Percorrer por autor "Freitas, Marta"
A mostrar 1 - 8 de 8
Resultados por página
Opções de ordenação
- Biomechanical assessment methods used in chronic stroke: A scoping review of non-linear approachesPublication . Freitas, Marta; Pinho, Francisco; Pinho, Liliana; Silva, Sandra; Figueira, Vânia; Vilas-Boas, João Paulo; Silva, AugustaNon-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.
- Clinical measures for tone assessment in adults with central nervous system disorders—A scoping review in a rehabilitation contextPublication . Pinho, Liliana; Silva, Sandra; Freitas, Marta; Figueira, Vânia; Pinho, Francisco; Cunha, Christine; Sousa, Andreia S. P.; Sousa, Filipa; Silva, AugustaAssessment of muscle tone in a clinical setting is important for the physiotherapist to better analyse and establish appropriate treatments for CNS disorders. This study aims to review and summarise how to assess changes in tone in the context of adult rehabilitation. Secondarily, this study aimed to identify the central nervous system disorders, the respective variable/concept under study, and the testing procedures employed. PRISMA-ScR guidelines were followed using the “population”, “concept”, and “context” to define the eligibility criteria and to delineate the research question. PubMed®, Science Direct®, Web of Science™, and Google Scholar® databases were used to search the literature. The search included studies published between 2011 and March 2023 in Portuguese, English, French, and Spanish that assessed an adult population (>19 years) with CNS injury. Review articles, qualitative studies, conference proceedings, letters to the editor, and editorials were excluded. Initially, 1519 references were identified, of which eight met the eligibility criteria. The measurement instruments included the Modified Ashworth Scale (n = 5), the Modified Modified Ashworth Scale (n = 3), the BioTone™ system (n = 2), the Montreal Spasticity Measurement (n = 1), and the Tone Evaluation Scale (n = 1). The health conditions considered included stroke sequelae (n = 7), multiple sclerosis (n = 4), spinal cord injuries (n = 4), cerebral palsy (n = 2), brain tumour (n = 2), and traumatic brain injuries (n = 3). The concepts of spasticity (n = 7) and muscle tone (n = 2) were explored. Considering the variables spasticity and muscle tone in different CNS disorders, mainly stroke, subjective instruments were preferred compared to objective ones, with the Modified Ashworth Scale being highlighted.
- A comprehensive understanding of postural tone biomechanics: intrinsic stiffness, functional stiffness, antagonist coactivation, and COP Dynamics in post-stroke adultsPublication . Pinho, Liliana; Freitas, Marta; Pinho, Francisco; Silva, Sandra; Figueira, Vânia; Ribeiro, Edgar; Sousa, Andreia S. P.; Sousa, Filipa; Silva, Augusta; Pinheiro de Sousa, Andreia Sofia; Ferreira Silva, Maria Augusta; Oliveira e Pinho, Liliana; Nicolau Gonçalves de Freitas, Marta SofiaTo analyse the relationship between traditional stiffness and muscle antagonist coactivation in both stroke and healthy participants, using linear and nonlinear measures of coactivation and COP during standing, stand-to-sit, and gait initiation. Participants were evaluated through a cross-sectional design. Electromyography, isokinetic dynamometer, and force plate were used to calculate coactivation, intrinsic and functional stiffness, and COP displacement, with both linear and non-linear metrics. Spearman’s correlations and Mann–Whitney tests were applied (p < 0.05). Poststroke participants showed higher contralesional intrinsic stiffness (p = 0.041) and higher functional stiffness (p = 0.047). Coactivation was higher on the ipsilesional side during standing (p = 0.012) and reduced on the contralesional side during standing and transitions (p < 0.01). Moderate correlations were found between intrinsic and functional stiffness (p = 0.030) and between coactivation and intrinsic stiffness (standing and stand-to-sit: p = 0.048) and functional stiffness (gait initiation: p = 0.045). COP displacement was reduced in post-stroke participants during standing (p < 0.001) and increased during gait initiation (p = 0.001). Post-stroke participants exhibited increased gastrocnemius/tibialis anterior coactivation during gait initiation (p = 0.038) and higher entropy and stability across tasks (p < 0.001). Post-stroke participants showed higher contralesional intrinsic and functional stiffness, reduced coactivation in static tasks, and increased coactivation in dynamic tasks. COP and coactivation analyses revealed impaired stability and random control, highlighting the importance of multidimensional evaluations of postural tone.
- European Portuguese version of the Mini-BESTest: a cross-cultural adaptation and psychometric measurements in individuals with sensorimotor impairmentsPublication . Freitas, Marta; Pinho, Francisco; Cruz-Martins, Natália; Pinho, Liliana; Silva, Sandra; Figueira, Vânia; Vilas-Boas, João Paulo; Silva, Augusta; Ferreira Silva, Maria AugustaThis study aimed to translate and cross-culturally adapt the Mini-BESTest into European Portuguese and to evaluate its psychometric properties in individuals with sensorimotor impairments. A cross-sectional cross-cultural adaptation and validation study was conducted according to the COSMIN guidelines and the STROBE statement. The study included 100 participants with sensorimotor impairments who were able to walk 6 m. Cronbach’s alpha and item-total correlations were used to assess internal consistency. Interpretability was assessed by examining floor and ceiling effects and skewness. To investigate construct validity, Spearman correlation coefficients and Bland-Altman analysis were performed to compare the Berg Balance Scale and the Mini-BESTest Inter- and intra-rater reliability were assessed by calculating the ICC, SEM and MDC based on video recordings of the participants during the Mini-BESTest assessments. The European Portuguese Mini-BESTest showed good internal consistency (Cronbach’s α = 0.892) and no significant floor or ceiling effects. Excellent inter- and intra-rater reliability (ICC = 0.97) were also demonstrated, with MDC of 2.58 and 2.57, respectively. Furthermore, this instrument showed a significant correlation with the BBS (r = 0.902). Bland-Altman analysis showed small absolute differences. The European Portuguese Mini-BESTest is comparable to the original English version in terms of validity and reliability and is therefore highly recommended for use by Portuguese-speaking professionals to assess postural control.
- Medidas de avaliação motora em indivíduos após AVC nas fases aguda e sub-aguda – scoping reviewPublication . Freitas, Marta; Pinho, Francisco; Pinho, Liliana; Figueira, Vânia; Silva, Sandra; Sousa, Andreia; Silva, AugustaAs alterações biomecânicas nos indivíduos após Acidente Vascular Cerebral (AVC) podem ser avaliadas em contexto clínico, com recurso a testes e escalas validadas, ou em contexto laboratorial através de uma análise instrumentada quantitativa e objetiva. Identificar e sumariar os instrumentos de avaliação, e respetivas tarefas motoras, utilizados na análise do movimento humano, nas fases aguda e subaguda recente, após AVC. Seguiu-se o protocolo PRISMA Extension for Scoping Reviews(PRISMA-ScR) e a estratégia “população”, “conceito” e “contexto” (PCC), para a definição da questão de pesquisa nas bases de dados PubMed®, Science Direct®, Web of Science®e Google Scholar®. Incluíram-se estudos publicados entre 2018 e 2022, em português e inglês, que descrevessem os instrumentos de avaliação clínicos e laboratoriais utilizados, e a tarefa motora associada, em indivíduos >19 anos, considerando até 3 meses após AVC. Excluíram-se artigos de revisão, estudos qualitativos, conference proceedings, cartas ao editor e editoriais. Foram selecionados 302 artigos, dos quais 15 foram elegíveis. A marcha (n=9), o sit to stand(n=2) e funções relacionadas com o membro superior(n=4) foram avaliadas por diferentes instrumentos clínicos (Functional Ambulation Categories; Functional Independence Measure; Fulgl-Meyer Assessment;) e laboratoriais (sistemas de captura de imagem (VICON, EXFH20, GoPro Hero5); plataformas de forças AMTI INc e AccuGait®). O Functional Ambulation Categoriese a Fulgl-Meyer Assessmentforam os instrumentos mais aplicados na análise clínica e o sistema de captura de imagem VICON na análise cinemática quantitativa. A tarefa motora mais estudada foi a marcha. Dada a evolução da tecnologia na procura de soluções viáveis para a tomada de decisão em contexto de reabilitação, sugerem-se estudos que privilegiam a avaliação em contexto real.
