Manipulation of human verticality using high-definition transcranial direct current stimulation

Background: Using conventional tDCS over the temporo-parietal junction (TPJ) we previously reported that it is possible to manipulate subjective visual vertical (SVV) and postural control. We also demonstrated that high-definition tDCS (HD-tDCS) can achieve substantially greater cortical stimulation focality than conventional tDCS. However, it is critical to establish dose-response effects using well-defined protocols with relevance to clinically meaningful applications. Objective: To conduct three pilot studies investigating polarity and intensity-dependent effects of HD-tDCS over the right TPJ on behavioral and physiological outcome measures in healthy subjects. We additionally aimed to establish the feasibility, safety, and tolerability of this stimulation protocol. Methods: We designed three separate randomized, double-blind, crossover phase I clinical trials in different cohorts of healthy adults using the same stimulation protocol. The primary outcome measure for trial 1 was SVV; trial 2, weight-bearing asymmetry (WBA); and trial 3, electroencephalography power spectral density (EEG-PSD). The HD-tDCS montage comprised a single central, and 3 surround electrodes (HD-tDCS3x1) over the right TPJ. For each study, we tested 3x2 min HD-tDCS3x1 at 1, 2 and 3 mA; with anode center, cathode center, or sham stimulation, in random order across days. Results: We found significant SVV deviation relative to baseline, specific to the cathode center condition, with consistent direction and increasing with stimulation intensity. We further showed significant WBA with direction governed by stimulation polarity (cathode center, left asymmetry; anode center, right asymmetry). EEG-PSD in the gamma band was significantly increased at 3 mA under the cathode. Conclusions: The present series of studies provide converging evidence for focal neuromodulation that can modify physiology and have behavioral consequences with clinical potential

Training Phantom For Neuronavigation Guided By Ultrasound and Magnetic Ressonance Imaging.

Este trabalho teve como objetivo o desenvolvimento de um phantom de cabeça, com características acústicas e magnéticas equivalentes à do cérebro humano, para a formação de imagens, tanto por ultrasom quanto em ressonância magnética, para uso de treinamento clínico em neuronavegação. Geralmente, nos procedimentos de neurocirurgia, são usadas ambas as modalidades de imagens, sendo a ressonância comumente usada durante o processo préoperatório e, o ultrasom usado durante o procedimento cirúrgico, a fim de localizar a lesão e guiar o ato cirúrgico. Para tanto, o material que mimetiza o tecido cerebral foi desenvolvido a base de gelatina animal e vegetal. Pó de vidro e outras substâncias químicas foram adicionados à gelatina de modo que a atenuação acústica, espalhamento da onda e velocidade acústica ficassem equivalentes ao observado no tecido humano. Para mimetizar o sinal de ressonância magnética, material paramagnético foi adicionado à gelatina de modo que os valores dos tempos de relaxação transversal (T2) e longitudinal (T1) ficassem equivalentes aos observados nos tecidos do cérebro humano. Testes de neuronavegação foram realizados com um sistema desenvolvido no próprio laboratório. Para simular um processo cirúrgico, uma janela de acesso ao tecido cerebral foi criada no lado esquerdo da cabeça. As propriedades acústicas e magnéticas do tecido mimetizador proporcionaram contraste nas imagens de ultrasom e ressonância magnética equivalentes aos observados no tecido do cérebro humano. A morfologia e o tamanho do phantom são equivalentes ao de um cérebro de uma criança de aproximadamente cinco anos. Para avaliar o potencial do phantom como uma ferramenta para treinamento de um processo précirúrgico, foi realizada o préprocessamento e reconstrução 3D do phantom a partir das imagens de ressonância magnética, utilizando um software comercial Brainvoyeger® .The goal of this work was to make a head phantom that can be used either in Ultrasonography (US) or Magnetic Resonance Imaging (MRI) to be applied as guided training for head surgery in a neuronavigation system. Generally, for neurosurgery procedures, both images modality (US and MRI) are used as guide. MRI images are used for previous evaluation of surgery, for localization of the tumor, choice of window on the head for craniotomy and path into the brain to access the tumor. The ultrasonography of the brain is used during the surgery procedure to guide and control the removal of the tumor. The phantom was developed with mimickingtissue material to generate contrast and intensity in the MRI and US image equivalent to that one obtained in human brain. The base material was made of pork gelatin (Bloom 250). The acoustic properties of this material (velocity, attenuation and Speckle) were controlled adding formaldehyde and glass bids. The magnetic properties (T1 and T2 relaxation) were controlled by adding sodiumEDTA and cupric chloride (CuCl2). The morphology and size of the brain were modeled into a head shell of rubber with size and geometry equivalent to a head of a child of approximately 5 years old. The evaluation of the phantom as tools for neuronavigation training was done simulating a surgery procedure. First, a volume of MRI image of the phantom was acquired using a tomography of 1.5 T (Siemens Vision®). After, using a 3D special sensor coupled to micro convex ultrasound transducer, the ultrasound and MRI image, of a same region, was showed simultaneously using a navigator software developed in the own lab by another student. For this evaluation, a craniotomy was done in the right side of the phantom. The 3D reconstruction of the phantom from MRI images volume was evaluated using commercial software Brainvoyeger®. The size, morphology of the head and the US and MRI image quality 12 of the simulated brain were very close to those ones observed in the brain of a young person. This product is very useful as a tool for training neurosurgeons and for calibration of neuronavegator system

Evaluation of brain tissue deformation during surgery: A study in vitro

Durante um procedimento cirúrgico cerebral existe o deslocamento das estruturas que é um problema tipicamente não-rígido e não-linear. A ultrassonografia intra-operatória é utilizada como guia cirúrgico e pode ser utilizada para correção das imagens pré- operatórias através do corregistro rígido entre estas e um sistema de rastreio. Isto torna possível a visualização do deslocamento das estruturas devida a remoção de parte delas durante o ato cirúrgico. O objetivo deste trabalho é um estudo do corregistro livre não-rígido a partir de um modelo in vitro experimental que simule uma situação cirúrgica de retirada de uma inclusão líquida, de forma controlada, para medir os deslocamentos das estruturas próximas, utilizando imagens de ultrassom. Alguns fantomas que simulam o tecido humano nas imagens de ultrassom, feitos de gelatina e parafina, foram escolhidos como modelo. Para realizar o corregistro foi escolhida a transformação geométrica por splines simples (B-Splines), o otimizador Limited- memory BroydenFletcherGoldfarbShanno (LBFGS) e a métrica de similaridade soma do quadrado das diferenças (SQD) e, utilizada a biblioteca Insight Segmentation and Registration Toolkit (ITK), assim como o estudo dos parâmetros adequados para a nossa tarefa. Foi demonstrado para as condições envolvidas que para as imagens em modo B as deformações até 5% e mapas de RF até 9%, sem nenhuma otimização dos parâmetros do corregistro, é factível sem uso excessivo de tempo computacional. Foi analisada a influência da grade em relação a dois tipos diferentes de deformação, ambas com valor de 2%. O tamanho da grade, levando em consideração o erro e o tempo, foram a 5x11 para as imagens em Modo B e 11x17 para os mapas de RF, independentemente do tipo de deformação. Os parâmetros do otimizador (Default Step Length, Gradient Convergence Tolerance e Line Search Accuraccy) também foram avaliados e os valores obtidos foram 1,6; 0,03 e 0,8 para as imagens modo B e 1,2; 0,05 e 1,0 para os mapas de RF. No entanto ao comparamos, utilizando os parâmetros propostos obtidos, os campos de deslocamentos esperados com os gerados pelo modo B e pelos mapas RF, foi demonstrado que os mapas de RF fornecem valores abaixo do esperado e que as imagens em modo B retratam mais fielmente os deslocamentos e isto se deve a escolha do conjunto de valores testados para o otimizador. Foram aplicados estes parâmetros em dois fantomas de parafina- gel e em dois de gelatina. Nos três primeiros fantomas foi retirada um inclusão líquida em várias etapas. Os deslocamentos das estruturas vizinhas foram avaliados durante as etapas de remoção para demonstrar os campos de sução e de torção. No último fantoma, que simula morfologicamente um cérebro humano, foram retiradas, em várias etapas, regiões sólidas, simulando a retirada de tecido e foram calculados os deslocamentos e demonstrados os campos provenientes deste tipo de intervenção. Os trabalhos futuros se concentrarão em utilizar os volumes para medir os movimentos das estruturas e em novos parâmetros do otimizador para os mapas de RF.During a brain surgery there is the displacement of the structures that is a typical non- rigid and non-linear problem. Intraoperative ultrasound is used as a surgical guide and can be used for spatial correction of preoperative images through the rigid registration between these and a track system. This makes it possible to visualize the displacement of structures due to removal of some piece of