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Abstract Background Children with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability. Methods/design Two investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1—cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05). Discussion The optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions. Trial registration Brazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator.

The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment.

To maintain the balance, the postural system needs to integrate the three main sensorial systems: visual, vestibular, and somatosensory to keep postural control within the limits of stabilization. Damage of one of these systems, in this case, the vision, will have a great disturbance on the postural control influencing the behavior of the balance, resulting in falls. The aim of this study protocol for a randomized, controlled clinical trial is to analyze the effects of transcranial direct current stimulation (tDCS) combined with proprioceptive exercises on postural control in individuals with congenital and acquired blindness. In this randomized, controlled, double-blind, clinical trial, male, and female individuals with blindness between 18 and 55 years of age will participate in this study divided into three phases: 1—Determine differences in postural control and gait between individuals with congenital and acquired blindness with and without the use of a guide stick when wearing shoes and when barefoot; 2—A pilot study to analyze the effects a bilateral cerebellar anodal tDCS on postural on postural control and gait; and 3—A treatment protocol will be conducted in which the participants will be allocated to four groups: G1—active tDCS + dynamic proprioceptive exercises; G2—sham tDCS + dynamic proprioceptive exercises; G3—active tDCS + static proprioceptive exercises; and G4—sham tDCS + static proprioceptive exercises. Evaluations will involve a camera system for three-dimensional gait analysis, a force plate, and electromyography. Dynamic stability will be determined using the Timed Up and Go test and static stability will be analyzed with the aid of the force plate. The viability of this study will allow the determination of differences in postural control between individuals with congenital and acquired blindness, the analysis of the effect of tDCS on postural control, and the establishment of a rehabilitation protocol.

Abstract Background Photobiomodulation using low-level laser therapy (LLLT) has been tested as a new technique to optimize recovery of patients with traumatic brain injury (TBI). The aim of this study is to evaluate inhibitory attentional control after 18 sessions of active LLLT and compare with the placebo group (sham LLLT). Our exploratory analysis will evaluate the efficacy of the active LLLT on verbal and visuospatial episodic memory, executive functions (working memory, verbal and visuospatial fluency, attentional processes), and anxiety and depressive symptoms compared to the sham group. Methods/Design A randomized double-blinded trial will be made in 36 patients with moderate and severe TBI. The active LLLT will use an optical device composed of LEDs emitting 632 nm of radiation at the site with full potency of 830 mW. The cranial region with an area of 400 cm2 will be irradiated for 30 min, giving a total dose per session of 3.74 J/cm2. The sham LLLT group contains only an LED device with power

The postural system requires the sensory systems to maintain postural control (PC). Blind subjects use the somatosensory system to keep PC whereas sighted subjects use the visual system. So what happens to PC when challenging the sensory systems? We analyzed the center of pressure (COP) in ten blind and 10 sighted subjects under conditions: eyes open/closed (interference of visual system) and on firm/foam surfaces (interference of somatosensory system). We found that under the condition of eyes open on a firm surface, the blind subjects relied on the somatosensory system, whereas sighted subjects relied on the visual system. However, when eyes closed and on foam surface, similar behavior was found in both groups for all COP variables. In general blind subjects use their somatosensory system as the main sensory input to maintain PC. [ABSTRACT FROM AUTHOR]

The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment. [ABSTRACT FROM AUTHOR]

Background: A lower developmental stage of the postural control system in childhood compared to adolescence and adulthood was reported in numerous studies and suggests differences (i.e., less improvements in children than in adolescents and young adults due to the immature postural control system) during learning a balance task. Therefore, the present study examined the effect practice on learning (i.e., retention and transfer) a balance task in healthy children, adolescents, and young adults. Methods: Healthy children (n = 32, 8.5 ± 0.5 years), adolescents (n = 30, 14.6 ± 0.6 years), and young adults (n = 28, 24.3 ± 3.3 years) practiced balancing on a stabilometer (i.e., to keep the platform as close to horizontal as possible) for 2 days. On the third day, learning was assessed using a retention (i.e., balance task only) and a transfer (i.e., balance task plus concurrent motor interference task) test. The root-mean-square-error (RMSE) was calculated and used as outcome measures. Results: Over the course of practice, significant improvements (p < 0.001) were detected in favor of children and young adults. However, neither the retention nor the transfer test showed significant group differences. Conclusion: Our findings indicate that learning a balance task did not seem to be influenced by the developmental stage of the postural control system. [ABSTRACT FROM AUTHOR]

