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Item Rehabilitation of a Female Dancer with Patellofemoral Pain Syndrome: Applying the Concepts of Regional Interdependence in Practice(2010) Podschun, LauraDue to complex movements and high physical demands, dance is often associated with a multitude of impairments including pain of the low back, pelvis, leg, knee, and foot. This case report provides an exercise progression, emphasizing enhancement of strength and neuromuscular performance using the concept of regional interdependence in a 17 year old female dancer with patellofemoral pain syndrome.Item Neuropeptides and Other Chemical Mediators, and the Role of Anti-inflammatory Drugs in Primary Headaches(2010) Samsam, MohtashemPrimary headaches including the migraine, cluster, and tension headaches are common neurological disorders which cause pain and disability to the patients. The pathomechanism of migraine is not very well understood however, current clinical findings indicate a possible primary brain disorder due to activation of the brain and brainstem as triggers for migraine. The headache phase of migraine may be due to activation of the peripheral nerves including the trigeminal nerve and others innervating the cranial blood vessels and release of vasoactive substances including the calcitonin generelated peptides (CGRP), possibly leading to vasodilation and brainstem activation. Several of our studies in an experimental model of pain using electrical stimulation of the trigeminal ganglion in rats focused on various neuropeptides release from the peripheral and central trigeminal nerve terminals, however, clinically only the CGRP in migraine and CGRP and vasoactive intestinal peptide (VIP) in cluster headache were found in patient's blood. Although several drugs are used in the treatment of migraine, the non-steroid anti-inflammatory drugs (NSAIDs) and the triptan family of drugs are the first choice drugs recommended for the treatment of acute migraine headache. Although clinically very few studies detected other vasoactive/inflammatory molecules in the blood of migraine patients, sensitization of peripheral axons can involve many inflammatory mediators affecting the peripheral tissue substrates of pain. Moreover, central sensitization in the trigeminal nucleus can also contribute to additional pain responses. This article reviews neuropeptides and other molecules involved in primary headaches and major drugs proposed for their treatment in recent years.Item Central Nervous System Acting Drugs in Treatment of Migraine Headache(2012) Samsam, MohtashemMigraine is a primary headache disorder with an unknown pathophysiology. The growing evidence in recent years indicates migraine being a brain disorder, a sensory dysmodulation, and a system failure of normal sensory processing of the brainstem that involves the vascular tone and pain. At the moment, triptan family and NSAIDs are the first choice drugs for the treatment of acute migraine. There are several prophylactic drugs including the antiepileptic drugs (AEDs), betablockers, and Ca2+ channel blockers that are used for the treatment of migraine. Although many drugs including the triptans, NSAIDs, and others target the peripheral sites of activation, several novel drugs are being developed to target neural sites of action in the central nervous system (CNS). The first trigeminal synapses in the brain stem as well as the ascending and descending pathways and higher brain centers are involved in the transmission of pain and therefore be the main targets of several drugs some of which are in clinical trials. Central sensitization may also aggravate the headache and some drugs tend to alleviate pain by targeting neurotransmitters, receptors, or signalling molecules involved in this phenomenon. This article discusses the CNS acting novel drugs and those that are currently in use for the treatment of migraine.Item Differential Diagnosis of Deep Gluteal Pain in a Female Runner with Pelvic Involvement: A Case Report(2013) Podschun, LauraBackground: Gluteal injuries, proximal hamstring injuries, and pelvic floor disorders have been reported in the literature among runners. Some suggest that hip, pelvis, and/or groin injuries occur in 3.3% to 11.5% of long distance runners. The purpose of this case report is to describe the differential diagnosis and treatment approach for a patient presenting with combined hip and pelvic pain. Case description: A 45-year-old female distance runner was referred to physical therapy for proximal hamstring pain that had been present for several months. This pain limited her ability to tolerate sitting and caused her to cease running. Examination of the patient’s lumbar spine, pelvis, and lower extremity led to the initial differential diagnosis of hamstring syndrome and ischiogluteal bursitis. The patient’s primary symptoms improved during the initial four visits, which focused on education, pain management, trunk stabilization and gluteus maximus strengthening, however pelvic pain persisted. Further examination led to a secondary diagnosis of pelvic floor hypertonic disorder. Interventions to address the pelvic floor led to resolution of symptoms and return to running. Outcomes: Pain level on the Visual Analog Scale decreased from 7/10 to 1/10 over the course of treatment. The patient was able to return to full sport activity and improved sitting tolerance to greater then two hours without significant discomfort. Discussion: This case suggests the interdependence of lumbopelvic and lower extremity kinematics in complaints of hamstring, posterior thigh and pelvic floor disorders. This case highlights the importance of a thorough examination as well as the need to consider a regional interdependence of the pelvic floor and lower quarter when treating individuals with proximal hamstring pain.Item Pathophysiology of Autism Spectrum Disorders: Revisiting Gastrointestinal Involvement and Immune Imbalance(2014) Samsam, MohtashemAutism spectrum disorders (ASD) comprise a group of neurodevelopmental abnormalities that begin in early childhood and are characterized by impairment of social communication and behavioral problems including restricted interests and repetitive behaviors. Several genes have been implicated in the pathogenesis of ASD, most of them are involved in neuronal synaptogenesis. A number of environmental factors and associated conditions such as gastrointestinal (GI) abnormalities and immune imbalance have been linked to the pathophysiology of ASD. According to the March 2012 report released by United States Centers for Disease Control and Prevention, the prevalence of ASD has sharply increased during the recent years and one out of 88 children suffers now from ASD symptoms. Although there is a strong genetic base for the disease, several associated factors could have a direct link to the pathogenesis of ASD or act as modifiers of the genes thus aggravating the initial problem. Many children suffering from ASD have GI problems such as abdominal pain, chronic diarrhea, constipation, vomiting, gastroesophageal reflux, and intestinal infections. A number of studies focusing on the intestinal mucosa, its permeability, abnormal gut development, leaky gut, and other GI problem raised many questions but studies were somehow inconclusive and an expert panel of American Academy of Pediatrics has strongly recommended further investigation in these areas. GI tract has a direct connection with the immune system and an imbalanced immune response is usually seen in ASD children. Maternal infection or autoimmune diseases have been suspected. Activation of the immune system during early development may have deleterious effect on various organs including the nervous system. In this review we revisited briefly the GI and immune system abnormalities and neuropeptide imbalance and their role in the pathophysiology of ASD and discussed some future research directions.Item The IBB Forelimb Scale as a Tool to Assess Functional Recovery after Peripheral Nerve Injury in Mice(2014) Swarowsky, AlessandraBackground This study was conducted to test whether the IBB Forelimb Scale (Irvine et al., 2010) which was originally developed for rats with spinal cord injury, is also capable of measuring the functional performance of Swiss mice with lesions of the median and ulnar nerves inflicted via crushing with standardized strength. New method This test was performed at days 1, 3, 7, 10, 14 and 21 after surgery and each animal gives a score of 9, where 0 represented the worst functionality and 9 represented the habitual behavior. Results The control animals usually exhibited movements in the task that were scored as 9 during the experimental period. The lesion group began with a score of 2 on the 1st and 3rd post-operative days. On the 7th and 10th postoperative days, respectively, they scored 7, and on the 14th post-operative day, they achieved a score of 8. Only on the 21st post-operative day, did they exhibit habitual skillful behaviors. Comparison with existing method(s) IBB Forelimb Scale is effective for determining how the animals perform the movements in detail, which is not readily revealed by other methods. Furthermore, this test show similar recovery periods with grasping test, staircase test and seems to be more sensitive than paw print analysis for this type of lesion. Conclusions Our data demonstrate that IBB scale was capable of measuring gradual improvements in motor forelimb functions in this model and may be a new and effective assessment tool for peripheral nerve injury.Item Is Body Weight-Support Treadmill Training Effective in Increasing Muscle Trophism After Traumatic Spinal Cord Injury?