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Individuals with neurodevelopmental disorders exhibit overlapping emotional, somatosensory and motor deficits. Although brain processes underlying these impairments have been extensively studied in a separate way, the brain interaction of these inputs is an innovative line of research. Here we present a new EEG methodology for exploring the interactive brain activity of sensorimotor and affective stimuli. The task consists in presenting affective stimuli of different modalities (e.g. affective pictures, affective touch) while simultaneously an arthromotor performs passive joint movements, unseen by the participant. Participants were then required to press one of two buttons to indicate if their joint position agreed with a picture shown in a screen. Pilot data of electroencephalography recordings revealed distinct somatosensory event-related potentials (SEP) when movement was subsequent to affective stimuli, compared to neutral stimuli, as well as a differentiation of SEPs for different neurodevelopmental conditions. Behavioral responses further showed that children with cerebral palsy had more errors to identify their hand position when they were exposed to affective stimuli. This paradigm is a valuable tool to explore the modulative influence of emotion in the sensorimotor brain processing of different populations with joint emotional and sensorimotor impairments, such as children with neurodevelopmental disorders or patients with stroke. • This method allows exploring the interaction between affective and sensoriomotor inputs in an EEG paradigm.

Abstract Background Verbal communication is the "gold standard" for assessing pain. Consequently, individuals with communication disorders are particularly vulnerable to incomplete pain management. This review aims at identifying the current pain assessment instruments for adult patients with communication disorders. Methods A systematic review with meta-analysis was conducted on PubMed, PEDRO, EBSCOhost, VHL and Cochrane databases from 2011 to 2023 using MeSH terms “pain assessment, “nonverbal communication” and “communication disorders” in conjunction with additional inclusion criteria: studies limited to humans, interventions involving adult patients, and empirical investigations. Results Fifty articles were included in the review. Seven studies report sufficient data to perform the meta-analysis. Observational scales are the most common instruments to evaluate pain in individuals with communication disorders followed by physiological measures and facial recognition systems. While most pain assessments rely on observational scales, current evidence does not strongly endorse one scale over others for clinical practice. However, specific observational scales appear to be particularly suitable for identifying pain during certain potentially painful procedures, such as suctioning and mobilization, in these populations. Additionally, specific observational scales appear to be well-suited for certain conditions, such as mechanically ventilated patients. Conclusions While observational scales dominate pain assessment, no universal tool exists for adults with communication disorders. Specific scales exhibit promise for distinct populations, yet the diverse landscape of tools hampers a one-size-fits-all solution. Crucially, further high-quality research, offering quantitative data like reliability findings, is needed to identify optimal tools for various contexts. Clinicians should be informed to select tools judiciously, recognizing the nuanced appropriateness of each in diverse clinical situations. Trial registration This systematic review is registered in PROSPERO (International prospective register of systematic reviews) with the ID: CRD42022323655 .

Objective Assessing pain in individuals with neurological conditions like cerebral palsy is challenging due to limited self-reporting and expression abilities. Current methods lack sensitivity and specificity, underlining the need for a reliable evaluation protocol. An automated facial recognition system could revolutionize pain assessment for such patients. The research focuses on two primary goals: developing a dataset of facial pain expressions for individuals with cerebral palsy and creating a deep learning-based automated system for pain assessment tailored to this group. Methods The study trained ten neural networks using three pain image databases and a newly curated CP-PAIN Dataset of 109 images from cerebral palsy patients, classified by experts using the Facial Action Coding System. Results The InceptionV3 model demonstrated promising results, achieving 62.67% accuracy and a 61.12% F1 score on the CP-PAIN dataset. Explainable AI techniques confirmed the consistency of crucial features for pain identification across models. Conclusion The study underscores the potential of deep learning in developing reliable pain detection systems using facial recognition for individuals with communication impairments due to neurological conditions. A more extensive and diverse dataset could further enhance the models’ sensitivity to subtle pain expressions in cerebral palsy patients and possibly extend to other complex neurological disorders. This research marks a significant step toward more empathetic and accurate pain management for vulnerable populations.

Proprioception has long been linked with emotional dysregulation in neurotypical adults. Neuropediatric disorders such as autism spectrum disorder (ASD) and cerebral palsy (CP) are distinct entities and yet both present with deficits and challenges in sensory processing and the regulation of emotions. This study aimed to explore the relationship between proprioception and emotional–social performance in children and to compare proprioception and emotional–social performance in different underlying neurodevelopmental conditions. For this purpose, this cross-sectional study included 42 children with ASD, 34 children with CP and 50 typically developing peers. Proprioceptive acuity, proprioceptive reactive behavior as well as emotion regulation and social responsiveness were assessed. The results show a significant correlation between proprioceptive deficits and emotional difficulties in this pediatric sample, with distinct proprioceptive impairment patterns according to the underlying neurological disorder. Children with CP showed significant emotional knowledge deficits, while children with ASD predominantly showed challenges in social responsiveness. These data thus suggest a differentiated impact of proprioception on emotional–social performance in neurodevelopmental disorders and highlight proprioception as a potential therapeutic target for balancing emotion regulation in children with neurodevelopmental conditions.

IntroductionAutistic children may have abnormal sensory perception, emotion dysregulation and behavior problems. The aim of this cross-sectional study was to explore the relationship between skin-mediated somatosensory signals and emotion/behavior difficulties in autistic children and adolescents, in comparison typically developing peers (TDP).MethodsThirty-eight autistic children and adolescents and 34 TDP completed a multidimensional assessment consisting of the measurement of somatosensory thresholds of touch, pain and temperature, a task on emotion knowledge and parent-reported questionnaires on sensory reactivity, emotion regulation and behavior.ResultsAutistic children had higher pain sensitivity, less sensory reactive behaviors and more behavior problems than their TDP. In contrast to TDP, several somatosensory thresholds of autistic children correlated with emotion regulation and behavior problems.DiscussionSensory dysfunction may affect the development of emotional processing and behavior in autistic children and adolescents. This knowledge can lay the foundation for future studies on co-occurring alterations in corresponding neural networks and for the implementation of early interventions, including sensory rehabilitation therapy, for promoting regulated behaviors in autistic children and adolescents.

Growing evidence suggests that aging is associated with less efficient endogenous pain modulation as demonstrated by reduced conditioned pain modulation, and that these changes may be mediated by differences in frontal functioning. Yet, little is known about potential age-related changes in cognitive pain modulation, such as distraction from pain. In a first session, 30 healthy young (19–35 years) and 30 healthy older (59–82 years) adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (high vs. low) and concurrently received individually adjusted heat stimuli (warm vs. painful). In both age groups, completing the high load task was associated with a significant reduction in the perceived intensity and unpleasantness of painful stimuli and a reduction in activation of brain regions involved in pain processing. Group comparisons revealed that young adults showed a stronger de-activation of brain regions involved in pain processing during the high load vs. the low load task, such as the right insula, right mid cingulate cortex and left supramarginal gyrus, compared to older adults. Older adults, on the other hand, showed an increased activation in the anterior cingulate cortex during the high load vs. low load task, when compared to young adults. Covariate analyses indicated that executive functions significantly predicted neural pain modulation in older adults: Better executive functions were associated with a more pronounced de-activation of the insula, thalamus and primary somatosensory cortex and increased activation of prefrontal regions during the high vs. low load task. These findings suggest that cognitive pain modulation is altered in older age and that the preservation of executive functions may have beneficial effects on the efficacy of distraction from pain.

BackgroundConcomitant psychological and cognitive impairments modulate nociceptive processing and contribute to chronic low back pain (CLBP) maintenance, poorly correlated with radiological findings. Clinical practice guidelines recommend self-management and multidisciplinary educational and exercise-based interventions. However, these recommendations are based on self-reported measurements, which lack evidence of related electrophysiological changes. Furthermore, current mobile health (mHealth) tools for self-management are of low quality and scarce evidence. Thus, it is necessary to increase knowledge on mHealth and electrophysiological changes elicited by current evidence-based interventions. ObjectiveThe aim of this study is to investigate changes elicited by a self-managed educational and exercise-based 4-week mHealth intervention (BackFit app) in electroencephalographic and electrocardiographic activity, pressure pain thresholds (PPTs), pain, disability, and psychological and cognitive functioning in CLBP versus the same intervention in a face-to-face modality. MethodsA 2-arm parallel nonrandomized clinical trial was conducted at the University of the Balearic Islands (Palma, Spain). A total of 50 patients with nonspecific CLBP were assigned to a self-managed group (23/50, 46%; mean age 45.00, SD 9.13 years; 10/23, 43% men) or a face-to-face group (27/50, 54%; mean age 48.63, SD 7.54 years; 7/27, 26% men). The primary outcomes were electroencephalographic activity (at rest and during a modified version of the Eriksen flanker task) and heart rate variability (at rest), PPTs, and pressure pain intensity ratings. The secondary outcomes were pain, disability, psychological functioning (mood, anxiety, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs), and cognitive performance (percentage of hits and reaction times). ResultsAfter the intervention, frequency analysis of electroencephalographic resting-state data showed increased beta-2 (16-23 Hz; 0.0020 vs 0.0024; P=.02) and beta-3 (23-30 Hz; 0.0013 vs 0.0018; P=.03) activity. In addition, source analyses revealed higher power density of beta (16-30 Hz) at the anterior cingulate cortex and alpha (8-12 Hz) at the postcentral gyrus and lower power density of delta (2-4 Hz) at the cuneus and precuneus. Both groups also improved depression (7.74 vs 5.15; P=.01), kinesiophobia (22.91 vs 20.87; P=.002), activity avoidance (14.49 vs 12.86; P

Many individuals with cerebral palsy (CP) suffer from pain and must develop pain-coping strategies, although the factors determining them are unknown. This observational study aims at exploring the association between different pain-coping strategies and factors such as age, sex, pain, health status, sleep or motor and cognitive function in individuals with cerebral palsy (CP) and typically developing peers (TD). Main caregivers of 94 individuals with CP (age range = 6–69 years, mean age = 17.78 (10.05)) and the closest relative of 145 individuals with TD (age range = 6–51 years, mean age = 19.13 (12.87)) completed questionnaires on the previous topics (Parent Report of the PEDsQL Pediatric Coping Inventory, the Health Utility Index HUI-3, Epworth Sleepiness Score and the Pittsburgh Sleep Quality Index). Pain presence, duration, intensity, location and ratings of current and worst pain in the last week in an 11-point numerical rating scale were assessed in an interview. Global health was the best predictor the of use of any type of pain-coping strategy, including cognitive self-instruction, problem-solving, distraction, seeking social support and catastrophizing, in both individuals with CP and individuals with TD. However, different health attributes predicted their use in each population. Emotional health was the best predictor in individuals with CP, whereas cognition and pain were the best predictors in individuals with TD. Speech ability was a predictor in both groups. In conclusion, the assessment of health attributes such as emotional health and speech may help design specific interventions for enhancing self-efficacy and adaptive pain coping skills.

BackgroundAnodal transcranial direct current stimulation (tDCS) of the somatosensory cortex causes cerebral hyperexcitability and a significant enhancement in pain thresholds and tactile spatial acuity. Sensory gating is a brain mechanism to suppress irrelevant incoming inputs, which is elicited by presenting pairs of identical stimuli (S1 and S2) within short time intervals between stimuli (e.g., 500 ms).Objectives/HypothesisThe present study addressed the question of whether tDCS could modulate the brain correlates of this inhibitory mechanism.MethodsForty-one healthy individuals aged 18–26 years participated in the study and were randomly assigned to tDCS (n = 21) or SHAM (n = 20). Somatosensory evoked potentials (SEP) elicited by S1 and S2 pneumatic stimuli (duration of 100 ms, ISI 550 ± 50 ms) and applied to the index finger of the dominant hand were recorded before and after tDCS.ResultsBefore the intervention, the second tactile stimuli significantly attenuated the amplitudes of P50, N100, and the late positive complex (LPC, mean amplitude in the time window 150–350) compared to the first stimuli. This confirmed that sensory gating is a widespread brain inhibitory mechanism that can affect early- and middle-latency components of SEPs. Furthermore, our data revealed that this response attenuation or sensory gating (computed as S1 minus S2) was improved after tDCS for LPC, while no changes were found in participants who received SHAM.ConclusionAll these findings suggested that anodal tDCS might modulate brain excitability leading to an enhancement of inhibitory mechanisms elicited in response to repetitive somatosensory stimuli during late stages of information processing.

Alterations in the affective component of pain perception are related to the development of chronic pain and may contribute to the increased vulnerability to pain observed in aging. The present study analyzed age-related changes in resting-state brain activity and their possible relation to an increased pain perception in older adults. For this purpose, we compared EEG current source density and fMRI functional-connectivity at rest in older (n = 20, 66.21 ± 3.08 years) and younger adults (n = 21, 20.71 ± 2.30 years) and correlated those brain activity parameters with pain intensity and unpleasantness ratings elicited by painful stimulation. We found an age-related increase in beta2 and beta3 activity in temporal, frontal, and limbic areas, and a decrease in alpha activity in frontal areas. Moreover, older participants displayed increased functional connectivity in the anterior cingulate cortex (ACC) and the insula with precentral and postcentral gyrus. Finally, ACC beta3 activity was positively correlated with pain intensity and unpleasantness ratings in older, and ACC-precentral/postcentral gyrus connectivity was positively correlated with unpleasantness ratings in older and younger participants. These results reveal that ACC resting-state hyperactivity is a stable trait of brain aging and may underlie their characteristic altered pain perception.

Fibromyalgia is a chronic pain disease with few effective therapeutic options. We evaluated the efficacy of a 12-weeks therapy program that involves the use of whole body vibration in patients with fibromyalgia. The experimental group (N = 20 patients) participated in a neuromuscular training with a rotational whole body vibration platform for 12 weeks. The control group (N = 20 patients) received no physiotherapy treatment. The following variables were assessed before, after and 3 months after the therapy program: Fibromyalgia impact questionnaire, pain intensity, quality of life, sensitivity measurements (pressure pain thresholds, vibration thresholds), motor function tasks (Berg scale, 6-min walk test, isometric back muscle strength), and static and dynamic balance. We found improvements in the indexes of functional disability, static equilibrium and vibration sensitivity and a reduction of pain sensitivity. Our results showed that the intervention group improved almost all parameters immediately after the therapy program, in contrast to the control group that showed no changes. These improvements were not maintained in the follow-up. The whole body vibration therapy can be an effective therapy in patients with fibromyalgia and it can improve symptomatology and quality of life in these patients.

The management of patients with diminished ovarian reserve (DOR) remains one of the most challenging tasks in IVF clinical practice. Despite the promising results obtained from animal studies regarding the importance of androgens on folliculogenesis, the evidence obtained from clinical studies remains inconclusive. This is mainly due to the lack of an evidence-based methodology applied in the available trials and to the heterogeneity in the inclusion criteria and IVF treatment protocols. In this review, we analyze the available evidence obtained from animal studies and highlight the pitfalls from the clinical studies that prevent us from closing the chapter of this line of research.

Aging affects pain experience and brain functioning. However, how aging leads to changes in pain perception and brain functional connectivity has not yet been completely understood. To investigate resting-state and pain perception changes in old and young participants, this study employed region of interest (ROI) to ROI resting-state functional connectivity (rsFC) analysis of imaging data by using regions implicated in sensory and affective dimensions of pain, descending pain modulation, and the default-mode networks (DMNs). Thirty-seven older (66.86 ± 4.04 years; 16 males) and 38 younger healthy participants (20.74 ± 4.15 years; 19 males) underwent 10 min’ eyes-closed resting-state scanning. We examined the relationship between rsFC parameters with pressure pain thresholds. Older participants showed higher pain thresholds than younger. Regarding rsFC, older adults displayed increased connectivity of pain-related sensory brain regions in comparison to younger participants: increased rsFC between bilateral primary somatosensory area (SI) and anterior cingulate cortex (ACC), and between SI(L) and secondary somatosensory area (SII)-(R) and dorsolateral prefrontal cortex (PFC). Moreover, decreased connectivity in the older compared to the younger group was found among descending pain modulatory regions: between the amygdala(R) and bilateral insula(R), thalamus(R), ACC, and amygdala(L); between the amygdala(L) and insula(R) and bilateral thalamus; between ACC and bilateral insula, and between periaqueductal gray (PAG) and bilateral thalamus. Regarding the DMN, the posterior parietal cortex and lateral parietal (LP; R) were more strongly connected in the older group than in the younger group. Correlational analyses also showed that SI(L)-SII(R) rsFC was positively associated with pressure pain thresholds in older participants. In conclusion, these findings suggest a compensatory mechanism for the sensory changes that typically accompanies aging. Furthermore, older participants showed reduced functional connectivity between key nodes of the descending pain inhibitory pathway.

Neuroimaging studies have demonstrated that altered activity in somatosensory and motor cortices play a key role in pain chronification. Neurofeedback training of sensorimotor rhythm (SMR) is a tool which allow individuals to self-modulate their brain activity and to produce significant changes over somatomotor brain areas. Several studies have further shown that neurofeedback training may reduce pain and other pain-related symptoms in chronic pain patients. The goal of the present study was to analyze changes in SMR power and brain functional connectivity of the somatosensory and motor cortices elicited by neurofeedback task designed to both synchronize and desynchronize the SMR power over motor and somatosensory areas in fibromyalgia patients. Seventeen patients were randomly assigned to the SMR training (n = 9) or to a sham protocol (n = 8). All participants were trained during 6 sessions, and fMRI and EEG power elicited by synchronization and desynchronization trials were analyzed. In the SMR training group, four patients achieved the objective of SMR modulation in more than 70% of the trials from the second training session (good responders), while five patients performed the task at the chance level (bad responders). Good responders to the neurofeedback training significantly reduced pain and increased both SMR power modulation and functional connectivity of motor and somatosensory related areas during the last neurofeedback training session, whereas no changes in brain activity or pain were observed in bad responders or participants in the sham group. In addition, we observed that good responders were characterized by reduced impact of fibromyalgia and pain symptoms, as well as by increased levels of health-related quality of life during the pre-training sessions. In summary, the present study revealed that neurofeedback training of SMR elicited significant brain changes in somatomotor areas leading to a significant reduction of pain in fibromyalgia patients. In this sense, our research provide evidence that neurofeedback training is a promising tool for a better understanding of brain mechanisms involved in pain chronification.

Abstract Background This randomized controlled trial explored the practicality and effectiveness of a novel tool-assisted self-help device, one that combines vibrational oscillation, leverage, and the shearing effect from the edges, for promoting meaningful changes in key biomechanical tissue indices and related parameters. Methods One hundred and thirteen male breakdancers were randomized to an intervention or control group. Individuals assigned to the intervention group performed the self-help treatment on the quadriceps and the iliotibial band of their right thighs for 8 min, while individuals assigned to the control condition merely sat quietly during this period. Various primary outcome measures (e.g., elasticity, stiffness, range of motion, pain pressure threshold sensitization, and blood flow) were assessed before and after the intervention for each participant, with position and posture being standardized throughout. Subjective sensations and a measure selected to assess for potential experimental demand effects, serving as secondary measures, were also administered pre- to post-treatment. Results Stiffness was significantly reduced for both structures (p

Abstract Background Knee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA. Methods Patients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention. Discussion The motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. Trial registration: Brazilian Registry on Clinical Trials (ReBEC) – Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B. Trial registration ID: RBR-9D7C7B . Registered on 29 February 2016.

Chronic pain is known as a complex disease due to its comorbidities with other symptoms and the lack of effective treatments. As a consequence, chronic pain seems to be under-diagnosed in more than 75% of patients. At the same time, the advance in brain imaging, the popularization of machine learning techniques and the development of new diagnostic tools based on these technologies have shown that these tools could be an option in supporting decision-making of healthcare professionals. In this study, we computed functional brain connectivity using resting-state fMRI data from one hundred and fifty participants to assess the performance of different machine learning models, including deep learning (DL) neural networks in classifying chronic pain patients and pain-free controls. The best result was obtained by training a convolutional neural network fed with data preprocessed using the MSDL probabilistic atlas and using the dynamic time warping (DTW) as connectivity measure. DL models had a better performance compared to other less costly models such as support vector machine (SVM) and RFC, with balanced accuracy ranged from 69 to 86%, while the area under the curve (ROC) ranged from 0.84 to 0.93. Also, DTW overperformed correlation as connectivity measure. These findings support the notion that resting-state fMRI data could be used as a potential biomarker of chronic pain conditions.

Objective: To study the time course of the electrocortical activity evoked by gains and losses in the Iowa Gambling Task (IGT), the brain sources of this electrical activity, and its association with behavioral parameters of task performance in order to achieve a better knowledge of decision-making processes.Method: Event-related potentials (ERPs) were obtained from a 64-channel EEG in 25 participants when performing the IGT. Brain source localization analyses of the ERP components were also assessed.Results: ERP amplitudes were sensitive to gains and losses. An early fronto-central negativity was elicited when feedback was provided for both gains and losses, and correlated with the number of gains at FCz and with the number of both gains and losses at Cz. The P200 component had larger amplitudes to losses and correlated positively with the number of losses. Feedback related negativity (FRN) was higher at frontal, temporal and occipital electrodes in trials with monetary losses. In addition, trials with monetary losses elicited larger P300 magnitudes than trials with monetary gains at all electrode localizations.Conclusions: All ERP components (except P300) were related to participants’ performance in the IGT. Amplitudes of P200 and P300 were associated with the conscious recognition of the error during the decision-making. Performance data and source analysis underline the importance of the medial prefrontal cortex when processing feedback about monetary losses in the IGT.

