TICAL C C HANGES HANGES IN IN B B RACHIAL RACHIAL P P LEXUS LEXUS - PowerPoint PPT Presentation

Núcleo ¡de ¡Pesquisa ¡em ¡ ¡ Neurociência ¡e ¡Reabilitação C OR TICAL C C HANGES HANGES IN IN B B RACHIAL RACHIAL P P LEXUS LEXUS ORTICAL I NJUR NJURY P P ATIENTS TIENTS WITH WITH C C HRONIC HRONIC P P AIN AIN Fernanda ¡de ¡Figueiredo ¡Torres ¡ Novembro/2016 ¡

Pain after Brachial Plexus Injury No ¡pain ¡ Chronic ¡pain ¡ No ¡treatment ¡ Severe ¡pain ¡+ ¡ ¡ Mild ¡pain ¡< ¡4 ¡ Recurrent ¡acute ¡pain ¡ No ¡ No ¡ Treatment ¡ Treatment ¡ treatment ¡ treatment ¡ No ¡opioids ¡ Opioids ¡ Vannier et al. , 2008

Brain Plasticity after Peripheral Injuries Nor Normal mal Amputee Amputee Cohen et al. , 1991; PascualLeone et al ., 1996; Flor et al. , 1995; Ojemann & Silbergeld, 1995

Brain Plasticity in Chronic Pain

Brain Plasticity in Chronic Pain Lotze et al. , 2001

Brain Plasticity in Chronic Pain Lotze et al. , 2001

Brain Plasticity in Chronic Pain Buttler & Moseley, 2013

Brain Plasticity after BPI

General Objective To investigate pain influence over cortical representations in brachial plexus injury patients using transcranial magnetic stimulation.

Transcranial Magnetic Stimulation (Baker et al ., 1985)

Methods 1. Identification of intact cortical motor connections after injury of different brachial plexus trunks through the presence of motor evoked potentials. Superior Trunk Inferior Trunk Biceps Brachii Abductor Digiti Minimi Superior and Middle Trunks Extensor Carpi Radialis

Methods 2. To assess cortical plasticity on the muscle groups of interest representation areas (changes in resting motor treshold and in MEP amplitude). Hot Spot Hot Spot Resting Motor Thr Resting Motor Threshold (RMT) eshold (RMT) Motor Evoked Potential (MEP) Motor Evoked Potential (MEP) Recruitment Curves (RC) Recruitment Curves (RC) Cortical Mapping Cortical Mapping

Methods 2. To assess cortical plasticity on the muscle groups of interest representation areas (changes in resting motor treshold and in MEP amplitude). Hot Spot Hot Spot Pulse Resting Motor Thr Resting Motor Threshold (RMT) eshold (RMT) Latency Motor Evoked Potential (MEP) Motor Evoked Potential (MEP) Amplitude Recruitment Curves (RC) Recruitment Curves (RC) Cortical Mapping Cortical Mapping

Methods 2. To assess cortical plasticity on the muscle groups of interest representation areas (changes in resting motor treshold and in MEP amplitude). Hot Spot Hot Spot Resting Motor Thr Resting Motor Threshold (RMT) eshold (RMT) Motor Evoked Potential (MEP) Motor Evoked Potential (MEP) Recruitment Curves (RC) Recruitment Curves (RC) Cortical Mapping Cortical Mapping

Methods 2. To assess cortical plasticity on the muscle groups of interest representation areas (changes in resting motor treshold and in MEP amplitude). Hot Spot Hot Spot Resting Motor Thr Resting Motor Threshold (RMT) eshold (RMT) Motor Evoked Potential (MEP) Motor Evoked Potential (MEP) Recruitment Curves (RC) Recruitment Curves (RC) Cortical Mapping Cortical Mapping

Methods 3. To verify any differences between cortical representations in brachial plexus injury patients with or without pain. Patients Patients WITH P WITH PAIN AIN Any degree, type or time since unilateral traumatic injury Presence of chronic pain Age ≥ 18 e ≤ 40 Both genders Patients Patients WITHOUT P WITHOUT PAIN AIN Any degree, type or time of unilateral traumatic injury Absence of chronic pain Age ≥ 18 e ≤ 40 Healthy V Healthy Volunteers olunteers Both genders Healthy subjects Age ≥ 18 e ≤ 40 Both genders No Nervous System or Motor System disorders

Methods Exclusion criteria: • Cranioencephalic trauma sequelae; • Cognitive deficits; • History of CNS and PNS diseases; • History of chronic pain before injury. Clinical Evaluation: • Subjective evaluation; • Identification of type of injury, complementary exams; • Objective evaluation (strength, sensibility, ROM); • Pain evaluation: Map Map and and Intensity Intensity, BPI, DN-4, , BPI, DN-4, McGill McGill Appr Approved oved by by the the INDC-UFRJ INDC-UFRJ Reaser Reaserch ch Ethics Ethics Committee Committee (CAAE: 21549913.4.0000.5261, (CAAE: 21549913.4.0000.5261, report eport # 642.803) # 642.803)

Expected Results ? ¡

Thank you!