Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration: ClinicalTrials.gov , NCT04044677. Registered on 05 August 2019.

Background: Sedentary lifestyles are increasingly common amongst children, and insufficient physical activity is a global epidemic estimated to contribute to future incapacities and potential deaths. Objective: We aimed to increase the amount of evidence concerning the effect of chronic exposure to exercise on heart rate variability in children and adolescents affected by obesity. Methods: A systematic review commenced following the PRISMA guidelines developed by Web of Science, Virtual Health Library, PubMed, Cochrane Library, Embase, Ovid, Medline Complete, and Scopus using keywords obtained from the Descriptors in Health Sciences and Medical Subject Headlines (MeSH) terms. We considered (1) Population: Pediatric individuals affected by obesity; (2) Intervention: Exercise; (3) Control: Pre-intervention and sedentary; (4) Outcomes: Clearly presented primary parameters; and (5) Studies: Clinical trials, case controls, case reports, and case series. Results: 11 articles were involved and predominantly included procedures observed during approximately 12 weeks with a distribution of three sessions per week, each session being 30–60 min of aerobic exercise; additionally, the exercise grades were typically completed at a percentage of subjects’ maximum heart rates. The meta-analyses displayed a significant effect on the domains of time (R-R interval, SDNN, rMSSD), frequency (HF ms2, HF (n.u.), LF/HF), and the non-linear index (SD1). Conclusion: Chronic exposure to exercise influences heart rate variability in children and adolescents affected by obesity by elevating the variability and parasympathetic activity and improving the sympathetic-vagal balance. Exercises should be recommended for the improvement of cardiac autonomic modulation to prevent the likelihood of further chronic diseases.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. As a result of the rapid progression and severity of the disease, people with ALS experience loss of functionality and independence. Furthermore, it has already been described presence of autonomic dysfunction. Despite the increasing use of virtual reality (VR) in the treatment of different diseases, the use of virtual reality environment as an intervention program for ALS patients is innovative. The benefits and limitations have not yet been proven. Our objective was to evaluate the autonomic function of individuals with amyotrophic lateral sclerosis throughout the virtual reality task. The analysis of autonomic function was completed before, during, and after the virtual reality task using the upper limbs; also, all steps lasted ten minutes in a sitting position. Heart rate variability (HRV) was taken via the Polar® RS800CX cardiofrequencymeter. The following questionnaire was enforced: Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS) and Fatigue Severity Scale (FSS). Different types of HRV were revealed for the groups, indicating that the ALS group has reduced HRV, with most of the representative indices of the sympathetic nervous system. Besides, the physiological process of reducing parasympathetic activity from rest to VR activity (vagal withdrawal), with reduction in HF (ms2) and an increase in HR from rest to activity, and a further increase throughout recovery, with withdrawal of sympathetic nervous system, occurs just for the control group (CG), with no alterations between rest, activity, and recovery in individuals with ALS. We could conclude that patients with ALS have the reduction of HRV with the sympathetic predominance when equated to the healthy CG. Besides that, the ALS individuals have no capability to adapt the autonomic nervous system when likened to the CG during therapy based on VR and their recovery.

ResumoConhecer as características de tabagistas é fundamental para estruturar adequadamente os programas de cessação tabagística, de forma a atender as necessidades específicas dessa população. Analisar características sóciodemográficas e o padrão de consumo tabagístico de fumantes que procuram atendimento em programas de cessação. Foi realizada análise retrospectiva de 38 meses dos dados da avaliação inicial de tabagistas que buscaram o Programa de Orientação e Conscientização Antitabagismo da UNESP-Presidente Prudente. A amostra foi constituída de 209 mulheres e 150 homens com idade de 48,16±12 anos; 34% cursaram ensino médio completo ou superior incompleto; 38,44% apresentaram nível elevado de dependência e 72,15% se apresentaram na fase motivacional de contemplação. Neste trabalho foram evidenciadas algumas características de tabagistas que procuram atendimento especializado para a cessação tabagística. Esses achados facilitarão a abordagem por profissionais que trabalham com essa temática, permitindo melhor direcionamento no tratamento e consequentemente aumento na taxa de sucesso na cessação tabagística dessa população. Knowing the characteristics of smokers is essential to adequately structure tobacco cessation programs in order to meet the specific needs of this population. To analyze socio-demographic characteristics and the smoking pattern of smokers seeking care in cessation programs. A 38-month retrospective analysis of data from the initial evaluation of smokers who sought the Anti-Smoking Counseling and Orientation Program of UNESP-Presidente Prudente was conducted. The sample consisted of 209 women and 150 men aged 48.16 ± 12 years; 34% did not complete high school or university, 38.44% presented a high level of dependence, and 72.15% presented themselves in the motivational phase of contemplation. In this study, some characteristics of smokers seeking specialized care for smoking cessation were evidenced. These findings will facilitate the approach by professionals who work with this theme, allowing for better targeting in the treatment and consequently an increase in the smoking cessation success rate of this population. Palavras-chave: