ABSTRACT
ABSTRACT Introduction Cognitive components are necessary to maintain posture during external perturbations. However, few studies have investigated postural control when external perturbations are associated with a concomitant cognitive task (DT). Objectives To analyze the behavior of reactive adjustments after perturbation with different intensities and displacements in active young adults; and to analyze the influence of DT on predictive and reactive adjustments in different perturbation conditions. Methods Twenty-eight physically active young adults stood on an item of equipment that produced displacements of the base. Four experimental conditions were introduced in a single task (ST) and DT (cognitive-report how many times a pre-established number appeared in the audio): 1 (5 cm and 10 cm/s); 2 (5 cm and 25 cm/s); 3 (12 cm and 10 cm/s) and 4 (12 cm and 25 cm/s). Three attempts were carried out for each condition (total=24). Center of pressure (CoP) parameters were analyzed considering the following windows: predictive (-250 to +50 ms), reactive 1 (+50 to +200 ms) and reactive 2 (+200 to +700 ms), in comparison to the start of the CoP activity. One-way ANOVAs were performed to analyze predictive adjustments, while two-way ANOVAs with factor for task (STxDT) and condition (1x2x3x4), with repeated measurements, were performed for the reactive adjustments. Results One-way ANOVA (predictive) indicated that the subjects had higher CoP parameters in ST vs DT. In reactive adjustments 1 and 2, ANOVA indicated greater CoP parameters in condition 2 and 4 when compared to 1 and 3, and in the ST vs DT. The subjects took longer to recover stable position in conditions 1 and 3 than in conditions 2 and 4. Conclusion Perturbation intensity has a greater influence on postural adjustments to maintain balance than on magnitude. Moreover, the association of cognitive tasks with external perturbation decreases CoP oscillation. Therefore, cognitive resources play an important role in postural control after perturbation. Level of evidence III; Study of nonconsecutive patients, with no "gold" standard applied uniformly.
RESUMO Introdução Componentes cognitivos são necessários para manter a postura nas perturbações externas. Porém, poucos estudos investigaram o controle postural quando perturbações externas são associadas à tarefa cognitiva concomitante (TD). Objetivo Analisar o comportamento dos ajustes reativos após perturbação com diferentes intensidades e deslocamentos em adultos jovens ativos; e analisar a influência da TD nos ajustes preditivos e reativos em diferentes condições de perturbação. Métodos Permaneceram em pé sobre um equipamento que provocou deslocamento da base de suporte 28 adultos jovens fisicamente ativos. Quatro condições experimentais foram realizadas em tarefa simples (TS) e TD (cognitiva-reportar quantas vezes um número preestabelecido apareceu no áudio): uma (5cm e 10cm/s); duas (5cm e 25cm/s); três (12cm e 10cm/s) e quatro (12cm e 25cm/s). Foram realizadas três tentativas para cada condição (total=24). Os parâmetros do centro de pressão (CoP) foram analisados em janelamentos: preditivo (-250 a +50ms), reativo 1 (+50 a +200ms) e reativo 2 (+200 a +700ms), em relação ao início da atividade do CoP. ANOVAs one-way foram realizadas para análise dos ajustes preditivos. Já para os ajustes reativos, foram realizadas ANOVAs two-way com fator para tarefa (TS×TD) e condição (1×2×3×4) com medidas repetidas. Resultados ANOVA one-way (preditivo) apontou que os indivíduos apresentaram maiores parâmetros do CoP na TS em relação à TD. Nos reativos 1 e 2, a ANOVA apontou maiores parâmetros do CoP na segunda e na quarta condição quando comparada à primeira e à terceira, e na TS em relação às TD. Apresentaram maior tempo para recuperar a posição estável na primeira e na terceira condição em comparação à segunda e à quarta. Conclusão A intensidade da perturbação influencia mais nos ajustes posturais para manutenção do equilíbrio do que a magnitude. Ainda, as tarefas cognitivas concomitantes à perturbação externa diminuem a oscilação do CoP. Com isso, recursos cognitivos possuem relevância no controle postural após perturbação. Nível de evidência III; Estudos de pacientes não consecutivos, sem padrão de referência "ouro" aplicado uniformemente.
