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Attention is a basic human function underlying every other cognitive process. It is demonstrated in the functional Magnetic Resonance Imaging literature that frontoparietal networks are involved with attentive performance while default mode networks are involved with inattentive performance. Yet, it is still not clear whether similar results would be found with functional Near-Infrared Spectroscopy. The goal of our study was to investigate differences in hemodynamic activity measured by functional Near-Infrared Spectroscopy between fast and slow responses on a simple sustained attention task both before and after stimulus onset. Thirty healthy adults took part in the study. Our results have shown differences between fast and slow responses only on channels over medial frontal cortex and inferior parietal cortex (p

Chronic pain is one of the most common symptoms of temporomandibular disorders (TMD). Although its pathophysiology is still a challenge, TMD has been associated with changes in central nervous system activity related to pain modulatory capacity. This study was conducted to examine the cortical activity of patients with temporomandibular disorders and chronic pain of myofascial origin using quantitative electroencephalography (qEEG). Individuals with TMD and chronic pain and healthy controls were evaluated using qEEG in four consecutive conditions, all with closed eyes: 1) initial resting condition; 2) non-painful motor imagery task of hand movement; 3) painful motor imagery task of clenching the teeth; 4) final resting condition. Participants with TMD and chronic pain overall presented decreased alpha power density during baseline at rest, and non-painful and painful motor imagery tasks when compared to healthy controls. Furthermore, functional brain connectivity was distinct between groups, with TMD and chronic pain showing lower small-world values for the delta (all conditions), theta (eyes closed, painful and non-painful motor imagery task), and alpha bands (painful motor imagery task), and an increase in the beta band (all conditions). These results suggest that TMD and related chronic pain is associated with maladaptive plasticity in the brain, which may correspond to a reduced ability to modify brain activity during different mental tasks, including painful and non-painful imagery. These changes can be detected by qEEG, a method which may be very important because of its characteristics of good temporal resolution and the possibility to be performed in naturalistic setups.

This study investigated the effect of transcranial direct current stimulation (tDCS) combined with a recovery training session on the well-being and self-perceived recovery of professional female soccer players after official matches. Data from 13 world-class players were analyzed after participating in four official soccer matches of the first division of the Brazilian Women’s Soccer Championship (7-, 10-, and 13-day intervals). We applied anodal tDCS (a-tDCS) over the left dorsolateral prefrontal cortex with 2 mA for 20 minutes (+F3/−F4 montage) the day after each match. Participants underwent two randomly ordered sessions of a-tDCS or sham. Players completed the Well-Being Questionnaire (WBQ) and the Total Quality Recovery (TQR) scale before each experimental condition and again the following morning. A two-way repeated-measures ANOVA showed a significant time x condition interaction on the WBQ (F(1,11)=5.21; p=0.043; ηp2=0.32), but not on the TQR (F(1,12) = 0.552; p = 0.47; ηp2 = 0.044). There was a large effect size (ES) for a-tDCS for the WBQ score (ES = 1.02; 95%CI = 0.17;1.88), and there was a moderate WBQ score increase (ES = 0.53; 95%CI = −0.29;1.34) for the sham condition. We found similar increases in the TQR score for a-tDCS (ES = 1.50; 95%CI = 0.63–2.37) and the sham condition (ES = 1.36; 95%CI = 0.51–2.22). These results suggest that a-tDCS (+F3/−F4 montage) combined with a recovery training session may slightly improve perceived well-being beyond the level of improvement after only the recovery training session among world-class female soccer players. Prior to widely adopting this recovery approach, further study is needed with larger and more diverse samples, including for female teams of different performance levels.

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (>40 days) and hospital stay (>50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Context: Migraine is a disabling condition that is currently underdiagnosed and undertreated. Transcutaneous vagus nerve stimulation (VNS) is among the most researched non-invasive brain stimulation techniques for migraine control. Objectives: In this integrative review, we discuss the effects of VNS parameters (waveform, frequency, intensity, cycle, and current), central, and clinical mechanisms in auricular (taVNS) or cervical (tcVNS) transcutaneous VNS in the control of migraine pain.Methods: PubMed (National Library of Medicine), Cochrane Library, CAPES Journals (Portal of Journals of the Coordination for the Improvement of Higher Education Personnel), Virtual Health Library (VHL), and Google Scholar were searched by computer from the establishment of within the 10-year period (2011–2021). Results: Initially, a total of 10,017 articles were identified. After applying the exclusion criteria, 10,007 articles were excluded. The eligibility criteria were analyzed and only ten articles fulfilled the criteria. The most used parameters in this study for VNS were the frequencies of 1 Hz, 25 Hz, and 30 Hz. The 1 Hz stimulation caused a more significant reduction in the number of days with headache. The total stimulation time varies between studies, ranging from 2 min to 240 min, and can be repeated for a period or a single session. Studies that used a longer treatment period showed clinical results in reducing pain and analyzed the scores. Moreover, studies have shown reduced intensity or severity of pain after taVNS.Conclusions: The studies performed taVNS or tcVNS, and both methods had positive effects on migraine control, pain reduction, and migraine score.

INTRODUCTION: Temporomandibular disorder (TMD) is currently considered a central sensitization syndrome that belongs to the orofacial nociplastic pain group and offers great challenges for clinical practice. It can also be identified in individuals with sickle cell disease. Neuromodulation is a promising therapy that can help individuals with refractory chronic pain. To our knowledge, there is no treatment proposal for these individuals with chronic orofacial pain resulting from sickle cell disease. OBJECTIVE: This is a protocol of a randomized, double-blind, cross-over clinical trial. The purpose of this protocol is to investigate whether the immediate effect of transcranial direct current stimulation can be increased by adding the effect of peripheral sensory electrical stimulation. METHODS: Twenty women between 18 and 49 years of age will be screened to participate in this cross-over study where they will all receive the three types of protocol with a one-week washout. Active transcranial Direct Current Stimulation (tDCS) + active Peripheral Electrical Stimulation (PES); Active tDCS + PES sham and tDCS sham + PES sham. Stimulation with tDCS will be at 2 mA anodic over the motor cortex for 20 minutes ipsilateral to the most painful temporomandibular joint (TMJ). Peripheral electrical stimulation will be at 100 Hz over the most painful TMJ masseter muscle for 30 min. OUTCOME: The main outcome will be pain intensity assessed by VAS scale and by a pressure algometer in grams. In addition, endogenous pain modulation will be analyzed through the temporal summation of pain with Aesthesio precision tactile sensory filaments and conditioned pain modulation (CPM) evaluated by an algometer and thermal conditioned stimulus, as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables.

A centralização do atendimento dos pacientes com doenças falciformes através da criação de centros de referência possibilitou um melhor acompanhamento desses pacientes. Este estudo caracterizou o perfil sociodemográfico e clínico dos pacientes com doenças falciformes atendidos nos centros de referência no município de Salvador. Os resultados deste estudo corroboram com a literatura e podem ajudar a melhorar os serviços oferecidos nos centros de referência pesquisados. As mulheres representaram a maior parcela dos pacientes registrados nos centros e com maior faixa etária e escolaridade do que os homens. Mais de 90,0% dos pacientes são solteiros, demonstrando a dificuldade das pessoas com doenças falciformes se socializarem devido ao estigma da doença. As manifestações clínicas mais comuns foram as crises álgicas e a icterícia e as intercorrências mais comuns foram internações devido as crises álgicas e hemotransfusão. Foram observadas associações entre sexo e acidente vascular cerebral, entre o genótipo e úlceras de membros inferiores e hemotransfusão. Também foi observado um percentual baixo de pacientes com osteonecrose indicando possível subnotificação. Os percentuais baixos de pacientes que fazem uso da morfina e hidroxiureia apontam para a necessidade de ampliar a oferta desses medicamentos para diminuir as crises álgicas e melhorar a qualidade de vida dos pacientes.

Transcranial direct current stimulation (tDCS) has emerged as a nonpharmacological tool in physical rehabilitation. There have currently no studies that evaluated the safety and efficacy of tDCS in patients with dermatomyositis. Case-report: Three adult women with dermatomyositis were allocated randomly to intervention (i-tDCS, one patient) or not (sham-tDCS, two patients) of three consecutive days of tDCS and evaluated in four periods: before-tDCS (PRE), 15 minutes after-tDCS (0th POST), 15 days after-tDCS (15th POST), and 30 days after-tDCS (30th POST). The tDCS was safe throughout the protocol, without disease relapsing or adverse effects related to tDCS. Furthermore, the tDCS increased the muscle torque and total work of dominant and non-dominant elbow flexors in the patient with i-tDCS, when compared to two patients with sham-tDCS. Conclusions: The tDCS was safe and appeared to influence long-term strength in the limb of the patient with stable dermatomyo-sitis.