(2015) Swarowsky, AlessandraObjective: To determine the effectiveness of body weight-support treadmill training (BWSTT) for muscle atrophy management in people with spinal cord injury (SCI). Setting: Studies from multiple countries were included. Methods: The following databases were consulted from January to October 2013: PubMed, Institute for Scientific Information (ISI), Science Direct and Lilacs. The methodological quality of the articles included was classified according to Jovell and Navarro-Rubio. Results: A total of five studies were included. These studies reported a significant association between BWSTT and increased trophism of the lower limb muscles of humans with SCI, which was observed as an increase in the cross-sectional area. Moreover, improvements in the ability to generate peak torque, contract the knee extensors and ankle plantarflexors with reduction of body weight support were observed after BWSTT. Conclusion: The results were considered inconclusive because of the low methodological quality of the articles, which was because of the absence of sample homogeneity, thereby providing a low level of evidence for clinical practice.Item The Use of Sensory Reweighting for a Woman with Persistent Mal de Debarquement: A Case Report(2015) Liphart, JodiBackground and Purpose: Persistent mal de debarquement is an uncommon disorder occurring after a sea voyage, or a plane or train trip. Symptoms include unsteadiness, rocking sensation, visual motion intolerance, cognitive slowing, and excessive fatigue. It is thought to be a result of faulty multisensory adaptation. The purpose of this case report was to describe the use of sensory reweighting, a therapeutic approach aimed at reweighting the balance between the 3 sensory systems, to decrease symptoms and increase functional abilities of a woman with persistent mal de debarquement. Case Description: A 69-year-old woman with a 4-year history of persistent mal de debarquement after a plane trip reported a constant feeling of rocking, unsteadiness, and a loss of balance in low lighting or visually rich environments. She experienced a previous fall and had limited her social activities because of her symptoms. Interventions: Sensory reweighting therapy was administered twice a week for 10 weeks. Activities included balance training using vestibular, somatosensory, and visual challenges to vary the sensory input available. Outcomes: A 5-point increase was observed on the Berg Balance Scale, she doubled her balance time in tandem stance position, and improved from moderate to low impairment on the Dizziness Handicap Inventory. She had a significant change on the Global Rating of Change Scale. Subjectively, she felt she had improved 50% and was less disabled. Discussion: A rehabilitation approach aimed at sensory reweighting improved this patient's function and community reintegration. Her symptoms were reduced and stability and balance improved.Item Parkinson Activity Scale: Cross-cultural Adaptation and Reliability of the Brazilian Version(2015) Swarowsky, AlessandraAim Following the substantial growth of the elderly population in Brazil, there has been an increase in cases of Parkinson's disease (PD), which raises the need for reliable and culturally adapted scales specific to the disease. The Parkinson Activity Scale (PAS) was developed in order to assess the activity level of people with PD through tasks related to mobility. The aims of the present study were to translate the cross-cultural adaptation of the PAS into Brazillian Portuguese and analyze its reliability during the “on” phase of PD. Methods A total of 25 patients with PD participated in the study. The intrarater reliability was evaluated using a test–retest design with a 1-week interval. Results The interrater reliability was tested twice on the same day by two different raters. The intraclass correlation coefficient (ICC), and the Bland and Altman plots were calculated to examine the test–retest and interrater reliabilities for total score of the PAS, whereas the weighted Kappa (Wk) was used to assess interrater agreement. The interrater ICC was 0.89 and Wk was 0.65 for the total score. For intrarater reliability, the total score ICC was 0.88. Conclusions The present study suggests that the Brazilian version of the PAS is a reliable instrument for the assessment of mobility in elderly patients with PD. Geriatr Gerontol Int 2015; 15: 89–95.Item Body Surface Posture Evaluation: Construction, Validation and Protocol of the SPGAP System (Posture Evaluation Rotating Platform System)(2016) Swarowsky, AlessandraBackground Several posture evaluation devices have been used to detect deviations of the vertebral column. However it has been observed that the instruments present measurement errors related to the equipment, environment or measurement protocol. This study aimed to build, validate, analyze the reliability and describe a measurement protocol for the use of the Posture Evaluation Rotating Platform System (SPGAP, Brazilian abbreviation). Methods The posture evaluation system comprises a Posture Evaluation Rotating Platform, video camera, calibration support and measurement software. Two pilot studies were carried out with 102 elderly individuals (average age 69 years old, SD = ±7.3) to establish a protocol for SPGAP, controlling the measurement errors related to the environment, equipment and the person under evaluation. Content validation was completed with input from judges with expertise in posture measurement. The variation coefficient method was used to validate the measurement by the instrument of an object with known dimensions. Finally, reliability was established using repeated measurements of the known object. Results Expert content judges gave the system excellent ratings for