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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.
- 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.
- Shoulder and scapular function before and after a scapular therapeutic exercise program for chronic shoulder pain and scapular dyskinesis: A pre–post single-group studyPublication . Melo, Ana S. C.; Soares, Ana L.; Castro, Catarina; Matias, Ricardo; Cruz, Eduardo B.; Vilas-Boas, J. Paulo; Sousa, Andreia S. P.; Pinheiro de Sousa, Andreia SofiaScapular adaptations have been associated with shoulder pain. However, conflicting findings have been reported after scapular-focused interventions. The present study aims to evaluate scapula-related outcomes before and after a scapular therapeutic exercise program. Eighteen adult volunteers with chronic shoulder pain participated in an 8-week scapular therapeutic exercise program that was personalized according to their pain condition and the presence of scapular dyskinesis. This program included preparation and warm-up, scapular neuromotor control, and strengthening and stretching exercises. Both self-reported (shoulder pain and function, psychosocial factors, and self-impression of change) and performance-based outcomes (scapular muscular stiffness and activity level, tridimensional motion, rhythm, and movement quality, measured while participants drank a bottle of water) were used for analysis. After the intervention, participants presented reduced shoulder pain (p < 0.0001) and pain catastrophizing (p = 0.004) and increased shoulder function (p < 0.0001). Additionally, the participants presented changes in scapular winging (p < 0.0001 to p = 0.043), increased scapular downward rotation (p < 0.0001) and depression (p = 0.038), and decreased global movement smoothness (p = 0.003). These were associated with changes in serratus anterior activity (p = 0.016 to p = 0.035), decreased middle (p < 0.0001 to p = 0.002) and lower trapezius (p < 0.0001) and levator scapulae (p = 0.048) activity levels, and decreased middle trapezius muscle stiffness (p = 0.014). Patients’ self-perception of change was rated favorably. After a scapular therapeutic exercise program, changes were observed in both self-reported and performance-based outcomes. These results need to be confirmed by a randomized controlled trial.
- Total sacrectomy rehabilitation: Implementation of the international classification of functioning, disability, and health model – A case reportPublication . Lopes, Alfredo A.; Mesquita, Inês; Torres, Rui; Torres, Rui; Lopes, Alfredo; Mesquita, InêsThis study aims to outline an evaluative diagnostic process and intervention for a patient who underwent total sacrectomy based on the International Classification of Functioning, Disability, and Health (ICF) model. A 70-year-old male with a history of an aggressive sacral chordoma experiencing intense pain, constipation, and polyuria without the sensation of bladder filling, underwent a total sacrectomy. Two evaluations at two-time points were conducted 12 weeks apart. The patient then underwent an individualized rehabilitation program tailored to address impairments, activity limitations, and participation restrictions. The care plan was adjusted based on the patient’s health status and relevant personal and environmental factors. The Barthel Scale scores improved from 60 to 80. Motor scores on the American Spinal Injury Association scale increased from 62 to 66, while sensory scores for light touch improved from 86 to 96. However, pain scores remained stable at 86. Functional reach tests showed notable enhancements, with anterior reach increasing from 16.4 cm to 23.7 cm and lateral reach from 9.6 cm to 15.2 cm. The patient also showed progress in mobility, increasing the number of steps taken from 0 to 10. This case report highlights the positive therapeutic outcomes achieved, illustrating improvements in functional activities and patient independence, thereby underscoring the effectiveness of the ICF model in managing patients undergoing total sacrectomy.