INTRODUCTION: As increase life expectancy, the searches for conducts to improve functional independence in chronically altered conditions as is common in the neurological dysfunction. OBJECTIVES: To evaluate the effect of therapeutic home based exercise programs (HBE) on impairment of walking activity due to stroke, Parkinson's disease (PD), multiple sclerosis and HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). METHODS: data sources PubMed, Scielo, Pedro, Cochrane Library; available in English, Portuguese, Spanish, German or French languages; no time restrictions; selection made by two independent researchers, in three stages; included Clinical Trials with interventions of HBE Programs for adults with gait or balance disabilities arising from the above neurological conditions; gait speed or distance, strength, balance, mobility, functionality and functional independence were the variables; methodological quality with PEDro scale; PICOS strategy guided the extraction date. Weighted mean differences (WMD), 95% confidence intervals (CI), and the heterogeneity assessed by the I2 test with RevMan 5.3 program. Results in balance (WMD 2.8; CI 1.5; 4.1) and in cardiorespiratory capacity (WMD 29.3m; IC 8.3; 50.2) for people with stroke are effectiveness. For people with Multiple Scleroses there is improvement in physiological profile (WMD -1.3; CI -0.5; 2.0) and mobility (WMD -3.3; CI -5.1; -1,4). CONCLUSIONS: The HBE is effective on walking activity, improve performance and functional mobility in neurological impairments. Is suggested HBE on public health to includ elements for management of disabilities on the programs and the use of functional scales such as WHODAS to compare the same disability in different neurological disorders.

Introduction: There is evidence that electroacupuncture (EA) acts through the modulation of brain activity, but little is known about its influence on corticospinal excitability of the primary motor cortex (M1). Objective: To investigate the influence of EA parameters on the excitability of M1 in healthy individuals. Methods: A parallel, double blind, randomized controlled trial in healthy subjects, evaluating the influence of an EA intervention on M1 excitability. Participants had a needle inserted at LI4 in the dominant hand and received electrical stimulation of different frequencies (10 or 100 Hz) and amplitude (sensory or motor threshold) for 20 min. In the control group, only a brief (30 s) electrical stimulation was applied. Single and paired pulse transcranial magnetic stimulation coupled with electromyography was applied before and immediately after the EA intervention. Resting motor threshold, motor evoked potential, short intracortical inhibition and intracortical facilitation were measured. Results: EA increased corticospinal excitability of M1 compared to the control group only when administered with a frequency of 100 Hz at the sensory threshold ( p Conclusion: The results suggest that EA with an intensity level at the sensorial threshold and 100 Hz frequency increases the corticospinal excitability of M1. This effect may be associated with a decrease in the activity of inhibitory intracortical mechanisms. Trial registration number: U1111-1173-1946 (Registro Brasileiro de Ensaios Clínicos; http://www.ensaiosclinicos.gov.br/ )

Individuals with sickle cell disease (SCD) exhibit changes in static brain connectivity in rest. However, little known as chronic pain associated with hip osteonecrosis affects dynamic brain connectivity during rest and the motor imagery task. The aim of this study was to investigate the characteristics of the dynamic functional brain connectivity of individuals with SCD and chronic pain secondary to hip osteonecrosis. This is a cross-sectional study comparing the dynamic brain connectivity of healthy individuals (n = 18) with the dynamic brain connectivity of individuals with SCD and chronic pain (n = 22). Individuals with SCD and chronic pain were stratified into high- or low-intensity pain groups based on pain intensity at the time of assessment. Dynamic brain connectivity was assessed through electroencephalography in 3 stages, resting state with eyes closed, and during hip (painful for the SCD individuals) and hand (control, nonpainful) motor imagery. Average weight of the edges and full synchronization time (FST)—time required for 95% of the possible edges to appear over time during a given task—were evaluated. Regarding the average weight of the edges, individuals with SCD and high-intensity pain presented higher edge weight during hip motor imagery. The average weight of the edges correlated positively with pain intensity and depression symptoms. Individuals with SCD and chronic pain complete the cerebral network at rest more quickly (lower FST). Individuals with SCD and chronic pain/hip osteonecrosis have impaired dynamic brain network with shorter FST in rest network and more pronounced diffuse connectivity in individuals with high-intensity pain. The dynamic brain network evaluated by time-varying graphs and motif synchronization was able to identify differences between groups.

Objectives: Currently, no studies have assessed the efficacy of transcranial direct current stimulation (tDCS) to treat fatigue and pain associated with or potentiated by post-COVID-19 syndrome in patients with systemic autoimmune rheumatic diseases (SARDs). Methods: This study included nine patients with different types of SARDs. All patients had previously confirmed RT-PCR test for COVID-19 as well as significant, persistent fatigue and pain that began to worsen after infection. Anodal tDCS was administered in five daily sessions (2mA, 20 minutes) over the C3 or C4 10/20 EEG positions, with the cathode placed at Fp1 or Fp2. Concomitantly, patients were involved in an aerobic exercise program by treadmill walking. All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and go test and sit-to-stand test at baseline (within one week before tDCS protocol), and one week after tDCS protocol. During all procedures, the patients’ treatments remained unchanged. Results: The sample was composed of eight women and one man with a mean age of 48.7±9.6. After the tDCS protocol, the pain and fatigue significantly improved by a visual analog scale (Pvs. 6.8±0.8 (P=0.001) for timed-up-go-test and 10.3±3.7 vs. 15.1±4.0 (P=0.037) for sit-to-stand test. No subject experienced adverse events. One-hundred percent of patients adhered to all protocols. Conclusions: The present study showed tDCS in combination with aerobic exercise was effective in improving the physical function, and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.Clinical Trials: NCT04890483.

BACKGROUND: The main symptoms of myelopathy associated with human T-cell lymphotropic virus type 1 or tropical spastic paraparesis (HAM / TSP) are the presence of high intensity pain in the lower back, spasticity and weakness in the lower limbs, loss of balance and difficulties in locomotion. Pulsed Transcranial Magnetic Stimulation (rTMS) has been able to influence cortical plasticity, decreasing spasticity, increasing motor performance and promoting analgesia in several similar conditions. OBJECTIVE: To analyze the effect of neuromodulation by pulsed transcranial magnetic stimulation (rTMS) on pain and functional mobility in individuals with HAM / TSP. METHODOLOGY: A randomized clinical trial will be conducted in a sample made up of 40 participants randomly allocated into two groups: Sham Group (SG) with 20 and Test Group (TG) with 20 patients. Individuals aged> 20 years, community walkers with or without orthosis, with chronic pain (? 6 months) in the lumbar region and / or lower limbs will be included. Individuals with epilepsy, cancer, pregnant women, patients with cardiac pacemakers, metallic implants in the brain or skull, users of illicit drugs and / or use of controlled medications in the last six months will be excluded. The protocol will be applied for 10 consecutive days with eight months of follow-up. Our hypothesis is that when using rTMs according to the proposed procedure, it will be possible to relieve pain and improve the functional mobility of these individuals with a long-lasting effect. CONCLUSION: We hope that rTMS is a promising treatment to reduce pain intensity and to improve functional mobility in individuals undergoing active modality. We declare this protocol a promising resource for the treatment of htlv-1 individuals in reducing pain and improving functional mobility. Yes, this protocol has already been applied to 6 patients. However, with the pandemic the study had to be discontinued. However, despite the small sample size and not being fully applied as suggested by the protocol, it was possible to notice a satisfactory result of the intervention. Thus, the application of this protocol can contribute to identify the result of this therapeutic modality in a safer way, as well as assist in the treatment of symptoms of this population, favoring a better quality of life.

The central nervous system plays a crucial role in integrating body signals during exercise, and in generating a relevant response which modulates the pacing and exercise performance. In this regard, the neuromodulatory effects of transcranial direct current stimulation (tDCS) may modulate certain behaviors related to exercise, psychophysiological responses to exercise, and exercise performance. Several studies have assessed the effect of tDCS on different brain regions and found promising results on heart rate, perceived exertion, and performance in different types of exercise such as strength (isometric, isokinetic, and isotonic), endurance (cycling, running), sprint, flexibility, and balance. In this chapter, we review the current evidence regarding the use of tDCS in the exercise science field, as well as safety issues, limitations, and future perspectives.

Transcranial direct current stimulation (tDCS) has been used aiming to boost exercise performance and inconsistent findings have been reported. One possible explanation is related to the limitations of the so-called “conventional” tDCS, which uses large rectangular electrodes, resulting in a diffuse electric field. A new tDCS technique called high-definition tDCS (HD-tDCS) has been recently developed. HD-tDCS uses small ring electrodes and produces improved focality and greater magnitude of its aftereffects. This study tested whether HD-tDCS would improve exercise performance to a greater extent than conventional tDCS. Twelve endurance athletes (29.4 ± 7.3 years; 60.15 ± 5.09 ml kg−1 min−1) were enrolled in this single-center, randomized, crossover, and sham-controlled trial. To test reliability, participants performed two time to exhaustion (TTE) tests (control conditions) on a cycle simulator with 80% of peak power until volitional exhaustion. Next, they randomly received HD-tDCS (2.4 mA), conventional (2.0 mA), or active sham tDCS (2.0 mA) over the motor cortex for 20-min before performing the TTE test. TTE, heart rate (HR), associative thoughts, peripheral (lower limbs), and whole-body ratings of perceived exertion (RPE) were recorded every minute. Outcome measures were reliable. There was no difference in TTE between HD-tDCS (853.1 ± 288.6 s), simulated conventional (827.8 ± 278.7 s), sham (794.3 ± 271.2 s), or control conditions (TTE1 = 751.1 ± 261.6 s or TTE2 = 770.8 ± 250.6 s) [F(1.95; 21.4) = 1.537; P = 0.24; η2p = 0.123]. There was no effect on peripheral or whole-body RPE and associative thoughts (P > 0.05). No serious adverse effect was reported. A single session of neither HD-tDCS nor conventional tDCS changed exercise performance and psychophysiological responses in athletes, suggesting that a ceiling effect may exist.