content validity (mean 9.4 out of 10; SD 1.13). The measurement of an object with known dimensions indicated excellent validity (all measurement errors <1 %) and test-retest reliability. A total of 26 images were needed to stabilize the system. Participants in the pilot studies indicated that they felt comfortable throughout the assessment. The use of only one image can offer measurements that underestimate or overestimate the reality. To verify the images of objects with known dimensions the values for the width and height were, respectively, CV 0.88 (width) and 2.33 (height), SD 0.22 (width) and 0.35 (height), minimum and maximum values 24.83–25.2 (width) and 14.56 – 15.75 (height). In the analysis of different images (similar) of an individual, greater discrepancies were observed in the values found. The cervical index, for example, presented minimum and maximum values of 15.38 and 37.5, a coefficient of variation of 0.29 and a standard deviation of 6.78. Conclusions The SPGAP was shown to be a valid and reliable instrument for the quantitative analysis of body posture with applicability and clinical use, since it managed to reduce several measurement errors, amongst which parallax distortion.Item Concordance and Discordance Between Measured Balance and Perceived Balance and the Effect on Gait Speed and Falls Following Stroke(2016) Liphart, JodiObjective: To ascertain the existence of discordance between perceived and measured balance in persons with stroke and to examine the impact on walking speed and falls. Design: A secondary analysis of a phase three, multicentered randomized controlled trial examining walking recovery following stroke. Subjects: A total of 352 participants from the Locomotor Experience Applied Post-Stroke (LEAPS) trial. Methods: Participants were categorized into four groups: two concordant and two discordant groups in relation to measured and perceived balance. Number and percentage of individuals with concordance and discordance were evaluated at two and 12 months. Walking speed and fall incidence between groups were examined. Main measures: Perceived balance was measured by the Activities-Specific Balance Confidence scale, measured balance was determined by the Berg Balance Scale and gait speed was measured by the 10-meter walk test. Results: Discordance was present for 35.8% of participants at two months post stroke with no statistically significant change in proportion at 12 months. Discordant participants with high perceived balance and low measured balance walked 0.09 m/s faster at two months than participants with concordant low perceived and measured balance (p < 0.05). Discordant participants with low perceived balance and high measured balance walked 0.15 m/s slower than those that were concordant with high perceived and measured balance (p ⩽ 0.0001) at 12 months. Concordant participants with high perceived and measured balance walked fastest and had fewer falls. Conclusions: Discordance existed between perceived and measured balance in one-third of individuals at two and 12 months post-stroke. Perceived balance impacted gait speed but not fall incidence.Item Anticipatory and Compensatory Postural Adjustments in Response to External Lateral Shoulder Perturbations in Subjects with Parkinson’s Disease(2016) Swarowsky, AlessandraThe purpose of this study was to investigate the anticipatory (APA) and compensatory (CPA) postural adjustments in individuals with Parkinson’s disease (PD) during lateral instability of posture. Twenty-six subjects (13 individuals with PD and 13 healthy matched controls) were exposed to predictable lateral postural perturbations. The electromyographic (EMG) activity of the lateral muscles and the displacement of the center of pressure (COP) were recorded during four time intervals that are typical for postural adjustments, i.e., immediately before (APA1, APA2) and after (CPA1 and CPA2) the postural disturbances. The magnitude of the activity of the lateral muscles in the group with PD was lower only during the CPA time intervals and not during the anticipatory adjustments (APAs). Despite this finding, subjects with PD exhibit smaller COP excursions before and after the disturbance, probably due to lack of flexibility and proprioceptive impairments. The results of this study suggest that postural instability in subjects with PD can be partially explained by decreased postural sway, before and after perturbations, and reduced muscular activity after body disturbances. Our findings can motivate new studies to investigate therapeutic interventions that optimize the use of postural adjustment strategies in subjects with PD.Item Comparison between Two Functional Mobility Scales for Parkinson's Disease Directly Applied to Physical Therapy Practice: Cross-cultural Adaptation and Measurement Properties(2017) Swarowsky, AlessandraThe Modified Parkinson Activity Scale (PASm) and Lindop Parkinson's Disease Mobility Assessment (LPA) scales were developed to assess the functional mobility in patients with Parkinson's disease (PD) being directly applied to physical therapy practice. To translate and perform the cross-cultural adaptation of PASm and LPA scales to Portuguese-Brazil, and to analyze some psychometric properties. Cross-cultural validation study. Clinical environment. Thirty-two Brazilian subjects with Parkinson's disease. The study consisted of two stages: 1) cross-cultural adaptation process; 2) evaluation of psychometric properties. Considering the total score, the interrater and test-retest reliabilities showed a coefficient of intra-class correlation that ranged between 0.97 and 0.98. Both scales showed excellent internal consistency (α=0.83 and 0.94). Positive correlations were obtained between the Brazilian versions of the LPA and PASm and PAS (ρ=0.63 and 0.92). The concurrent validity between scales and part III of UPDRS, established a moderate negative correlation, (ρ=-0.54 and -0.65). The one way ANOVA showed that LPA-Brazil discriminates the individual with PD between all stages according HY, and the PASm- Brazil between mild and severe stages, and moderate and severe. The MDC of scales ranging from 1 to 2 points. There was Ceiling effect only for the LPA-Brazil. Brazilian versions of PASm and LPA are valid and reliable instruments to assess the functional mobility in patients with PD, being directly applied to physical therapy clinical practice. The major goal of physical therapy in PD is to maintain functional mobility and independence of the patient. The results of study are relevant and could improve the physical therapy practice in Brazil, since it provides the Brazilian version of two mobility scales (one of them recommended by the European Guidelines for Physical Therapy Practice in patients with Parkinson disease).Item Assessing Timed Up and Go in Parkinson's Disease: Reliability and Validity of Timed Up and Go Assessment of Biomechanical Strategies(2017) Swarowsky, AlessandraObjective: To investigate the measurement properties of the Timed Up and Go Assessment of Biomechanical Strategies (TUG-ABS) to determine its adequacy for use with individuals with Parkinson's disease. Subjects: Fifty individuals with Parkinson's disease. Design: Diagnostic accuracy. Methods: The study investigated the following properties: reliability (inter-examiner, intra-examiner, test-retest, internal consistency and minimal detectable change), construct validity, and floor and ceiling effect. Results: Considering the total score, the inter-examiner, test-retest and intra-examiner reliabilities were classified as excellent (0.95 ≤ intra-class correlation coefficient (ICC)≤0.99). The TUG-ABS presented excellent internal consistency (α = 0.98). The minimal detectable change was 3.82 points. The construct validity between the TUG-ABS and the Unified Parkinson's Disease Rating Scale (UPDRS) - part III was classified as moderate (ρ = -0.62). Significant, elevated and positive correlations were obtained between TUG-ABS and the Balance Evaluation System Test (BESTest)-VI (ρ = 0.72) and negative correlations between TUG-ABS and TUG (ρ = -0.78). The discriminant function obtained with the total score of TUG-ABS classified 60% of the individuals correctly with respect to the group (determined by the performance in TUG) to which they belonged. One-way analysis of variance (ANOVA) showed that TUG-ABS discriminated the individuals with Parkinson's disease in all stages according to Hoehn & Yahr. There was a ceiling effect of 22%. Conclusion: TUG-ABS presented adequate measurement properties in individuals with Parkinson's disease.Item “Test D'évaluation Des Membres Supérieurs Des Personnes Âgées” (TEMPA) to Assess Upper Limb Activity in Parkinson's Disease(2017) Swarowsky, AlessandraStudy Design Cross-sectional and observational study. Purpose of the Study Assess upper limb (UL) activity limitations using the “Test d'Evaluation des Membres Supérieurs Des Personnes Agées” (TEMPA) in individuals with Parkinson's disease (PD) and verify its clinimetrics properties. Methods The following were evaluated: internal consistency, interrater and test-retest reliability; concurrent validity; convergent validity; know group's validity; minimal detectable change, floor and ceiling effects, and the relationship between UL activity limitations and the presence of freezing of gait. Results Excellent reliability and interrater agreement (intraclass correlation coefficient = 0.99 and κ = 0.92) and test-retest reliability (intraclass correlation coefficient = 0.97) were found, as well internal consistency (α = 0.99). A moderate negative correlation was found between TEMPA and section II of the Unified Parkinson's Disease Rating Scale (ρ = −0.58; P = .001), and moderate/low between the test and the Nine Hole Peg Test values of the right UL and moderate for left UL (ρ = 0.56 and ρ = 0.41; P = .001) (ρ = 0.52 and ρ = 0.51; P = .001 and P = .002), respectively. No significant relationship was found with freezing episodes (P = .057). Discussion TEMPA is useful for assessing UL activity limitations in PD, have adequate clinimetrics properties and is capable of detecting the influence of motor symptoms during the carrying out of daily living tasks. No differences were found between freezers and no freezers. Level of Evidence N/A.Item Cross Cultural Adaptations and Sychometric