Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients.

OBJECTIVE: Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients. METHODS: Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up. RESULTS: The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05). CONCLUSION: One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.

Applicability of a motor rehabilitation system in stroke victims / Aplicabilidade de um sistema de reabilitação motora em pacientes pós-acidente vascular encefálico

Abstract Introduction: The recovery of stroke patients is long and boring due to the repetitive nature of the exercises used and the length of treatment. Thus, we started using virtual reality as an alternative and, because of its advantages, health professionals are adapting video games for physical therapy. However, there are some limitations, such as the fact that games are designed for entertainment and not for therapeutic purposes. Objective: In order to mitigate gaps in assistive devices for physical therapy, this study describes the development and applicability of a computer support system for motor rehabilitation - Ikapp - in stroke victims. Methods: Twenty-seven stroke patients filled out a socioeconomic questionnaire, tested Ikapp during five minutes and answered a usability and satisfaction questionnaire about handling the tool. The chi-square test was used to analyze any association between sociodemographic factors and the features of the system. Results: The Ikapp system can be an excellent device to assist neurological rehabilitation of stroke patients, as participants questionnaires showed that 85.2% were satisfied in regard to motivation and inclusion of Ikapp in physiotherapy and 77.8% relative to ease of interaction with the tool. Conclusion: The Ikapp system proved to be an easy-to-use and accessible computer support system for patients with functional limitations.

Resumo Introdução: A recuperação de indivíduos pós-Acidente Vascular Encefálico (AVE) tem se mostrado longa e monótona devido ao caráter repetitivo dos exercícios utilizados na clínica e aos anos de tratamento. Logo, tem-se utilizado a Realidade Virtual (RV) como uma alternativa e diante de suas vantagens, profissionais de saúde vêm adaptando vídeo games à fisioterapia. No entanto, existem algumas limitações, como a do fato de estes vídeo games terem sido desenvolvidos para diversão e não serem apropriados para uso terapêutico. Objetivo: Em busca de atenuar lacunas existentes em dispositivos adaptados à fisioterapia, este estudo descreve o desenvolvimento e a aplicabilidade de um sistema computacional de suporte a reabilitação motora - Ikapp - em pacientes pós-AVE. Métodos: 27 pacientes pós-AVE preencheram um questionário socioeconômico, testaram o Ikapp durante 5 min e responderam a um questionário de usabilidade e satisfação sobre o manuseio da ferramenta. Para analisar a associação de fatores sociodemográficos com funcionalidades do sistema, o teste qui quadrado (Exato de Fisher) foi utilizado. Resultados: O Ikapp pode ser uma excelente ferramenta de auxílio à reabilitação neurológica de pacientes pós-AVE, visto que seus testes evidenciaram 85,2% de satisfação no que diz respeito à motivação e inclusão no processo fisioterápico e 77,8% em relação à facilidade de interação com a ferramenta. Conclusão: O Ikapp mostrou ser um sistema computacional de fácil aplicação e acessível a pacientes com diferentes limitações funcionais.

"How Did I Make It?": Uncertainty about Own Motor Performance after Inhibition of the Premotor Cortex.

Optimal motor performance requires the monitoring of sensorimotor input to ensure that the motor output matches current intentions. The brain is thought to be equipped with a "comparator" system, which monitors and detects the congruence between intended and actual movement; results of such a comparison can reach awareness. This study explored in healthy participants whether the cathodal transcranial direct current stimulation (tDCS) of the right premotor cortex (PM) and right posterior parietal cortex (PPC) can disrupt performance monitoring in a skilled motor task. Before and after tDCS, participants underwent a two-digit sequence motor task; in post-tDCS session, single-pulse TMS (sTMS) was applied to the right motor cortex, contralateral to the performing hand, with the aim of interfering with motor execution. Then, participants rated on a five-item questionnaire their performance at the motor task. Cathodal tDCS of PM (but not sham or PPC tDCS) impaired the participants' ability to evaluate their motor performance reliably, making them unconfident about their judgments. Congruently with the worsened motor performance induced by sTMS, participants reported to have committed more errors after sham and PPC tDCS; such a correlation was not significant after PM tDCS. In line with current computational and neuropsychological models of motor control and awareness, the present results show that a mechanism in the PM monitors and compares intended versus actual movements, evaluating their congruence. Cathodal tDCS of the PM impairs the activity of such a "comparator," disrupting self-confidence about own motor performance.

