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

Proposta de um sistema para avaliação biomecânica de atletas de taekwondo

The Taekwondo is an antique and traditional Korean martial art often used in personal defense, which in the past few years has been considered an Olympic sport. The Taekwondo is known as the ability of using hands and feet in high speed and amplitude scams in direction to the head and to the chest. Currently the Biomechanics has been used as a way to prevent injuries and improve the performance of athletes. The Biomechanics studies the athlete controls and compensates movement s patterns. And it is also possible to perform more functional evaluations of athletes through observation of parameters. These parameters can indicate, for example, the performance of the proprioceptive system, articular stability and muscle strength during specific movements. This research aims to develop a biomechanical analysis through the correlation between muscle activity and kinematic analysis of movements performed by the Taekwondo athletes in a more objective way. For that, during the trainings, biomechanical parameters will be obtained through a movement analysis system based on infrared cameras and reflexive markers. Synchronously, the electromyography activity of the muscles will be collected using wireless electrodes to allowing the athlete s movement freely. For this, it was developed software and synchronism systems to analyze muscle activity to each movement registered by system cameras. To that muscle activity behavior were analyzed, including the fatigue, the concentration of blood lactate were detected via portable device. The data obtained by this system were analyzed by statistical tools and were investigated biomechanical parameters that better assist in the analysis of the movements. It is emphasized that, in this study, the results of each athletes were not compared to results of another athletes, because each one has a different pattern of movement. With the result noted that, despite the difficulties in obtaining information from dynamic contractions, it is possible to detect fatigue by analyzing the parameters obtained by these systems. And the fatigue cause, in the majority cases is consequence of the wrong movements or techniques executed by athletes. We believe that this system can be used for study another\'s sports or another biomechanical analysis.Fundação de Amparo a Pesquisa do Estado de Minas GeraisMestre em CiênciasO Taekwondo é uma arte marcial coreana antiga e tradicional, usada para a defesa pessoal e reconhecida atualmente como esporte olímpico. O Taekwondo é conhecido pela capacidade de seus praticantes em usar as mãos e os pés na execução de golpes de alta velocidade e amplitude em direção à cabeça ou ao peito do adversário. A biomecânica esportiva, responsável pelo estudo da compensação dos padrões de movimentos adotados nos esportes, tem sido muito utilizada para prevenir lesões e melhorar o desempenho dos atleta por meio da observação de parâmetros biomecânicos. Estes parâmetros podem indicar, por exemplo, o desempenho do sistema proprioceptivo, estabilidade articular e força muscular durante os movimentos específicos, permitindo, de uma maneira geral, a realização de avaliações mais funcionais de atletas. O objetivo desta pesquisa é desenvolver uma análise biomecânica por meio da correlação entre a atividade muscular e análise cinemática dos movimentos realizados pelos atletas de Taekwondo de forma mais objetiva. Para isso, durante os treinamentos, parâmetros biomecânicos serão obtidos através de um sistema de captura de movimento composto por câmeras infravermelhas e marcadores reflexivos. De forma simultânea, será realizada a aquisição da atividade muscular por meio de eletromiografos sem fio, permitindo a livre movimentação do atleta durante a coleta. Para o desenvolvimento deste trabalho, foram desenvolvidos softwares e sistemas de sincronismo que permitiram a análise da atividade muscular para cada movimento registrado pelas câmeras do sistema. No entanto, para que o comportamento da atividade muscular pudesse ser analisado mais a fundo, buscando formas de se evitar lesões musculares associadas à fadiga, neste estudo também foi realizada a coleta da concentração de lactato no sangue por meio de um dispositivo portátil. Os parâmetros biomecânicos observados e os dados obtidos pelo sistema desenvolvido foram analisados por ferramentas estatísticas e, por meio dos resultados, observou-se que, apesar das dificuldades na obtenção de informações a partir de contrações dinâmicas, é possível detectar a fadiga e a suas causas, que mostrou ser, na maioria dos caso, consequência de movimentos ou técnicas de movimento errôneas executados pelos atletas. Portanto, concluiu-se que esse sistema é capaz de realizar a avaliação biomecânica de aletas e acredita-se que ele pode ser usado para o estudo de outros esportes ou outras análises biomecânicas

Motor cortex activation with serious games in adolescents with hemiparetic cerebral palsy

