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

Critérios de elegibilidade e efeitos da rizotomia dorsal seletiva sobre a função motora e marcha de crianças e adolescentes com paralisia cerebral: revisão sistemática

Introdução: A espasticidade pode ser considerada como uma das mais impactantes alterações secundárias à paralisia cerebral. Nosúltimos anos, a Rizotomia Dorsal Seletiva (RDS) tem sido destacada como um procedimento cirúrgico eficaz para o tratamento da espasticidade dos membros inferiores de crianças com paralisia cerebral. Objetivos: Verificar por meio de uma revisão sistemática da literatura os efeitos em médio e longo prazo, da RDS sobre a função motora grossa e a marcha em crianças e adolescentes com paralisia cerebral. Além de averiguar se existe um consenso na literatura sobre oscritérios de indicação da RDS. Métodos: Uma pesquisa foi realizada na rede internacional nos bancos de dados de acordo com os seguintes critérios de inclusão: (1) desenho: estudos envolvendo o acompanhamento pós-operatório longitudinal; (2) população: crianças e adolescentes com paralisia cerebral espástica; (3) intervenção: RDS; (4) grupo controle com intervenção diferente ou sem intervenção; (5) desfecho: melhora da função motora, melhora da espasticidade e desempenho da marcha. Resultados: Foi encontrado um total de seis artigos que preencheram os critérios de inclusão e foram utilizadosnesta revisão. Nos estudos analisados, foram observadas melhoras significativas na variável cinemática da marcha com diminuição da espasticidade no grupo RDS. Conclusão: A RDS diminui a espasticidade com efeitos positivos sobre a função motora grossa e a marcha de crianças e adolescentes com paralisia cerebral, porém estudos adicionais são necessários para esclarecer a eficácia da RDS aplicada em grupos musculares de membros inferiores.

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

Protocol study for a randomised, controlled, double-blind, clinical trial involving virtual reality and anodal transcranial direct current stimulation for the improvement of upper limb motor function in children with Down syndrome

Introduction Down syndrome results in neuromotor impairment that affects selective motor control, compromising the acquisition of motor skills and functional independence. The aim of the proposed study is to evaluate and compare the effects of multiple-monopolar anodal transcranial direct current stimulation and sham stimulation over the primary motor cortex during upper limb motor training involving virtual reality on motor control, muscle activity, cerebral activity and functional independence. Methods and analysis A randomised, controlled, double-blind, clinical trial is proposed. The calculation of the sample size will be defined based on the results of a pilot study involving the same methods. The participants will be randomly allocated to two groups. Evaluations will be conducted before and after the intervention as well as 1 month after the end of the intervention process. At each evaluation, three-dimensional analysis of upper limb movement muscle activity will be measured using electromyography, cerebral activity will be measured using an electroencephalogram system and intellectual capacity will be assessed using the Wechsler Intelligence Scale for Children. Virtual reality training will be performed three times a week (one 20 min session per day) for a total of 10 sessions. During the protocol, transcranial stimulation will be administered concomitantly to upper limb motor training. The results will be analysed statistically, with a p valueâ\u89¤0.05 considered indicative of statistical significance. Ethical aspects and publicity The present study received approval from the Institutional Review Board of Universidade Nove de Julho (Sao Paulo,Brazil) under process number 1.540.113 and is registered with the Brazilian Registry of Clinical Trials (N° RBR3PHPXB). The participating institutions have presented a declaration of participation. The volunteers will be permitted to drop out of the study at any time with no negative repercussions. The results will be published and will contribute evidence regarding the use of this type of intervention on children

Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial

The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy

Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial

The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy

A comparison of treadmill training and overground walking in ambulant children with cerebral palsy: randomized controlled clinical trial

Objective: Compare the effects of treadmill training and training with overground walking (both without partial weight support) on motor skills in children with cerebral palsy.Design: Randomized controlled clinical trial.Setting: Physical therapy clinics.Subjects: Thirty-six children with cerebral palsy (levels I-III of the Gross Motor Functional Classification System) randomly divided into two intervention groups.Interventions: Experimental group (17 children) submitted to treadmill training without partial weight support. Overground walking group (18 children) submitted to gait training on a fixed surface (ground). Training was performed for seven consecutive weeks (two sessions per week), with four subsequent weeks of follow-up.Results: Both groups demonstrated improvements on the 6-minute walk test (experimental group from 227.4 SD 49.4 to 377.2 SD 93.0; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0), timed up-and-go test (experimental group from 14.3 SD 2.9 to 7.8 SD 2.2; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5), Pediatric Evaluation Disability Inventory (experimental group from 128.0 SD 19.9 to 139.0 SD 18.4; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2), Gross Motor Function Measure-88 (experimental group from 81.6 SD 8.7 to 93.0 SD 5.7; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2), Berg Balance Scale (experimental group from 34.9 SD 8.5 to 46.7 SD 7.6; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8) after treatment. the experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up (p < 0.05).Conclusion: Treadmill training proved more effective than training with overground walking regarding functional mobility, functional performance, gross motor function and functional balance in children with cerebral palsy.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Nine July, São Paulo, BrazilCtr Pediat Neurosurg CENEPE, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Distúrbios osteomusculares autorreferidos em funcionários de supermercado