The neurovisceral integration model proposes a neuronal network that is related to heart rate activity and cognitive performance. The aim of this study was to determine whether heart rate variability (HRV) and variability in electroencephalographic (EEG) functional connectivity in the resting state are related to cognitive flexibility. Thirty-eight right-handed students completed the CAMBIOS test, and their heart and EEG activity was recorded during 6 min in the resting state with their eyes open. We calculated correlations, partial correlations and multiple linear regressions among HRV indices, functional brain connectivity variability and CAMBIOS scores. Furthermore, the sample was divided into groups according to CAMBIOS performance, and one-way ANOVA was applied to evaluate group differences. Our results show direct and inverse correlations among cognitive flexibility, connectivity (positive and negative task networks) and heartbeat variability. Partial correlations and multiple linear regressions suggest that the relation between HRV and CAMBIOS performance is mediated by neuronal oscillations. ANOVA confirms that HRV and variability in functional brain connectivity is related to cognitive performance. In conclusion, the levels of brain signal variability might predict cognitive flexibility in a cognitive task, while HRV might predict cognitive flexibility only when it is mediated by neuronal oscillations.

Cerebral palsy (CP) is an impacting chronic condition. Concomitant comorbidities such as pain and speech inability may further affect parents’ perception of the pathology impact in the family quality of life and the provided care. The objective of this cross-sectional descriptive correlational study was to compare parental reports on family impact and healthcare satisfaction in children with CP with and without chronic pain and with and without speech ability. Parents of 59 children with CP (age range = 4–18 years) completed several questions about pain and speech ability and two modules of the Pediatric Quality of Life Measurement Model: The PedsQLTM 2.0 Family Impact Module and the PedsQLTM Healthcare Satisfaction Generic Module. Our findings revealed that children’s pain slightly impacted family physical health, social health and worry. In children without pain, speech inability increased the perceived health impact. Parents’ healthcare satisfaction was barely affected by pain or speech inability, both increasing parents’ satisfaction in the professional technical skills and inclusion of family domains on the care plan. In conclusion, pain and speech inability in children with CP can impact family health but not healthcare satisfaction. Regular assessment and intervention in family health is essential for the design of family-centred programs for children with CP.

In the last decade, machine learning has been widely used in different fields, especially because of its capacity to work with complex data. With the support of machine learning techniques, different studies have been using data-driven approaches to better understand some syndromes like mild cognitive impairment, Alzheimer’s disease, schizophrenia, and chronic pain. Chronic pain is a complex disease that can recurrently be misdiagnosed due to its comorbidities with other syndromes with which it shares symptoms. Within that context, several studies have been suggesting different machine learning algorithms to classify or predict chronic pain conditions. Those algorithms were fed with a diversity of data types, from self-report data based on questionnaires to the most advanced brain imaging techniques. In this study, we assessed the sensitivity of different algorithms and datasets classifying chronic pain syndromes. Together with this assessment, we highlighted important methodological steps that should be taken into account when an experiment using machine learning is conducted. The best results were obtained by ensemble-based algorithms and the dataset containing the greatest diversity of information, resulting in area under the receiver operating curve (AUC) values of around 0.85. In addition, the performance of the algorithms is strongly related to the hyper-parameters. Thus, a good strategy for hyper-parameter optimization should be used to extract the most from the algorithm. These findings support the notion that machine learning can be a powerful tool to better understand chronic pain conditions.

Neurofeedback is a form of neuromodulation based on learning to modify some aspects of cortical activity. Sensorimotor rhythm (SMR) oscillation is one of the most used frequency bands in neurofeedback. Several studies have shown that subjects can learn to modulate SMR power to control output devices, but little is known about possible related changes in brain networks. The aim of this study was to investigate the enhanced performance and changes in EEG power spectral density at somatosensory cerebral areas due to a bidirectional modulation-based SMR neurofeedback training. Furthermore, we also analyzed the functional changes in somatosensory areas during resting state induced by the training as exploratory procedure. A six-session neurofeedback protocol based on learning to synchronize and desynchronize (modulate) the SMR was implemented. Moreover, half of the participants were enrolled in two functional magnetic resonance imaging resting-state sessions (before and after the training). At the end of the training, participants showed a successful performance enhancement, an increase in SMR power specific to somatosensory locations, and higher functional connectivity between areas associated with somatosensory activity in resting state. Our research increases the better understanding of the relation between EEG neuromodulation and functional changes and the use of SMR training in clinical practice.

The capacity to suppress irrelevant incoming input, termed sensory gating, is one of the most investigated inhibitory processes associated with cognitive impairments due to aging. The aim of this study was to examine the influence of aging on sensory gating by using somatosensory event-related potentials (ERPs) elicited by repetitive non-painful tactile stimulation (paired-pulsed task). Somatosensory ERPs were recorded in 20 healthy young adults and 20 healthy older adults while they received two identical pneumatic stimuli (S1 and S2) of 100 ms duration with an inter-stimulus interval of 550 ± 50 ms on both forefingers. The difference between the somatosensory ERPs amplitude elicited by S1 and S2 was computed as a sensory gating measure. The amplitude and the latency of P50, N100 and late positive complex (LPC) were analyzed as well as the source generators of the gating effect. Reduced sensory gating was found in older individuals for N100 at frontal and centro-parietal electrodes and for LPC at fronto-central electrodes. Source localization analyses also revealed a reduced current density during gating effect in the older group in frontal areas in N100 and LPC. Moreover, older individuals showed delayed latencies in N100. No significant gating effect differences were found between groups in P50. These findings suggest an age-related slowing of processing speed and a reduced efficiency of inhibitory mechanisms in response to repetitive somatosensory information during stimulus evaluation, and a preservation of processing speed and inhibitory control during early stimulus coding in aging.

Chronic pain in Sickle Cell Disease (SCD) is probably related to maladaptive plasticity of brain areas involved in nociceptive processing. Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES) can modulate cortical excitability and help to control chronic pain. Studies have shown that combined use of tDCS and PES has additive effects. However, to date, no study investigated additive effects of these neuromodulatory techniques on chronic pain in patients with SCD. This protocol describes a study aiming to assess whether combined use of tDCS and PES more effectively alleviate pain in patients with SCD compared to single use of each technique. The study consists of a one-session double blind, block-randomized clinical trial (NCT02813629) in which 128 participants with SCD and femoral osteonecrosis will be enrolled. Stepwise procedures will occur on two independent days. On day 1, participants will be screened for eligibility criteria. On day 2, data collection will occur in four stages: sample characterization, baseline assessment, intervention, and post-intervention assessment. These procedures will last ~5 h. Participants will be divided into two groups according to homozygous for S allele (HbSS) (n = 64) and heterozygous for S and C alleles (HbSC) (n = 64) genotypes. Participants in each group will be randomly assigned, equally, to one of the following interventions: (1) active tDCS + active PES; (2) active tDCS + sham PES; (3) sham tDCS + active PES; and (4) sham tDCS + sham PES. Active tDCS intervention will consist of 20 min 2 mA anodic stimulation over the primary motor cortex contralateral to the most painful hip. Active PES intervention will consist of 30 min sensory electrical stimulation at 100 Hz over the most painful hip. The main study outcome will be pain intensity, measured by a Visual Analogue Scale. In addition, electroencephalographic power density, cortical maps of the gluteus maximus muscle elicited by Transcranial Magnetic Stimulation (TMS), serum levels of Brain-derived Neurotrophic Factor (BDNF), and Tumor Necrosis Factor (TNF) will be assessed as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables.

The aim of this study is to characterize in resting-state conditions the cerebral blood flow velocity (CBFV) signals of fibromyalgia patients. The anterior and middle cerebral arteries of both hemispheres from 15 women with fibromyalgia and 15 healthy women were monitored using Transcranial Doppler (TCD) during a 5-minute eyes-closed resting period. Several signal processing methods based on time, information theory, frequency and time-frequency analyses were used in order to extract different features to characterize the CBFV signals in the different vessels. Main results indicated that, in comparison with control subjects, fibromyalgia patients showed a higher complexity of the envelope CBFV and a different distribution of the power spectral density. In addition, it has been observed that complexity and spectral features show correlations with clinical pain parameters and emotional factors. The characterization features were used in a lineal model to discriminate between fibromyalgia patients and healthy controls, providing a high accuracy. These findings indicate that CBFV signals, specifically their complexity and spectral characteristics, contain information that may be relevant for the assessment of fibromyalgia patients in resting-state conditions.

Patients with chronic pain due to neuropathy or musculoskeletal injury frequently exhibit reduced alpha and increased theta power densities. However, little is known about electrical brain activity and chronic pain in patients with rheumatoid arthritis (RA). For this purpose, we evaluated power densities of spontaneous electroencephalogram (EEG) band frequencies (delta, theta, alpha, and beta) in females with persistent pain due to RA. This was a cross-sectional study of 21 participants with RA and 21 healthy controls (mean age = 47.20; SD = 10.40). EEG was recorded at rest over five minutes with participant's eyes closed. Twenty electrodes were placed over five brain regions (frontal, central, parietal, temporal, and occipital). Significant differences were observed in depression and anxiety with higher scores in RA participants than healthy controls (p = .002). Participants with RA exhibited increased average absolute alpha power density in all brain regions when compared to controls (F (1.39) = 6.39, p = .016), as well as increased average relative alpha power density (F (1.39) = 5.82, p = .021) in all regions, except the frontal region, controlling for depression/anxiety. Absolute theta power density also increased in the frontal, central, and parietal regions for participants with RA when compared to controls (F(1,39) = 4.51, p = .040), controlling for depression/anxiety. Differences were not exhibited on beta and delta absolute and relative power densities. The diffuse increased alpha may suggest a possible neurogenic mechanism for chronic pain in individuals with RA.

Neurofeedback is a self-regulation technique that can be applied to learn to voluntarily control cerebral activity in specific brain regions. In this work, a Transcranial Doppler-based configurable neurofeedback system is proposed and described. The hardware configuration is based on the Red Pitaya board, which gives great flexibility and processing power to the system. The parameter to be trained can be selected between several temporal, spectral, or complexity features from the cerebral blood flow velocity signal in different vessels. As previous studies have found alterations in these parameters in chronic pain patients, the system could be applied to help them to voluntarily control these parameters. Two protocols based on different temporal lengths of the training periods have been proposed and tested with six healthy subjects that were randomly assigned to one of the protocols at the beginning of the procedure. For the purposes of the testing, the trained parameter was the mean cerebral blood flow velocity in the aggregated data from the two anterior cerebral arteries. Results show that, using the proposed neurofeedback system, the two groups of healthy volunteers can learn to self-regulate a parameter from their brain activity in a reduced number of training sessions.

En este estudio de caso único se registró la actividad electroencefalográfica (EEG) de una paciente fóbica a las serpientes una semana antes del tratamiento, una semana después de una exitosa terapia de exposición en una sesión y un año después. El EEG se obtuvo en situación de reposo y durante la presentación de imágenes de serpientes, imágenes con un valor de activación equivalente e imágenes emocionalmente neutras, todas ellas pertenecientes al Sistema Internacional de Imágenes Afectivas. Se midió la entropía (SampEn) de cada señal/canal y la sincronización de fase entre pares de canales EEG. Los resultados mostraron cambios pronunciados una semana después de la intervención: la entropía aumentó en todas las localizaciones y la sincronía de fase decreció en todos los pares de canales analizados. En el seguimiento, la paciente no presentaba ningún miedo pero los patrones de cambio en EEG eran similares a los observados antes de la intervención. A pesar de las limitaciones metodológicas, estos resultados sugieren que los cambios inducidos por la exposición en la entropía y sincronización del EEG son importantes pero pasajeros. El aumento de la flexibilidad cerebral podría ser uno de los mecanismos neuropsicológicos de la terapia de exposición.

The main objective of this study is to review and summarize recent findings on electroencephalographic patterns in individuals with chronic pain. We also discuss recent advances in the use of quantitative Electroencephalography (qEEG) for the assessment of pathophysiology and biopsychosocial factors involved in its maintenance over time. Data collection took place from February 2014 to July 2015 in PubMed, SciELO and PEDro databases. Data from cross-sectional studies and longitudinal studies, as well as clinical trials involving chronic pain participants were incorporated into the final analysis. Our primary findings related to chronic pain were an increase of theta and alpha EEG power at rest, and a decrease in the amplitude of evoked potentials after sensory stimulation and cognitive tasks. This review suggests that qEEG could be considered as a simple and objective tool for the study of brain mechanisms involved in chronic pain, as well as for identifying the specific characteristics of chronic pain condition. In addition, results show that qEEG probably is a relevant outcome measure for assessing changes in therapeutic studies.

Children with autism spectrum disorders (ASD) often display an abnormal reactivity to tactile stimuli, altered pain perception, and lower motor skills than healthy children. Nevertheless, these motor and sensory deficits have been mostly assessed by using clinical observation and self-report questionnaires. The present study aims to explore somatosensory and motor function in children with ASD by using standardized and objective testing procedures. Methods. Tactile and pressure pain thresholds in hands and lips, stereognosis, proprioception, and fine motor performance of the upper limbs were assessed in high-functioning children with ASD (n=27) and compared with typically developing peers (n=30). Results. Children with ASD showed increased pain sensitivity, increased touch sensitivity in C-tactile afferents innervated areas, and diminished fine motor performance and proprioception compared to healthy children. No group differences were observed for stereognosis. Conclusion. Increased pain sensitivity and increased touch sensitivity in areas classically related to affective touch (C-tactile afferents innervated areas) may explain typical avoiding behaviors associated with hypersensitivity. Both sensory and motor impairments should be assessed and treated in children with ASD.

En este estudio se analizan los cambios en la variabilidad de la tasa cardíaca (HRV) relacionada con el sistema vagal en sujetos fóbicos durante la exposición a estímulos temidos. Se ha introducido una tarea de respiración pautada para controlar los efectos de la misma en la medida de la HRV. Han participado en el estudio 61 pacientes con fobia a volar (40 mujeres) con una edad media de 39,07 años (SD = 11,24). Como medida de la HRV en el dominio del tiempo se ha tomado la RMSSD (media cuadrática de las diferencias de los intervalos RR sucesivos). Se ha calculado la potencia espectral en las bandas de alta (HF: 0.15-0.4 Hz) y de baja frecuencia (LF: 0.04-0.15 Hz) sobre los registros de ECG obtenidos durante una línea base sin respiración controlada (BL), una fase de respiración pautada (PB) y la exposición (E) a estímulos temidos. La tasa cardíaca aumentó de forma inesperada de BL a PB, disminuyó de PB a E, y no se obtuvieron diferencias entre BL y E. No se observaron cambios en RMSSD entre las tres condiciones. La potencia espectral de HF aumentó, como se esperaba, de BL a PB, y disminuyó de forma significativa de PB a E. La potencia espectral de LF, así como la relación LF/HF, aumentó de BL a E. La discusión se centra en (a) el papel de los sistemas simpático y parasimpático en las situaciones de miedo, y (b) los efectos de la respiración pautada en la preparación del sistema para afrontar estímulos temidos.

Current standardized treatments for cognitive impairment in attention-deficit/hyperactivity disorder remain limited and their efficacy restricted. Transcranial direct current stimulation (tDCS) is a promising tool for enhancing cognitive performance in several neuropsychiatric disorders. Nevertheless, the effects of tDCS in reducing cognitive impairment in patients with attention-deficit/hyperactivity disorder (ADHD) have not yet been investigated.A parallel, randomized, double-blind, sham-controlled trial was conducted to examine the efficacy of tDCS on the modulation of inhibitory control in adults with ADHD. Thirty patients were randomly allocated to each group and performed a go/no-go task before and after a single session of either anodal stimulation (1 mA) over the left dorsolateral prefrontal cortex or sham stimulation.A nonparametric two-sample Wilcoxon rank-sum (Mann-Whitney) test revealed no significant differences between the two groups of individuals with ADHD (tDCS vs. sham) in regard to behavioral performance in the go/no go tasks. Furthermore, the effect sizes of group differences after treatment for the primary outcome measures-correct responses, impulsivity and omission errors--were small. No adverse events resulting from stimulation were reported.According to these findings, there is no evidence in support of the use of anodal stimulation over the left dorsolateral prefrontal cortex as an approach for improving inhibitory control in ADHD patients. To the best of our knowledge, this is the first clinical study to assess the cognitive effects of tDCS in individuals with ADHD. Further research is needed to assess the clinical efficacy of tDCS in this population.ClinicalTrials.gov NCT01968512.