- Home-based rehabilitation maintenance with or without an exercise-based pilates program in COPD patientsPublication . Barbosa, Marisela; Melo, Cristina Argel de; Torres, Rui; Melo, Cristina; Torres, RuiPilates exercise may complement pulmonary rehabilitation of Chronic Obstructive Pulmonary Disease (COPD) to improve Patient-Reported Outcome Measures (PROMs). To investigate the effects on PROMs after incorporating a six-month Pilates exercise maintenance program compared to a home-only exercise program. A total of 32 participants with COPD (GOLD B) were assigned to either the intervention group (n = 14) or the control group (n = 18). Both groups participated in a three-month pulmonary rehabilitation program. For the next six months, the intervention group engaged in a Pilates exercise program and home-based exercises, while the control group continued with home-based exercises only. Primary outcomes were evaluated at baseline, three, six, and nine months. At the nine-month follow-up, the intervention group exhibited significantly fewer activity-related impairments in the St George’s Respiratory Questionnaire Activity domain (p = 0.029) and experienced less symptoms of anxiety (p = 0.002) and depression (p = 0.014) according to the Hospital Anxiety and Depression Scale scores. Other PROMs did not show statistically significant differences between the groups. Incorporating a six-month Pilates exercise maintenance program resulted in fewer activity-related impairments and reduced anxiety and depression symptoms compared to those who followed a home-based exercise maintenance program alone.
- Principal component analysis of stair negotiation and floor transition kinematics in older adults with and without functional disability: cross-sectional studyPublication . Moreira, Juliana; Teles, Ivone da Silva; Cunha, Bruno; Félix, José; Guedes, Diana C.; Alves, Leonel A. T.; Santos, Rubim; Sousa, Andreia S P; Pinheiro de Sousa, Andreia Sofia; Rubim Silva Santos, Manuel; Santos Moreira, Juliana; Sousa Félix, José ManuelStair negotiation (ascending and descending) and transitions to level walking are complex motor tasks influenced by aging; yet the impact of functional disability on these changes remains underexplored. This study aimed to evaluate the lower limb joint positions, velocities, and the center of mass (CoM) displacement and velocity during stair negotiation and transitions in older adults with and without functional disability. Sixty community-dwelling adults, aged 60 years and older, were assessed for lower limb tridimensional joint positions and velocities during the instances of foot contact or leaving the step and foot contact or leaving the floor; the joint range of motion, angular velocity range, and the CoM displacement and angular velocity range were assessed during stair ascend and descend and transitions floor-to-stair and stair-to-floor through an optoelectronic system. Principal component analysis was used to assess 8 groups of variables to compute principal component models (I-VIII). Participants were classified as with or without disability based on functional disability indicators. Group differences were assessed using the Mann-Whitney U test. From 240 variables, 41 key parameters were identified, mainly related to hip and knee angular velocities in the sagittal plane. Significant differences between older adults with disability (n=25) and without disability (n=35) were found in 12 principal components. Older adults with functional disability showed changes in the sagittal plane hip as well as in the knee angular velocity and mediolateral and vertical CoM displacement and velocity during stair negotiation and transitions. These findings can inform targeted strategies to improve mobility and stability in this population.
- 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.
- Assessing work-related musculoskeletal disorders and psychosocial risks in bus drivers: Insights from a municipal company case study in PortugalPublication . Silva, Tânia T.; Mendes, Tatiana R.; Lapa, Inês; Carvalho, Paulo; Rodrigues, Matilde A.; Rodrigues, Matilde; Carvalho, PauloThe public transport sector plays a crucial role in society, oering essential services and providing employment to a significant number of drivers. Despite the importance of this sector, it is essential to recognize that drivers are exposed to various occupational risks inherent to their daily work, which can have serious implications for their health. This study aims to characterize and analyse Work-Related Musculoskeletal Disorders (WMSD) and psychosocial risks in a public transport company. In the initial phase of the study, a questionnaire was administered to assess musculoskeletal symptoms and psychosocial risks. In the second phase, an inertial motion capture system was used to evaluate the risk of developing WMSD. The results revealed a significant and concerning prevalence of burnout, with over 60% of workers reporting high or severe levels across all dimensions (i.e., personal, work-related, and client-related burnout). Depression, anxiety, and stress were within typical ranges, though a relevant percentage of participants exhibited severe and extremely severe levels of depression (7.2%), anxiety (12.2%), and stress (8%). Musculoskeletal discomfort was highly prevalent, particularly in the lower back (68.3%) and neck regions (57.2%), regarding pain over the last 12 months. Additionally, the risk of developing WMSDs was high across the various microtasks, which were analyzed across dierent bus lines and routes, with Rapid Upper Limb Assessment (RULA) scores ranging from 4 (Medium Risk) to 7 (Very High Risk). Based on the results, varying bus types and routes is recommended. Programs should enhance wellbeing, and studies should assess interventions on health, stress, and occupational risks focused on enhancing worker wellbeing should be implemented, and future studies should assess the impact of interventions targeting health, stress, and occupational risks.
