Browsing by Author "Moreira, Juliana"
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- Association between gait lower limb intra and interlimb coordination and fear of falling and falling history in older adultsPublication . Castro, Márcia; Moreira, Juliana; Sousa, Andreia S. P.; Santos Moreira, Juliana; Pinheiro de Sousa, Andreia SofiaAging often leads to a decline in intersegmental coordination, particularly in the lower limbs, which can negatively impact gait stability and symmetry. While fear of falling (FoF) and a history of falls (HoF) increase fall risk in older adults, their relationship with intra- and intersegmental coordination during gait remains understudied. This cross-sectional observational study involved 60 participants aged 60 and older. The three-dimensional range of motion of lower limb joints during gait was assessed using an optoelectronic system. Intra- and intersegmental coordination were evaluated via the Continuous Relative Phase (CRP) variable, including its mean, standard deviation, and coefficient of variation. The results showed that the HoF and FoF groups had higher mean CRP values in the left hip-knee (HOF, p = 0.004) and hip-ankle (FOF, p = 0.030) in the sagittal plane, as well as higher standard deviation values in the left knee-ankle (HOF, p = 0.006) and right hip-ankle (HOF, p = 0.004). Inter-segmental coordination differences were also observed, with higher mean CRP values between the knee joints in the sagittal plane (HOF, p = 0.046) and lower mean and standard deviation values between the ankle joints (FOF, p = 0.048 and p = 0.038, respectively). This study concludes that fear of falling and history of falling are significantly associated with altered intra- and intersegmental coordination in older adults, which may contribute to fall risk. Understanding these altered coordination patterns is crucial, as it underscores the therapeutic significance of targeting these changes, which could lead to interventions aimed at improving gait stability and reducing fall risk in elderly individuals.
- Association between the history of fall and the fear of falling on stair descent and gait transition spatiotemporal parameters and lower-limb kinematics in older adultsPublication . Teles, Ivone; Moreira, Juliana; Sousa, Andreia S. P.; Santos Moreira, Juliana; Pinheiro de Sousa, Andreia SofiaAmong older adults, there is a high incidence of history of fall (HoF), fear of falling (FoF), and falls on stair descent during gait transitions. We aim to evaluate the association between HoF and FoF on spatiotemporal and lower-limb kinematic parameters in older adults during stair descents and gait transitions. Sixty older adults (>60 years) were evaluated through an optoelectrical motion capture system during stair descents and gait transitions, using the mean value of the task velocity and time; single- and double-support time; peak downward center of mass (CoM) velocity; hip, knee, and ankle positions of ipsi and the contralateral limb; and foot clearance and foot placement, assessed through multivariate analysis of variance. FOF exhibited longer time to complete (p = 0.009) and double-support (p = 0.047) and single-support (p = 0.009) times and a reduced peak downward CoM velocity (p = 0.043). In the gait transition cycle, HOF exhibited reduced ipsi ankle angles at toe-off (p = 0.015), and FOF presented reduced ipsi ankle angles at heel-strike (p = 0.041) and toe-off (p = 0.026) and reduced contralateral ankle angles at toe-off (p = 0.022).Older adults with HoF and FoF exhibit biomechanical changes during stair descents and gait transitions, in line with the use of more conservative strategies to avoid falling.
- Effectiveness of specific scapular therapeutic exercises in patients with shoulder pain: a systematic review with meta-analysisPublication . Melo, Ana; Moreira, Juliana; Afreixo, Vera; Gonçalves, Daniel Moreira; Donato, Helena; Cruz, Eduardo B.; Vilas-Boas, J. Paulo; Sousa, AndreiaTherapeutic exercise has been considered a useful tool to rehabilitate shoulder pain, namely through its influence on scapular dynamics. Accordingly, the effectiveness of scapular therapeutic exercise needs to be explored. The present study aims to evaluate the effectiveness of scapular therapeutic exercises in shoulder pain and to identify the most effective exercise type (focal or multijoint) and ways of delivering them (as dose and progression). Search was conducted at EMBASE, Cochrane Library, MEDLINE via PubMed, Web of Science, PEDro (Physiotherapy Evidence Database), and trial registration databases. The meta-analysis considered randomized controlled/crossover trials that compared the effect of scapular exercises against other types of intervention in the shoulder pain, shoulder function, scapular motion, and/or muscular activity. The risk of bias was assessed through the PEDro scale. From the 8318 records identified, 8 (high to low risk of bias– scoring from 4 to 8 on the PEDro scale) were included. The overall data, before sensitivity analysis, indicated that the scapular therapeutic exercises are: a) more effective than comparators in improving shoulder function (standardized mean difference [SMD] = 0.52 [95% Cl: 0.05, 0.99], P = .03, I2 = 76%); and b) as effective as comparators in reducing shoulder pain (SMD = 0.32 [95% Cl: −0.09, 0.73], P = .13, I2 = 70%). Subgroup analysis revealed that scapular exercises are more effective in improving shoulder function when the program duration is equal to or higher than 6 weeks (SMD = 0.43 [95% Cl: 0.09, 0.76] P = .01, I2 = 21%) and/or when the maximum number of exercise repetitions per session is lower than 30 (SMD = 0.79 [95% Cl: 0.15, 1.42], P = .01, I2 = 77%). Only 1 study considered scapular motion as an outcome measure, revealing therapeutic exercise effectiveness to improve scapular range of motion. Intervention programs involving scapular therapeutic exercises are effective in improving shoulder function, presenting benefits when performed for 6 or more weeks and/or when used up to a maximum of 30 repetitions per exercise, per session.
- Electrodermal activity wrist-based systems: A review of validity, reliability, and responsive measuresPublication . Félix, José; Moreira, Juliana; Santos, Rubim; Sousa, AndreiaElectrodermal activity (EDA) can be defined as an electrical property of the skin, measured in the palm and sole, related to the level of conductivity, influenced by the sweat level that may depend on various stimuli. Different equipments have been used to capture EDA with high levels of reliability, validity, and responsiveness, however these values vary according to the site of measurement. The increased use of EDA wrist-based systems highlights the need of characterizing the psychometric properties of these kind of systems. The aim of this chapter is to review the validity, reliability, and responsiveness of EDA measurement in the wrist. Previous studies have demonstrated that wrist measurement present low to moderate correlations, against the gold standard systems, with moderate levels of responsiveness, while no study addressed reliability. Wrist EDA measurement could be therefore an acceptable option, however, more studies are demanded not only to assess related values of reliability, as well to best characterize validity and responsiveness measures.
- Health-related telemonitoring parameters/signals of older adults: An umbrella reviewPublication . Félix, José; Moreira, Juliana; Santos, Rubim; Kontio, Elina; Pinheiro, Ana Rita; Sousa, Andreia S. P.Aging is one of the greatest challenges in modern society. The development of wearable solutions for telemonitoring biological signals has been viewed as a strategy to enhance older adults’ healthcare sustainability. This study aims to review the biological signals remotely monitored by technologies in older adults. PubMed, the Cochrane Database of Systematic Reviews, the Web of Science, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports were systematically searched in December 2021. Only systematic reviews and meta-analyses of remote health-related biological and environmental monitoring signals in older adults were considered, with publication dates between 2016 and 2022, written in English, Portuguese, or Spanish. Studies referring to conference proceedings or articles with abstract access only were excluded. The data were extracted independently by two reviewers, using a predefined table form, consulting a third reviewer in case of doubts or concerns. Eighteen studies were included, fourteen systematic reviews and four meta-analyses. Nine of the reviews included older adults from the community, whereas the others also included institutionalized participants. Heart and respiratory rate, physical activity, electrocardiography, body temperature, blood pressure, glucose, and heart rate were the most frequently measured biological variables, with physical activity and heart rate foremost. These were obtained through wearables, with the waist, wrist, and ankle being the most mentioned body regions for the device’s placement. Six of the reviews presented the psychometric properties of the systems, most of which were valid and accurate. In relation to environmental signals, only two articles presented data on this topic. Luminosity, temperature, and movement were the most mentioned variables. The need for large-scale long-term health-related telemonitoring implementation of studies with larger sample sizes was pointed out by several reviews in order to define the feasibility levels of wearable devices.
- Interlimb coordination during double support phase of gait in people with and without strokePublication . Couto, Ana G. B.; Vaz, Mário A. P.; Pinho, Liliana; Félix, José; Moreira, Juliana; Pinho, Francisco; Mesquita, Inês; Mesquita Montes, António; Crasto, Carlos; Sousa, AndreiaThis study aims to identify differences between participants with and without stroke regarding the ipsilesional and contralesional lower limbs kinematics, kinetics, muscle activity and their variability during double support phase of gait. Eleven post-stroke and thirteen healthy participants performed 10 gait trials at a self-selected speed while being monitored by an optoelectronic motion capture system, two force plates and an electromyographic system. The following outcomes were evaluated during the double support: the time and the joint position; the external mechanical work on the centre of mass; and the relative electromyographic activity. Both, contralesional/ipsilesional and dominant/non-dominant of participants with and without stroke, respectively, were evaluated during double support phase of gait in trailing or leading positions. The average value of each parameter and the coefficient of variation of the 10 trials were analysed. Post-stroke participants present bilateral decreased mechanical work on the centre of mass and increased variability, decreased contralesional knee and ankle flexion in trailing position, increased ipsilesional knee flexion in leading position and increased variability. Increased relative muscle activity was observed in post-stroke participants with decreased variability. Mechanical work on the centre of mass seems to be the most relevant parameter to identify interlimb coordination impairments in post-stroke subjects.