Children diagnosed with hemiparetic cerebral palsy are characterized by pronounced motor deficits on one side of the body, often accompanied by perceptual, cognitive, communicative and behavioral disorders. As a way to analyze the brain activity of this population during a motor and cognitive activity, this study aim to compare the electroencephalographic signs of children with typical development and children diagnosed with hemiparetic cerebral palsy (left and right) during the execution of a voluntary movement, with and without the use of a motivational game. We evaluated 40 children (20 with hemiparetic cerebral palsy and 20 with typical development) of both genders and with ages ranging from 6 to 12 years of age. The data collection consisted of two steps: (1) Acquisition of electroencephalographic signals and capture of the three-dimensional trajectory of the movements during the execution of a reach motor task (first study); (2) Acquisition of the electroencephalographic signals and capture of the three-dimensional trajectory of the movements during the execution of a motor task of reach motivated by a game (second study). Kinematic data were extracted from the trajectory of the movements and from these were extracted the execution times of each phase of the movement, the exact moment the volunteer started the task, and the intervals of analysis of the brain activity were defined. Electroencephalographic data were processed in order to obtain information about the synchronizations and desynchronizations related to the event of the mu and beta waves, spectral perturbations related to the event and the cortical reorganization for each of the studies. Subsequently the data were analyzed statistically through the Unidirectional ANOVA Test, using the Bootsrap resampling method. The results of this study revealed significant differences between the analyzed groups, mainly for the cerebral behavior observed during the movement performed in the two studies. However, it was observed that for most children with cerebral palsy there were no significant differences between the data obtained at the time of motor planning, especially for the second study. It is believed that this is one of the main factors for motor impairment and oscillatory brain behavior during the development of activities with non-paretic and paretic limbs.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorTese (Doutorado)As crianças diagnosticadas com paralisia cerebral hemiparética apresentam como característica déficits motores pronunciados em um lado do corpo acompanhadas, frequentemente, de perturbações perceptivas, cognitivas, comunicativas e comportamentais. Como forma de analisar a atividade cerebral dessa população durante uma atividade motora e cognitiva, este estudo tem como objetivo comparar os sinais eletroencefalográficos de crianças com desenvolvimento típico e crianças diagnosticadas com paralisia cerebral hemiparética (esquerda e direita) durante a execução de um movimento voluntário, com e sem o uso de um jogo sério. Foram avaliadas 40 crianças (20 com paralisia cerebral hemiparética e 20 com desenvolvimento típico) de ambos os gêneros e com faixa etária entre 6 e 14 anos de idade. A coleta de dados foi composta por duas etapas: (1) Aquisição dos sinais eletroencefalográficos e captura da trajetória tridimensional dos movimentos durante a execução de uma tarefa motora de alcance (primeiro estudo); (2) Aquisição dos sinais eletroencefalográficos e captura da trajetória tridimensional dos movimentos durante a execução de uma tarefa motora de alcance motivada por um jogo (segundo estudo). Dados cinemáticos foram extraídos a partir da trajetória dos movimentos e destes foram extraídos os tempos de execução de cada fase do movimento, o exato momento em que o voluntário iniciou a tarefa, e definidas os intervalos de análise da atividade cerebral. Os dados eletroencefalográficos foram processados a fim de obter informações quanto as sincronizações e dessincronizações relacionadas ao evento das ondas mu e beta, perturbações espectrais relacionados ao evento e a reorganização cortical para cada um dos estudos. Posteriormente os dados foram analisados estatisticamente por meio do Teste ANOVA Unidirecional, utilizando o método de reamostragem Bootsrap. Os resultados desse estudo revelaram diferenças significativas entre os grupos analisados, principalmente para o comportamento cerebral observado durante o movimento executado nos dois estudos. Contudo, observou-se que para a maioria das crianças com paralisia cerebral não foram encontradas diferenças significativas entre os dados obtidos no instante do planejamento motor, principalmente para o segundo estudo. Acredita-se que esse seja um dos principais fatores para o comprometimento motor e comportamento cerebral oscilatório durante o desenvolvimento das atividades com os membros paréticos e não paréticos

Using the cell phone while standing or walking affects balance and mobility in people with Parkinson's disease

Background Cell phones are part of peoples' lives. The literature indicates risks when cell phones are used during a secondary motor task. Studies addressing this topic in people with Parkinson's disease are still scarce. Objective To investigate the impact of daily dual tasks with cell phone on balance and mobility in people with Parkinson's disease, compared to healthy control peers. Methods Participants with Parkinson's disease and controls underwent three motor tasks: (1) Standing and walking without using a cell phone; (2) Standing and walking while talking on the phone; and (3) Standing and walking while texting messages on the phone. Assessments involved balance and mobility tests. Statistical analysis was performed with multivariate analysis of variance, comparing main effect for group (Parkinson's disease × control), task (using × not using cell phone) and interactions (group × task). Significance was set at 5%. Effect sizes are reported. Results Participants with Parkinson's disease showed worse balance (p = 0.001, effect size of 0.471) and mobility (p = 0.001, effect size of 0.472) than control peers. The use of cell phone while performing a secondary motor task affected both groups (p = 0.005, effect size of 0.673 for balance and p = 0.001, effect size of 0.549 for mobility). The dual task impact, however, was higher in the Parkinson's disease group (p = 0.009, effect size of 0.407 for mobility). Conclusion Daily dual tasks with cell phones increase imbalance and mobility risks in Parkinson's disease. People should be careful when using their cell phone while standing or walking

Brain activity and upper limb movement analysis in children with Down syndrome undergoing transcranial direct current stimulation combined with virtual reality training : study protocol for a randomized controlled trial

Abstract: Background: Children with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability. Methods/design: Two investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1—cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05). Discussion: The optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions. Trial registration: Brazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator