RESUMO

The purpose of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-support treadmill training (BWSTT) for improving walking function of individuals with chronic incomplete spinal cord injury (iSCI). A 4-week, double-blinded, randomized, sham-controlled pilot study involved 12 sessions of real (10 Hz, 1800 pulses) or sham rTMS combined with BWSTT (15-20 min, moderate intensity). Walking independence was assessed using the Walking Index for Spinal Cord Injury II (WISCI-II). Lower extremity motor function (lower extremity motor score [LEMS]) and spasticity, sensory function, functional independence (Spinal Cord Injury Measure III [SCIM-III]), and quality of life were also assessed. Walking independence (WISCI-II) after the 6th session was higher in the BWSTT/rTMS real (n = 7) (median change (IQR): 3 (1.5 to 3.5)) than in the sham group (n = 8) (median change (IQR): 0 (0 to 0.25), but there was no difference between groups after 12th session (BWSTT/rTMS real median change (IQR): 4 (2 to 5); BWSSTT/rTMS sham median change (IQR): 0 (0 to 3.25). Compared to baseline, LEMS and SCIM-III mobility scores were increased after 12 sessions in the BWSTT/rTMS real but not in the sham group. Within- and between-group sensory function, functional independence, and quality of life remained similar. This preliminary result suggests that combining BWSTT with rTMS could lead to earlier gait improvement in patients with chronic iSCI.

Assuntos

RESUMO

Metabolic syndrome (MetS) is characterized by endocrine-metabolic and cardiac alterations that increase the risk of cardiovascular disease, dyslipidemia, and type-2 diabetes mellitus. Dietary supplementation with l-Arginine (L-Arg) is beneficial for fat loss, while chronic aerobic exercise has several benefits in reversing cardiovascular, autonomic, and metabolic dysfunctions caused by obesity. However, the association between these two approaches has not yet been described. This study aimed to evaluate the possible benefits of physical training, with or without l-Arg-supplementation, on cardiovascular, autonomic, and metabolic parameters in rats with MetS, which was induced by the subcutaneous administration of monosodium glutamate at 4 mg g-1day-1 in rats from the first to fifth day of life. Physical training on a treadmill and supplementation with l-Arg-in adulthood were carried out concomitantly for 8 weeks. After this, the animals underwent femoral artery catheterization to record their cardiovascular parameters and autonomic modulation. Organs and blood were removed to measure levels of nitrite, glucose, and hepatic steatosis. In adult rats with MetS, supplementation with l-Arg-in combination with physical training reduced hypertension, tachycardia, adipose tissue mass, free fatty acids, and hepatic steatosis. Supplementation with l-Arg-and physical training separately was beneficial in reducing several aspects of MetS, but a combination of both was especially effective in reducing adipose tissue and hepatic steatosis. Together, the two therapies can form a good strategy to combat MetS.

Assuntos

RESUMO

PURPOSE: Our report describes the effect of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-supported treadmill training (BWSTT) on independent gait recovery in a patient with incomplete spinal cord injury (iSCI). CASE DESCRIPTION: The patient was a 31-year-old male, household ambulator (aid walker) and community wheelchair user who was 8.5 year post traumatic iSCI (T8 vertebra injury, AIS D). INTERVENTION: The patient participated in 12 sessions (three times/week for four weeks) of rTMS (1800 pulses, 10 Hz, intensity of 90% resting motor threshold) followed by BWSTT (15-20 min, moderate intensity). OUTCOMES: After treatment, the patient's score increased 3 points on the Walking Index for Spinal Cord Injury II (walking independence) and he became a community ambulator with crutches. His American Spinal Injury Association (ASIA) lower extremities motor score (motor function) increased from 33 to 45 points and the Spinal Cord Independence Measure III (functional independence) score increased from 23 to 29 for the mobility indoors/outdoors subscale. The patient's lower limb spasticity was reduced (Modified Ashworth Scale), and quality of life improved based on the Short-Form Health Survey - 36, and the Patient Global Impression of Change Scale showed considerable perception of improvement. CONCLUSION: Our report suggests that a short protocol of rTMS combined with BWSTT improved walking independence, motor function, spasticity, functional mobility and quality of life in this patient with iSCI.

Assuntos

RESUMO

Spinal cord injury (SCI) is considered a serious neurological disorder that can lead to severe sensory, motor and autonomic deficits. In this work, we investigated whether cell therapy associated with physical activity after mouse SCI could promote morphological and functional outcomes, using a lesion model established by our group. Mesenchymal stem cells (8 × 105 cells/2 µL) or DMEM (2 µL), were injected in the epicenter of the lesion at 7 days after SCI, and the mice started a moderate treadmill training 14 days after injury. Functional assessments were performed weekly up to 8 weeks after injury when the morphological analyses were also performed. Four injured groups were analyzed: DMEM (SCI plus DMEM injection), MSCT (SCI plus MSC injection), DMEM + TMT (SCI plus DMEM injection and treadmill training) and MSCT + TMT (SCI plus MSC injection and treadmill training). The animals that received the combined therapy (MSCT + TMT) were able to recover and maintained the better functional results throughout the analyzed period. The morphometric analysis from MSCT + TMT group evidenced a larger spared white matter area and a higher number of preserved myelinated fibers with the majority of them reaching the ideal G-ratio values, when compared to other groups. Ultrastructural analysis from this group, using transmission electron microscopy, showed better tissue preservation with few microcavitations and degenerating nerve fibers. Also, this group exhibited a significantly higher neurotrophin 4 (NT4) expression as compared to the other groups. The results provided by this study support the conclusion that the association of strategies is a potential therapeutic approach to treat SCI, with the possibility of translation into the clinical practice.

Assuntos

RESUMO

This study aims to investigate the frequency and total duration effects of the 2-week treadmill training after experimental ischemic stroke in the passive avoidance test. We performed bilateral occlusion of common external carotid arteries, for five minutes, in Mongolian gerbils. The training groups were: continuous training for twelve consecutive days or not continuous training for six non-consecutive days. The groups remained in the treadmill for 15min, with the speed set at 10m/min, and the training started 24h after the stroke. In the Shuttle Box, each animal had ten trials during the Learning Session (LS), which occurred 24h before the stroke. The Retention Test (RT) occurred 24h after the stroke and started on the second, third, seventh and twelfth day after LS. After the experiments, the brains were perfused, and coronal sections of the CA1 area of the hippocampus were cut and stained with hematoxylin and eosin. ANOVA on Ranks was used for Behavioral data analysis and morphological data by percentage. Ischemic training groups showed preservation in neuron density in the CA1 area of the hippocampus, when compared to the control groups. Animals subjected to continuous training, showed a higher latency in the RT when compared to ischemic animals in both weeks [(2nd, H=39.81; P<0.05), (3rd, H=38.08; P<0.05), (7th, H=44.17; P<0.05), and (12th, H=39.55; P<0.05). Animals in the not continuous training showed higher latency in the RT, in the second week only [(2nd, H=39.81; P<0.05), (3rd, H=38.08; P<0.05), (7th, H=44.17; P<0.05), and (12th, H=39.55; P<0.05). These findings suggest that improvement of memory after stroke after treadmill training is dependent on the frequency and total duration of training.

Assuntos

RESUMO

Nutrition and physical training have important roles in the accumulation and maintenance of bone mass. The aim of this study was to evaluate, in ovariectomized rats (OVX), the effects of treadmill training (T) with high-fat diet (F) on weight gain and bone tissue properties with eight groups (n = 10) for 12 weeks: OVX SC (OVX, sedentary lifestyle, diet control); OVX SF; OVX TC; OVX TF; SH SC (SHAM, sedentary lifestyle, diet control); SH SF; SH TC; and SH TF. Weekly weight gain and final body composition were assessed. After euthanasia, tibiae were analyzed. The trained animals had higher body weight (P = 0.001), bone mineral density (P < 0.001), and trabecular bone (P < 0.001). The animals with a high-fat diet showed higher global fat (P < 0.001), percentage of global fat (P < 0.001) and deformation at impact (P = 0.031) and reduced tibial bone mineral content (P = 0.036). Physical training improves bone microarchitecture, without presenting an increase in impact resistance, and a high-fat diet increases body fat and impairs bone mineralization.