The dynamical approach represents a new branch in the understanding of functional brain networks. Using simple indices to represent time connectivity and topological stability, we evaluated the hypothesis of increased brain stability during the meditative state in comparison to the relaxation state. We used a new way to consider the time evolution of synchronization patterns in electroencephalography (EEG) data. The time-varying graph approach and the motif synchronization method were combined to build a set of graphs representing time evolution for the synchronization of 29 EEG electrodes. We analysed these graphs during meditation and relaxation states in 17 experienced meditators. As result, we found significant increasing of time connectivity (t(15) $= -2.50$, p $= 0.023$) and topological stability (t(15) $= 1.23$, p $= 0.020$) in the meditation state when compared to the relaxation state. These findings suggest that dynamical properties of the synchronization network may revel aspects of brain activity in altered states of consciousness not possible to measure using a static approach. We concluded that the topological patterns evolution in the functional networks of experienced meditators are more stable in the meditative state than in the relaxation state.

The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.

High spinal cord injured patients (SCI) are susceptible to respiratory muscle impairments. Transcranial direct current stimulation (tDCS) and peripheral electrical stimulation (PES) may influence the diaphragm's central control, but until now they are not described as a therapeutic resource for difficult weaning. We present two case reports of SCI patients (P1 and P2) with long-term tracheostomy (40 days) and hospital stay (50 days). In association with respiratory exercise, P1 received a combined application of anodal tDCS over the supplementary motor area plus sensory PES in the thoracic-abdominal muscles, and P2 received isolated excitatory PES in the abdominal muscles, applied daily except on weekends. Maximum inspiratory/expiratory pressure, peak cough flow, diaphragm excursion, and thickening fraction were measured in the first and last days of the protocol. Both patients had improvements, with clinical impact such as cough effectiveness, decannulated after 15 applications of stimulation. Augmentation of neural respiratory drive and corticospinal excitability is suggested.

Background: Brazil has a top position regarding scientific production on noninvasive neuromodulation worldwide. Knowledge of scientometric phenomena involving Brazilian researchers who produce science on this theme may aid confidence in Brazilian clinical and research professionals. Objective: To investigate the scenario of research on the theme of noninvasive neuromodulation in Brazil. Methods: This was a scientometric study for mapping scientific production on this subject involving network phenomena, the professions of researchers, institutional affiliation, main research unit, total number of scientific articles on noninvasive neuromodulation published in journals, research sub-area and year of obtaining the PhD title. Public data from Lattes Platform curricula vitae and from VOSViewer© were used. Results: A total of 54 Brazilian researchers were identified, of whom 16 are research productivity fellows. Most of them are linked to institutions in southeastern Brazil, involving the professions of biology, biochemistry, physical education, physiotherapy, speech therapy, gerontology, medicine and psychology, with 1175 articles published in journals. These studies involve experimental animal and human models to account for mechanisms, observational studies, case reports, randomized clinical trials, systematic reviews, meta-analyses, product and process development, computer modeling and guidelines. Conclusions: Brazil occupies a prominent place in the world scenario of research on noninvasive neuromodulation, which is used by different professions for treatment of brain dysfunctions, with a trend towards expansion to other fields. RESUMO Antecedentes: O Brasil ocupa posição de destaque na produção científica de neuromodulação não invasiva no mundo. O conhecimento dos fenômenos cientométricos envolvendo pesquisadores brasileiros que produzem ciência neste tema pode auxiliar na confiança dos profissionais clínicos e pesquisadores brasileiros. Objetivo: Investigar o cenário das pesquisas sobre a temática da neuromodulação não invasiva no Brasil. Métodos: Estudo cienciométrico para mapeamento da produção científica sobre o tema envolvendo fenômenos de rede, profissão dos pesquisadores, afiliação à instituição, unidade principal de pesquisa, número total de artigos científicos publicados em periódicos sobre neuromodulação não invasiva, subárea de pesquisa e ano de obtenção do título de doutor. Utilizou-se dados públicos dos currículos da Plataforma Lattes e do sistema VOSViewer©. Resultados: Foram identificados 54 pesquisadores brasileiros, dos quais 16 são bolsistas de produtividade em pesquisa, a maioria deles vinculados a instituições do Sudeste do Brasil, envolvendo as profissões de Biologia, Bioquímica, Educação Física, Fisioterapia, Fonoaudiologia, Gerontologia, Medicina e Psicologia, com 1175 artigos publicados em periódicos. As pesquisas envolvem modelos experimentais animais e humanos para estudar dos mecanismos, estudos observacionais, relatos de casos, ensaios clínicos randomizados, revisões sistemáticas, meta-análises, desenvolvimento de produtos e processos, modelagem computacional e diretrizes. Conclusões: O Brasil ocupa lugar de destaque no cenário mundial das pesquisas em neuromodulação não invasiva, sendo utilizado por diferentes profissões para o tratamento de disfunções cerebrais, que tendem a se expandir para outros campos.

