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.

JM; Hernandez AJ. Reproducibility of maximum aerobic power (VO 2max ) among soccer players using a modified heck protocol. Clinics. 2007;62(4):391-6. OBJECTIVE:To determine the degree of reproducibility of maximum oxygen consumption (VO 2max ) among soccer players, using a modified Heck protocol. METHODS: 2 evaluations with an interval of 15 days between them were performed on 11 male soccer players. All the players were at a high performance level; they were training for an average of 10 hours per week, totaling 5 times a week. When they were evaluated, they were in the middle of the competitive season, playing 1 match per week. The soccer players were evaluated on an ergometric treadmill with velocity increments of 1.2 km . h -1 every 2 minutes and a fixed inclination of 3% during the test. VO 2max was measured directly using a breath-by-breath metabolic gas analyzer. RESULTS:The maximum running speed and VO 2max attained in the 2 tests were, respectively: (15.6 ± 1.1 vs. 15.7 ± 1.2 km ; [P = .88]). There was high and significant correlation of VO 2max between the 2 tests with a 15-day interval between them [r = 0.97; P < .001]. CONCLUSION: The modified Heck protocol was reproducible, and the 15-day interval between the ergospirometric testing was insufficient to significantly modify the soccer players' VO 2max values.

DEDICATÓRIAAos meus pais, que com tantas dificuldades, prepararam-me para a vida.Ao meu marido, pelo seu amor e compreensão.Aos meus filhos, fonte inesgotável de alegrias.À minha avó Miina, que sempre me incentivou. In memorian Agradecimentos

The purpose of this study was to identify the prevalence of the human leukocyte antigen (HLA) class I and II on the spinal cord injury (SCI) patients and its relation with heterotopic ossification (HO). Fifty-four patients were studied (47 men and 7 women) with an average age of 33,5 ± 12,5 years (range 18 to 59 years) with SCI. Forty-four patients (81,5%) had complete and 10 had incomplete lesions. Twenty-three patients (42,6%) were tetraplegics, 31(57,4%) were paraplegics, 28 had thoracic injury and 3 had lumbar lesion. The tests used in the diagnosis of HO were bone scintigraphy, anteroposterior radiography of hip and knee in the paraplegics and also the shoulders in the tetraplegics. Computerized tomography was used when the others tests were unconcluded. The patients were divided in two groups: 28 patients with HO (52%) and 26 without HO (48%). The typing of HLA antigens class I and II was done in all patients. The results of the distribution of frequency of HLA antigens were assessed on both groups and it was not shown any difference with statistic significance. It was conclude that there was no association between HLA antigens class I and II with the OH development.

Pressure ulcers are frequent complications in patients with spinal cord injuries. These ulcers need an early diagnosis and a strict follow-up to prevent a more severe evolution and delays in the rehabilitation process. Unfortunately, patients do not always have access to a center specialized in the treatment of wounds, and thus, telemedicine can be useful in such cases. Objective: To evaluate the effectiveness of a protocol for the assessment of pressure ulcers through digital images. Methods: 15 patients were selected, totaling 33 ulcers. The patients were separately assessed by 2 on-site physiatrists, who filled out the first part of the protocol (patients’ clinical data) at the time of the consultation and took the photographs. These were sent to the physiatrists at-distance, who evaluated the wounds through the photographs and the data sent by the on-site physician. The similarities and differences between the two on-site physicians, between the on-site physicians and the physicians at-distance and between the two physicians at-distance were compared regarding the degree, necrosis, infection, fistula, secretion, wound border and depth aspect and conduct. The statistical analysis was based on Kappa calculations, a confidence interval and P value. Results: The highest Kappa values were observed when the on-site assessments were compared. For necrosis, degree and infection, the On-site Assessment (S) x Assessment at distance (D) Kappas were substantial and moderate. For the item conduct, the Kappa varied from weak to almost perfect. As for the evaluations of the borders, depth, secretion and fistula, there were divergences. Conclusion: The protocol is effective to assess wound necrosis, degree and infection. There is some difficulty in using the method to evaluate the border and depth aspect, secretion and fistula. The method showed to be more satisfactory for the assessment of pressure ulcers grade I and II.