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OBJECTIVE: Investigate the effects of botulinum toxin type A (BoNT-A) combined with physical therapy on functional capacity in children with spastic cerebral palsy (CP). METHODS: Twenty-four children with spastic CP were treated with either BoNT-A and physical therapy or physical therapy alone. RESULTS: Significant differences (p < 0.05) were found after 30 days of treatment for the Berg Scale, Timed Up and Go (TUG) test, Ashworth Scale and Pediatric Evaluation of Disability Inventory (PEDI) and after three months for the Berg Scale, TUG test and PEDI. No significant differences (p > 0.05) were found in the control group. DISCUSSION: BoNT-A combined with physical therapy leads to significant improvements in spasticity and functionality in children with CP within a period of three months from the onset of treatment.

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BACKGROUND: Parkinson's Disease (PD), a neurodegenerative condition, affects normal aging and leads to reduced motor abilities. In addition, frailty syndrome can increase vulnerability and risks of undesirable effects such as disease progression, falls, disability, and premature death among individuals with PD. AIMS: To assess the impact of frailty on balance and gait parameters in older with PD and to determine if sex mediates these measures. METHODS: Twenty-seven (27) participants (n = 18 men; n = 10 frail) performed 4 balance tasks on a force platform (eyes opened/closed in bipodal/semi-tandem position) while linear center of pressure (COP) parameters were calculated. Participants also performed two different speed walks on a gait analysis system to assess gait parameters. RESULTS: Significant differences between the frail and non-frail group were observed on postural control (mainly for area of COP p = 0.013/d = 0.47/70 %; sway velocity p = 0.048/d = 0.41/23 %) where frail reported poor balance. No significant sex differences were reported for postural control. Gait analysis was comparable between frail and non-frail, while significant differences between men and women were observed for step length (p = 0.002, d = 0.71), step width (p = 0.001, d = 0.75) and base of support (p = 0.012, d = 0.64) variables. CONCLUSION: Frail Parkinson's individuals present poorer postural control than non-frail individuals, but comparable gait parameters. Men and women are comparable on postural control but show different gait parameters. These results may have implications in clinical decision-making in rehabilitation for frailty in older adults, men and women with Parkinson's disease when balance and gait are of concern.

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OBJECTIVE: The purpose of this study was to generate data for conduction of a power analysis to investigate short-term effects of visceral manipulation associated with conventional physical therapy on pain intensity, lumbar mobility, and functionality of people with chronic low back pain and visceral dysfunctions. METHODS: This was a double-blinded, randomized, controlled, clinical trial preliminary study. A blinded evaluation was conducted involving 20 people with chronic low back pain with visceral dysfunction. Pain perception, lumbar mobility, and functionality were assessed in 3 moments: evaluation 1 (1 week before the intervention), evaluation 2 (immediately after the last intervention), and evaluation 3 (1 week after the last intervention). The protocol consisted of 50-minute session of conventional physical therapy and visceral manipulation. The participants were randomly allocated to 2 groups: 10 for the experimental group (conventional physical therapy and visceral manipulation) and 10 for the control group (conventional physical therapy and placebo visceral manipulation). RESULTS: Significant reductions were found in the experimental group for lumbar mobility and specific functionality in comparison with the control group (P < .05). There were no significant differences for pain perception and global functionality. CONCLUSION: The combination of visceral manipulation and conventional physical therapy program demonstrated significant between-groups differences over time for lumbar spine mobility and specific functionality. These gains occurred after 5 sessions, once a week, and were maintained 1 week after the end of the treatment. This study generated data for conduction of a power analysis to inform the design for future clinical research in this line of inquiry.

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PURPOSE: To compare the clinical and functional effects of treadmill training combined with anodic transcranial direct current stimulation (atDCS) on the primary motor cortex (Cz), specifically on the area of motor cortex representation of the lower limbs, and on the cerebellum (Cb) in children with spastic cerebral palsy (CP). METHODS: Thirty children and adolescents with spastic CP will be randomly allocated in 3 groups: (1) treadmill training and atDCS on Cz; (2) treadmill training and atDCS on Cb; (3) treadmill training and sham tDCS on Cz. Evaluations of gait spatial-temporal parameters, functional mobility, functional balance, gross motor function, and functional performance will be performed 1 week before intervention and 1 week, 1 month, and 3 months after intervention. Every 3 months the participants will cross over groups. DISCUSSION: This is a protocol for an intervention study comparing the clinical and functional effects of atDCS over Cz and Cb.

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PURPOSE: To assess the best electrode position of transcranial direct current stimulation combined with treadmill training in children with unilateral spastic cerebral palsy. METHODS: Thirty children with cerebral palsy were randomly allocated to 3 groups: (1) treadmill training combined with anodal electrode positioned over the primary motor cortex in the region of the dominant hemisphere and the cathode positioned in the supraorbital region contralateral to anode; (2) sham anodal transcranial direct current stimulation over the primary motor cortex and sham cathode over the contralateral supraorbital region combined with treadmill training; (3) treadmill training combined with the anodal electrode positioned over the primary motor cortex in the region of the injured hemisphere and the cathode positioned contralateral to anode over the primary motor cortex. Evaluations of gait, balance, quality of life, and electromyographic activity were performed. DISCUSSION: This is the protocol for an intervention study investigating electrode position to achieve improved function.

