Past evidence has shown that motor cortical stimulation with invasive and non-invasive brain stimulation is effective to relieve central pain. Here we aimed to study the effects of another, very safe technique of non-invasive brain stimulation--transcranial direct current stimulation (tDCS)--on pain control in patients with central pain due to traumatic spinal cord injury. Patients were randomized to receive sham or active motor tDCS (2mA, 20 min for 5 consecutive days). A blinded evaluator rated the pain using the visual analogue scale for pain, Clinician Global Impression and Patient Global Assessment. Safety was assessed with a neuropsychological battery and confounders with the evaluation of depression and anxiety changes. There was a significant pain improvement after active anodal stimulation of the motor cortex, but not after sham stimulation. These results were not confounded by depression or anxiety changes. Furthermore, cognitive performance was not significantly changed throughout the trial in both treatment groups. The results of our study suggest that this new approach of cortical stimulation can be effective to control pain in patients with spinal cord lesion. We discuss potential mechanisms for pain amelioration after tDCS, such as a secondary modulation of thalamic nuclei activity.

These results support and extend the findings of previous studies on rTMS in stroke patients because five consecutive sessions of rTMS increased the magnitude and duration of the motor effects. Furthermore, this increased dose of rTMS is not associated with cognitive adverse effects and/or epileptogenic activity.

MIF) foi desenvolvida por meio de um processo de tradução para o português do Brasil por equipe médica bilíngüe familiarizada com o instrumento e tradutor profissional, seguido de tradução reversa para o inglês por tradutor independente. Não foram identificados problemas de equivalência cultural quando a versão obtida foi apresentada a um conjunto de 25 profissionais de saúde treinados no seu uso. Oito centros de reabilitação participaram da captação de dados para a obtenção de medidas de reprodutibilidade. Todos os pacientes adultos com história de pelo menos 4 meses de acidente vascular cerebral, consultados no período entre dezembro de 1999 e janeiro de 2000, foram avaliados por dois avaliadores treinados na aplicação da MIF, de forma independente, e reavaliados por apenas um desses examinadores após uma semana (teste/reteste). Uma amostra de 164 pacientes foi examinada e os valores de kappa para concordância em cada um dos itens da MIF variaram entre dois observadores de 0,50 (alimentação) a 0,64 (controle da urina) e no teste/ reteste entre 0,61 (vestir abaixo da cintura) a 0,77 (transferência para o vaso sanitário). As subescalas da MIF apresentaram no teste/reteste boa correlação (Pearson: 0,91 -0,98; ICC: 0,91 -0,98); a reprodutibilidade interobservadores também foi boa (Pearson: 0,87 -0,98; ICC: 0,87 -0,98). Análise de variância mostra boa concordância entre as médias dos resultados de dois avaliadores na primeira avaliação e na medida após uma semana. Concluímos que a versão brasileira da MIF tem boa equivalência cultural e boa reprodutibilidade. UNITERMOSMedida de independência funcional, reprodutibilidade, equivalência cultural, avaliação funcional, tradução SUMMARYA Brazilian version of Functional Independence Measure (FIM) was developed in a translation process to Brazilian Portuguese by a bilingual medical team and a professional translator, followed by a reverse translation to English by an independent traslator. No problems of cultural equivalence were identified in the resultant version when it was presented to a group of 25 clinicians trained in its use. Eight rehabilitation centers participated in the gathering of data for the study of reproductibility. Two independent observers evaluated, between December 1999 and January 2000, all adult stroke patients with more than 4 months of impairment onset at the same day and only one of these clinicians repeated the observation after one week (test/retest). A total of 164 patients were examined, kappa agreement values in each of the FIM items varied between two observers form 0,50 (feeding) to 0,64 (bladder control), at test/retest they varied from 0,61 (dressing below waist) to 0,77 (toilet transfer). MIF subscales showed good correlation at test/retest (Pearson: 0,91 -0,98; ICC: 0,91 -0,98) and between two observers (Pearson: 0,87 -0,98; ICC: 0,87 -0,98). Analysis of variance shows good agreement for these subscales between two observers and at test/retest condition. We conclude that the Brazilian version of FIM has good cultural equivalence and rep...

The authors investigated the use of slow-frequency repetitive transcranial magnetic stimulation (rTMS) to the unaffected hemisphere to decrease interhemispheric inhibition of the lesioned hemisphere and improve motor function in patients within 12 months of a stroke. Patients showed a significant decrease in simple and choice reaction time and improved performance of the Purdue Pegboard test with their affected hand after rTMS of the motor cortex in the intact hemisphere as compared with sham rTMS.

The results of this study provide evidence that the Brazilian IKDC Subjective Knee Form has psychometric properties similar to the original version. In addition, it was a reliable evaluation instrument for patients with knee-related problems.