- Análise da funcionalidade em idosos do Alto Minho após o programa OtagoPublication . Alves, Odete; Carvalho, Ana de; Francisco, Ana; Pinho, Mariana; Carvalho, Camila; Martins, Hélder; Mesquita, Cristina; Lopes, Sofia; Santos, Paula; Carvalho Mesquita, Cristina; Lopes, SofiaO norte de Portugal apresenta uma elevadataxa de envelhecimento, associada a condições como sarcopenia, diminuição do equilíbrio e da força muscular. O obje,vo deste estudo foi avaliar o impacto do programa de exercícios de Otago (PEO) na funcionalidade e, de forma secundária, na perceção de saúde e no medo de cair em idososresidentes em estruturas residenciais no Alto Minho. Realizou-se um estudo pré-experimental com 37 par,cipantes (83,46 ± 6,53 anos)sendo a maioria mulheres (75,60%). O PEO foi implementado durante oitosemanas, com avaliação da funcionalidade antes e após a intervenção u,lizando os testes 30 seconds Sit to Stand (30STS), Timed Up and Go (TUG), 4 Stage Balance Test "Modified" (4SBTM), 15 seconds Step Test (15SST) e 10 meters Walking Speed (10MWS). A perceção de saúde e o medo de cair foram avaliados através de um ques,onário. Após a intervenção, observou-se uma melhoria significa,va na funcionalidade, com aumento das repe,ções do 30STS (6,69 ± 4,35 para 9,16 ± 5,35; p < 0,001) e redução do tempo do TUG (p = 0,006). No entanto, não foram encontradas diferenças significa,vas do 15SST (p = 0,142) e do 10MWS (p = 0,815). Houve uma melhoria significa,va do equilíbrio dinâmico (4SBTM, p < 0,001), mas não da perceção de saúde ou do medo de cair (p > 0,05). Conclui-se que o PEO melhora a força muscular, mobilidade e equilíbrio dinâmico, sem afetar a perceção de saúde ou o medo de cair.
- Portuguese translation, cultural adaptation and psychometric properties of the temporomandibular joint scale: a cross-sectional studyPublication . Cervaens, Mariana; Vilarinho, Rui; Pereira, Jéssica; Magalhães, André; Esteves, Mário; Vilarinho, Rui; Abreu, Verónica; Amaral, LuísaThe temporomandibular joint (TMJ) scale assesses the severity of temporomandibular joint disorders (TMD), yet a European Portuguese translation is lacking. To translate, cross-culturally adapt and to examine the psychometric properties (construct validity and reliability) of the TMJ scale. Translation and cultural adaptation were carried out according to international recommendations, including initial translation, evaluation of this translation and cultural adaptation by a panel of experts, and back translation. The final Portuguese version was used to examine the reliability and validity, and participants with TMD were recruited from a Portuguese outpatient clinic. Reliability measures included internal consistency with Cronbach’s alpha and test-retest reliability with the intraclass correlation coefficient (ICC2,1). The Spearman correlation comparing the TMJ scale with the Fonseca and Helkimo indexes was used to assess the construct validity. A total of 63 participants (23 ± 2 years; 61,9% female) were included. Similar internal consistency was observed between the two moments of application (0.921 and 0.918), and test-retest reliability was excellent, with an ICC2,1 = 0.998 (95%CI: 0.988–0.999). Robust positive correlations (rho 0.554–0.611, p < 0.001) were found between the TMJ scale and Fonseca and Helkimo indexes. The European Portuguese version of TMJ scale is now available to improve the assessment of severity of TMD in routine clinical practice. This version is also reliable and valid.