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INTRODUCTION: Cerebral palsy is a group of movement and posture development disorders. 90% of this population has gait impairment, often due to the presence of spasticity. A number of studies emphasize the importance of combined physical therapy with botulinum toxin A treatment. However, no consensus can be reached concerning the content of the physiotherapy program after treatment with botulinum toxin A. The purpose of the present study was to investigate, through a systematic review of the literature, the effects of physiotherapeutic intervention on gait after botulinum toxin application in children with cerebral palsy. EVIDENCE ACQUISITION: PubMed, Scielo, Cochrane Library, OTseeker, and PEDro databases were searched for randomized trial published between January 2000 and January 2017. EVIDENCE SYNTHESIS: Sixty-eight articles were identified, four of which met the eligibility criteria and were selected for the present systematic review. A table was created showing the main characteristics of the studies (groups, inclusion criteria, dosage, injection site, physiotherapeutic intervention, evaluation and outcomes). CONCLUSIONS: This study offers a view on the increase in the therapeutic effectiveness of botulinum toxin A on the lower limbs when used in conjunction with a physiotherapeutic intervention, with improvements in mobility, gait pattern, range of motion and spasticity, which are maintained after the end of the physical therapy protocol. The use of botulinum toxin A on the lower limbs when used in conjunction with a physiotherapeutic intervention, can improve muscle tone, allowing a combined treatment and intended to provide improvement of motor ability and functional skills, and potentially, delay the need for surgery.

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INTRODUCTION: Down syndrome results in neuromotor impairment that affects selective motor control, compromising the acquisition of motor skills and functional independence. The aim of the proposed study is to evaluate and compare the effects of multiple-monopolar anodal transcranial direct current stimulation and sham stimulation over the primary motor cortex during upper limb motor training involving virtual reality on motor control, muscle activity, cerebral activity and functional independence. METHODS AND ANALYSIS: A randomised, controlled, double-blind, clinical trial is proposed. The calculation of the sample size will be defined based on the results of a pilot study involving the same methods. The participants will be randomly allocated to two groups. Evaluations will be conducted before and after the intervention as well as 1 month after the end of the intervention process. At each evaluation, three-dimensional analysis of upper limb movement muscle activity will be measured using electromyography, cerebral activity will be measured using an electroencephalogram system and intellectual capacity will be assessed using the Wechsler Intelligence Scale for Children. Virtual reality training will be performed three times a week (one 20 min session per day) for a total of 10 sessions. During the protocol, transcranial stimulation will be administered concomitantly to upper limb motor training. The results will be analysed statistically, with a p value≤0.05 considered indicative of statistical significance. ETHICAL ASPECTS AND PUBLICITY: The present study received approval from the Institutional Review Board of Universidade Nove de Julho (Sao Paulo,Brazil) under process number 1.540.113 and is registered with the Brazilian Registry of Clinical Trials (N° RBR3PHPXB). The participating institutions have presented a declaration of participation. The volunteers will be permitted to drop out of the study at any time with no negative repercussions. The results will be published and will contribute evidence regarding the use of this type of intervention on children.

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The authors' aim was to investigate the effects of continuous transcranial direct current stimulation (tDCS) combined with virtual reality training on static and functional balance in children with cerebral palsy (CP). Twenty children with CP (6 girls and 14 boys; M age = 7 years 6 months ± 2 years) were randomly allocated to two groups. The experimental group received active tDCS and the control group received sham stimulation during the 10 sessions of virtual reality mobility training protocols. The children were evaluated on 3 occasions (preintervention, postintervention, and 1-month follow-up). Static balance was evaluated using a force plate under 4 conditions: feet on force plate with (a) eyes open and (b) with eyes closed, and feet on foam mat with (c) eyes open and (d) with eyes closed. Functional balance was evaluated using the Pediatric Balance Scale and the Timed Up and Go Test. The analyses demonstrated statistically significant postintervention and follow-up effects favoring the experimental group over the control group with regard to the Pediatric Balance Scale, Timed Up and Go Test, and area of oscillation of the center of pressure when standing on the force plate with eyes open. The present findings suggest that tDCS can potentiate the effects of virtual reality training on static and functional balance among children with CP.

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A review of the literature was performed to answer the following questions: Does motor cortex excitability correlate with motor function? Do motor cortex excitability and cortex activation change after a rehabilitation program that results in improvements in motor outcomes? Can the 10-20 electroencephalography (EEG) system be used to locate the primary motor cortex when employing transcranial direct current stimulation? Is there a bihemispheric imbalance in individuals with cerebral palsy similar to what is observed in stroke survivors? the authors found there is an adaptation in the geometry of motor areas and the cortical representation of movement is variable following a brain lesion. The 10-20 EEG system may not be the best option for locating the primary motor cortex and positioning electrodes for noninvasive brain stimulation in children with cerebral palsy.