Se busca determinar si el diagnóstico de corioamnionitis en biopsia por congelación de placenta se relaciona con desenlace desfavorable en el recién nacido. Materiales y métodos: cohorte prospectiva de gestantes con alta sospecha de corioamnionitis a quienes se les practicó biopsia por congelación de cordón y membranas con estudio histopatológico usual, y se relacionó con la morbimortalidad del recién nacido. Resultados: en 23 placentas con sospecha de corioamnionitis se hizo estudio por congelación y parafina; cuatro fueron positivos en ambos y 19 negativos. Cinco desarrollaron sepsis temprana, todos con diagnóstico clínico de corioamnionitis en sus madres, de los cuales tres fueron positivos en ambos estudios microscópicos. Conclusiones: se evaluó la sepsis temprana y la mortalidad en hijos de madres con corioamnionitis diagnosticada mediante biopsias por congelación y parafina, evidenciando una adecuada relación. El diagnóstico por congelación fue preciso y temprano, posicionándose como una posible herramienta diagnóstica que permite un abordaje temprano tanto materno como del neonato con infección potencial, para así disminuir los desenlaces adversos con impacto en la morbimortalidad neonatal. Abreviaturas: RN, recién nacido (s).

Affective facial expressions are potent social cues that can induce relevant physiological changes, as well as behavioral dispositions in the observer. Previous studies have revealed that angry faces induced significant reductions in body sway as compared with neutral and happy faces, reflecting an avoidance behavioral tendency as freezing. The expression of pain is usually considered an unpleasant stimulus, but also a relevant cue for delivering effective care and social support. Nevertheless, there are few data about behavioral dispositions elicited by the observation of pain expressions in others. The aim of the present research was to evaluate approach-avoidance tendencies by using video recordings of postural body sway when participants were standing and observing facial expressions of pain, happy and neutral. We hypothesized that although pain faces would be rated as more unpleasant than the other faces, they would provoke significant changes in postural body sway as compared to neutral facial expressions. Forty healthy female volunteers (mean age 25) participated in the study. Amplitude of forward movements and backward movements in the anterior-posterior and medial-lateral axes were obtained. Statistical analyses revealed that pain faces were the most unpleasant stimuli, and that both happy and pain faces were more arousing than neutral ones. Happy and pain faces also elicited greater amplitude of body sway in the anterior-posterior axes as compared with neutral faces. In addition, significant positive correlations were found between body sway elicited by pain faces and pleasantness and empathic ratings, suggesting that changes in postural body sway elicited by pain faces might be associated with approach and cooperative behavioral responses.

Recent work on functional magnetic resonance imaging (fMRI) large scale brain networks under resting conditions demonstrated its potential to evaluate the integrity of brain function under normal and pathological conditions. A similar approach is used in this work to study a group of chronic back pain patients (CBP) and healthy controls (HC) to determine the impact of long enduring pain over brain dynamics. Correlation networks were constructed from the mutual partial correlations of brain activity's time series selected from ninety regions using a well validated brain parcellation atlas. The study of the resulting networks revealed an organization of up to six communities with similar modularity in both groups, but with important differences in the membership of key communities of frontal and temporal regions. The bulk of these findings were confirmed by a surprisingly naive analysis based on the pairwise correlations of the strongest and weakest correlated healthy regions. Beside confirming the brain effects of long enduring pain, these results provide a framework to study the effect of other chronic conditions over cortical function.

The study investigated the possibility of identifying the speed of an imagined movement from EEG recordings in amyotrophic lateral sclerosis (ALS) patients. EEG signals were acquired from four ALS patients during imagination of wrist extensions at two speeds (fast and slow), each repeated up to 100 times in random order. The movement-related cortical potentials (MRCPs) and averaged sensorimotor rhythm associated with the two tasks were obtained from the EEG recordings. Moreover, offline single-trial EEG classification was performed with discrete wavelet transform for feature extraction and support vector machine for classification. The speed of the task was encoded in the time delay of peak negativity in the MRCPs, which was shorter for faster than for slower movements. The average single-trial misclassification rate between speeds was 30.4 ± 3.5 % when the best scalp location and time interval were selected for each individual. The scalp location and time interval leading to the lowest misclassification rate varied among patients. The results indicate that the imagination of movements at different speeds is a viable strategy for controlling a brain-computer interface system by ALS patients.

ABSTRACT Background: In recent years there has been an increasing number of elderly people who care for another elderly person in the same household. These elderly people are more susceptible to overload and the presence of chronic pain, while pain can negatively influence cognitive variables. Objective: To compare the performance and cognitive processing of elderly caregivers and non-caregivers with and without chronic pain. Methods: This was a cross-sectional study carried out among 149 elderly people divided into four groups that were matched according to sex, age and schooling. The tests used were a numerical pain assessment scale, the Brief Cognitive Screening Battery (BCSB), Addenbrooke’s Cognitive Examination (ACER-R) and cognitive processing through event-related potentials (P300). Results: Statistically significant differences between participants with and without chronic pain were found with regard to attention/orientation (p=0.045) and visual-spatial skills (p=0.017), and in the total score (p=0.033). In the pain-free group, the caregivers showed better results than the non-caregivers. There were no effects between subjects or interactions (caregiving and pain factors) either on P300 amplitude or on P300 latency. Conclusion: In general, it was observed that pain-free individuals presented better performance. No relationship was observed between the factors care and pain regarding cognitive performance.

ABSTRACT Objective: to compare cognitive performance of elderly caregivers with and without chronic pain over four years and verify the effect of pain intensity on cognitive performance of elderly caregivers with chronic pain. Method: a longitudinal study with data collected in 2014 and 2018. Community-dwelling elderly caregivers of a Brazilian city participated in the study. Cognition was assessed using the Addenbrooke’s Cognitive Examination instrument. Pain was assessed by an 11-point scale. For data analysis, a mixed linear model and ANCOVA with a 5% significance level were used. Results: they were divided into two groups. A cognitive decline over four years was found in elderly people with pain (p=0.02; 95%CI=0.32-4.25), while those without pain did not show a significant change. Conclusion: the results show that elderly caregivers with pain had a worse cognitive performance, but when comparing groups with the ANCOVA test for intergroup analysis, there was no difference in cognitive performance.