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- Avaliação isocinética dos músculos extensores e flexores do joelho em atletas de basquetebol feminino da região nortePublication . Ferreira, Samuel; Macedo, Rui; Carvalho, Paulo; Macedo, Rui; Carvalho, PauloOs desequilíbrios musculares (DM) são apontados, por alguns investigadores, como causa de uma maior incidência de lesões nos joelhos das atletas de basquetebol comparativamente ao sexo oposto. Descrever e comparar a força isocinética entre atletas de basquetebol feminino e estudantes sedentárias. A avaliação da força muscular, bem como do seu equilíbrio, é um factor de elevada importância para os fisioterapeutas, para que se consiga objectivar uma melhor recuperação do atleta e prevenir a ocorrência de lesões. Estudo observacional, analítico, transversal em que se avaliaram 38 sujeitos (Grupo A= 21 atletas federadas de basquetebol; Grupo B= 17 estudantes sedentárias) do sexo feminino. Para avaliação do Peak Torque (PT ) foi utilizado um dinamómetro isocinético da marca Biodex Medical System 3 Pro® . Foi realizada a correcção da força da gravidade na avaliação do PT concêntrico dos músculos extensores e flexores do joelho, para a velocidade angular de 60º/s (6 repetições). Verificaram-se diferenças significativas para os valores do PT e Peak Torque/Body Weight (PT /BW), enquanto que para os valores do rácio isquiotibiais/ quadricípite (Rácio I/Q) e diferenças bilaterais (DB) de força do quadricípite e isquiotibiais, não se verificaram diferenças significativas. As atletas de basquetebol feminino federado apresentam valores mais elevados de PT e PT /BW comparativamente com as estudantes sedentárias. O maior desenvolvimento da mesma musculatura é feita de uma forma equilibrada, na medida em que não altera, nas atletas, a relação I/Q nem as DB de força no sentido de um DM.
- Prevalence, characteristics, and impact of spinal and lower limb recurrent pain at age 13Publication . Rodrigues, Elisa; Bessa, Isabel Moura; Brochado, Gabriela; Carvalho, Paulo; Talih, Makram; Pires, Catarina; Lucas, Raquel; Rodrigues, Elisa; Moura Bessa, IsabelTo compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. Methods: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. Results: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. Conclusion: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.
- Effectiveness of global postural reeducation in postural changes and postural stability in young adultsPublication . Pacheco, Maria Paula; Morais, Sara; Carvalho, Paulo José; Cavalheiro, Luís; Sousa, Filipa; Carvalho, PauloPostural changes are considered a public health issue and have gathered significant interest in both research and clinical practice. To evaluate the effectiveness of Global Postural Reeducation (GPR) in improving postural changes and postural stability in healthy young adults. Additionally, this study aims to identify the main postural changes in the sample population. A longitudinal study was conducted with a sample of students (n = 38) from the 2nd and 3rd years of undergraduate programs at Coimbra Health School, divided into an experimental group (EG) with 20 subjects and a control group (CG) with 18 subjects. The EG underwent a GPR intervention, while the CG received no intervention. Postural changes were assessed using a 3D motion analysis system (Qualisys), and stabilometry was evaluated using a Bertec force platform. At baseline (T0), the groups were homogeneous regarding sample characterization variables, as well as postural and stabilometric variables (p > 0.05). After four weeks of the intervention (T1), no significant differences were observed between the EG and CG for any of the variables studied (p > 0.05). However, within-group analysis for the experimental group revealed a significant difference (p = 0.04) in anterior-posterior velocity, indicating a reduction in this parameter from T0 to T1. In the control group, a significant difference was observed (p = 0.03) in the left knee valgus, indicating a reduction in valgus alignment. GPR does not appear to be effective in improving postural changes or center of pressure displacement in healthy young students.
- Electromyographic assessment of agonist and antagonist muscles related to the anterior cruciate ligament following surgical reconstruction: A cross-sectional studyPublication . Paredes, Ricardo; Pereira, Soraia; Crasto, Carlos; Guedes, Diana; Montes, António Mesquita; Alves, Leonel; Arias-Buría, José L.; C. Guedes, Diana; Mesquita Montes, AntónioFollowing anterior cruciate ligament reconstruction (ACLR), neuromuscular control alterations may persist, increasing the risk of reinjury. This study aimed to investigate electromyographic (EMG) muscle activation and the co-contraction index (CCI) of ACL-related agonist and antagonist muscles during side- hop tasks in ACLR individuals, offering novel insights into neuromuscular strategies during dynamic tasks. A cross-sectional study was conducted with 15 ACLR individuals and 15 participants without ACL injury (N-ACLR). Participants performed side-hop tasks while kinematic, kinetic, and EMG data were recorded during the preparatory and loading phases. Statistical analyses were performed at a 95 % confidence level. During ipsilateral side hops, ACLR individuals exhibited higher semitendinosus (ST) activity in the initial contact (IC) and risk phases and increased quadriceps:hamstrings (Q:H) CCI in the risk phase compared to N-ACLR (p < 0.05). In contralateral side hops, ACLR individuals demonstrated higher Q:H CCI in the preparatory phase and higher vastus lateralis:biceps femoris (VL:BF) CCI in the IC and risk phases (p < 0.05). ACLR individuals display altered neuromuscular strategies during side-hop tasks compared to N-ACLR, highlighting adaptations in muscle activation and co-contraction patterns.
- Sit-to-stand and stand-to-sit kinematics in older adults with and without functional disability: A principal component analysisPublication . Moreira, Juliana; Cunha, Bruno; Félix, José; Santos, Rubim; Sousa, Andreia S. P.; Rubim Silva Santos, Manuel; Pinheiro de Sousa, Andreia Sofia; Santos Moreira, JulianaSit- to-Stand (Sit- TS) and Stand-to-Sit (Stand- TS) transitions are essential daily movements affected by ageing and disability. This study aimed toexplore related kinematic domains in older adults with and without disability. A cross-sectional study including adults aged 60 years or older, with(n = 25) and without disability (n = 35). Comparisons between groups includedtask time, centre of mass (CoM) acceleration, postural sway and principal com-ponent (PC) scores for each task. Principal component models (PCMs) includedlower limb and trunk tridimensional joint ranges of motion, angular velocityrange, CoM displacement and velocity along each Sit-TS (flexion, momentumtransfer, extension and stabilisation) and Stand-TS (initiation, flexion, momen-tum transfer and extension) phases. Older adults with functional disability exhibited increased Sit-TS peakantero-posterior CoM acceleration (p = .02). The Sit-TS and Stand-TS PCMs in-cluded nine PCs each. In Sit-TS, the first three explained half the variance: PC1captured transverse hip and knee stabilisation kinematics, PC2 described trunkand hip frontal and transverse control during flexion, and PC3 represented sagittalknee and ankle control during momentum transfer and extension. In Stand-TS,variance was more distributed (PC1 describing frontal hip and knee flexion ve-locity, PC2 sagittal trunk and hip extension velocity, and PC3 vertical CoM veloc-ity at extension). Significant group differences emerged in PC4 (transverse kneeand frontal hip kinematics) and PC9 (sagittal and frontal trunk angular velocityranges during momentum transfer). Both transitions revealed distinct joint and trunk control de-mands. Principal components involving transverse knee, frontal hip and trunkangular velocities distinguished disability groups, with Stand-TS showing greaterdiscriminative power.
- 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.