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[Purpose] This systematic review evaluated the presence of sleep-disordered breathing in patients with myasthenia gravis and clarified the role of physiotherapy. [Subjects and Methods] We followed the PRISMA declaration criteria. The evaluation was performed in accordance with the STROBE statement for observational and cross-sectional studies and the CONSORT checklist for clinical trials. Searches were followed by hand on MEDLINE, EMBASE, SciELO, PubMed Central, and the Cochrane Central Register of Controlled Trials. [Results] Our searches yielded a total of 36 studies published between 1970 and 2014. The number of patients involved ranged from 9-490. Of the 36 studies, 19 articles were excluded because they did not meet the inclusion criteria. Therefore, 17 observational, cross-sectional, or clinical studies assessing the quality of sleep and prevalence of sleep disorders in patients with myasthenia gravis were eligible for our review. [Conclusion] Some studies of patients with MG show that patients with MG are associated with poor sleep quality, excessive daytime sleepiness, presence of restless syndrome, and a higher incidence of SDB, while other studies do not report such associations. Therefore, given the current inconclusive evidence and limited literature, further study of sleep disturbances in patients with MG is needed.

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Impaired gait constitutes an important functional limitation in children with cerebral palsy (CP). Treadmill training has achieved encouraging results regarding improvements in the gait pattern of this population. Moreover, transcranial direct current stimulation (tDCS) is believed to potentiate the results achieved during the motor rehabilitation process. The aim of the present study was to determine the effect of the administration of tDCS during treadmill training on the gait pattern of children with spastic diparetic CP. A double-blind randomized controlled trial was carried out involving 24 children with CP allocated to either an experimental group (active anodal tDCS [1mA] over the primary motor cortex of the dominant hemisphere) or control group (placebo tDCS) during ten 20-min sessions of treadmill training. The experimental group exhibited improvements in temporal functional mobility, gait variables (spatiotemporal and kinematics variables). The results were maintained one month after the end of the intervention. There was a significant change in corticospinal excitability as compared to control group. In the present study, the administration of tDCS during treadmill training potentiated the effects of motor training in children with spastic diparetic CP.

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PURPOSE: The aim of this review was to compare the effects of rigid and articulated ankle-foot orthoses on gait in children with cerebral palsy (CP). METHOD: A systematic review was carried out in 4 databases. The papers identified were evaluated on the basis of the following inclusion criteria: (1) design--controlled clinical trial; (2) population--children and adolescents with CP; (3) intervention--rigid or articulated ankle-foot orthoses; and (4) outcome--improved motor function and gait performance. RESULTS: Seven controlled studies comparing the effects of different ankle-foot orthoses were found. Studies achieved PEDro scores of 3 and 4 for methodological quality. CONCLUSION: There is evidence supporting the use of an articulated ankle-foot orthosis by children with CP, because of the improved function this type of orthosis provides. However, other studies point out the advantages of a rigid orthosis for children with greater impairment related to spasticity and contractures.

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Objetivo: Analisar os efeitos do laser de baixa intensidade sobre a regeneração de células do sistema nervoso central, após lesão medular traumática. Métodos: Foram utilizados 20 ratos wistars, divididos em cinco grupos. Foi lesionada, por meio de cirurgia, a região de T8, expondo as meninges e ocasionando um trauma medular compressivo com a queda de um peso de 39 g que comprimiu a medula espinhal. A laserterapia foi aplicada sobre a dimensão da ferida suturada, por um período de 21 dias, em dois animais por grupo, sendo X1 o grupo controle; X2 aplicação de 4J/cm2; X3 aplicação de 10 J/cm2; X4 aplicação de 15 J/cm2 e X5aplicação de 20 J/cm2).. Resultados: Na análise de células observou-se que todas apresentavam 75% de linfócitos na fase aguda, a presença de neutrófilos em 75% nos grupos X1 e X5, enquanto nos grupos X2 e X3, 25% de células inflamatórias. Conclusão: Constatou-se que a aplicação de laserterapia é um método não invasivo que pode auxiliar na resolução do processo inflamatório e edematoso na lesão medular, prevenindo sequelas maiores decorrentes do trauma.

Objective: To analyze the effects of low intensity laser on the regeneration of cells in the central nervous system after spinal cord injury. Methods: 20 rats Wistars divided into five groups. Was damaged through surgery, the region of T8, exposing the meninges and causing a compressive spinal cord trauma with the fall of a weight of 39 g which compressed the spinal cord. The laser therapy was applied on the size of the wound sutured, for a period of 21 days in two animals per group and the control group X1, X2 4J/cm2 application, application of 10 J/cm2 X3, X4 application of 15 J / cm2 and X5 application of 20 J/cm2) .. Results: Analysis of cells showed that all had 75% of lymphocytes in the acute phase, neutrophils in 75% in the groups X1 and X5, while groups X2 and X3, 25% of inflammatory cells. Conclusion: We found that the application of laser therapy is a noninvasive method that can assist in the resolution of the inflammatory and edematous in spinal cord, preventing major sequelae caused by trauma.

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