BACKGROUND: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder, characterized by cardinal motor symptoms in addition to cognitive impairment. New insights concerning multisite non-invasive brain stimulation effects have been gained, which can now be used to develop innovative treatment approaches. OBJECTIVE: Map the researchs involving multisite non-invasive brain stimulation in PD, synthesize the available evidence and discuss future directions. METHODS: The databases PubMed, PsycINFO, CINAHL, LILACS and The Cochrane Library were searched from inception until April 2020, without restrictions on the date of publication or the language in which it was published. The reviewers worked in pairs and sequentially evaluated the titles, abstracts and then the full text of all publications identified as potentially relevant. RESULTS: Twelve articles met the inclusion criteria. The target brain regions included mainly the combination of a motor and a frontal area, such as stimulation of the primary motor córtex associated with the dorsolateral prefrontal cortex. Most of the trials showed that this modality was only more effective for the motor component, or for the cognitive and/or non-motor, separately. CONCLUSIONS: Despite the results being encouraging for the use of the multisite aproach, the indication for PD management should be carried out with caution and deserves scientific deepening.

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Background: Chronic Obstructive Pulmonary Disease (COPD) treatment includes a multidisciplinary approach, with physiotherapy a prominent role that promotes a positive impact on the quality of life (QOL) of these patients. Objective: To analyze the effects of physiotherapeutic interventions on QOL, lung volumes and capacities, and respiratory muscle strength in COPD patients. Methods: 17 subjects participated in the study, randomly divided into 2 groups: 1) Maneuvers: 62.7 ± 15.4 years, 1.65 ± 0.12 m, 81.4 ± 18.2 kg, body Mass Index (BMI) 29.9± 5.0 kg/m2 ; 2) Threshold: 64.4 ± 11.2 years, 1.58 ± 0.08 m, 70.7 ± 9.4 kg, BMI 28.6 ± 3.7 kg/m2 , with COPD, without neurological, musculoskeletal, cardiovascular or cognitive impairment, which made it impossible to participate in the physiotherapeutic intervention programs. QOL was analyzed using the Saint George Hospital questionnaire on Respiratory Disease (SGRQ); spirometry and respiratory muscle strength were analyzed by manovacuometry using a pneumotachograph. Data were analyzed in SPSS (20.0), Student’s t-test (paired) and Wilcoxon test were used for pre and post-intervention comparison of the SGRQ domains and total score, Vital Capacity (VC), Forced Vital Capacity (FVC), Forced Expiratory Volume (FEV1 ), Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP); and Student’s t-tests (independent) and Mann-Whitney were used in the intergroup comparison, all with a significance level of 5%. Results: There was a significant difference in both groups (P<0.05) in the pre- and post-intervention comparison of the three domains (Symptoms, Activities and Psychosocial Impact) and total SGRQ score, but this did not occur with spirometric variables. In the manovacuometry, the Wilcoxon test showed a significant difference in the pre and post-intervention values of MIP and MEP. Conclusion: Improved QOL and MIP and MEP muscle strength of all COPD patients was observed, regardless of the groups Maneuvers or Threshold.

Background: Chronic obstructive pulmonary disease (COPD) modifies the electrical activity of accessory respiratory muscles, also leading to a marked peripheral muscular dysfunction, measured by the handgrip strength taken as an indicator of total body strength. Objective: To compare the effects of two different physiotherapeutic programs on handgrip strength and myoelectric activity in COPD patients. Methods: Participated in the study 17 individuals, randomly allocated into 2 groups: 1) Maneuvers: 62.7±15.4 years, 1.65±0.12 m, 81.4±18.2 kg, BMI: 29.9±5.0 kg/m2 ; 2) Threshold: 64.4±11.2 years, 1.58±0.08 m, 70.7±9.4 kg, BMI: 28.6±3.7 kg/m2 , diagnosed with COPD, submitted to surface electromyographic (sEMG) evaluation of sternocleidomatoid (SCM) and anterior scalene (AS), and handgrip strength, before and after the interventions. The data were analyzed with SPSS (20.0). Pared t-student and Wilcoxon tests were used to compare mean values of the handgrip strength and the Root Mean Square (RMS) of the sEMG signal (SCM and AS muscles), pre- and post-interventions. In addition, independent t-Student and Mann-Whitney tests were used to compare the RMS average of the sEMG signal between the right and left sides. Significant level was set at 5%. Results: When comparing pre and post-intervention values, there was a significant increase for the Threshold group handgrip strength (P=0.037). It was observed a sEMG activity of SCM and AS during dynamometry, vital capacity, forced vital capacity on inspiratory and expiratory pressure (P<0.05) for both analyzed groups. In the comparison of the myoelectric activity between the right and left sides for the SCM and AS, there was a significant difference in handgrip strength (P=0.009) and forced vital capacity (P=0.001) of the SCM muscle, post intervention for the Threshold group. Conclusion: The proposed physiotherapeutic programs improved the overall muscle strength for the Threshold group and the electromyographic activity of SCM and AS in the 2 groups.This study was registered in ReBEC: RBR-4VGP58