Domains of Brazilian Version of PROFILE PD for Parkinson’s Disease(2017) Swarowsky, AlessandraPurpose: The PROFILE PD scale was developed specifically to evaluate patients with Parkinson’s disease (PD) within the context of the International Classification of Functioning, Disability and Health, directly applied to physical therapy practice. The study aimed to translate and cross-culturally adapt the PROFILE PD scale to Portuguese-Brazil, and to analyze its psychometric domains. Methods: Fifty participants with PD participated in the study. We assessed the clarity of the Brazilian version of the scale by physiotherapists, presence of floor and ceiling effects, interrater and test–retest reliabilities, in addition to discriminant, concurrent (UPDRS) and construct validity, internal consistence, minimal detectable change (MDC), and responsiveness. Results: The scale was considered highly clear for physical therapists. The interrater ICC was 0.74 and Wk was 0.89 for the total score. For test–retest reliability, the total ICC score was 0.99. The analysis of concurrent validity showed the Spearman correlation between Brazilian version of PROFILE PD and UPDRS (ρ = 0.77; p < 0.001). Factor analyses demonstrated that the test comprises a single scale. Brazilian version of PROFILE PD was able to discriminate the subject with PD in mild and moderate stages, and in mild and severe stages. A high internal consistency was found (α = 0.99). MDC was 2.41 points and there were no floor and ceiling effects. Also, the scale was responsive to physical therapy intervention, with improvement in 8 points after two months (effect size = 0.85). Conclusion: The Brazilian version of PROFILE PD is an instrument reliable, valid, and responsive to physical therapy intervention, that can be used to quantify impairments and limitations in patients with PD and can provide an overall summary of the impact of disease, useful for physiotherapy practice. Implications for Rehabilitation • PROFILE PD is a reliable and valid instrument to be applied in Brazilian Parkinson disease patients. • This scale is design specially to be used in physical therapy practice within the contexts surrounding the International Classification of Functioning, Disability and Health. • PROFILE PD was able to discriminate between patients in mild and moderate stages of disease which is difficult in clinical practice mainly because the scale used for this relies on balance and gait rather than a global profile.Item Brazilian Samba Protocol for Individuals with Parkinson’s Disease: A Clinical Non-randomized Study(2017) Swarowsky, AlessandraBackground: In the 10 most populated countries in the world, Parkinson's disease (PD) affects more than 5 million individuals. Despite optimal treatment options already developed for the disease, concomitant involvement of other areas of health care plays an important role in complementing the treatment. From this perspective, dancing can be viewed as a non-drug alternative that can reduce falls by improving some motor skills, such as mobility, balance, gait, and posture, and can also improve the overall quality of life. Brazilian samba promotes improvement in motor and non-motor symptoms in individuals with PD, providing a new treatment option for this population. Objective: The main objective of this quasi-experimental study is to provide a 12-week samba protocol (2x/week) for individuals with PD and to compare its effects with the group without intervention. The hypothesis is that the Brazilian samba protocol will promote improvement in primary (motor) and secondary (non-motor) outcomes in individuals with PD. Methods: The sample will be selected at random from individuals diagnosed with PD in the city of Florianopolis (SC, Brazil). Sample size calculation was performed with the G*Power 3.1.9.2 software, with 0.447 effect size, at 5% significance level, power of 0.9, and test and sample loss of 20%. This yielded 60 individuals divided between the intervention and control groups. The questionnaires will be filled out before and after the dance intervention. The data collection for the control group will be held simultaneously to the intervention group. The classes will last for 1 hour, twice a week in the evening for 12 weeks, and all classes will be divided into warm-up, main part, and relaxation. Two-way analysis of variance with repeated measures and Sidak post-hoc comparison test will be used for a comparative analysis of the final results of the control group with the experimental group and of the within-group changes between pre- and postintervention period. Results: We expect to complete follow-up in September 2017. Conclusions: The major inspiration for this study was to encourage the creation of new rehabilitation programs that do not emphasize doctor involvement. This is a unique protocol for PD and we believe it can be an important tool to alleviate the motor and non-motor symptoms of individuals with PD. Dance is a simple activity depending on little equipment and few financial resources, facilitating its implementation and improving the cost-benefit relationship. In addition, activities that have a