of View (FoV) were obtained. Moreover, we proved the imaging capabilities of this demonstrator with extended sources, considering the acquisition of two simultaneous sources of 1 mm diameter placed at known distances. However, some important limitations were also detected with the BrainPET prototype. In the first place, it was confirmed that there was a lack of flexibility working with an Application Specific Integrated Circuit (ASIC) whose electronic design was not own but commercial, along with the high cost required to modify an ASIC design with such features. Furthermore, the final characterization of the BrainPET ASIC showed a timing resolution with room for improvement (~ 13 ns FWHM). Taking into consideration the limitations obtained with the BrainPET prototype, along with the technological evolution in magnetically compatible devices, the knowledge acquired with the monolithic blocks were transferred to the new technology available, the SiPMs. Moreover, we opted for a new strategy in the front-end electronics, the FlexToT ASIC, an own design ASIC based on a Time over Threshold (ToT) scheme. One of the most interesting features underlying a ToT architecture is the encoding of the analog input signal amplitude information into the duration of the output signals, delivering directly digital pulses. The electronic architecture helps substitute the Analog to Digital Converters (ADCs) for Time to Digital Converters (TDCs), and they are easily implemented in Field Programmable Gate Arrays (FPGA), reducing the consumption and the complexity of the design. A new prototype demonstrator based on SiPMs was implemented to validate the FlexToT ASIC for monolithic or segmented blocks. The design and characterization of the necessary front-end electronic to read-out the signals from the ASIC was carried out by evaluating its linearity and dynamic range, its performance with an external noise signal, as well as the differential nonlinearity obtained with the TDCs implemented in the FPGA. Furthermore, the electronic presented in this work is capable of working at high count rates and discriminates different phoswich scintillators. The FlexToT ASIC provides an excellent coincidence time resolution for events that correspond to 511 keV photopeak (128 ps FWHM), resolving the limitations of the poor timing resolution of the BrainPET prototype. Furthermore, the energy resolution with monolithic blocks read by FlexToT ASICs provides an energy resolution of 15.4 % FWHM at 511 keV. Finally, good results were obtained in the quality of the PET image and the resolving power of the FlexToT demonstrator, providing spatial resolutions in the centre of the FoV at about 1.4 mm FWHM.

Tunable dispersion compensator based on distributed Gires-Tournois etalons

We report a novel tunable dispersion compensator (TDC) based on all-fiber distributed Gires-Tournois etaIons (DGTE), which is formed by overlapped chirped fiber gratings. Two DGTEs of opposite dispersion slope work together to generate a tunable periodical dispersion profile. The demonstrated TDCs have the advantages of multichannel operation, extremely low group-delay ripple, low loss, and low cost.

Estimulação transcraniana por corrente contínua (ETCC) sobre o córtex motor na modulação autonômica em pessoas com lesão medular com diferentes graus e níveis de lesão

Introduction: Transcranial Direct Current Stimulation (tDCS) has been used in studies for the treatment of chronic pain, but their effects on the autonomic nervous system (ANS) are non-existent. Therefore, the need for studies is of fundamental importance, as these individuals have autonomic imbalance and the intensity of this is dependent on the degree and level of injury. Objective: We investigated the effect of tDCS on the ANS in people with spinal cord injury (SCI) with different degrees and levels of injury. Methods: Randomized, placebo-controlled, double-blind, applied anodal tDCS or sham on the primary motor cortex (M1), bilaterally. The subjects (lower incomplete injury, n = 7; lower complete injury, n = 9; and high complete thoracic injury, n = 3) visited the laboratory three times and received active or sham tDCS for 13min. The heart rate variability (HRV) was measured before, during and after stimulation and analyzed the variables LF, HF and LF / HF. Results: The tDCS modulated the ANS in different ways among the groups. In individuals with SCI high complete thoracic the tDCS did not change the HRV. However, for individuals with SCI low incomplete, tDCS changed the HRV in order to increase sympathetic (LF, p = 0.046) and reduced parasympathetic (HF, p = 0.046). For individuals SCI low complete to tDCS changed the HRV reduction sympathetic (LF, p = 0.017) and increased parasympathetic (HF, p = 0.017). Conclusions: The present study suggests that anodal tDCS applied on the motor cortex bilaterally could modulate the ANS balance in people with spinal cord injury and that this effect is dependent on the degree and level of injury.

