Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review.

QUESTIONS: Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? DESIGN: A systematic review with meta-analyses of randomised clinical trials. PARTICIPANTS: Ambulatory adults with a clinical diagnosis of Parkinson's disease. INTERVENTION: tDCS combined with walking training. OUTCOME MEASURES: Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. RESULTS: Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. CONCLUSION: The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. REGISTRATION: PROSPERO CRD42020162908.

Fatores associados ao uso clínico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde por fisioterapeutas: estudo survey exploratório / Factors associated with the clinical use of the International Classification of Functioning, Disability and Health by physical therapists: an exploratory survey

Objetivo: Identificar os fatores contextuais (i.e., fatores pessoais e fatores relacionados ao trabalho) associados ao uso clínico da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) por fisioterapeutas. Métodos: Foi realizado um estudo exploratório do tipo survey. O questionário Barreiras pessoais e ambientais para implementação da CIF por fisioterapeutas" foi enviado aos fisioterapeutas do Espírito Santo, Brasil. Análise de regressão logística foi usada para explorar associações entre características pessoais e organizacionais com educação, atitudes, crenças, interesses, percepção de suporte e disponibilidade de recursos no ambiente de trabalho para uso da CIF na prática clínica. Resultados: A taxa de resposta para a maioria das análises foi 46% (n= 59). Seis características explicaram 35% da variação associada a interesses, atitudes e crenças para o uso da CIF (X²= 16.6, p= 0.01). Três características explicaram 24% da variação associada à educação para o uso da CIF (X²= 8.9, p= 0.03). Três características explicaram 61% da variação associada à percepção de suporte e disponibilidade de recursos para o uso da CIF (X²= 30.5, p<0.01). A barreira mais citada foi dificuldade ao aplicar a CIF para avaliar pacientes (62%). Conclusão: Os fisioterapeutas possuem atitudes positivas em relação ao uso da CIF, mas a grande maioria não recebeu formação acadêmica adequada e reporta auto-eficácia insuficiente para seu uso na prática clínica. É necessária a adoção de uma infraestrutura organizacional que endosse o uso clínico da CIF alinhada à modificação nos currículos de formação e capacitação continuada.

Objective: To identify the contextual factors (i.e., personal, and work-related factors) associated with the clinical use of the International Classification of Functioning, Disability and Health (ICF) by physical therapists. Method: A cross-sectional exploratory survey was carried out. The questionnaire Personal and environmental barriers for the implementation of the ICF by physical therapists was mailed to physical therapists living in Espírito Santo, Brazil. Logistic regression analysis was used to explore associations between personal and work-related characteristics with education, attitudes, beliefs, interest, and perception related to work resources for applying the ICF. Results: The response rate for most analyses was 46% (n= 59). Six characteristics explained 35% of the variance associated with interests, attitudes, and beliefs for the use of the ICF (X²= 16.6, p= 0.01). Three characteristics explained 24% of the variance associated with education for the use of ICF (X²= 8.9, p= 0.03). Three characteristics explained 61% of the variance associated with the perception of support and availability of resources for the use of the ICF (X²= 30.5, p<0.01). The most cited barrier was difficulty in applying the ICF for assessments of patients (62%). Conclusions: Physical therapists have positive attitudes towards the use of ICF, but most respondents did not receive satisfactory academic training and reported insufficient self-efficacy for using ICF in clinical practice. The adoption of an organizational infrastructure that endorses the clinical use of the ICF in association with an updated and continued education is required.

Efeitos da intervenção motora com tarefa dupla na cognição e presença de depressão em idosos residentes em instituição de longa permanência / Effects of motor intervention with dual task in cognition and the presence of depression in elderly living in long-stay institutions

Introdução: Existe uma escassez de programas sociais e de saúde voltados para a manutenção do idoso dependente, o que leva ao aumento do número de idosos institucionalizados e a um quadro precoce de demência e/ou depressão. Objetivo: Avaliar os efeitos da intervenção motora com tarefa dupla na cognição e presença de depressão nos idosos deste estudo e a aplicabilidade dos instrumentos Mini Exame do Estado Mental (MEEM) e Avaliação Cognitiva Montreal (MoCA) na detecção de alterações cognitivas. Material e métodos: Foi realizado um estudo experimental com 33 idosos: 14 idosos realizaram os exercícios com tarefa dupla por 5 semanas e foram chamados grupo intervenção (GI); 19 idosos não participaram da intervenção e foram chamados grupo controle (GC). Os grupos foram avaliados pelo: MEEM, MoCA e Escala de Depressão Geriátrica (EDG). Resultados: Não houve diferença significante na função cognitiva dos idosos após a intervenção em nenhum dos dois grupos estudados. O GC apresentou na EDG escore acima de 5, indicando depressão. Foi constatada uma forte correlação entre a MoCA e o MEEM. Conclusão: A intervenção fisioterapêutica com tarefa dupla, durante 5 semanas, não foi suficiente para melhora cognitiva. O fato da presença de depressão no GC pode estar relacionada ao nível de atividade e socialização desse idoso. O MoCa mostrou-se um instrumento capaz de detectar comprometimento cognitivo leve, enquanto o MEEM foi um instrumento de mais fácil aplicação. (AU)

Introduction: There is a shortage of social and health programs for the maintenance of dependent elderly, which leads to an increase in the number of institutionalized elderly and an early disorder of dementia and/or depression. Objective: To evaluate the effects of motor intervention with dual task in cognition and the presence of depression in the elderly of this study and the applicability of the instruments Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in detecting cognitive impairment. Methods: We conducted an experimental study of 33 elderly, 14 elderly performed the exercises with double duty for 5 weeks and were called the intervention group (GI); 19 elderly did not participate in the intervention and were called control group (CG). The groups were evaluated by: MMSE, MoCA and Geriatric Depression Scale (GDS). Results: There was no significant difference in cognitive function of the elderly after the intervention in any of the two groups. The CG presented in EDG score above 5 indicating depression. A strong correlation was found between the MoCA and the MMSE. Conclusion: Physical therapy intervention with double duty for 5 weeks was not enough to cognitive improvement. The fact of the presence of depression in the GC may be related to the level of activity and socialization of that old. MoCA proved to be an instrument able to detect mild cognitive impairment, while the MMSE was an instrument easier to apply. (AU)

SERCA-2a is involved in the right ventricular function following myocardial infarction in rats.

