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- Petrha+: A serious game to enhance physiotherapy students' clinical reasoningPublication . Macedo, Rui; Silva, Cláudia; Albouy, Bruno; F. San Juan, Alejandro; Pystynen, TiinaRole play and simulated patients are tools frequently used in undergraduate physiotherapy courses to help students gain familiarity with what they will find in future real-life encounters. However, these approaches have limitations when it comes to delivering diversity and repetition to a large number of students and are mostly bounded to the school’s premises. Web-based virtual patient software can help to overcome these shortcomings as they equally require students to go through most of the steps of the physiotherapy process, and simultaneously offer unlimited diversity of cases and repetition opportunities and can be delocalized from physical schools. PETRHA + is an Erasmus+ strategic partnership of European high education institutions aiming at the improvement of a web-based serious game prototype designed to enhance physiotherapy students’ clinical reasoning using virtual patients. The objective of this chapter is the presentation of the background context that led to the development of the serious game, its design features, functions, and ongoing and future developments.
- Kinematic and electromyographic features of upper-limb movement performed by healthy and post-stroke patientsPublication . Silva, Rosa Mariana; Fonseca, Pedro; Pinheiro, Ana Rita; Vila-Chã, Carolina; Silva, Cláudia; Correia, Miguel Velhote; Mouta, SandraIt is extremely difficult to simplify the relation between several body parts, which perform human motion, into one set of features. Mainly, the upper-limb is capable of a wider range of actions, going from fine manipulation to prehension and grasping. Aiming to describe its complexity, several studies have been conducted in order to better understand the upper-limb specificities. However, most of studies restrain the task to pointing, reaching, or grasping, which seems not enough to explain the wide range of tasks possible to be performed in a daily scenario.
- Co-activation of upper limb muscles during reaching in post-stroke subjects: An analysis of the contralesional and ipsilesional limbsPublication . Silva, Cláudia; Silva, Augusta; Pinheiro De Sousa, Andreia Sofia; Pinheiro, Ana Rita; Bourlinova, Catarina; Silva, Ana; Salazar, António; Borges, Carla; Crasto, Carlos; Correia, Miguel Velhote; Vilas-Boas, João Paulo; Santos, RubimThe purpose of this study was to analyze the change in antagonist co-activation ratio of upper-limb muscle pairs, during the reaching movement, of both ipsilesional and contralesional limbs of post-stroke subjects. Nine healthy and nine post-stroke subjects were instructed to reach and grasp a target, placed in the sagittal and scapular planes of movement. Surface EMG was recorded from postural control and movement related muscles. Reaching movement was divided in two sub-phases, according to proximal postural control versus movement control demands, during which antagonist co-activation ratios were calculated for the muscle pairs LD/PM, PD/AD, TRIlat/BB and TRIlat/BR. Post-stroke's ipsilesional limb presented lower co-activation in muscles with an important role in postural control (LD/PM), comparing to the healthy subjects during the first sub-phase, when the movement was performed in the sagittal plane (p<0.05). Conversely, the post-stroke's contralesional limb showed in general an increased co-activation ratio in muscles related to movement control, comparing to the healthy subjects. Our findings demonstrate that, in post-stroke subjects, the reaching movement performed with the ipsilesional upper limb seems to show co-activation impairments in muscle pairs associated to postural control, whereas the contralesional upper limb seems to have signs of impairment of muscle pairs related to movement.