cultural aspect for the population in question, and which are pleasant, enable the participants to commit long term. This can enhance patient’s compliance with the therapy, which is often a problem for many rehabilitation programs.Item Neuromodulation in the Treatment of Migraine: Progress in Nerve Stimulation(2017) Samsam, MohtashemMigraine is a type of primary headache disorder that can become chronic and disabling. The exact pathomechanism of migraine is not known very well and its treatment is also difficult in some cases. There are several medications for the acute and preventive treatment of migraine including the “triptan” family drugs, nonsteroidal anti-inflammatory drugs, anti-epileptic drugs, beta-blockers, and Ca2+-channel blockers1 and those against calcitonin gene-related peptide or its receptor that are reviewed elsewhere.2 However, there are some medically intractable headaches or patient management is unsatisfactory or medications are poorly tolerated3 or there are contraindications. Therefore, neuromodulation and nerve stimulation methods that have proven effective in clinical research may provide an additional treatment option for acute and preventive treatment of migraine. In this brief review, we will discuss recent advances using neuromodulatory techniques that are currently used in the treatment of headaches in clinical studies. These include the electrical stimulation of occipital nerve, sphenopalatine ganglion, supraorbital nerve, and transcutaneous electrical stimulation of vagus nerve as well as single-pulse transcranial magnetic stimulation. Several clinical studies have conducted neurostimulation for the acute and preventive treatment of migraine in recent years but more studies are necessary to see their efficacy and long-term effect.Item Locomotor Treadmill Training Promotes Soleus Trophism by Mammalian Target of Rapamycin Pathway in Paraplegic Rats(2018) Swarowsky, AlessandraAssisted-treadmill training, may be helpful in promoting muscle mass preservation after incomplete spinal cord injury (SCI). However, biological mechanism involved in this process is still not fully understood. This study investigated the effects of locomotor treadmill training on muscle trophism mediated by protein kinase B (Akt)/mammalian target of rapamycin (mTOR)/p70 ribosomal protein S6 kinase (p70S6K) in paraplegic rats. Adult female Wistar rats underwent an incomplete thoracic SCI induced by compression using an aneurysm clip. After 7 days, injured animals started a 3-week locomotor treadmill training with body weight-support and manual step help. Soleus trophism was measured by muscle weight and transverse myofiber cross-sectional area (CSA). An enzyme-linked immunosorbent assay (ELISA) and western blot analysis were used to detect brain-derived neurotrophic factor (BDNF), tropomyosin-related kinase B (TrkB), Akt, mTOR and p70S6K in paretic soleus. Trained animals did not show locomotor improved, but present an increase in muscle weight and myofiber CSA. Furthermore, the levels of Akt, p70S6K phosphorylation, mTOR and TrkB receptor were increased by training in soleus. In contrast, muscle BDNF levels were significantly reduced after training. The results suggest locomotor treadmill training partially reverts/prevents soleus muscle hypotrophy in rats with SCI. Furthermore, this study provided the first evidence that morphological muscle changes were caused by Akt/mTOR/p70S6K signaling pathway and TrkB up-regulation, which may increase the sensitivity of muscle, reducing autocrine signaling pathway demand of BDNF for cell growth.Item Are Functional Mobility Tests Responsive to Group Physical Therapy Intervention in Individuals with Parkinson’s Disease?(2018) Swarowsky, AlessandraBACKGROUND: The Timed up and go test (TUG), the Five times sit-to-stand test (FTSTS) and the Bed Mobility test (BMT) are widely used in clinical practice for Parkinson Disease (PD). However, no reported studies have evaluated the responsiveness to group physical therapy intervention (GPTI). OBJECTIVE: To verify if TUG, FTSTS and BMT were responsive to GPTI. METHODS: Thirty individuals with PD were assessed prior to and after an 8-week evidence-based GPTI. Paired t test was used to determine statistically significant change pre-and post-intervention. Internal responsiveness (IR) was classified with the standardized response mean (SRM). A 5-point Likert scale assessed self-perceived performance by the subjects after the intervention. Analysis of the receiver operating characteristic (ROC) curve was used to determine the accuracy and cut-off scores for identifying participants who had shown improvement. RESULTS: GPTI was efficient in improving real (p ≤0.001) and self-perceived mobility performance in all measures. All tests were responsive to changes: the IR varied from medium to high (SRM = 0.7–1.5); the cut-off point for TUG test was >2.2 s, for FTSTS test was >2.5 s and for BM test >1.4 s. CONCLUSIONS: The TUG, FTSTS and BMT were responsive to the GPTI and accurately detected meaningful clinical changes. Our results provide an important information about the clinical application of these tests in PD individuals.