Effects of Transcranial Direct Current Stimulation Associated With Neurofunctional Rehabilitation in Individuals With Spinocerebellar Ataxias

The severity of ataxia will be assessed using the Ataxia Rating and Assessment (SARA) scale, which consists of eight items: gait, posture, sitting, speech, finger-chasing, nose-finger test, rapid alternation of hand movements, and lower limb coordination. The higher the score, the greater the severity of the disease.

The Mini-BEST is an instrument that assesses postural control. The Mini-BEST includes 14 items divided into: anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. The following tasks will be assessed: sitting to standing, standing on tiptoe, single-leg support, correction with anterior, posterior, and lateral steps, eyes open on a firm surface, eyes closed on an unstable surface, tilt with eyes closed, change in gait speed, walking with head turns, walking and turning on the axis, passing through obstacles, gait speed with and without dual task. The individual may use an assistive device during the test, if necessary, but each domain will be scored one level below the item for which the device was used . The maximum score is 28 (twenty-eight) points; Items can be scored as 0 (unable),

Stabilometry assesses balance in the orthostatic posture and quantifies the anteroposterior and lateral oscillations of the body's center of pressure (COP). This analysis will be performed using a Baiobit inertial sensor (BTS Bioengineering). The sensor will be connected to the individual by an elastic belt placed at the height of the S1-S2 vertebrae. The patient will remain in a bipedal position for 30 (thirty) seconds. The sensor will measure the following indices: angle of oscillations, elliptical area, oscillations, speed of anteroposterior and lateral oscillations of the center of mass and the length of the trajectory of the center of mass.

This scale assesses the risk of falls. It is a questionnaire of self-efficacy and confidence in balance, with 16 (sixteen) items. It includes questions about activities of daily living in the home environment and in the community environment. Response options include: not at all concerned, somewhat concerned, very concerned and extremely concerned.

The score ranges from a minimum of 16 (no concern about falls) to a maximum of 64 (severe concern about falls). Therefore, the higher the score, the greater the risk of falls.

The Timed Up Go (TUG) test will be used to assess functional mobility and the risk of falls. The test identifies the speed at which the patient can get up from a chair, walk 3 (three) meters, return and sit down. The time spent performing the task can be classified as low risk, medium risk and high risk of falls. During the test, the patient will be wearing a Baiobit inertial sensor (BTS Bioengineering). The sensor will be connected to the individual by an elastic belt placed at the height of the S1-S2 vertebrae. This sensor will assess the duration of the TUG phases (sitting to standing, walking, turning and standing to sitting).

The 8-meter walk test is a functional assessment that measures an individual's walking speed. The test will be performed indoors on a flat surface, on a path marked out at 8 meters. Adhesive tape will be used to clearly mark the start and end of the path, and a stopwatch will be used to measure walking time. Individuals will be instructed to walk "as quickly but safely as possible." If necessary, individuals may use any assistive device, but without the help of another person or a wall. Three (3) repetitions will be performed, with a 1 (one) minute recovery interval between each repetition. The average time will be calculated and from this average the speed will be determined using the equation: Speed = distance traveled/time.

This analysis will be performed using a Baiobit inertial sensor (BTS Bioengineering). The sensor will be connected to the individual by an elastic belt placed at the height of the S1-S2 vertebrae. The individuals will be instructed to walk a distance of 7 meters. The following variables will be collected: speed (m/s), cadence (steps/min), stride length (meters), number of steps, stance phase (% of cycle) and swing phase (% of cycle).

Quality of life will be assessed using the Form Health Survey 36 (SF-36), a questionnaire consisting of 36 scores that assess 8 subdomains: vitality, limitation due to physical aspect, functional capacity, bodily pain, general health perceptions, social aspects, emotional aspects and mental health . This instrument has been translated and culturally validated for the Brazilian population . It presents a score from 0 to 100, in which zero corresponds to the "worst general health status" and 100 the "best general health status" .

The Modified Fatigue Impact Scale (MFIS) is a scale that assesses fatigue. It consists of 21 statements that assess the physical, cognitive and psychosocial domains. The individual must choose an alternative (scored from 0 to 4) for each item. Possible answers include: "never", "rarely", "rarely", "often" and "always". To answer it, the last two weeks up to the present day must be considered. The total MFIS score ranges from 0 to 84 and is calculated by adding the statements. Its objective is to assess the impact of fatigue on the patient's life. Values below 38 correspond to the absence of fatigue. For scores equal to or greater than 38, the higher the score, the greater the impact of fatigue