This study aimed to examine the effect of transcranial direct current stimulation (tDCS) used as a recovery strategy, on heart rate (HR) measures and perceived well-being in 12 male professional soccer players. tDCS was applied in the days after official matches targeting the left dorsolateral prefrontal cortex (DLPFC) with 2 mA for 20 min (F3-F4 montage). Participants were randomly assigned to anodal tDCS (a-tDCS) or sham tDCS sessions. Players completed the Well-Being Questionnaire (WBQ) and performed the Submaximal Running Test (SRT) before and after tDCS. HR during exercise (HRex) was determined during the last 30 s of SRT. HR recovery (HRR) was recorded at 60 s after SRT. The HRR index was calculated from the absolute difference between HRex and HRR. A significant increase was observed for WBQ (effect of time; p 0.05). These results suggest that a-tDCS over the DLPFC may have a positive effect on enhancing well-being and parasympathetic autonomic markers, which opens up a possibility for testing tDCS as a promising recovery-enhancing strategy targeting the brain in soccer players. The findings suggest that brain areas related to emotional and autonomic control might be involved in these changes with a possible interaction effect of tDCS by placebo-related effects, but more research is needed to verify this effect.

Objective This systematic review aims to synthesize the available evidence on the effects of transcranial direct current stimulation on heart rate modulation, indexed by heart rate variability parameters in healthy individuals and those with clinical disorders. Introduction There is some evidence that altered heart rate variability parameters are associated with different clinical disorders. For example, diminished parasympathetic activity has been explored as a potential biomarker for some chronic pain conditions. Considering the dynamic interaction between brain and heart, neuromodulatory strategies targeting this relationship could exert a positive influence on the cardiac autonomic system. Transcranial direct current stimulation is a non-invasive neuromodulation technique that has been presenting recent advances in the treatment of various clinical disorders. However, the evidence concerning transcranial direct current stimulation application focusing on brain-heart interaction is still controversial. Inclusion criteria This review will consider studies that investigate the effects of transcranial direct current stimulation on heart rate variability in healthy participants or those with clinical disorders. Methods This review will follow JBI systematic review methodology recommendations. PubMed, Embase, CINAHL, Web of Science, PsycNET, Cochrane Controlled Register of Trials (CENTRAL) and Physiotherapy Evidence Database (PEDro) will be searched, along with several sources of gray literature. Retrieval of full-text studies, and assessment of methodological quality and data extraction, will be performed independently by two reviewers. Data will be pooled in statistical meta-analysis, where possible. Systematic review registration number PROSPERO CRD42018114105.

We thank Dr. Zugaib et al. for the interest in our work.1 It has been suggested that modeling electric fields within the deep cortical structures would provide more reliable, target-effect conclusions. So far, the use of linear projection to target1 the posterior superior insula (PSI) has provided antinociceptive effects as measured by increases in the heat-pain threshold in patients with central pain2 and in healthy volunteers.3o Importantly, in a unique study,4 direct cortical stimulation of the PSI during stereo-EEG showed exactly4 the same heat-pain changes described by the linear projection-targeted deep transcranial magnetic stimulation (TMS). Taken together, these are very strong arguments for the precision of such an approach. In addition, in the setups cited above, stimulation intensity was calculated using the anterior tibialis muscle as a parameter (with the leg representation buried medially within the primary motor cortex), which attests that a measurable amount of induced electric current was indeed delivered to the PSI. As pointed out by Zugaib and Souza,5 computing electric field would not solve the issue of intensity of stimulation. Because the linear projection-based deep TMS approach proved itself accurate on psychophysical terms, we propose a pragmatic “reverse-modeling” perspective that future electric-field models should take into account the data from linear projection in their algorithms because they have been validated against sham and active controls and provided information on the intensity of stimulation all at once.

