Does trans-spinal direct current stimulation modulate the Hoffmann reflexes of healthy individuals? A systematic review and meta-analysisc.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVES: To summarize the available evidence regarding the effects of trans-spinal direct current stimulation (tsDCS) on spinal monosynaptic circuit excitability in healthy individuals. SETTING: Applied Neuroscience Laboratory, Brazil. METHODS: Abstract screening was performed independently by two authors for studies found in the following databases: PubMed, CINAHL, PsycINFO, Web of Science, and LILACS. If the authors were unable to agree, a third reviewer was consulted. Randomized clinical trials that reported monosynaptic reflex measures were included. Methodological quality was assessed using the Cochrane tool for assessing the risk of bias, and information extracted about the spinal neurophysiological and stimulation protocols and their results. RESULTS: The initial search identified 538 studies. After applying the inclusion criteria and excluding duplicates, seven crossover studies were included in the risk of bias assessment, and six studies in the meta-analyses. The meta-analysis results did not show any significant differences between anodal (pooled standardized mean difference (SMD) = -0.09, 95% CI = -0.72 to 0.55, p = 0.79, I2 = 67%) or cathodal tsDCS (pooled SMD = 0.28, 95% CI = -0.07 to 0.63, p = 0.11, I2 = 0%) and sham tsDCS for Hoffmann reflex modulation. CONCLUSION: tsDCS did not affect the Hoffmann reflex, as shown in six studies. However, these findings come from studies with selection, performance and detection bias, and further research is needed to examine the effect of this intervention.

Effects of repetitive transcranial magnetic stimulation and trans-spinal direct current stimulation associated with treadmill exercise in spinal cord and cortical excitability of healthy subjects: A triple-blind, randomized and sham-controlled study.

Repetitive transcranial magnetic stimulation (rTMS) over motor cortex and trans-spinal direct current stimulation (tsDCS) modulate corticospinal circuits in healthy and injured subjects. However, their associated effects with physical exercise is still not defined. This study aimed to investigate the effect of three different settings of rTMS and tsDCS combined with treadmill exercise on spinal cord and cortical excitability of healthy subjects. We performed a triple blind, randomized, sham-controlled crossover study with 12 healthy volunteers who underwent single sessions of rTMS (1Hz, 20Hz and Sham) and tsDCS (anodal, cathodal and Sham) associated with 20 minutes of treadmill walking. Cortical excitability was assessed by motor evoked potential (MEP) and spinal cord excitability by the Hoffmann reflex (Hr), nociceptive flexion reflex (NFR) and homosynaptic depression (HD). All measures were assessed before, immediately, 30 and 60 minutes after the experimental procedures. Our results demonstrated that anodal tsDCS/treadmill exercise reduced MEP's amplitude and NFR's area compared to sham condition, conversely, cathodal tsDCS/treadmill exercise increased NFR's area. High-frequency rTMS increased MEP's amplitude and NFR's area compared to sham condition. Anodal tsDCS/treadmill exercise and 20Hz rTMS/treadmill exercise reduced Hr amplitude up to 30 minutes after stimulation offset and no changes were observed in HD measures. We demonstrated that tsDCS and rTMS combined with treadmill exercise modulated cortical and spinal cord excitability through different mechanisms. tsDCS modulated spinal reflexes in a polarity-dependent way acting at local spinal circuits while rTMS probably promoted changes in the presynaptic inhibition of spinal motoneurons. In addition, the association of two neuromodulatory techniques induced long-lasting changes.

Concurrent validity of the Alberta Infant Motor Scale to detect delayed gross motor development in preterm infants: A comparative study with the Bayley III.

OBJECTIVE: To investigate the concurrent validity of AIMS in relation to the gross motor subtest of the Bayley Scale III/GM in preterm infants. METHODS: A total of 159 gross motor development assessments were performed with the AIMS and Bayley-III/GM. Linear regression was used to assess the correlation between AIMS and Bayley-III/GM scores. The intra-class correlation coefficient (ICC) and the Bland-Altman plot were used to analyze intra- and inter-rater reliability. RESULTS: There was a prevalence of delayed gross motor development of 20.8% according to the Bayley-III/GM, and 11.9% for the 5th percentile and 21.4% for the 10th percentile of AIMS. A good correlation of AIMS with Bayley-III/GM scores and intra- and inter-rater reliability was encountered in this study. CONCLUSION: AIMS proved very capable of detecting delayed gross motor development in preterm infants when compared with the Bayley-III/GM. The 10th percentile of AIMS provided the best combination of indicators, with greater specificity.

Efeito da hidroterapia no condicionamento cardiovascular e na qualidade de vida de pacientes após acidente vascular encefálico / Effects of hydrotherapy on the endurance and quality of life in stroke survivors

Introdução: os efeitos do treinamento cardiovascular são potencializados quando realizados na piscina terapêutica devido às propriedades físicas da água. Objetivo: avaliar os efeitos de um protocolo de hidroterapia na qualidade de vida e no condicionamento cardiovascular de pacientes pós-AVE. Métodos: dez pacientes foram divididos nos grupos: controle (exposto ao protocolo de exercícios no solo) e experimental (submetidos a 10 sessões de hidroterapia). As medidas para frequência cardíaca e respiratória, o número de voltas, saturação de oxigênio durante o teste de caminhada de seis minutos e qualidade de vida segundo a escala EQVE-AVE, foram avaliadas antes e após o programa de atividades. Resultados: houve um aumento expressivo da quantidade de voltas [12,80 ± 2,78 (p=0,01) ] em ambos os grupos e dos escores para a qualidade de vida [196,20±42,92 (p=0,046) ] apenas no grupo experimental em relação a condição inicial. Conclusão: o protocolo de hidroterapia promoveu os mesmos efeitos do treinamento no solo sobre o condicionamento cardiovascular, no entanto, aumentou os escores para qualidade de vida. (AU)

Introduction: Cardiovascular training programs effects are extended when performed in the therapeutic pool due to physical properties of the water. Objective: To evaluate the effects of a hydrotherapy protocol on the quality of life and endurance in stroke survivors. Methods: ten stroke survivors were divided into two groups: control (exposed to a floor exercise protocol) and experimental (underwent to 10 sessions of hydrotherapy). Heart and respiratory rate and oxygen saturation were assessed during the six-minute walk test. Additionally, the number of turns and stroke specific quality of life scale (SS-QOL) were assessed before and after the exercise protocols. Results: there was a significant increase in the number of turns [12.80 ± 2.78 (p = 0.01)] in both groups and in the quality of life scores [196.20 ± 42.92 (p = 0.046)] only after hydrotherapy protocol when compared to the baseline condition. Conclusion: the hydrotherapy protocol promoted the same benefits of the floor exercise's protocol on the endurance, however, it increased the quality of life scores. (AU)

Accuracy of the Alberta Infant Motor Scale (AIMS) to detect developmental delay of gross motor skills in preterm infants: a systematic review.

OBJECTIVE: To assess, through a systematic review, the ability of Alberta Infant Motor Scale (AIMS) to diagnose delayed motor development in preterm infants. METHODS: Systematic searches identified five studies meeting inclusion criteria. These studies were evaluated in terms of: participants' characteristics, main results and risk of bias. The risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies--second edition (QUADAS-2). RESULTS: All five studies included a high risk of bias in at least one of the assessed fields. The most frequent biases included were presented in patient selection and lost follow up. All studies used the Pearson correlation coefficient to assess the diagnostic capability of the Alberta Infant Motor Scale. None of the assessed studies used psychometric measures to analyze the data. CONCLUSION: Given the evidence, the research supporting the ability of Alberta Infant Motor Scale to diagnose delayed motor development in preterm infants presents limitations. Further studies are suggested in order to avoid the above-mentioned biases to assess the Alberta Infant Motor Scale accuracy in preterm babies.