- Necessidades reportadas por sobreviventes de Acidente Vascular Cerebral crónico: Resultados preliminares de um estudo longitudinal multicêntricoPublication . Silva, Augusta; Lata, Sara; Vasconcelos, Mariana; Silva, Claúdia; Cunha, Christine; Sousa, Andreia; Ferreira, Rosália; Pereira, Soraia; Rocha, Artemisa; Pinto, Joana; Patrício, Brígida; Trigueiro, Maria João; Tavares, Diana; Freitas, Marta; Alexandrino, Ana Silva; Barbosa, Pedro Maciel; Ferreira Silva, Maria Augusta; Silva, Cláudia; Pinheiro de Sousa, Andreia Sofia; Dores, Artemisa; Pinto, Joana ONeste trabalho apresentam-se os resultados preliminares do projeto de investigação “Cuidados de saúde, fatores clínicos, económicos e sociais preditivos da qualidade de vida após Acidente Vascular Cerebral (AVC): Estudo longitudinal multicêntrico”, no que diz respeito às necessidades reportadas por sobreviventes, em fase crónica. Apesar dos avanços clínicos observados nas últimas décadas, subsiste, ainda, um número elevado de sujeitos a necessitarem de cuidados de saúde de longo prazo. As incapacidades físicas, cognitivas e emocionais exibidas, com consequências pessoais, familiares, laborais, económicas e sociais, traduzem um conjunto de necessidades complexas e de natureza heterogénea. De facto, a diversidade e a extensão destas necessidades impactam, de modo inegável, a qualidade de vida e o bem-estar psicossocial dos sobreviventes. Neste contexto, o presente estudo pretende contribuir para o conhecimento compreensivo das necessidades do sobrevivente de AVC, na senda de uma prestação de serviços de reabilitação centrados no indivíduo. Objetivo: Caracterizar as principais necessidades reportadas por sobreviventes de AVC, nomeadamente necessidades de natureza física, de comunicação, cognitiva, psicológica e emocional, de atividades e participação, ambiental, económica, social, profissional e familiar; e necessidades de acesso a serviços de saúde. Metodologia: Estudo observacional descritivo transversal, constituído por 31 sobreviventes de AVC em estádio crónico, 18 do sexo feminino e 13 do masculino, com uma média de idades de 52 anos (DP=10). Apenas três dos sobreviventes apresentam um tempo decorrido após o evento inferior a 2 anos. Os participantes foram entrevistados, via Zoom, momento em que foram aplicados dois questionários, um de caráter sociodemográfico e clínico, para a caraterização da amostra, e um segundo questionário, de levantamento de necessidades, construído com base na evidência científica mais atual e revisto por um grupo de peritos das diversas áreas. Através da estatística descritiva, foi possível realizar uma análise de frequências das respostas ao segundo questionário. Resultados: A necessidade de serviços especializados foi a principal reportada pelos participantes (90%), tendo sido a fisioterapia e a neuropsicologia as especialidades mais referenciadas (70% e 32%, respetivamente). Seguiram-se as necessidades físicas, reportadas por 87% dos participantes, destacando-se a tensão muscular (52%) e a perda de equilíbrio/medo de cair (39%) como as mais assinaladas. Também os domínios psicológico e emocional e de atividades e participação foram eleitos pela maior parte dos participantes, 71% e 68%, respetivamente. Em oposição, as necessidades menos assinaladas correspondem às de caráter económico, ambiental e social. Conclusões: No geral, os resultados destacaram uma elevada percentagem de sobreviventes que partilham um vasto leque de necessidades não atendidas, que persistem mesmo após decorridos 2 anos do evento vascular. Estes resultados preliminares apontam para a importância de compreender a génese das necessidades reportadas, apelando para um levantamento aprofundado da oferta pelas diferentes áreas de atuação e inerente identificação de possíveis barreiras para a sua acessibilidade.