- Antagonist coactivation of muscles of ankle and thigh in post-stroke vs. healthy subjects during sit-to-stand taskPublication . Pinho, Liliana; Sousa, Andreia S. P.; Silva, Cláudia; Cunha, Christine; Santos, Rubim; Tavares, João Manuel R. S.; Pereira, Soraia; Pinheiro, Ana Rita; Félix, José; Pinho, Francisco; Sousa, Filipa; Silva, AugustaThis study aims to analyse the coactivation of antagonist muscles of the thigh and ankle during the sit-to-stand task in post-stroke subjects, specifically during forward and antigravity sub-phases. A group of 18 healthy subjects and another with 18 subjects with a history of stroke participated voluntarily in this study. Bilateral surface electromyography (EMGs) of the soleus, gastrocnemius medialis, tibialis anterior, rectus femoris and biceps femoris muscles were collected synchronously with ground reaction forces (GRF) during the sit-to-stand task. The magnitude of electromyographic (EMG) activity was analysed during forward translation and antigravity sub-phases which were determined through GRF signals. The coactivation was calculated to quantify the degree of antagonist coactivation according to the role of the muscles during the task. Statistically significant values were found between antagonist coactivation on both sub-phases of the sit-to-stand task when comparing healthy and post-stroke subjects (healthy with ipsilesional (IPSI); healthy with contralesional (CONTRA); and healthy with IPSI and with CONTRA limbs) in all muscle pairs analysed (p < 0.01), except on thigh muscles (p > 0.05), in the antigravity sub-phase. When comparing IPSI with CONTRA sides in post-stroke subjects, no statistically significant differences were found. Increased values of antagonist coactivation were observed in post-stroke subjects compared to healthy subjects (both IPSI and CONTRA limb) in the two sub-phases analysed. The forward sub-phase CONTRA limb showed higher antagonist coactivation compared to IPSI, while in the antigravity sub-phase, IPSI antagonist coactivation was higher than in the CONTRA. In conclusion, post-stroke subjects presented an antagonist coactivation more dysfunctional at the ankle joint muscles compared to the thigh segment. So, it seems that the distal segment could express more accurately the central nervous system dysfunction in post-stroke subjects, despite the need for further studies to achieve a better spatiotemporal understanding of the variability on coactivation levels.
- The use of FES as a strategy to improve upper limb function in stroke. What is missing?Publication . Sousa, Andreia; Silva, Cláudia; Mesquita, Inês; Silva, Augusta; Macedo, Rui; Santos, RubimStroke is the main cause of adult disability that leads to significant impairment of upper limb (UL) function. However, despite the various rehabilitation strategies, only 5-20% recover completely. This data point to the need of improving stroke intervention methods.
- Caracterização biomecânica do gesto de alcançar em indiv'iduos pós acidente vascular encefálicoPublication . Silva, Cláudia; Correia, Miguel V.; Vilas-Boas, João Paulo; Santos, RubimÉ objectivo deste trabalho caracterizar biomecanicamente o gesto de alcançar em indivíduos pós Acidente Vascular Encefálico. A amostra é constituída por 4 indivíduos sem patologia do foro neuro-músculo-esquelético e 4 indivíduos com confirmação imagiológica do diagnóstico de AVE único e unilateral no território da artéria cerebral média, há pelo menos 3 meses; ausência de neglet; ausência de alterações visuais, perceptivas ou cognitivas e capacidade de realizar movimento activo no membro superior predominantemente afectado de pelo menos 15º no ombro e cotovelo. A partir de uma posição de sentado pré-definida, cada indivíduo foi instruído a executar a tarefa funcional de alcançar um alvo (copo com sumo), colocado sobre uma mesa, no limite anatómico da distância de alcance funcional da mão. Para a análise cinemática foram usadas 4 câmaras dispostas duas a duas para avaliação do movimento de cada um dos membros superiores. Foram colocados marcadores reflectores nas seguintes estruturas ósseas: esterno; acrómio (bilateralmente); epicôndilo lateral; processo estilóide do cúbito, 3º metacarpo e grande trocânter. Foi também colocado um marcador no objecto-alvo. Recorreu-se ao software APAS para análise das seguintes variáveis cinemáticas: tempo de execução do movimento, velocidade máxima da mão, unidades de movimento, trajectória (através do índex de curvatura) e extensão do cotovelo. Verificou-se que no grupo de indivíduos com AVE comparativamente ao grupo de indivíduos sem patologia, o tempo de execução do movimento foi superior (5,8±2,48 e 0,9±0,22 respectivamente), a velocidade máxima da mão foi inferior (101,7±32,62 e 153,3±56,32 respectivamente), o número de unidades de movimento foi superior (6,3±1,50 e 2,5±0,58 respectivamente), o índex de curvatura foi superior (1,8±0,54 e 1,2±0,1 respectivamente) e a amplitude de extensão do cotovelo foi inferior (15,3±16,48 e 50,2±6,72 respectivamente). Os indivíduos com AVE apresentam alterações nos parâmetros cinemáticos analisados, quando comparados com indivíduos sem patologia.
