Background Pupil reactivity and the Glasgow Coma Scale (GCS) score are the most clinically relevant information to predict the survival of traumatic brain injury (TBI) patients. Objective We evaluated the accuracy of the GCS-Pupil score (GCS-P) as a prognostic index to predict hospital mortality in Brazilian patients with severe TBI and compare it with a model combining GCS and pupil response with additional clinical and radiological prognostic factors. Methods Data from 1,066 patients with severe TBI from 5 prospective studies were analyzed. We determined the association between hospital mortality and the combination of GCS, pupil reactivity, age, glucose levels, cranial computed tomography (CT), or the GCS-P score by multivariate binary logistic regression. Results Eighty-five percent (n = 908) of patients were men. The mean age was 35 years old, and the overall hospital mortality was 32.8%. The area under the receiver operating characteristic curve (AUROC) was 0.73 (0.70–0.77) for the model using the GCS-P score and 0.80 (0.77–0.83) for the model including clinical and radiological variables. The GCS-P score showed similar accuracy in predicting the mortality reported for the patients with severe TBI derived from the International Mission for Prognosis and Clinical Trials in TBI (IMPACT) and the Corticosteroid Randomization After Significant Head Injury (CRASH) studies. Conclusion Our results support the external validation of the GCS-P to predict hospital mortality following a severe TBI. The predictive value of the GCS-P for long-term mortality, functional, and neuropsychiatric outcomes in Brazilian patients with mild, moderate, and severe TBI deserves further investigation.

Objective: This systematic review aimed to examine the effects of home-based exercises in comparison with centre-based exercises for improving the paretic upper limb after stroke.Data sources: AMED, MEDLINE, EMBASE CINAHL, Cochrane, PsycINFO, and PEDro databases.Review methods: Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention was home-based exercises compared with centre-based exercises. Outcome data related to strength, motor recovery, dexterity, activity, and participation were extracted from the eligible trials and combined in meta-analyses. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.Results: Eight trials, involving 488 participants, were included. Most trials (63%) delivered semi-supervised interventions (amount of supervision 3–43%), and three trials provided full supervision. Random-effects meta-analyses provided moderate- to high-quality evidence that home- and centre-based exercises provide similar effects on motor recovery (MD 1.4 points; 95% CI −0.9 to 3.8), dexterity (MD −0.01 pegs/s; 95% CI −0.04 to 0.05), upper limb activity performance (SMD −0.04; 95% CI −0.25 to 0.18), and quality of movement (0.1 points; 95% CI −0.2 to 0.4). Effects on strength were also similar but the quality of the evidence was rated as low. No trials examined effects on participation.Conclusion: Effects of home-based prescribed exercises on upper limb motor recovery, dexterity, and activity are likely to be similar to improvements obtained by centre-based exercises after stroke.

Objective: To evaluate the effectiveness of osteopathic manipulative treatment (OMT) associated with transcranial direct current stimulation (tDCS) in reducing pain, disability, and improving quality of life in participants with non-specific chronic low back pain. Design: A randomised double-blind clinical trial. Setting: Clinical outpatient unit. Subjects: 72 participants with non-specific chronic low back pain were randomised into three groups: active tDCS + OMT ( n = 24), sham tDCS + sham OMT ( n = 24), and sham tDCS + OMT ( n = 24). Interventions: Evaluations were performed before, after the intervention, and one month post-intervention. tDCS consisted of ten 20-minute sessions over two weeks (five sessions per week). OMT was administered once per week, with two sessions conducted before the first and sixth tDCS sessions. Main measures: Pain, disability, and quality of life were assessed at baseline, after two weeks, and at one month of follow-up. Results: The visual analogue scale showed a significant decrease in all groups ( p < 0.001). However, tDCS + OMT and sham tDCS + OMT demonstrated a clinically significant reduction compared to the sham combination (effect size n² = 0.315). Roland-Morris scores decreased across all groups without specific group effects. EuroQoL 5-Dimension 3-Level improvement was observed only in the tDCS + OMT and sham tDCS + OMT groups (significant difference between T2 and T0, p = 0.002). Conclusion: The combination of OMT and tDCS did not provide clinically significant improvement over OMT alone in participants with non-specific chronic low back pain.

Giovanni Aldini was an Italian physicist interested in propagating Galvanism. With his uncle, Luigi Galvani, he learned techniques of electrical stimulation in humans and helped him to develop them. He later developed his own ideas and created transcranial electric stimulation. This paper presents some of Aldini's personal and professional traits, showing his trajectory and how his performance was important for the development of non-invasive brain stimulation techniques as a whole. Through research on animals and, later, on cadavers, his fundamental discoveries at the beginning of the treatment proposals are used so far.

Severe traumatic brain injury (sTBI) is an important cause of disability and mortality and affects people of all ages. Current scientific evidence indicates that motor dysfunction and cognitive impairment are the main limiting factors in patients with sTBI. Transcranial direct current stimulation (tDCS) seems to be a good therapeutic option, but when it comes to patients with sTBI, the results are inconclusive, and some protocols have not yet been tested. In addition, there is still a lack of information on tDCS-related physiological mechanisms, especially during the acute phase. In the present study, based on current evidence on tDCS mechanisms of action, we hypothesized that performing tDCS sessions in individuals with sTBI, especially in the acute and subacute phases, together with conventional therapy sessions, could improve cognition and motor function in this population. This hypothesis presents a new possibility for treating sTBI, seeking to elucidate the extent to which early tDCS may affect long-term clinical outcomes.