Effects of Transcranial Direct Current Stimulation on Muscle Fatigue in Recreational Runners: Randomized, Sham-Controlled, Triple-Blind, Crossover Study-Protocol Study.

OBJECTIVES: The aim of this study is to evaluate the effects of transcranial direct current stimulation (tDCS) on central and peripheral fatigue in recreational runners. DESIGN: This is a clinical randomized, sham-controlled, triple-blind, crossover study. Twenty adult runners will be randomized on the first day of the intervention to receive active or sham tDCS before fatigue protocol. After 1 wk, the participants will receive the opposite therapy to the one that they received on the first day. The tDCS, 2 mA, will be applied for 20 mins over the motor cortex. The fatigue protocol will be performed after tDCS, in which the participant should perform concentric knee flexion/extension contractions until reaching three contractions at only 50% of maximum voluntary contraction. Central fatigue will be evaluated with the motor evoked potential of the quadriceps muscle; peripheral fatigue with the peak torque (N.m) using an isokinetic dynamometer; the electrical activity of the quadriceps muscle using surface electromyography (Hz); blood lactate level (mmol/L); and the subjective perception of effort (Borg scale). All evaluations will be repeated before and after the interventions. CONCLUSION: This study will evaluate the effect of tDCS on fatigue in runners, possibly determining an application protocol for this population.

Applications of Non-invasive Neuromodulation for the Management of Disorders Related to COVID-19.

Background: Novel coronavirus disease (COVID-19) morbidity is not restricted to the respiratory system, but also affects the nervous system. Non-invasive neuromodulation may be useful in the treatment of the disorders associated with COVID-19. Objective: To describe the rationale and empirical basis of the use of non-invasive neuromodulation in the management of patients with COVID-10 and related disorders. Methods: We summarize COVID-19 pathophysiology with emphasis of direct neuroinvasiveness, neuroimmune response and inflammation, autonomic balance and neurological, musculoskeletal and neuropsychiatric sequela. This supports the development of a framework for advancing applications of non-invasive neuromodulation in the management COVID-19 and related disorders. Results: Non-invasive neuromodulation may manage disorders associated with COVID-19 through four pathways: (1) Direct infection mitigation through the stimulation of regions involved in the regulation of systemic anti-inflammatory responses and/or autonomic responses and prevention of neuroinflammation and recovery of respiration; (2) Amelioration of COVID-19 symptoms of musculoskeletal pain and systemic fatigue; (3) Augmenting cognitive and physical rehabilitation following critical illness; and (4) Treating outbreak-related mental distress including neurological and psychiatric disorders exacerbated by surrounding psychosocial stressors related to COVID-19. The selection of the appropriate techniques will depend on the identified target treatment pathway. Conclusion: COVID-19 infection results in a myriad of acute and chronic symptoms, both directly associated with respiratory distress (e.g., rehabilitation) or of yet-to-be-determined etiology (e.g., fatigue). Non-invasive neuromodulation is a toolbox of techniques that based on targeted pathways and empirical evidence (largely in non-COVID-19 patients) can be investigated in the management of patients with COVID-19.

Electromyographic Biofeedback in Motor Function Recovery After Peripheral Nerve Injury: An Integrative Review of the Literature.

Electromyographic biofeedback (EMG-BF) has been applied to treat different types of peripheral nerve injuries (PNI). However, despite the clinical practice widespread use its evidence is controversial. With the objective of summarize the available evidence on the electromyographic biofeedback effectiveness and efficacy to help motor function recovery after PNI an integrative review was performed. A secondary objective was to identify the conceptual framework and strategies of EMG-BF intervention, and the quality of technical description of EMG-BF procedures. To conduct this integrative review a systematic search of the literature was performed between October 2013 and July 2018, in PUBMED, ISI and COCHRANE databases for EMG-BF original studies in PNI patients of any etiology, in English, Portuguese, Spanish or French, published after 1990. Exclusion criteria were poor description of EMG-BF treatment, associated treatment that could impair EMG-BF effect, inclusion of non-PNI individuals and case studies design. The PEDro scale was used to evaluate study quality of randomized clinical trials (RCTs) included. This resulted in 71 potential articles enrolled to full reading, although only nine matched the inclusion criteria. PNI included facial paralysis, acute sciatic inflammation and carpal tunnel syndrome. The average quality score of the included RCTs was five, corresponding to low methodological quality. Due to the small number of included articles, low quality studies and heterogeneity of interventions, outcomes and population we concluded that there is limited evidence of EMG-BF effectiveness and efficacy for motor function recovery in PNI patients.