them during surgery. This work is a study of the non-rigid free-from registration using an experimental in vitro model to simulate a surgical situation withdrawal of a fluid inclusion in a controlled manner, to measure the displacement of nearby structures, using ultrasound images. Some phantoms that simulate the human tissue in the ultrasound images made of gelatin and paraffin were chosen as a model. To perform the registration it was used the framework Insight Segmentation and Registration Toolkit (ITK) and were chosen a geometric transformation of simple splines (B-splines), the Limited-memory Broyden-Fletcher- Goldfarb-Shanno (LBFGS) optimizer and the similarity metric sum of the squared differences (SQD). The search for the suitable parameters for our task are done and it has been shown that for the conditions involved for B-mode images deformations up to 5% and RF maps up to 9% without any optimization of the parameters of registration, is feasible without excessive use of computational time. The influence of the grid was examined for two different types of deformation, both for 2%. The size of the grid, taking into account the error and time were the 5x11 for the images in B mode and 11x17 maps for RF, regardless of the type of deformation. The parameters of the optimizer (Default Step Length, Gradient Convergence Tolerance and Line Search Accuraccy) were also evaluated and the values obtained were 1.6, 0.03 and 0.8 for the B-mode images and 1.2, 0.05 and 1.0 for RF maps. However when comparing the expected displacement fields with the generated by B-mode images and the RF maps, using the obtained parameters, it have been shown that RF maps provide values are lower than expected and that the B-mode images portray more faithfully displacements. This is due to the choice set of values tested for the optimizer. Finally, image registration parameters for B-mode were applied in two paraffin-gel and two gelatin phantoms. In the first three phantoms the fluid inclusion was removed in several stages and the displacements of neighboring structures were evaluated during the removal steps to demonstrate the fields of suction and torsion. The last phantom, which morphologically mimics a human brain, a solid region was removed, also in several stages, simulating a surgery. The displacements were calculated and demonstrated the fields from this type of intervention. Future work will focus on using the volumes to measure the movements of the structures and new parameters test of the optimizer to RF maps

Teste de fadiga de preensão palmar usando contrações dinâmicas e EMG em crianças com espinha bífida

A espinha bífida (EB) consiste no fechamento incompleto do canal espinhal que pode envolver protrusão da medula espinhal, meninges e raízes nervosas.A espinha bífida (EB) consiste no fechamento incompleto do canal espinhal que pode envolver protrusão da medula espinhal, meninges e raízes nervosas

Taxa de desenvolvimento de torque dos músculos do cotovelo em pacientes com espinha bífida

Espinha bífida (EB) cística é o defeito congênito na coluna vertebral, medula espinhal e cérebro com consequente presença de déficits motores e sensoriais principalmente nos membros inferiores, os quais podem dificultar ou impedir a deambulação independente.Espinha bífida (EB) cística é o defeito congênito na coluna vertebral, medula espinhal e cérebro com consequente presença de déficits motores e sensoriais principalmente nos membros inferiores, os quais podem dificultar ou impedir a deambulação independente