- Anticipatory postural adjustments in the shoulder girdle in the reach movement performed in standing by post-stroke subjectsPublication . Silva, Cláudia F.; Pereira, Soraia; Silva, Cláudia; Ferreira, Sílvia; Oliveira, Nuno; Santos, RubimAfter a stroke in middle cerebral artery territory, there is a high probability of dysfunction of the ventromedial pathways, mainly related with postural control mechanisms such as the anticipatory postural adjustments (APAs). According to neuroanatomical knowledge, these pathways have a predominant ipsilesional disposition, which justifies a bilateral postural control dysfunction, often neglected in rehabilitation. In order to assess this bilateral postural control dysfunction, electromyography activity was assessed in eight post-stroke and 10 healthy individuals in the anterior deltoids, the superior and lower trapezius, and the latissimus dorsi as they reached for a bottle with both upper limbs separately at a self-selected velocity and fast velocity while standing associated with trunk kinematics analysis. Through this analysis it was possible to compare the timing of APAs in scapular muscles between sides in post-stroke and with healthy individuals, and to verify if there is a relation between the timing and the displacement of the trunk in the temporal window of the APAs. Indeed, post-stroke individuals show a delayed activation of APAs on scapular girdle muscles on both ipsilesional and contralesional sides, which were not reflected in the trunk displacement.
- Ankle antagonist coactivation in the double-support phase of walking: Stroke vs. healthy subjectsPublication . Silva, Augusta; Pinheiro De Sousa, Andreia Sofia; Silva, Cláudia; Tavares, João Manuel R. S.; Santos, Rubim; Sousa, FilipaLesions at ipsilateral systems related to postural control at ipsilesional side, may justify the lower performance of stroke subjects during walking. To analyse bilateral ankle antagonist coactivation during double-support in stroke subjects. Methods: Sixteen (8 females; 8 males) subjects with a first isquemic stroke, and twenty two controls (12 females; 10 males) participated in this study. The double support phase was assessed through ground reaction forces and electromyography of ankle muscles was assessed in both limbs. Ipsilesional limb presented statistical significant differences from control when assuming specific roles during double support, being the tibialis anterior and soleus pair the one in which this atypical behavior was more pronounced. The ipsilesional limb presents a dysfunctional behavior when a higher postural control activity was demanded.
- Associação entre a dependência autorreferida do uso de smartphone e a raquialgia em estudantes universitáriosPublication . Oliosi, Maria Eduarda; Silva, Cláudia; Simões, Daniela; Pinheiro, Ana RitaA raquialgia crónica é cada vez mais frequente nos estudantes universitários. O posicionamento mantido tem sido referido como um potencial fator de risco. Nas últimas décadas, o desenvolvimento de dispositivos eletrónicos tem mudado os hábitos posturais. Um exemplo disso são os smartphones. Mediante o exposto, este estudo pretendeu analisar a associação entre a dependência autorreferida do uso de smartphone e a raquialgia crónica em estudantes universitários.
- Low-cost wearable data acquisition for stroke rehabilitation: A proof-of-concept study on accelerometry for functional task assessmentPublication . Salazar, Antonio J.; Silva, Ana S.; Silva, Cláudia; Borges, Carla M.; Correia, Miguel V.; Santos, Rubim; Vilas-Boas, Joao P.Background: An increasingly aging society and consequently rising number of patients with poststroke-related neurological dysfunctions are forcing the rehabilitation field to adapt to ever-growing demands. Although clinical reasoning within rehabilitation is dependent on patient movement performance analysis, current strategies for monitoring rehabilitation progress are based on subjective time-consuming assessment scales, not often applied. Therefore, a need exists for efficient nonsubjective monitoring methods. Wearable monitoring devices are rapidly becoming a recognized option in rehabilitation for quantitative measures. Developments in sensors, embedded technology, and smart textile are driving rehabilitation to adopt an objective, seamless, efficient, and cost-effective delivery system. This study aims to assist physiotherapists’ clinical reasoning process through the incorporation of accelerometers as part of an electronic data acquisition system. Methods: A simple, low-cost, wearable device for poststroke rehabilitation progress monitoring was developed based on commercially available inertial sensors. Accelerometry data acquisition was performed for 4 first-time poststroke patients during a reach-press-return task. Results: Preliminary studies revealed acceleration profiles of stroke patients through which it is possible to quantitatively assess the functional movement, identify compensatory strategies, and help define proper movement. Conclusion: An inertial data acquisition system was designed and developed as a low-cost option for monitoring rehabilitation. The device seeks to ease the data-gathering process by physiotherapists to complement current practices with accelerometry profiles and aid the development of quantifiable methodologies and protocols.