Virtual task associated with transcranial stimulation by continuing the current in people with parkinson's disease

Abstract

Parkinson's disease (PD) is a chronic and degenerative disease of the central nervous system due to the death of motor neurons of the substantia nigra, decreasing dopamine. The most common motor disorders are bradykinesia, hypokinesia, akinesia, tremor, stiffness, changes in balance and gait, in addition to pain and fatigue limiting the execution of daily activities1. The action of Transcranial Direct Current Stimulation (ETCC) occurs through changes in rates of spontaneous neuronal firing, synaptic and non-synaptic plasticity, and changes in the resting polarization of neurons, triggering neuroplasticity in cortical areas critically involved in the performance of tasks, leading to an improved non-invasive functional response2. The use of virtual reality (VR) in rehabilitation is based on the use of games and tasks in virtual environments to stimulate physical and cognitive functions in people with different types of disabilities without great demands for physical space and equipment3. With the variety of motor dysfunctions, the alternatives of treatments and spaces adapted for these people became necessary the alternatives that fill these gaps, showing the possibility of mixed therapeutic interventions through VR and ETCC, enabling the stimulation of lower limbs (lower limbs) in a functional, pleasant, safe and capable of offering performance data for people with PD. OBJECTIVES: To assess the motor performance of lower limbs in virtual tasks through the number of losses and hits to the target in people with PD associated with the use of Transcranial Direct Current Stimulation (ETCC). MATERIALS AND METHODS: The CAAE ethics committee approved this project: 02908218.0.0000.5390, registered in the Clinical CONCLUSION: People who had active ETCC showed better performance, observed for better accuracy (absolute error) and precision (variable error) of movement. Trials: NCT04527809. That was a Cross-Sectional Study using a randomized, double-blind design that included people diagnosed with PD of both sexes and excluded people who were not able to stand independently and with associated neurological pathologies. In a single session, participants were evaluated by the MoveHero software, a game with balls that fall into two imaginary columns on the screen, in the rhythm of a song chosen by the researcher. The balls should be touched when they reached four circles placed in parallel, on two levels of height, at a distance of one and a half meters from the screen, together with the ETCC. This non-invasive, painless tool through electrical current is capable of modulating the dopaminergic system and cortical excitability, using two electrodes, increasing (anodic) or decreasing (cathodic) with an intensity of 2 mA, ramp = 20 s (rise = 10 s; descent = 10 s) at Active Group (GA) and a single ramp with duration = 30 s in the Sham Group (GS), with the anode electrode fixed in M1 (primary motor cortex) and the cathode fixed in the contralateral supraorbital region in the area for 20 minutes in both groups. As variables dependent on MoveHero, the number of hits, losses, and anticipations to the target were considered. The hit attempts in each position (Left and Right) on MoveHero were divided by two and thus transformed into two blocks of attempts to assess the initial attempts' improvement for the end of the movement. For comparison between GS and GA, the t-test was used, and for repeated measures for the Blocks and Ball Position factor (Right and Left), the paired t-test was used. RESULTS: 55 people were evaluated, randomly divided into 2 groups, 26 in GA with 62.2 ± 11.1 years, and 29 in GS with 66.3 ± 7.2 years, with a score on the Unified Parkinson's Disease Classification Scale ( UPDRS) in the Exame Motor Part GA 10.7 ± 6.3 and GS 14.2 ± 6.3 (p = 0.04), in the Complications and Dyskinesias Part GA 1.2 ± 1.4 and GS 2.3 ± 1.9 (p = 0.02) and in the Other Complications Part GA 0.6 ± 0.6 and GS 1.0 ± 0.8 (p = 0.05). Effects were found for Blocks in Absolute Error (which represents movement accuracy) between Block 1 (331.3 ± 200.8) and Block 2 (493.0 ± 347.3) on the left in GA (p = 0.005, Cohens 'd = 0.43), and for Groups in Absolute Error Block 1 on the Left GA 352.6 ± 197.4 and GS 513.8 ± 279.2 (p = 0.018, Cohens' d = 0.63) and in Variable Error ( representing the precision of movement) Block 2 on the Left GA 358.0 ± 251.3 and GS 523.0 ± 257.2 (p = 0.035, Cohens' d = 0.64) of the GA, without effects or interactions for hits with respect a Groups, Blocks or Position of the ball. This result shows that the Sham group presented a much larger number of lost balls (Errors and Anticipations) in the game than the Active group, corroborating with Conceição4, where the anodic ETCC active in the prefrontal cortex promoted benefits superior to those of a session of placebo in cortical activity, cognition and walking in PD patients.