Impact of dry needling and ischemic pressure in the myofascial syndrome: controlled clinical trial / Impacto do agulhamento seco e compressão isquêmica na síndrome miofascial: ensaio clínico controlado

Introduction Musculoskeletal pain is a common clinical condition and about 10% of the population have musculoskeletal disorder. Objective The aim of this study was to evaluate whether ischemic pressure and dry needling techniques are able to reduce the pain of patients with myofascial pain syndrome. Method 22 patients aged 20-75 years were randomized into 3 groups: ischemic pressure (IPG = 8), dry needling (DNG = 7) and control (CG = 7). Patients in the IPG and DNG were assessed before and after 10 intervention sessions, which occurred 3 times per week. The CG was assessed initially and reassessed three weeks later. The assessment of pain was done through Visual Analogic Scale (VAS) and quality of life through WHOQOL-BREF (5 domains: global, physical, psychological, social and environmental). Results There was no significant difference for clinical and demographic data of all groups at baseline, except for age (p = 0.042). The results of the VAS expressed that IPG had pain relief in most sessions, the same was not observed for DNG. Comparing the 2 groups was obtained difference in the 4th and 8th sessions. The results of the WHOQOL-BREF showed that the three groups had a significant increase in the psychological domain. The same was not true for global domains, physical, environmental and social. Conclusion Ischemic pressure and dry needling were able to reduce the pain of patients and also change their quality of life, specifically the psychological aspect.

Introdução A dor musculoesquelética é uma condição clínica comum e cerca de 10% da população possui distúrbio do sistema musculoesquelético. Objetivo O objetivo deste estudo foi avaliar se a compressão isquêmica e o agulhamento seco são técnicas capazes de reduzir a dor de pacientes com síndrome miofascial. Método 22 pacientes com idade entre 20-75 anos foram randomizados em 3 grupos: compressão isquêmica (GCI = 8), agulhamento seco (GAS = 7) e controle (GC = 7). Os pacientes do GCI e GAS foram avaliados antes e após as 10 sessões terapêuticas, que ocorreram 3 vezes por semana. O GC foi avaliado inicialmente e reavaliado 3 semanas depois. Para mensuração da dor usou-se a Escala Visual Analógica (EVA) e da qualidade de vida o WHOQOL-BREF (5 domínios: global, físico, psicológico, social e meio ambiente). Resultados A análise dos dados clínicos e demográficos mostrou que não houve diferença entre os grupos, exceto para idade (p = 0,042). Os resultados da EVA expressaram que o GCI teve redução da dor na maioria das sessões, o mesmo não se observou para o GAS. Comparando os 2 grupos obteve-se diferença na 4ª e 8ª sessões. Os resultados do WHOQOL-BREF demonstraram que os 3 grupos tiveram um aumento significante no domínio psicológico. O mesmo não ocorreu para os domínios global, físico, meio ambiente e social. Conclusão A compressão isquêmica e o agulhamento seco foram capazes de reduzir a dor dos pacientes e também intervir na sua qualidade de vida, especificamente no aspecto psicológico.

Desenvolvimento e aprimoramento de um sistema computacional- Ikapp- de suporte a reabilitação motora / Development and improvement of a computational system- Ikapp- to support motor rehabilitation

A aplicabilidade das Tecnologias Interativas (TIs) na área de saúde, em particular na reabilitação motora, tem sido uma alternativa clínica usada com intuito de estimular maior engajamento do paciente ao seu processo de recuperação que por vezes é extenuante. O presente estudo descreve uma ferramenta tecnológica -Ikapp- de suporte a reabilitação motora. Ferramenta essa que busca ampliar as possibilidades dos dispositivos comerciais já existentes no contexto clínico. Sessenta (60) voluntários foram convidados a interagir com as interfaces do setup e do jogo do Ikapp com objetivo de examinar a funcionalidade, grau de aceitação, demandas e limitações para aprimoramentos. Os resultados do presente estudo demonstram altos índices de satisfação pelos participantes. Além disso, os resultados demonstraram que o Ikapp é uma ferramenta que agrega valores terapêuticos à ludicidade e motivação de acordo com a perspectiva dos participantes.

The applicability of Interactive Technologies (ITs) in the health area, especially in motor rehabilitation, has been a therapeutic alternative used aiming to encourage a greater patient engagement in their recovery process that is sometimes lengthy. The present study describes the technological tool (Ikapp) to support motor rehabilitation, which aims to expand the possibility of the commercial devices that is already used in clinical practice. Sixty (60) volunteers were invited to interact with the setup and game interfaces of Ikapp aiming to examine their features, the degree of acceptance, demands and limitations to the enhancement. The results of present study showed high levels of satisfaction for the participants. Furthermore, the results demonstrated that the Ikapp is a tool that adds value to therapeutic playfulness and motivation according to the participant' perspective.