- Neurobiomechanical characterization of feedforward phase of gait initiation in chronic stroke: A linear and non-linear approachPublication . Freitas, Marta; Fonseca, Pedro; Alves, Leonel; Pinho, Liliana; Silva, Sandra; Figueira, Vânia; Félix, José; Pinho, Francisco; Vilas-Boas, João Paulo; Silva, Augusta; Ferreira Silva, Maria AugustaPostural control arises from the complex interplay of stability, adaptability, and dynamic adjustments, which are disrupted post-stroke, emphasizing the importance of examining these mechanisms during functional tasks. This study aimed to analyze the complexity and variability of postural control in post-stroke individuals during the feedforward phase of gait initiation. A cross-sectional study analyzed 17 post-stroke individuals and 16 matched controls. Participants had a unilateral ischemic stroke in the chronic phase and could walk independently. Exclusions included cognitive impairments, recent surgery, and neurological/orthopedic conditions. Kinematic and kinetic data were collected during 10 self-initiated gait trials to analyze centre of pressure (CoP) dynamics and joint angles (−600 ms to +50 ms). A 12-camera motion capture system (Qualisys, Gothenburg, Sweden) recorded full-body kinematics using 72 reflective markers placed on anatomical landmarks of the lower limbs, pelvis, trunk, and upper limbs. Ground reaction forces were measured via force plates (Bertec, Columbus, OH, USA) to compute CoP variables. Linear (displacement, amplitude, and velocity) and non-linear (Lyapunov exponent—LyE and multiscale entropy—MSE) measures were applied to assess postural control complexity and variability. Mann–Whitney U tests were applied (p < 0.05). The stroke group showed greater CoP displacement (p < 0.05) and reduced velocity (p = 0.021). Non-linear analysis indicated lower LyE values and reduced complexity and adaptability in CoP position and amplitude across scales (p < 0.05). In the sagittal plane, the stroke group had higher displacement and amplitude in the head, trunk, pelvis, and limbs, with reduced LyE and MSE values (p < 0.05). Frontal plane findings showed increased displacement and amplitude in the head, trunk, and ankle, with reduced LyE and MSE (p < 0.05). In the transverse plane, exaggerated rotational patterns were observed with increased displacement and amplitude in the head, trunk, pelvis, and hip, alongside reduced LyE convergence and MSE complexity (p < 0.05). Stroke survivors exhibit increased linear variability, indicating instability, and reduced non-linear complexity, reflecting limited adaptability. These results highlight the need for rehabilitation strategies that address both stability and adaptability across time scales.
- Wearables for monitoring and postural feedback in the work context: A scoping reviewPublication . Figueira, Vânia; Silva, Sandra; Costa, Inês; Campos, Bruna; Salgado, João; Pinho, Liliana; Freitas, Marta; Carvalho, Paulo; Marques, João; Pinho, FranciscoWearables offer a promising solution for simultaneous posture monitoring and/or corrective feedback. The main objective was to identify, synthesise, and characterise the wearables used in the workplace to monitor and postural feedback to workers. The PRISMA-ScR guidelines were followed. Studies were included between 1 January 2000 and 22 March 2023 in Spanish, French, English, and Portuguese without geographical restriction. The databases selected for the research were PubMed®, Web of Science®, Scopus®, and Google Scholar®. Qualitative studies, theses, reviews, and meta-analyses were excluded. Twelve studies were included, involving a total of 304 workers, mostly health professionals (n = 8). The remaining studies covered workers in the industry (n = 2), in the construction (n = 1), and welders (n = 1). For assessment purposes, most studies used one (n = 5) or two sensors (n = 5) characterised as accelerometers (n = 7), sixaxial (n = 2) or nonaxial inertial measurement units (n = 3). The most common source of feedback was the sensor itself (n = 6) or smartphones (n = 4). Haptic feedback was the most prevalent (n = 6), followed by auditory (n = 5) and visual (n = 3). Most studies employed prototype wearables emphasising kinematic variables of human movement. Healthcare professionals were the primary focus of the study along with haptic feedback that proved to be the most common and effective method for correcting posture during work activities.