A neuromodulação do córtex pré-frontal dorsolateral na percepção de tempo em contexto neutro ou emocionalmente ativo

The time perception is critical for environmental adaptation in humans and other species. The temporal processing, has evolved through different neural systems, each responsible for processing different time scales. Among the most studied scales is that spans the arrangement of seconds to minutes. Evidence suggests that the dorsolateral prefrontal (DLPFC) cortex has relationship with the time perception scale of seconds. However, it is unclear whether the deficit of time perception in patients with brain injuries or even "reversible lesions" caused by transcranial magnetic stimulation (TMS) in this region, whether by disruption of other cognitive processes (such as attention and working memory) or the time perception itself. Studies also link the region of DLPFC in emotional regulation and specifically the judgment and emotional anticipation. Given this, our objective was to study the role of the dorsolateral prefrontal cortex in the time perception intervals of active and emotionally neutral stimuli, from the effects of cortical modulation by transcranial direct current stimulation (tDCS), through the cortical excitation (anodic current), inhibition (cathode current) and control (sham) using the ranges of 4 and 8 seconds. Our results showed that there is an underestimation when the picture was presented by 8 seconds, with the anodic current in the right DLPFC, there is an underestimation and with cathodic current in the left DLPFC, there is an overestimation of the time reproduction with neutral ones. The cathodic current over the left DLPFC leads to an inverse effect of neutral ones, an underestimation of time with negative pictures. Positive or negative pictures improved estimates for 8 second and positive pictures inhibited the effect of tDCS in DLPFC in estimating time to 4 seconds. With this work, we conclude that the DLPFC plays a key role in the o time perception and largely corresponds to the stages of memory and decision on the internal clock model. The left hemisphere participates in the perception of time in both active and emotionally neutral contexts, and we can conclude that the ETCC and an effective method to study the cortical functions in the time perception in terms of cause and effect.

Pseudoneglect and visual attention networks

Pseudoneglect represents the tendency for healthy individuals to show a slight but consistent bias in favour of stimuli appearing in the left visual field. The bias is often measured using variants of the line bisection task. An accurate model of the functional architecture of the visuospatial attention system must account for this widely observed phenomenon, as well as for modulation of the direction and magnitude of the bias within individuals by a variety of factors relating to the state of the participant and/or stimulus characteristics. To date, the neural correlates of pseudoneglect remain relatively unmapped. In the current thesis, I employed a combination of psychophysical measurements, electroencephalography (EEG) recording and transcranial direct current stimulation (tDCS) in an attempt to probe the neural generator(s) of pseudoneglect. In particular, I wished to utilise and investigate some of the factors known to modulate the bias (including age, time-on-task and the length of the to-be-bisected line) in order to identify neural processes and activity that are necessary and sufficient for the lateralized bias to arise. Across four experiments utilising a computerized version of a perceptual line bisection task, pseudoneglect was consistently observed at baseline in healthy young participants. However, decreased line length (experiments 1, 2 and 3), time-on-task (experiment 1) and healthy aging (experiment 3) were all found to modulate the bias. Specifically, all three modulations induced a rightward shift in subjective midpoint estimation. Additionally, the line length and time-on-task effects (experiment 1) and the line length and aging effects (experiment 3) were found to have additive relationships. In experiment 2, EEG measurements revealed the line length effect to be reflected in neural activity 100 – 200ms post-stimulus onset over source estimated posterior regions of the right hemisphere (RH: temporo-parietal junction (TPJ)). Long lines induced a hemispheric asymmetry in processing (in favour of the RH) during this period that was absent in short lines. In experiment 4, bi-parietal tDCS (Left Anodal/Right Cathodal) induced a polarity-specific rightward shift in bias, highlighting the crucial role played by parietal cortex in the genesis of pseudoneglect. The opposite polarity (Left Cathodal/Right Anodal) did not induce a change in bias. The combined results from the four experiments of the current thesis provide converging evidence as to the crucial role played by the RH in the genesis of pseudoneglect and in the processing of visual input more generally. The reduction in pseudoneglect with decreased line length, increased time-on-task and healthy aging may be explained by a reduction in RH function, and hence contribution to task processing, induced by each of these modulations. I discuss how behavioural and neuroimaging studies of pseudoneglect (and its various modulators) can provide empirical data upon which accurate formal models of visuospatial attention networks may be based and further tested.

Anodal transcranial direct current stimulation of the motor cortex increases cortical voluntary activation and neural plasticity

INTRODUCTION: We examined the cumulative effect of 4 consecutive bouts of non-invasive brain stimulation on corticospinal plasticity and motor performance, and whether these responses were influenced by the brain-derived neurotrophic factor (BDNF) polymorphism.

METHODS: In a randomized double-blinded cross-over design, changes in strength and indices of corticospinal plasticity were analyzed in 14 adults who were exposed to 4 consecutive sessions of anodal and sham transcranial direct current stimulation (tDCS). Participants also undertook a blood sample for BDNF genotyping (N=13).

RESULTS: We observed a significant increase in isometric wrist flexor strength with transcranial magnetic stimulation revealing increased corticospinal excitability, decreased silent period duration, and increased cortical voluntary activation compared to sham tDCS.

DISCUSSION: The results show that 4 consecutive sessions of anodal tDCS increased cortical voluntary activation manifested as an improvement in strength. Induction of corticospinal plasticity appears to be influenced by the BDNF polymorphism.

Does a combination of virtual reality, neuromodulation and neuroimaging provide a comprehensive platform for neurorehabilitation? - A narrative review of the literature

In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.