Assuntos

RESUMO

Spinal cord injury (SCI) is a disabling condition resulting in deficits of sensory and motor functions, and has no effective treatment. Considering that protocols with stem cell transplantation and treadmill training have shown promising results, the present study evaluated the effectiveness of stem cells from human exfoliated deciduous teeth (SHEDs) transplantation combined with treadmill training in rats with experimental spinal cord injury. Fifty-four Wistar rats were spinalized using NYU impactor. The rats were randomly distributed into 5 groups: Sham (laminectomy with no SCI, n=10); SCI (laminectomy followed by SCI, n=12); SHEDs (SCI treated with SHEDs, n=11); TT (SCI treated with treadmill training, n=11); SHEDs+TT (SCI treated with SHEDs and treadmill training; n=10). Treatment with SHEDs alone or in combination with treadmill training promoted functional recovery, reaching scores of 15 and 14, respectively, in the BBB scale, being different from the SCI group, which reached 11. SHEDs treatment was able to reduce the cystic cavity area and glial scar, increase neurofilament. Treadmill training alone had no functional effectiveness or tissue effects. In a second experiment, the SHEDs transplantation reduced the TNF-α levels in the cord tissue measured 6 h after the injury. Contrary to our hypothesis, treadmill training either alone or in combination, caused no functional improvement. However, SHEDs showed to be neuroprotective, by the reduction of TNF-α levels, the cystic cavity and the glial scar associated with the improvement of motor function after SCI. These results provide evidence that grafted SHEDs might be an effective therapy to spinal cord lesions, with possible anti-inflammatory action.

Assuntos

RESUMO

This study aims to investigate the effects of treadmill training and the possible influences of the start, regularity, and duration after experimental ischemic stroke. We performed bilateral occlusion of both the carotid arteries for 5 min in Mongolian gerbils. The training groups were: continuous training for 5 consecutive days or not continuous training for 3 non-consecutive days. The groups remained in the treadmill for 15 min, and the training started 12 or 24h after the stroke. In the activity cage (AC), behaviors of crossing and distance traveled were registered. The forced motor behavior was analyzed by a Rota Rod test. After the experiments, the brains were perfused, and coronal sections of the striatum, motor cortex M1, and CA1 area of the hippocampus were cut and stained with hematoxylin and eosin. Behavioral and morphological data analysis was performed by an ANOVA and MANCOVA. Results showed an increased density of neurons in the CA1 area of the hippocampus, motor cortex M1, and the striatum in ischemic training groups compared to the not training ischemic groups. Animals subjected to continuous training that started 24h after ischemia showed a satisfactory behavior in the AC and a higher number of striatal neurons when compared to ischemic animals. The animals in the not continuous training started 12h after the stroke showed an unsatisfactory performance in the AC and Rota Rod. These findings suggest that early training and not continuous training are inadequate for motor behavior improvement after stroke.

Assuntos

RESUMO

BACKGROUND: Parkinson's disease (PD) causes motor and non-motor impairments that affect the subject's quality of life. OBJECTIVE: To assess the effects of treadmill-walking training with additional body load on the quality of life and motor function of subjects with PD. METHODS: Nine subjects with PD, Hoehn and Yahr stages 2-3, not demented and with capability to ambulate independently took part in this study. The training program was divided into three phases (A1-B-A2): treadmill training with additional body load (A1), control condition (conventional physical therapy group; B) and a second period of treadmill training with load (A2). Each phase lasted six weeks. Quality of life and motor function were assessed by the PDQ-39 and the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS), respectively. The evaluations and the training were performed during the on-phase of the medication cycle. RESULTS: There was improvement in the total PDQ-39 score across the training period. The subscores mobility, activities of daily living and cognition subscores significantly improved after the training period. The improvement in the total score was associated with motor and non-motor factors in all of the training phases. The UPDRS motor score also improved, however it did not present any association with the improvement in quality of life. CONCLUSIONS: The results showed that the treadmill-walking training with additional body load allowed an improvement in motor and non-motor aspects related to quality of life and motor function in subjects with PD.

