Effect of Transcranial Direct-Current Stimulation Combined with Treadmill Training on Balance and Functional Performance in Children with Cerebral Palsy: A Double-Blind Randomized Controlled Trial

Background: Cerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy. Methods: A double-blind randomized controlled study was carried out with 24 children aged five to 12 years with cerebral palsy randomly allocated to two intervention groups (blocks of six and stratified based on GMFCS level (levels I-II or level III).The experimental group (12 children) was submitted to treadmill training and anodal stimulation of the primary motor cortex. The control group (12 children) was submitted to treadmill training and placebo transcranial direct-current stimulation. Training was performed in five weekly sessions for 2 weeks. Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention, one week after the completion of the intervention and one month after the completion of the intervention. All patients and two examiners were blinded to the allocation of the children to the different groups. Results: The experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway (eyes open and closed; p<0.05), mediolateral sway (eyes closed; p<0.05) and the Pediatric Balance Scale both one week and one month after the completion of the protocol. Conclusion: Gait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy. Trial Registration Ensaiosclinicos.gov.br/RBR-9B5DH

Atualizações do impacto da atividade física na hipertensão arterial sistêmica

O objetivo do atual estudo é esclarecer a associação entre a Hipertensão Arterial Sistêmica e a prática de exercício físico, de forma que seja clara quais os efeitos dessa relação. Trata-se de uma revisão integrativa, que foi realizada através de uma pesquisa na base de dados PubMed, com os Descritores em Ciências da Saúde (DeCS) a seguir: physical; exercise; hypertension; arterial. Sendo selecionados aqueles que foram publicados no ano de 2023 e nos idiomas Português e Inglês. Sendo encontrados 49 artigos, no entanto foram excluídos 42, totalizando 7 artigos revisados. A hipertensão se resume em uma doença sistêmica, de evolução crônica e silenciosa, podendo afetar órgãos vitais como os rins e podendo afetar sistemas vitais como o sistema cardiovascular, mas que pode ser prevenida e tratada com o auxílio da prática de exercício físico. Sendo uma doença, que apesar de não ser aguda, pode ocasionar problemas agudos como o infarto do miocárdio e o acidente vascular cerebral. Tendo em vista sua gravidade e suas sequelas, além dos benefícios que se pode ter da associação da atividade física no método terapêutico, faz-se necessário um apanhado daquilo que a ciência traz de mais recente no que se refere a essa relação

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial

Background: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. Methods/design A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. Discussion This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. Trial registration ReBEC RBR-9B5DH

NEU: recurso de aproximação do estudante de medicina com a comunidade

It is part of the training of the medical professional the strengthening of citizenship and the capacitation in health promotion and disease prevention in different sociocultural realities. Thus, the Extension Nucleus of Unifenas - BH (NEU) was planned as a resource that will provide an exchange of knowledge among medical academics, teachers and community. Objective: NEU proposes to bring medical students closer to the Brazilian reality, as well as to work in needy communities through varied projects. Method: In July of 2016, the NEU made its first expedition in Urucânia - MG, with a duration of seven days. For children and teenagers, music workshops were developed, sanitation in the APAE and topics such as violence and sex education were discussed. With the adult population other topics were discussed: violence against women, affective bond, human health and breastfeeding. Coming from the town’s solicitation, a project for drug user rehabilitation center was developed. With the elderly population: hypertension and diabetes workshop, walking groups and asylum visits were conducted. The applied workshops included several target groups: educators, municipal health agents and community leaders. Results: The actions promoted by the NEU were positive for the population of Urucânia, as well as for the members of the group. Thereafter, several reflections were generated that provided a set for an academic and personal formation of the members. In relation to the difficulties, the group faced, in some moments, lack of infrastructure; lack of interest in some institutions and unpredictability of the public. Conclusion: The actions carried out by NEU, in this expedition, contributed not only to the development of the town, but also to strengthen the concept of social responsibility between the academic program and community.Fazem parte da formação do profissional médico o fortalecimento da cidadania e a capacitação para atuar na promoção e prevenção da saúde em diferentes realidades socioculturais. Assim, o Núcleo de Extensão Universitária (NEU) do curso de medicina – UNIFENAS - BH foi planejado como um recurso que proporcionará o intercâmbio de saberes entre acadêmicos de medicina, docentes e a comunidade. Objetivo: o NEU propõe uma maior vinculação entre universitários e membros da comunidade, a fim de aproximá-los da realidade brasileira, bem como atuar em localidades carentes por meio de projetos variados, ressaltando a importância da medicina humanizada. Método: Em julho de 2016, o NEU, durante sete dias, realizou sua primeira expedição em Urucânia – MG. Foram desenvolvidas oficinas de música, higienização e abordados temas, como violência e educação sexual para crianças e adolescentes. Com a população adulta foi debatido sobre violência contra a mulher, vínculo afetivo, saúde do homem e amamentação. Por demanda da cidade, foi incluído um projeto para o centro de reabilitação de usuários de drogas. Para o público idoso a abordagem incluiu oficinas de hipertensão e diabetes, grupo de caminhada e visitas ao asilo. Além do público-alvo já mencionado, as atividades abrangeram educadores, agentes municipais de saúde e lideranças comunitárias. Resultados: As ações promovidas pelo NEU foram positivas para a população de Urucânia, bem como para os membros do grupo, possibilitando reflexões que engrandeceram a formação acadêmica e pessoal dos integrantes. Em relação às dificuldades, o grupo enfrentou, em alguns momentos, falta de estrutura, desinteresse de algumas instituições e a imprevisibilidade do público. Conclusão: Nessa expedição, a verdadeira essência do ser médico se mostrou efetiva, contribuindo para o desenvolvimento do município e para o fortalecimento do conceito de corresponsabilidade social entre acadêmico e comunidade

Protocol Proposal For The Care Of The Person With Venous Ulcer

Objective: To propose a care protocol for the care of the person with a venous ulcer in highly complex services. Methods and results: This is a methodological study, in three stages: literature review, validation of content and validation in the clinical context. The literature review was carried out from June to August/2011, being the basis for the construction of the Protocol for Venous Ulcers. The content validation included 53 judges (44 nurses, 8 physicians and 1 physiotherapist) selected through the Lattes platform to evaluate the items of the protocol. Validation in the clinical context occurred at the University Hospital Onofre Lopes, in Natal/RN with four judges (nurses), who worked in pairs, evaluating 32 patients with venous ulcers. The protocol was validated with 15 categories: sociodemographic data; anamnesis; examinations; ulcer characteristics; care with the lesion and perilesional area; medicines used to treat the lesion; evaluation and treatment of pain; surgical treatment of chronic venous disease; recurrence prevention (clinical and educational strategies); reference; counter-reference; and quality of life. Conclusion: The validated protocol regarding content and clinical context was applicable. Its implementation is a viable measure that assists in the reorientation of the team in high complexity services, aiming at wound healing and restoration of the patient´s integral health. Keywords: Varicose ulcer; Tertiary Health Care; Protocols; Validation studies

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost