BackgroundMild traumatic brain injury (MTBI) represents 70–80% of all treated brain injuries. A considerable proportion of MTBI patients experience post-concussion symptoms for a prolonged period after MTBI, and these symptoms are diagnosed as persistent post-concussion syndrome (PPCS). PPCS is defined as a range of physical, cognitive, and emotional symptoms. However, memory and executive dysfunction seems to be one of the most debilitating symptoms. Recently, non-invasive brain stimulation has been studied as a potential treatment method for traumatic brain injury (TBI) patients. Therefore, our primary goal is to verify the effects of transcranial direct current stimulation (tDCS) in patients with PPCS who demonstrate cognitive deficits in long-term episodic memory, working memory, and executive function following MTBI.Methods/designThis is a randomized crossover trial of patients with a history of MTBI with cognitive deficits in memory and executive function. Thirty adult patients will be randomized in a crossover manner to receive three weekly sessions of anodal tDCS (2 mA) at left dorsolateral prefrontal cortex, left temporal cortex, and sham stimulation that will be performed at 7-day intervals (washout period). The clinical diagnosis of PPCS will be determined using the Rivermead Post-Concussion Symptoms Questionnaire. Patients who meet the inclusion criteria will be assessed with a neuropsychological evaluation. A new battery of computerized neuropsychological tests will be performed before and immediately after each stimulation. Statistical analysis will be performed to determine trends of cognitive improvement.DiscussionThere is paucity of studies regarding the use of tDCS in TBI patients, and although recent results showed controversial data regarding the effects of tDCS in such patients, we will address specifically patients with PPCS and MTBI and no brain abnormalities on CT scan other than subarachnoid hemorrhage. Moreover, due to the missing information on literature regarding the best brain region to be studied, we will evaluate two different regions to find immediate effects of tDCS on memory and executive dysfunction.Clinical Trial Registration, identifier NCT02292589 ().
RESUMONeste trabalho realiza-se uma análise do processo de adaptação e padronização da Bateria neuropsicológica Luria-Christensen para crianças, adolescentes e adultos brasileiros. Caracteriza-se por uma pesquisa motivada pela necessidade do desenvolvimento de instrumentos de avaliação diagnóstica padronizados à realidade sociocultural brasileira. A Bateria é composta por dez conjuntos de testes, e cada um deles avalia uma parte da dinâ-mica funcional cerebral, promovendo o mapeamento
Institutionalization is an exceptional and temporary measure that occurs when there is a violation of rights; lasting until the family reintegration or, in the impossibility of this, the placement in a substitute family through adoption. Among the main reasons for institutionalization in Brazil are the financial difficulties, abandonment, domestic violence, drug addiction, homelessness of the responsible for the child, sexual abuse, and the loss of parents by death or imprisonment. Although children and adolescents have their rights assured when they are institutionalized, the care provided in these spaces does not include all their needs and demands, which may damage their affective-relational development. Maternal deprivation in the first years of life can be detrimental to the development of these children, if not provided by adequate substitute care. Therefore, to understand which place the institutionalized baby occupies in the imaginary of the social caregivers and, from this, how is established the relationship regarding the care, is of fundamental importance to assess and address the risk factors in child development at this stage of life and in situation of institutionalization. This is an exploratory and descriptive study, developed in a childcare institution, located in the city of São Paulo, Brazil, capable of accommodating up to 20 babies between 0 and 2 years old. Data collection was performed with nine employees, eight social caregivers and one general service assistant who work directly in the care of the institutionalized babies. Drawing-Story with Theme (DS-T) procedures were used. Qualitative analysis was based on Interpretative Phenomenological Analysis. The appreciation of the nine applied Drawing-Story procedures allowed the establishment of three discussion axes representations of baby, baby care, and early separation process. This study concluded that the difficulties that permeate the context of caregivers' work are the high turnover of institutionalized children, as well as employees, the difficulty of dealing with processes of bonding and breaking bonds and no recognition of the profession. We highlight that the place that these babies occupy in the imaginary of these
Sexual abuse impacts different spheres of a child's life, generating consequences for physical, psychological, social, affective and cognitive development. This study aims to present the phenomenon of intrafamily sexual abuse and the psychological, social and legal aspects experienced by victims. For that, a case study of two brothers victims of sexual abuse was used. Observation of the children was carried out in the institutional reception environment; projective techniques with social educators, and documentary research of the legal processes of the brothers, o In 2018, the brothers were welcomed after presenting, in an emergency medical consultation, signs of sexual violence and neglect of care. The documents contained in the legal proceedings found intrafamily sexual abuse, neglect of parental care, developmental problems: speech delay and muscle tone; and difficulty in establishing affective bonds and socialization, among other health problems. The storytelling of the educators showed anguish and commitment in the care of the brothers. The observation of the children pointed to the global improvement over the months, the establishment of affective bonds and initial difficulties overcome. It is concluded that the institutional reception promoted an environment of protection and individualized and affective care, allowing the siblings to develop again and to establish an affective bond between themselves and with others. The study reiterates the seriousness of sexual abuse in early childhood, highlights the serious violation of rights, which must be addressed within the scope of public and mental health and social assistance, implementing and expanding public policies aimed at early childhood.
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