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- Repeatability and temporal consistency of lower limb biomechanical variables expressing interlimb coordination during the double-support phase in people with and without stroke sequelaePublication . Couto, Ana G. B.; Vaz, Mário A. P.; Pinho, Liliana; Félix, José; Moreira, Juliana; Pinho, Francisco; Mesquita, Inês Albuquerque; Mesquita Montes, António; Crasto, Carlos; Sousa, AndreiaReliable biomechanical methods to assess interlimb coordination during the double-support phase in post-stroke subjects are needed for assessing movement dysfunction and related variability. The data obtained could provide a significant contribution for designing rehabilitation programs and for their monitorisation. The present study aimed to determine the minimum number of gait cycles needed to obtain adequate values of repeatability and temporal consistency of lower limb kinematic, kinetic, and electromyographic parameters during the double support of walking in people with and without stroke sequelae. Eleven post-stroke and thirteen healthy participants performed 20 gait trials at self-selected speed in two separate moments with an interval between 72 h and 7 days. The joint position, the external mechanical work on the centre of mass, and the surface electromyographic activity of the tibialis anterior, soleus, gastrocnemius medialis, rectus femoris, vastus medialis, biceps femoris, and gluteus maximus muscles were extracted for analysis. Both the contralesional and ipsilesional and dominant and non-dominant limbs of participants with and without stroke sequelae, respectively, were evaluated either in trailing or leading positions. The intraclass correlation coefficient was used for assessing intra-session and inter-session consistency analysis. For most of the kinematic and the kinetic variables studied in each session, two to three trials were required for both groups, limbs, and positions. The electromyographic variables presented higher variability, requiring, therefore, a number of trials ranging from 2 to >10. Globally, the number of trials required inter-session ranged from 1 to >10 for kinematic, from 1 to 9 for kinetic, and 1 to >10 for electromyographic variables. Thus, for the double support analysis, three gait trials were required in order to assess the kinematic and kinetic variables in cross-sectional studies, while for longitudinal studies, a higher number of trials (>10) were required for kinematic, kinetic, and electromyographic variables.
- Worker 4.0: A textile exoskeleton to support apparel industryPublication . Oliveira, João; Costa, Luani; Ramôa, Ana; Silva, Ricardo; Fertuzinhos, Aureliano; Estudante, Inês; Pinheiro, João; Vale, Bruno; Pilastri, André; Dias, Paula; Matta, Arthur; Sampaio, Rosane; Machado, Dário; Cortez, Paulo; Costa, Marta; Roças, Ana; Madureira, Pedro; Moreira, Juliana; Pereira, João Rui; Pereira, Carla; Bruno, FernandoSTVgoDigital project aims the transition of the textile and apparel industries to the new Industry 4.0 paradigm promoting the digitalization to increase productivity and efficiency of the entire value chain. Specifically, the PPS4 Worker 4.0 aims to develop an exoskeleton solution based on sensing and active components within a garment to support sewing operation movements that may cause injuries and/or pain in sewing machine workers. Seamstresses’ work requires physical efforts related to poor posture and repetitive tasks that increase the risk of developing musculoskeletal disorders. In a general context, in industrial environments have been implemented lower and upper limb devices empowered for human ergonomic improvement, due to the high prevalence of postural complaints and consequently pain. With this, much has been developed in the realm of exoskeletons and artificial muscles aimed at various situations. To achieve the objectives of developing an exoskeleton that integrates a sensing component that monitors workers’ movements in real-time, identifying its ergonomic posture, feeds the actuation component, and uses machine learning algorithms to predict future ergonomic risks in a wearable, light, and flexible garment to support the execution of movements inherent to some professional activities, this research was based on an ergonomic risk assessment and definition of performance parameters, the definition of the architecture system and the wearable garment, and in the construction of prototypes and analysis in a laboratory environment with seamstress’ volunteers.
- 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.
- Usability of functional electrical stimulation in upper limb rehabilitation in post-stroke patients: A narrative reviewPublication . Sousa, Andreia; Moreira, Juliana; Silva, Cláudia; Mesquita, Inês; Macedo, Rui; Silva, Augusta; Santos, RubimStroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.
- Powered smart textile-based exoskeleton for human support movementPublication . Ferreira, C.; Fertuzinhos, A.; Silva, R.; Ramalho, M.; Vale, B.; Silva, J.; Costa, L.; Oliveira, C.; Ramôa, A.; Aguiar, F.; Pilastri, A.; Matta, A.; Dias, P.; Sampaio, R.; Machado, D.; Costa, M.; Roças, A.; Madureira, P.; Moreira, Juliana; Pereira, J. R.; Pereira, C.; Pereira, F. B.Industrial environments require people’s physical efforts related to excessive force, poor posture, and repetitive tasks that increase the risk of developing musculoskeletal diseases. Due to the high prevalence of postural complaints and consequent global health burdens, a significant demand has been conducted to build and implement powered lower and upper limb devices for human enhancement, considering the working layout/position, anthropometric and ergonomic data to generate valuable information for posture correction guidance.
- 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.
- Indicators and instruments to assess components of disability in community-dwelling older adults: a systematic reviewPublication . Moreira, Juliana Santos; Melo, Ana; Santos, Rubim; Pinheiro De Sousa, Andreia SofiaThe epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults’ disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults’ disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.
- 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.
- 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.
- 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.