RESUMEN Introducción Los componentes cognitivos son necesarios para mantener la postura en perturbaciones externas. Sin embargo, pocos estudios investigaron el control postural cuando son asociadas perturbaciones a la tarea cognitiva concomitante (TD). Objetivo Analizar el comportamiento de los ajustes reactivos después de una perturbación con diferentes intensidades y desplazamientos en adultos jóvenes activos; y analizar la influencia de la TD en ajustes predictivos y reactivos en diferentes condiciones de perturbación. Métodos Veintiocho adultos jóvenes físicamente activos permanecieron en pie sobre un equipo que provocó desplazamiento de la base de soporte. Cuatro condiciones experimentales fueron realizadas en tareas simples (TS) y TD (cognitiva-reportar cuántas veces un número preestablecido apareció en el audio): una (5 cm y 10 cm/s); dos (5 cm y 25 cm/s); tres (12 cm y 10 cm/s) y cuatro (12 cm y 25 cm/s). Fueron realizadas tres tentativas para cada condición (total=24). Los parámetros del centro de presión (CoP) fueron analizados en ventanas: predictiva (-250 a +50 ms), reactiva 1 (+50 a +200 ms) y reactiva 2 (+200 a +700 ms) en relación al inicio de la actividad del CoP. Fueron realizadas ANOVAs one-way para análisis de los ajustes predictivos. Fueron realizadas ANOVAs two-way con factor para tarea (TSxTD) y condición (1x2x3x4) con medidas repetidas para análisis de los ajustes reactivos. Resultados ANOVA one-way (predictivo) mostró que los individuos presentaron parámetros mayores de CoP en TS con relación a TD. En los reactivos 1 y 2, ANOVA mostró parámetros del CoP en la segunda y cuarta condición cuando comparada a la primera y la tercera, y en la TS con relación a las TD. Presentaron tiempo mayor para recuperar la posición estable en la primera y tercera condición en comparación a la segunda y la cuarta. Conclusión La intensidad de perturbación influencia más en los ajustes posturales para mantenimiento del equilibrio que la magnitud. Además, las tareas cognitivas concomitantes a la perturbación externa disminuyen la oscilación del CoP. Con eso, los recursos cognitivos poseen relevancia en el control postural después de la perturbación. Nivel de evidencia III; Estudios de pacientes no consecutivos, sin estándar de referencia "oro" aplicado uniformemente.
ABSTRACT
Craniocerebral gunshot injuries [CGI] are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately, more prevalent condition in developing countries, with major armed conflicts which is still persisting, since the main trigger is violence at the national or state level. Management goals of CGI should focus on aggressive resuscitation and correction of coagulopathy; those with stable vital signs should undergo CT scan head at the earliest possible opportunity. Neuroimaging is vital for planning of surgical management, especially to determine the type of surgery, routes of the approach to the surgical target area and extraction of the impacted foreign bodies, however, surgical management is not always indicated. Although subset of such cases may be managed even with non-surgical management. The treatment comprises of immediate life salvaging resuscitative measures including control of the persistent bleeding, care of associated injury, management of raised intracranial pressure, prevention of cerebrospinal fistula formation by primary watertight dural repair and prevention of infection, through extensive debridement of contaminated, macerated or ischemic tissues; preservation of nervous tissue and restoration of anatomic structures through the hermetic sealing of dural and scalp defect. Recently, only few studies of craniocerebral penetrating injuries are published that too involving smaller patients sample sizes; although classic studies in the military and civil situation noticed associated relatively very high mortality and morbidity and psychological as well as economic impact on the affected individual, the family and the health system in providing ongoing care to the sufferers and society at large. Currently various measures are advocated with aim to reduce the incidence of CGI especially in civilian populations. It is highly necessary and immensely urgent to promote research in a neurocritical care of CGI to provide positive impact on improvement of the quality of life and further providing better care and reduction of overall health care cost
ABSTRACT
Craniocerebral gunshot injuries (CGI) are increasingly encountered by neurosurgeons in civilian and urban settings. Unfortunately this is a prevalent condition in developing countries, with major armed conflicts which is not very likely to achieve a high rate of prevention. Management goals should focus on early aggressive, vigorous resuscitation and correction of coagulopathy; those with stable vital signs undergo brain computed tomography scan. Neuroimaging is vital for surgical purposes, especially for determine type surgery, size and location of the approach, route of extraction of the foreign body; however not always surgical management is indicated, there is also the not uncommon decision to choose non-surgical management. The treatment consist of immediate life salvage, through control of persistent bleeding and cerebral decompression; prevention of infection, through extensive debridement of all contaminated, macerated or ischemic tissues; preservation of nervous tissue, through preventing meningocerebral scars; and restoration of anatomic structures through the hermetic seal of dura and scalp. There have been few recent studies involving penetrating craniocerebral injuries, and most studies have been restricted to small numbers of patients; classic studies in military and civil environment have identified that this is a highly lethal or devastating violent condition, able to leave marked consequences for the affected individual, the family and the health system itself. Various measures have been aimed to lower the incidence of CGI, especially in civilians. It is necessarily urgent to promote research in a neurocritical topic such as CGI, looking impact positively the quality of life for those who survive.