AIMS: Right ventricular (RV) function is considered an independent predictor of mortality and development of heart failure (HF) in patients with left ventricle dysfunction following myocardial infarction (MI). The functional and molecular mechanisms that may explain the RV dysfunction are still poorly understood. Our study was conducted to investigate RV contractility and the myocardium protein involved in the calcium handling following MI in rats. MAIN METHODS: MI was surgically induced in male Wistar rats to create transmural infarctions involving 40-60% of the left ventricle surface. Infarcted rats were divided into two groups: those that presented classical signs of congestive heart failure (HF group) and those that did not (INF group), and compared to control animals (Sham). RV contractility was studied using isometric contraction in isolated strips and isovolumetric pressure in isolated heart. KEY FINDINGS: Inotropic responses in RV strips were preserved in the INF group but were reduced in the HF group (3.75 mM Ca(2+) treatment: Sham = 163 ± 18; INF = 148 ± 19; HF = 68 ± 11 g/g*; *p < 0.05; 5 × 10(-5) M isoproterenol: Sham = 151 ± 15, INF = 134 ± 17, HF = 52 ± 7 g/g*; *p < 0.05). An increase in SERCA-2a protein expression in the RV was observed in the INF group but not in the HF group, which could explain the preserved inotropic response in these animals. SIGNIFICANCE: Increased SERCA-2a protein expression may play a role in the preservation of RV function post-MI. Therefore, therapeutic strategies that attempt to increase SERCA protein expression levels may be useful for the treatment of HF.

Na+K+-ATPase activity and K+ channels differently contribute to vascular relaxation in male and female rats.

Gender associated differences in vascular reactivity regulation might contribute to the low incidence of cardiovascular disease in women. Cardiovascular protection is suggested to depend on female sex hormones' effects on endothelial function and vascular tone regulation. We tested the hypothesis that potassium (K+) channels and Na+K+-ATPase may be involved in the gender-based vascular reactivity differences. Aortic rings from female and male rats were used to examine the involvement of K+ channels and Na+K+-ATPase in vascular reactivity. Acetylcholine (ACh)-induced relaxation was analyzed in the presence of L-NAME (100 µM) and the following K+ channels blockers: tetraethylammonium (TEA, 2 mM), 4-aminopyridine (4-AP, 5 mM), iberiotoxin (IbTX, 30 nM), apamin (0.5 µM) and charybdotoxin (ChTX, 0.1 µM). The ACh-induced relaxation sensitivity was greater in the female group. After incubation with 4-AP the ACh-dependent relaxation was reduced in both groups. However, the dAUC was greater in males, suggesting that the voltage-dependent K+ channel (Kv) participates more in males. Inhibition of the three types of Ca2+-activated K+ channels induced a greater reduction in Rmax in females than in males. The functional activity of the Na+K+-ATPase was evaluated by KCl-induced relaxation after L-NAME and OUA incubation. OUA reduced K+-induced relaxation in female and male groups, however, it was greater in males, suggesting a greater Na+K+-ATPase functional activity. L-NAME reduced K+-induced relaxation only in the female group, suggesting that nitric oxide (NO) participates more in their functional Na+K+-ATPase activity. These results suggest that the K+ channels involved in the gender-based vascular relaxation differences are the large conductance Ca2+-activated K+ channels (BKCa) in females and Kv in males and in the K+-induced relaxation and the Na+K+-ATPase vascular functional activity is greater in males.

Myocardial contractile dysfunction induced by ovariectomy requires AT1 receptor activation in female rats.

BACKGROUND/AIM: Estrogen deficiency induces myocardial contractile dysfunction and increases cardiovascular disease risk. However, the mechanism underlying this response is unclear. Our aim was to investigate whether AT(1)receptor blockade would prevent ovariectomy-induced myocardial contractile dysfunction. METHODS: Female rats (8 weeks old, 280 g) that underwent bilateral ovariectomy were randomly assigned to receive daily treatment with losartan (OVX + LOS, 15 mg/kg, s.c., in 0.9 % NaCl), placebo (OVX), estrogen replacement (OVX + E2, 1 mg/ kg, once a week, i.m.) and SHAM for 58 days. RESULTS: Losartan and estrogen treatment 1) prevented ovariectomy-induced weight gain and slight hypertrophy, 2) restored the positive inotropic responses to Ca(2+) and isoproterenol in the isolated papillary muscle in the OVX group, 3) prevented the reduction in SERCA2a levels and the increase in phospholamban (PLB) expression in the OVX group, 4) abolished the increase in superoxide anion that was increased in the OVX group, and 5) normalized the increase in p22(phox) expression after ovariectomy. Estrogen treatment but not losartan restored the increase in serum angiotensin converting enzyme activity in the OVX group. CONCLUSION: This study demonstrated that myocardial contractile dysfunction induced by ovariectomy and expression of key Ca(2+)-handling proteins were prevented by losartan treatment and that AT(1) receptor activation is involved in this response.