Interferência da prática de atividade física habitual na postura de jovens / Interference of the practice of habitual physical activity in the young people posture

Introdução: Diversos estudos descritos na literatura apontam os benefícios da prática da atividade física habitual na melhoria do nível de saúde de seus praticantes. Em atitude oposta, o sedentarismo tem sido vinculado ao aparecimento de desordens dos sistemas cardiovascular, respiratório e musculoesquelético. Objetivo: Averiguar a presença de possíveis relações entre alterações posturais e a prática da atividade física habitual em sujeitos jovens. Método: A casuística foi composta de 36 indivíduos divididos em 2 grupos: a) sedentários (21,24±1,87 anos; 62,12±11,38 kg; l,69±O,09m; IMC=21,72±13,l1kg/m2) formado por 7 homens e 14 mulheres; b) fisicamente ativos (21,20±3,23 anos; 66,38± 18,56 kg; 1,72±0, 11m; IMC=22,18±4,23kg/m2) formado por 10 homens e 5 mulheres. Para classificação dos grupos foi utilizado o questionário de Atividade Física Habitual de Baecke, adaptado para adultos considerando apenas os escores de exercícios físicos no lazer (EFL) e atividades de lazer e locomoção (ALL), contendo 8 questões relacionadas à prática de exercícios físicos e de atividades laborais dos últimos 12 meses. Os sujeitos foram colocados em posição ortostática para o registro de fotos nos planos frontal (anterior e posterior) e sagital (direito e esquerdo), com marcadores passivos em 17 pontos anatômicos, para em seguida serem -analisadas pelo Software de AvaliaçãoPostural (SAPO), de onde foram obtidos os dados referentes aos desalinhamentos entre os mesmos. Os dados foram analisados pelo SPSS 10.0, por meio do teste t Student para comparação dos grupos, com um nível de significância de 5%. Resultados: Os dados do estudo apontaram diferenças estatisticamente significantes para Alinhamento entre as Espinhas Ilíacas Ântero-superiores (AHEIAS; p = 0,04) e Diferença de Comprimento entre os Membros Inferiores (DCMI; p = 0,04). Conclusão: Os sujeitos que não praticam atividade física habitual mostraram assimetrias nos membros inferiores, que podem levar as alterações.

Introduction: Several studies in the literature show the benefits of physical activity practice in improving the healthstatus of its practitioners. However, the inactivity has been linked to the appearance of disorders of the cardiovascular, respiratory and musculoskeletal. Objective: To investigate the presence of possible relationships between postural changes and the practice of physical activity in young subjects. Method: The sample consisted of 36 individuais divided into 2 groups: a) sedentary (21.24±1.87 years, 62.12±11.38 kilograms, 1.69±0.09 m, BMI=21.72±13.11 kg/m2) consistingof7 men and 14 women, b) physically active (21.20 ± 3.23 years, 66.38 ± 18.56 kg, 1.72 ± 0.11 m, BMI=22.18± 4.23 kg/m2), comprising 10 men and 5 women. For classification of the groups used the questionnaire of habitual physical activity of Baecke adapted for adults, just considering the scores of physical exe2S for recreation and transportation with 8 questions related to physical exercise and work activities of the past 12 -c-:hs. The subjects were placed in standing position and pictures were taken in the frontal (front and rear) and sagit-- ight and left) with passive markers in 17 anatomical points, and are then analyzed using the postural assessment'>- ",-flore (POAS) of where they obtained the data concerning misalignment between them. The data were analyzed by _:::s.5 10.0, using the Student t test to compare groups, with a significance levei of 5%. Results: Data from the study _.ied statistically significant differences in alignment between the anterior iliac spine top (AHEIAS p = 0.04) and length::=Sence between the Leg (DCMI, p = 0.04). Conclusion: The subjects who do not practice regular physical activity--cwed asymmetries in the lower limbs, which can lead to postural changes. However, it is necessary to further studies larger sample to confirm the effects of inactivity on the misalignment and positioning of certain body structures.