CONTEXTUALIZAÇÃO: A doença de Parkinson (DP) causa prejuízos motores e não-motores que afetam a qualidade de vida dos sujeitos. OBJETIVO: Avaliar os efeitos de um treino de marcha em esteira, com aumento da carga corporal, sobre a qualidade de vida e a função motora de sujeitos com DP. MÉTODOS: Nove sujeitos com DP idiopática, estágio 2 a 3 da escala de Hoehn & Yahr, sem demência e com capacidade de andar independentemente participaram do estudo. O programa de treino foi dividido em três fases (A1-B-A2) de seis semanas cada: treino da marcha em esteira com aumento da carga corporal (A1), condição controle (fisioterapia convencional) (B) e treino da marcha em esteira novamente (A2). A qualidade de vida e a função motora foram avaliadas, respectivamente, pela PDQ-39 e escore motor da UPDRS (Escala Unificada de Avaliação da Doença de Parkinson). As avaliações e os treinos foram realizados na fase on do ciclo da medicação. RESULTADOS: Houve melhora no escore total da PDQ-39 ao longo do período de treino. Os subitens mobilidade, atividades da vida diária e cognição da PDQ-39 melhoraram significativamente após o treino. A melhora no escore total mostrou correlação com fatores motores e não-motores. O escore motor da UPDRS também melhorou, no entanto, não houve correlação com a melhora na qualidade de vida. CONCLUSÃO: Os resultados mostraram que o treino em esteira com aumento de carga corporal permitiu uma melhora de aspectos motores e não-motores relacionados à qualidade de vida e à função motora de sujeitos com DP.

Assuntos

RESUMO

As revisões sistemáticas reúnem evidências capazes de guiar a prática clínica e nortear o desenvolvimento de novas pesquisas, sendo de extrema relevância para profissionais de reabilitação. Esta revisão sistemática se refere ao uso da esteira ergométrica para o aprimoramento da marcha em crianças com Paralisia Cerebral (PC). Foi realizada busca nas bases de dados Medline, Lilacs, PEDro, Cochrane, Scielo, CINAHL, EMBASE e DARE, abrangendo o período de janeiro de 1998 a dezembro de 2008. Oito estudos foram selecionados, analisados e categorizados segundo os níveis de evidência de Sackett. Os resultados foram discutidos com base na metodologia adotada pela American Academy of Cerebral Palsy and Development Medicine (AACPDM), abordando-se os seguintes tópicos: tipo de desenho metodológico, caracterização dos participantes dos estudos, descrição da intervenção, e análise dos desfechos de cada estudo, segundo os domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Há evidências que comprovam que o uso da esteira ergométrica nessas crianças é capaz de promover alterações nos parâmetros da marcha (aumento da velocidade e do comprimento do passo), e nos escores da Gross Motor Function Measure (GMFM). Apesar de a diversidade dos protocolos, de as características dos participantes, e de a variedade de instrumentação utilizada nos estudos dificultarem o agrupamento dos efeitos, há evidências que suportam o uso da esteira ergométrica em crianças com PC. Dessa forma, essa intervenção parece ser promissora e eficaz para a melhora da marcha neste grupo clínico.(AU)

A systematic review gathers evidence to guide the clinical practice and the development of new research, being extremely relevant to rehabilitation professionals. This systematic review concerns the use of treadmill training for the improvement of gait in children with Cerebral Palsy (CP). A search was conducted in databases Medline, Lilacs, PEDro, Cochrane, Scielo CINAHL, EMBASE and DARE, from January 1998 to December 2008. Eight studies were selected, analyzed and categorized according to levels of evidence of Sackett. The results were discussed based on the methodology adopted by the American Academy of Cerebral Palsy and Development Medicine (AACPDM), addressing the following topics: type of methodological design, characterization of participants in the studies, intervention description, and outcomes analysis of each study based on the domains of the International Classification of Functioning, Disability and Health (ICF). There is evidence that the use of treadmill training by these children can promote changes in the parameters of gait (increase in speed and in step length), and in the scores of the Gross Motor Function Measure (GMFM). Despite the diversity of the protocols, the participants’ characteristics, as well as the diversity of tools used by the studies limiting the pooling of outcomes, there are evidences supporting the use of treadmill training in children with CP. This intervention seems to be promising and effective for the improvement of gait in this clinical group.(AU)

Assuntos

RESUMO

As revisões sistemáticas reúnem evidências capazes de guiar a prática clínica e nortear o desenvolvimento de novas pesquisas, sendo de extrema relevância para profissionais de reabilitação. Esta revisão sistemática se refere ao uso da esteira ergométrica para o aprimoramento da marcha em crianças com Paralisia Cerebral (PC). Foi realizada busca nas bases de dados Medline, Lilacs, PEDro, Cochrane, Scielo, CINAHL, EMBASE e DARE, abrangendo o período de janeiro de 1998 a dezembro de 2008. Oito estudos foram selecionados, analisados e categorizados segundo os níveis de evidência de Sackett. Os resultados foram discutidos com base na metodologia adotada pela American Academy of Cerebral Palsy and Development Medicine (AACPDM), abordando-se os seguintes tópicos: tipo de desenho metodológico, caracterização dos participantes dos estudos, descrição da intervenção, e análise dos desfechos de cada estudo, segundo os domínios da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Há evidências que comprovam que o uso da esteira ergométrica nessas crianças é capaz de promover alterações nos parâmetros da marcha (aumento da velocidade e do comprimento do passo), e nos escores da Gross Motor Function Measure (GMFM). Apesar de a diversidade dos protocolos, de as características dos participantes, e de a variedade de instrumentação utilizada nos estudos dificultarem o agrupamento dos efeitos, há evidências que suportam o uso da esteira ergométrica em crianças com PC. Dessa forma, essa intervenção parece ser promissora e eficaz para a melhora da marcha neste grupo clínico.

A systematic review gathers evidence to guide the clinical practice and the development of new research, being extremely relevant to rehabilitation professionals. This systematic review concerns the use of treadmill training for the improvement of gait in children with Cerebral Palsy (CP). A search was conducted in databases Medline, Lilacs, PEDro, Cochrane, Scielo CINAHL, EMBASE and DARE, from January 1998 to December 2008. Eight studies were selected, analyzed and categorized according to levels of evidence of Sackett. The results were discussed based on the methodology adopted by the American Academy of Cerebral Palsy and Development Medicine (AACPDM), addressing the following topics: type of methodological design, characterization of participants in the studies, intervention description, and outcomes analysis of each study based on the domains of the International Classification of Functioning, Disability and Health (ICF). There is evidence that the use of treadmill training by these children can promote changes in the parameters of gait (increase in speed and in step length), and in the scores of the Gross Motor Function Measure (GMFM). Despite the diversity of the protocols, the participants’ characteristics, as well as the diversity of tools used by the studies limiting the pooling of outcomes, there are evidences supporting the use of treadmill training in children with CP. This intervention seems to be promising and effective for the improvement of gait in this clinical group.

Assuntos

RESUMO

OBJECTIVES: We investigated the effects of treadmill training (10 weeks) on hindlimb motor function and nerve morphometric parameters in diabetic rats submitted to sciatic nerve crush. MATERIALS AND METHOD: Wistar rats (n = 64) were divided into the following groups: non-diabetic; trained non-diabetic; non-diabetic with sciatic nerve crush; trained non-diabetic with sciatic nerve crush; diabetic; trained diabetic; diabetic with sciatic nerve crush or trained diabetic with sciatic nerve crush. Diabetes was induced by streptozotocin injection (50 mg/kg, iv). Hindlimb motor function was evaluated weekly by assessing sciatic functional indices, and the proximal and distal portions of the sciatic nerve were used for morphometric analysis. RESULTS: At 13 weeks post-injury, the distal nerve portion of all injured groups and the proximal nerve portion of the diabetic with sciatic nerve crush group presented altered morphometric parameters such as decreased myelinated fiber diameter (~7.4 + 0.3μm vs ~4.8 + 0.2μm), axonal diameter (~5 + 0.2μm vs ~3.5 + 0.1μm) and myelin sheath thickness (~1.2 + 0.07μm vs ~0.65 + 0.07μm) and an increase in the percentage of area occupied by endoneurium (~28 + 3 percent vs ~60 + 3 percent). In addition, in the non-diabetic with sciatic nerve crush group the proximal nerve portion showed a decreased myelinated fiber diameter (7.4+0.3μm vs 5.8 + 0.3μm) and myelin sheath thickness (1.29 + 0.08μm vs 0.92 + 0.08μm). The non-diabetic with sciatic nerve crush, trained non-diabetic with sciatic nerve crush, diabetic with sciatic nerve crush and trained diabetic with sciatic nerve crush groups showed normal sciatic functional index from the 4th,4th,9th and 7th week post-injury, respectively. Morphometric alterations in the proximal nerve portion of the diabetic with sciatic nerve crush and non-diabetic with sciatic nerve crush groups were either prevented or reverted to values similar to the non-diabetic group by treadmill training. CONCLUSION: Diabetic condition promoted delay in sciatic nerve regeneration. Treadmill training is able to accelerate hindlimb motor function recovery in diabetic injured rats and prevent or revert morphometric alterations in proximal nerve portions in non-diabetic and diabetic injured rats.

Assuntos