- Kinematic and Kinetic gait principal component domains in older adults with and without functional disability: a cross-sectional studyPublication . Moreira, Juliana; Cunha, Bruno; Félix, José; Santos, Rubim; Sousa, Andreia S. P.; Pinheiro de Sousa, Andreia Sofia; Rubim Silva Santos, Manuel; Santos Moreira, Juliana; Sousa Félix, José ManuelGait kinematic and kinetic changes have been identified in older adults, highlighting the need to explore the principal age-related components and how these are associated with functional disability. This study aims to perform a factor analysis, including gait kinematic and kinetic parameters in older adults to establish determinant gait domains. Additionally, this study aims to identify which domains differentiate those without and with functional disability. Through a cross-sectional design, older adults aged 60 and over (n = 35 without and n = 25 with functional disability) were analyzed during overground gait. A principal component analysis (PCA) was used to determine principal components from gait parameters previously demonstrated to express age-related effects (spatiotemporal parameters, sagittal ankle moment and power, ground reaction forces peak, and tridimensional lower limb joints range of motion and positions at heel strike and toe-off). Pace, variability, propulsion, hip and knee control, transverse ankle control, asymmetry, sagittal ankle control, frontal ankle control, frontal hip control, and pre-swing control domains explained 83.90% of the total gait variance in older adults. pace and frontal hip control distinguished individuals with disabilities. PCA identified ten gait domains in older adults. Pace and frontal hip control distinguished disabilities, revealing cautious walking patterns and weaker hip abductor strength.
- Optimal multi-field functional electrical stimulation parameters for the “drinking task - reaching phase” and related upper limb kinematics repeatability in post stroke subjectsPublication . Sousa, Andreia; Silva, Cláudia; Mesquita, Inês Albuquerque; Silva, Augusta; Macedo, Rui; Imatz-Ojanguren, Eukene; Hernandez, Erik; Keller, Thierry; Moreira, Juliana; Fonseca, Pedro Filipe Pereira da; Santos, RubimNo specific guidelines for the management of functional electrical stimulation (FES) parameters in post stroke patients have been defined yet, despite its frequent use. The purpose of this study is to characterize the optimal FES parameters that assist the reaching phase of drinking task (“drinking task - reaching phase”) on post stroke subjects and to analyze the related upper limb (UL) movement quality indicators repeatability. Methods: An observational study with a test and re-test design involving ten post stroke subjects with UL dysfunction was performed. End-point and joint kinematics of contralesional UL were assessed during the “drinking task - reaching phase” with FES through a test and retest design. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists‟ and patients‟ perspective. Findings: It was possible to establish reliable FES parameters that assisted the “drinking task - reaching phase”. All FES parameters presented high to very high repeatability and led to moderate to very high repeatability in almost UL movement quality indicators during the “drinking task - reaching phase”. Interpretation: These findings show that the main characteristics of FES parameters that improves patient perception of change are quiet stable, which facilitate its implementation in clinical practice by allowing consistence between intervention sessions.
- Optimal multi-field functional electrical stimulation parameters for the “Turn on the Light” task and related upper limb kinematics repeatability in post stroke subjectsPublication . Sousa, Andreia; Mesquita, Inês Albuquerque; Silva, Cláudia; Silva, Augusta; Macedo, Rui; Imatz-Ojanguren, Eukene; Hernandez, Erik; Keller, Thierry; Moreira, Juliana; Filipe Pereira da Fonseca, Pedro; Santos, RubimTo characterize the optimal Functional Electrical Stimulation (FES) parameters that assist the “turn on the light” task (TOTL) on post stroke participants and to analyze the related upper limb (UL) kinematics repeatability.
- Postural control during turn on the light task assisted by functional electrical stimulation in post stroke subjectsPublication . Sousa, Andreia S. P.; Moreira, Juliana; Silva, Cláudia; Mesquita, Inês; Silva, Augusta; Macedo, Rui; Santos, RubimPostural control mechanisms have a determinant role in reaching tasks and are typically impaired in post-stroke patients. Functional electrical stimulation (FES) has been demonstrated to be a promising therapy for improving upper limb (UL) function. However, according to our knowledge, no study has evaluated FES infuence on postural control. This study aims to evaluate the infuence of FES UL assistance, during turning on the light task, in the related postural control mechanisms. An observational study involving ten post-stroke subjects with UL dysfunction was performed. Early and anticipatory postural adjustments (EPAs and APAs, respectively), the weight shift, the center of pressure and the center of mass (CoM) displacement were analyzed during the turning on the light task with and without the FES assistance. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists’ and patients’ perspectives. The ANOVA repeated measures, Paired sample t and McNemar tests were used to compare postural control between the assisted and non-assisted conditions. When the task was assisted by FES, the number of participants that presented APAs increased (p= 0.031). UL FES assistance during turning on the light task can improve postural control in neurological patients with UL impairments.