Objective: To determine the prevalence of self-reported pains in employees of a supermarket chain. Methods: A descriptive cross-sectional observational study conducted in a supermarket chain in the city of São Paulo from January 2011 to February 2012, with a sample of 300 employees. Information on sociodemographics, physical activity and characterization of the labor process were collected. It was assumed as the outcome the reports of symptoms of musculoskeletal pain obtained through The Nordic Musculoskeletal Questionnaire. For statistical analysis, frequencies and percentages were calculated. Results: The population was mostly composed of young, single women who attended up to the 2nd year of high school. Only 25 % of employees performed physical activities. All employees had presented sometype of musculoskeletal symptoms in the last 12 months, and half of them (50%) had three or more symptoms. The pain predominantly occurred in the lower limbs, followed by the thoracic and lumbar spine. Age may be associated with the onset of neck pain. In addition, the job is associated with pain in elbows, lumbar spine and legs. Finally, the lumbar spine is the region with the highest association among the independent variables. Conclusion: It was verified that the employees investigated in the supermarket chain presented a prevalence of pains or some type of musculoskeletal symptom in the past 12 months in the lower limb, regions that make up the spine, wrists, fingers and hands. doi:10.5020/18061230.2014.p13Objetivo: Verificar la prevalencia de dolores auto reportadas por empleados de una red de centros comerciales. Métodos: Estudio observacional, transversal y descriptivo, realizado en una red de centros comerciales en una capital entre enero de 2011 y febrero de 2012 con una muestra de 300 empleados. Fueron recogidas informaciones sociodemográficas, de actividad física y caracterización del proceso de trabajo. Se asumió como desenlace el relato de síntomas de dolores osteomusculares a través del Cuestionario Nórdico de Síntomas Osteomusculares. En el análisis estadístico fueron calculados frecuencias y porcentajes. Resultados: La población era en su mayoría del sexo femenino, joven, soltera y de educación secundaria como máxima escolaridad. Solamente el 25% de los empleados realizaban actividades físicas. Todos habían presentado algún tipo de sintomatología en la musculatura esquelética de los últimos 12 meses y la mitad (50%) presentó tres o más síntomas. El dolor fue predominante en los miembros inferiores, seguido de la columna torácica y lumbar. La edad puede estar asociada a la aparición de dolores del cuello. Además, la función se asocia a dolores del codo, columna lumbar y miembros inferiores. Por fin, la columna lumbar es la región con más asociación de las variables independientes. Conclusión: Se identificó que los empleados investigados de la referida red de centro comercial presentaron prevalencia de dolores o algún síntoma musculoesquelético en los últimos 12 meses que incluyeron el miembro inferior, regiones que constituyen la columna vertebral, puños, dedos y manos. doi:10.5020/18061230.2014.p13Objetivo: Verificar a prevalência das algias autorreferidas em funcionários de uma rede de supermercados. Métodos: Estudo observacional, transversal, descritivo, realizado em uma rede de supermercados da capital paulista, no período de janeiro de 2011 a fevereiro de 2012, em uma amostra de 300 funcionários. Foram coletadas informações sociodemográficas, de atividade física e caracterização do processo de trabalho. Assumiu-se como desfecho o relato de sintomas de dores osteomusculares, por meio do Questionário Nórdico de Sintomas Osteomusculares. Para análise estatística, foram calculadas frequências e porcentagens. Resultados: A população, em sua maioria, era do sexo feminino, jovem, solteira e possuía escolaridade até o 2º grau. Apenas 25% dos funcionários realizavam atividades físicas. Todos haviam apresentado algum tipo de sintomatologia musculoesquelética nos últimos 12 meses e metade (50%) apresentou três ou mais sintomas. A dor apareceu predominante nos membros inferiores, seguida pela coluna torácica e lombar. A idade pode estar associada ao aparecimento de dores no pescoço. Além disso, a função associa-se a dores no cotovelo, coluna lombar e membros inferiores. Por fim, a coluna lombar é a região com maior associação dentre as variáveis independentes. Conclusão: Identificou-se que os funcionários investigados da referida rede de supermercado apresentavam prevalência de algias ou algum sintoma musculoesquelético nos últimos 12 meses, que englobaram o membro inferior, regiões que compõem a coluna vertebral, região dos punhos, dedos e mãos. doi:10.5020/18061230.2014.p1

Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review

: [Purpose] To describe (1) the current knowledge on gait and postural control in individuals with Down syndrome in terms of spatiotemporal, kinematics and kinetics, and (2) relevant rehabilitation strategies. [Methods] Randomized and non-randomized clinical trials published between January 1997 and October 2019 were selected by searching four scientific databases. We included studies on patients with Down syndrome involving gait analysis or postural control. A custom data-extraction and appraisal form was developed to collect the key features of each article. The PEDro Scale was used to evaluate the methodological quality of the studies. [Results] A total of 37 out of 146 cross-sectional and longitudinal studies were included in the review. The main abnormalities included: reduction of gait velocity and step length, poor static balance with increased anteroposterior and mediolateral oscillations and a larger step width. [Conclusion] A number of compensatory patterns during movement was observed, with a direct influence on improvements in stability and postural control throughout daily life. Intensive gait training at an early age appears to produce long-term improvements in this population. Future research should focus on the interaction between the motor and cognitive function, and on the functional effects due to the exposure to an enriched environment