Context: Thousands of people worldwide have been infected by the chikungunya virus (CHIKV), and the persistence of joint pain symptoms has been considered the main problem. Neuromodulation techniques such as transcranial direct current stimulation (tDCS) act on brain areas involved in the processing of chronic pain. It was previously demonstrated that tDCS for five consecutive days significantly reduced pain in the chronic phase of chikungunya (CHIK). Objective: To analyze the effect of alternate tDCS sessions on pain and functional capacity in individuals affected by CHIK. Methods: In a randomized clinical trial, 58 women in the chronic phase of CHIK were divided into two groups: active-tDCS (M1-S0, 2 mA, 20 min) and sham-tDCS. The Visual Analogue Scale (VAS) and the Brief Pain Inventory (BPI) were used to assess pain, while the Health Assessment Questionnaire (HAQ) assessed functional capacity. These scales were used before and after six sessions of tDCS in nonconsecutive days on the primary motor cortex, and at follow-up consultation 7 and 15 days after the last session. A repeated measures mixed-model ANOVA was used for comparison between groups (significant p-values

nociceptive pain from joint damage caused by autoimmune inflammatory disease is expected in rheumatoid arthritis. However, neuropathic pain also occurs and persists even with the disease under control. This study aimed to investigate factors associated with neuropathic pain in rheumatoid arthritis by considering sociodemographic and behavioral data as well as lifestyle and clinical aspects in a self-referenced afro-descendant ethnicity sample.In a cross-sectional study, the Douleur Neuropathique 4, Health Assessment Questionnaire, the Hospital Anxiety and Depression Scale and sociodemographic characteristics were used. Additionally, a Bivariate analysis was performed, followed by hierarchical multiple logistic regression, with results expressed asthe frequency of NP was at a proximal level consisting of clinical characteristics related to anxiety (p=0.03) and depression (p=0.04). When a hierarchical multiple logistic regression analysis was conducted, an independent association was identified between neuropathic pain and black race. At the third and fourth stages, when the clinical variables were adjusted by race, an association was found with moderate functionality (p=0.04) and anxiety (p=0.04).neuropathic pain in rheumatoid arthritis is related to the Afro-descendant ethnicity that affects functionality and anxiety levels.

The objective of this study is to describe the chronic pain characteristics in individuals infected with human T cell lymphotropic virus type 1 (HTLV-1) per subgroup (asymptomatic, oligosymptomatic, and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)) compared with controls with chronic pain without HTLV-1. This is a cross-sectional study investigating associations between pain profile, psychopathological symptoms, and quality of life. Individuals infected with HTLV-1 refer high-intensity pain compared with controls, with more severe characteristics being present in oligosymptomatic and HAM/TSP individuals. Oligosymptomatic individuals have a tendency of diffuse and frequent pain, mainly in the head/neck region and more depressive symptoms, resembling nociplastic pain. Neuropathic pain was localized in the lower limbs in all infected groups, worse in HAM/TSP individuals, and associated with a worse perception of quality of life. Pain was associated to higher levels of TNF-alpha and interferon-gamma. HTLV-1 pain is generally more severe when compared with other chronic pain syndromes, being present mainly in the lower limbs. Certain characteristics are typical, depending on the affected group. Oligosymptomatic and HAM/TSP individuals present more diffuse pain, with higher intensity and greater impact in quality of life. Increased levels of inflammatory cytokines are associated with HTLV-1-related pain.

Background: It is well accepted that pain in brachial plexus injury (BPI) have a major neuropathic component, but the nociceptive aspects may play an important role in the generation and maintenance of pain in patients with PBI and should be investigated also. An example of a source of nociceptive pain in these individuals is the involvement of myofascial trigger points. Aim: To estimate the prevalence of myofascial pain in individuals with BPI. Methods: This was a cross-sectional study with 31 volunteers who had suffered traumatic BPI, and were treated for a two-year period in three reference centers. All participants were evaluated for the presence of trigger points (TP) in specific muscles. Their demographic and clinical data related to injury and pain were collected in an evaluation form that included the Visual Analogue Scale, Brief Pain Inventory, Douleur Neuropathique 4 and McGill Pain Questionnaire instruments. Results: The sample was predominantly composed of males (93.5%), under the age of 30 years (58.0%), who were injured mainly in motorcycle accidents (77.4%). The prevalence of myofascial pain was 38.7%. The muscles on the injured side were more affected than those on the non-injured side. Interpretation: This study suggests that there may be myofascial components involved in pain of patients with BPI.

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.