Background: Children with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability.Methods/design: Two investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1-cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05).Discussion: The optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions.Trial Registration: Brazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator. [ABSTRACT FROM AUTHOR]

To maintain the balance, the postural system needs to integrate the three main sensorial systems: visual, vestibular, and somatosensory to keep postural control within the limits of stabilization. Damage of one of these systems, in this case, the vision, will have a great disturbance on the postural control influencing the behavior of the balance, resulting in falls. The aim of this study protocol for a randomized, controlled clinical trial is to analyze the effects of transcranial direct current stimulation (tDCS) combined with proprioceptive exercises on postural control in individuals with congenital and acquired blindness. In this randomized, controlled, double-blind, clinical trial, male, and female individuals with blindness between 18 and 55 years of age will participate in this study divided into three phases: 1—Determine differences in postural control and gait between individuals with congenital and acquired blindness with and without the use of a guide stick when wearing shoes and when barefoot; 2—A pilot study to analyze the effects a bilateral cerebellar anodal tDCS on postural on postural control and gait; and 3—A treatment protocol will be conducted in which the participants will be allocated to four groups: G1—active tDCS + dynamic proprioceptive exercises; G2—sham tDCS + dynamic proprioceptive exercises; G3—active tDCS + static proprioceptive exercises; and G4—sham tDCS + static proprioceptive exercises. Evaluations will involve a camera system for three-dimensional gait analysis, a force plate, and electromyography. Dynamic stability will be determined using the Timed Up and Go test and static stability will be analyzed with the aid of the force plate. The viability of this study will allow the determination of differences in postural control between individuals with congenital and acquired blindness, the analysis of the effect of tDCS on postural control, and the establishment of a rehabilitation protocol. [ABSTRACT FROM AUTHOR]

Background: Photobiomodulation using low-level laser therapy (LLLT) has been tested as a new technique to optimize recovery of patients with traumatic brain injury (TBI). The aim of this study is to evaluate inhibitory attentional control after 18 sessions of active LLLT and compare with the placebo group (sham LLLT). Our exploratory analysis will evaluate the efficacy of the active LLLT on verbal and visuospatial episodic memory, executive functions (working memory, verbal and visuospatial fluency, attentional processes), and anxiety and depressive symptoms compared to the sham group.Methods/design: A randomized double-blinded trial will be made in 36 patients with moderate and severe TBI. The active LLLT will use an optical device composed of LEDs emitting 632 nm of radiation at the site with full potency of 830 mW. The cranial region with an area of 400 cm2 will be irradiated for 30 min, giving a total dose per session of 3.74 J/cm2. The sham LLLT group contains only an LED device with power < 1 mW, only serving to simulate the irradiation. Each patient will be irradiated three times per week for six weeks, totaling 18 sessions. Neuropsychological assessments will be held one week before the beginning of the sessions, after one week, and three months after the end of LLLT sessions. Memory domain, attention, executive functioning, and visual construction will be evaluated, in addition to symptoms of depression, anxiety, and social demographics.Discussion: LLLT has been demonstrated as a safe and effective technique in significantly improving the memory, attention, and mood performance in healthy and neurologic patients. We expect that our trial can complement previous finds, as an effective low-cost therapy to improve cognitive sequel after TBI.Trial Registration: ClinicalTrials.gov, NCT02393079 . Registered on 20 February 2015. [ABSTRACT FROM AUTHOR]

Introduction: Microkinesitherapie technique was developed in France. This word comes from Greek, which means (“micro”: small and “kinesi”: movement and “therapie”: treatment), being literally “treatment by small movements”. The objective of this study is to analyze the autonomic nervous system behavior in healthy subjects undergone microkinesitherapie technique through the heart rate variability (HRV) analysis. Method: Sixteen Caucasian (11 women) healthy subjects were voluntarily recruited to participate of this study who have never been undergone any manual therapy treatment. All patients who attended the inclusion criteria were evaluated according to anthropometric data, and after this, they underwent a 45 minutes session of microkinesitherapie technique. Orthostatic test was performed by all participants before and right after the treatment, using the Nerve-Express System software to data acquisition and the Kubios HRV to data analysis. We analyzed the HRV according to time domain and frequency domain parameters. Result: We could observe a statistically significant difference in the mean RR intervals, with the subjects becoming closer to the normal values (p ≤ 0.05). There was also a significant difference in the high frequency domain (HF) after the treatment, which corresponds to an increase of parasympathetic nervous system activity (p ≤ 0.05). Conclusion: We have concluded that this technique has contributed to the sympathetic and parasympathetic balance. [ABSTRACT FROM AUTHOR]

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