The immediate effect of Electrical Stimulation Transcranial Direct Current (tDCS) associated the use of FES in muscle tibialis previous activity and balance, of individuals with hemiparesis resulting of stroke - study randomized, controlled, double-blind

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-18T19:16:59Z No. of bitstreams: 1 Aline Marina Alves Fruhauf.pdf: 1453096 bytes, checksum: 48897b7f7729d68294f85c6738b2da54 (MD5) Made available in DSpace on 2018-06-18T19:16:59Z (GMT). No. of bitstreams: 1 Aline Marina Alves Fruhauf.pdf: 1453096 bytes, checksum: 48897b7f7729d68294f85c6738b2da54 (MD5) Previous issue date: 2016-02-17 Increased cortical activity induced by brain stimulation, associated or not with other rehabilitation techniques, may potentiate the therapeutic effects in patients with neurological deficits. To assess the immediate effects of two related techniques, transcranial direct-current stimulation (tDCS) and functional electrical stimulation (FES), the electrical activity of the tibialis anterior (TA) and static balance of individuals with post stroke hemiparesis. Methods: clinical trial, controlled, randomized, double-blind, 30 individuals hemiparesis due to stroke. Rating: median frequency and RMS TA by electromyography (EMG) and evaluation of static balance (area, speed and frequency of oscillation in open eyes (OE) and closed (CE)) by stabilometry. Interventions: 4 protocols with 48h interval: 1 (tDCS anodic + FES sham), 2 (tDCS sham + FES active), 3 (tDCS anodic + FES active) and 4 (tDCS sham + FES sham). The anode was applied on etcc C3 and / or C4 and cathode on the contralateral supraorbital region and FES on hemiparetic TA for 20 minutes. Results: There was no statistically significant difference (p> 0.05) of the median frequency and RMS for the acquisition of isotonic and maximal voluntary isometric contraction (MVIC) of TA and static balance both OE and CE condition of the protocols by the Friedman test . Conclusion: There was no difference in the electrical activity of the TA muscle and static balance after application of the associated technical or isolated. The application time may not be enough to verify a motor learning, moreover, it is suggested that the tDCS may have a cortical hyperexcitability generated response any competitor inhibiting action; and a second hypothesis is that the stimulation of both the FES or active contraction has generated supposed peripheral fatigue, even with preconization contractions to avoid that this factor. It is believed that the two suggestive lead to additive effects (a technique inhibiting possibly other). O aumento da atividade cortical, induzido pela estimula????o cerebral, associado ou n??o com outras t??cnicas de reabilita????o, pode potencializar os efeitos terap??uticos em indiv??duos com d??ficits neurol??gicos. Objetivos: Avaliar os efeitos imediatos de duas t??cnicas associadas, estimula????o transcraniana por corrente cont??nua (ETCC) e estimula????o el??trica funcional (FES), na atividade el??trica do m??sculo tibial anterior (TA) e equil??brio est??tico de indiv??duos com hemiparesia p??s acidente vascular encef??lico (AVE). M??todos: Ensaio cl??nico, controlado, randomizado, duplo cego, em 30 indiv??duos hemipar??ticos decorrente de AVE. Avalia????es: frequ??ncia mediana e RMS do TA por eletromiografia (EMG) e avalia????o do equil??brio est??tico (??rea, velocidade e frequ??ncia de oscila????o em olhos abertos (AO) e fechados (OF)) por estabilometria. Interven????es: 4 protocolos com intervalo de 48h: 1 (ETCC an??dica + FES placebo), 2 (ETCC placebo + FES ativo), 3 (ETCC an??dica + FES ativo) e 4 (ETCC placebo + FES placebo). A ETCC an??dica foi aplicada sobre C3 e/ou C4 e cat??dica sobre regi??o supraorbital contralateral e FES sobre TA hemipar??tico,durante 20 minutos. Resultados: N??o houve diferen??a estatisticamente significante (p > 0,05) da frequ??ncia mediana e RMS durante as aquisi????es de isotonia e contra????o isom??trica volunt??ria m??xima (CIVM) do TA e equil??brio est??tico tanto na condi????o OA e OF entre os protocolos pelo teste de Friedman. Conclus??o: N??o houve diferen??a na atividade el??trica do m??sculo TA e equil??brio est??tico, ap??s aplica????o das t??cnicas associadas ou isoladas. O tempo de aplica????o pode n??o ter sido insuficiente para se verificar um aprendizado motor, al??m disso, sugere-se que a ETCC possa ter gerado uma resposta de hiperexcitabilidade cortical inibindo qualquer a????o concorrente; e uma segunda hip??tese seria que o est??mulo tanto da FES ou da contra????o ativa tenha gerado suposta fadiga perif??rica, mesmo com preconiza????o das contra????es para que se evitasse esse fator. Acredita-se que as duas sugestivas, levaram a efeitos aditivos (uma t??cnica possivelmente inibindo a outra).