BACKGROUND: Knee osteoarthritis (OA) is associated with chronic pain, impaired function and loss of quality of life. Brain maladaptive plasticity may be involved and prevent beneficial effects of exercises and other interventions. Neuromodulation with peripheral electrical stimulation guided by TMS mapping may specifically influence those maladaptive modifications. OBJECTIVE: To compare the cortical organization and excitability of three muscles (straight femuris, vastus lateralis and vastus medialis) in a subject with OA knee. METHODS: This single case ABA study involved a 66 yo woman with knee OA that was considering an arthroplasty. She was assessed for pain (VAS), function (WOMAC, ICOAP), and quadriceps strength one time a week, for 10 weeks (A – four weeks assessment; B – two weeks assessment and intervention; A – four weeks assessment). TMS mapping was performed at baseline, after the two-week intervention period and at the end of the study. This examination initially revealed a prominent decrease in the volume of vastus medialis portion of the quadriceps muscle over the primary motor cortex (M1), which determined a peripheral electrical stimulation protocol specifically designed to increase this muscle’s excitability. During the intervention period the participant also carried over specific exercises daily. RESULTS: WOMAC scores, and quadriceps strength were not changed during the study period. Improvements were seen in the three subscales of the ICOAP following the intervention. This clinical change was associated with an increase in vastus medialis and also Vastus lateralis, and a decrease in rectus femuris TMS map volumes, which were maintained until the last evaluation. CONCLUSION: TMS mapping may guide specific interventions to counteract motor cortex maladaptive plasticity and positively influence pain and function in knee OA.

Objective The purpose of this study was to review the literature regarding the relationship between spinal manipulative therapy (SMT) and sports performance. Methods PubMed and Embase databases were searched for original studies published up to July 2016. Inclusion criteria were if SMT has been applied to athletes and if any sports performance–related outcome was measured. Results Of the 581 potential studies, 7 clinical trials were selected. Most studies had adequate quality (≥6/11) when assessed by the PEDro scale. None of those studies assessed performance at an event or competition. Four studies revealed improvement in a sports performance test after SMT. Meta-analysis could not be performed because of the wide differences in methodologies, design, and outcomes measured. Spinal manipulative therapy influences a wide range of neurophysiological parameters that could be associated with sports performance. Of the 3 studies where SMT did not improve test performance, 2 used SMT not for therapeutic correction of a dysfunctional vertebral joint but to an arbitrary previously set joint. Conclusions Although 4 of 7 studies showed that SMT improved sports performance tests, the evidence is still weak to support its use. Spinal manipulative therapy may be a promising approach for performance enhancement that should be investigated with more consistent methodologic designs.

Transcranial Direct Current Stimulation (tDCS) uses a direct electrical current to modulate the activity of cortical neurons. Anodal tDCS (positive pole) increases the excitability of cortical neurons, while cathodic tDCS (negative pole) reduces it. However, when applied in the peripheral nervous system the effects are the opposite of cranial application. Furthermore, when central and peripheral stimuli are used concomitantly, their effects can be summed up. This has been demonstrated by combining tDCS with other forms of sensory peripheral stimulation. We propose a new electrode configuration to potentiate the excitatory and inhibitory effects of tDCS on neuronal excitability and increase upper limb motor function. Our hypothesis is that placement of the electrodes in the primary motor cortex (M1) and the contralateral brachial plexus (BP) would promote this potentiation by central and peripheral synaptic summation. We will test our hypothesis in two proof-of-concept studies. Study 1) Secondary trial, in which we will evaluate the effects of these configurations on the neuronal excitability of healthy individuals; Study 2) A double-blind, randomized and crossover clinical trial in which we will test the stimulation with the anode in M1 and the cathode in the contralateral BP on the motor function and electrophysiological markers of individuals with cerebral palsy. The effects of the new configurations will be compared with the conventional configuration (M1 / contralateral supraorbital region). We expect that our investigations will identify a more efficient way to apply tDCS and consequently a better clinical use of this technique.

Peripheral nerve lesions may be associated with abnormal scarring that lead to regenerative failure and dysfunction. Neurodynamic mobilization (NM) imposes controlled mechanical loads on the peripheral nerve and may influence inflammation and collagen deposition after a lesion. However, there is lack of experimental data to support these claims. Objective: To evaluate the impact of NM in the intraneural number of mast cells, collagen deposition and number of blood vessels after an ischiatic crush lesion in rats. Methods: This is a laboratory animal study, where 20 rats (Rattus norvegicus) were randomly divided into two groups, NM (n=10) and control (n=10), submitted to a right ischiatic nerve lesion. A tensioning NM began 10 days after lesion, and was maintained once a day, six times a week, for three weeks. After this period, the animals were euthanized and the nerves assessed for the number of mast cells, collagen area and number of blood vessels. Results: NM led to a lower number of degranulated mast cells (Kruskal-Wallis=0.29 p