Neck Active Movements Assessment in Women with Episodic and Chronic Migraine

We aimed to compare movement parameters and muscle activity during active cervical spine movements between women with episodic or chronic migraine and asymptomatic control. We also assessed the correlations between cervical movement measures with neck-related disability and kinesiophobia. Women with episodic (n = 27; EM) or chronic (n = 27; CM) migraine and headache-free controls (n = 27; CG) performed active cervical movements. Cervical range of motion, angular velocity, and percentage of muscular activation were calculated in a blinded fashion. Compared to CG, the EM and CM groups presented a reduced total range of motion (p < 0.05). Reduced mean angular velocity of cervical movement was also observed in both EM and CM compared to CG (p < 0.05). Total cervical range of motion and mean angular velocity showed weak correlations with disability (r = −0.25 and −0.30, respectively; p < 0.05) and weak-to-moderate correlations with kinesiophobia (r = −0.30 and −0.40, respectively; p < 0.05). No significant correlation was observed between headache features and total cervical range of motion or mean angular velocity (p > 0.05). No differences in the percentage of activation of both flexors and extensors cervical muscles during active neck movements were seen (p > 0.05). In conclusion, episodic and chronic migraines were associated with less mobility and less velocity of neck movements, without differences within muscle activity. Neck disability and kinesiophobia are negative and weakly associated with cervical movement

Characterizing postural oscillation in children and adolescents with hereditary sensorimotor neuropathy.

Charcot Marie Tooth disease (CMT) has negative functional impact on postural control of children; however, it has not been widely studied. Stabilometry can provide insights about postural control and guide preventive interventions in immature perceptual and musculoskeletal systems as those seen in children with CMT. This cross-sectional study aimed to identify and interpret stabilometric variables that reflect the postural control of children with CMT. 53 subjects (age 6-17) were assigned to one of the two groups: CMT (15 males and 14 females with CMT) or Control (13 males and 11 females healthy). Quiet standing was tested in different conditions: with open and closed eyes on regular surface (open-regular, closed-regular) and foam surface (open-foam, closed-foam) using a force platform. The minimum of 2 and maximum of 3 trials of 30 seconds for each test condition provided the classical stabilometric variables and Romberg Quotient (RQv). CMT group showed increase of confidence ellipse area, mean velocity, mediolateral and anteroposterior velocities associated with decreased mean body oscillation frequency, as the complexity of tasks increased. CMT postural deficit was identified by greater and faster sway associated with these lower frequencies, when compared to Control

Knee Kinetics and Kinematics of Young Asymptomatic Participants during Single-Leg Weight-Bearing Tasks: Task and Sex Comparison of a Cross-Sectional Study

This cross-sectional study aimed to describe and compare kinetic and kinematic variables of the knee joint during stair descent, single-leg step down, and single-leg squat tasks. It also aimed to investigate potential sex difference during the tasks. Thirty young asymptomatic individuals (15 males, 15 females) were assessed during the performance of single-leg weight-bearing tasks. The kinetic and kinematic data from the knee were evaluated at the peak knee moment and at peak knee flexion. Single-leg squat presented a higher peak knee moment (2.37 Nm/kg) and the greatest knee moment (1.91 Nm/kg) at knee peak angle in the frontal plane, but the lowest knee flexion (67°) than the other two tasks (p < 0.05). Additionally, the single-leg step down task presented a higher varus knee angle (5.70°) when compared to stair descent (3.71°) (p < 0.001). No substantial sex difference could be observed. In conclusion, in asymptomatic young individuals, single-leg squats presented the greatest demand in the frontal and sagittal planes. Single-leg step down demanded a greater angular displacement than stair descent in the frontal plane. We did not identify a significant difference among the sex and studied variables