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- Methodological considerations for kinematic analysis of upper limbs in healthy and poststroke adultsPublication . Mesquita, Inês; Pinheiro, Ana Rita; Correia, Miguel Fernando Paiva Velhote; Silva, Cláudia Isabel Costa daThe purpose of this study was to review the methods used to analyze the kinematics of upper limbs (ULs) of healthy and poststroke adults, namely specificities of sampling and motor tasks. A database of articles published in the last decade was compiled using the following search terms combinations: (“upper extremity” OR “upper limb” OR arm) AND (kinematics OR motion OR movement) AND (analysis OR assessment OR measurement). The articles included in this review (1) had the purpose to analyze objectively a three-dimension kinematics of ULs, (2) studied functional movements or activities of daily living (ADL) involving uppers limbs, and (3) studied healthy and/or poststroke adults. Fourteen articles were included (four studied a healthy sample, three analyzed poststroke patients, and seven examined both poststroke and healthy participants). Most of the recommended demographic and stroke information, such as some pre existing conditions to stroke, initial stroke severity, and stroke location, were not collected by all or most of the articles. Time poststroke onset was presented in all articles but showed great variability. Few articles identified anthropometric characteristics and adjusted task environment to them. Most of the samples were composed mainly by males and had a low mean age, which does not represent poststroke population. Most articles analyzed “functional movements”, namely simulations of ADL. Future research should identify the recommended information to allow an adequate stratification. Acute phase after stroke, real ADL with different complexities, and ipsilesional UL should be studied.
- 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.
- Obesity effects on muscular activity during lifting and lowering tasksPublication . Colim, Ana; Arezes, Pedro; Flores, Paulo; Monteiro, Pedro; Mesquita, Inês; Braga, Ana CristinaObesity is an emerging health problem and its incidence has been increasing throughout the workforce. In industrial workstations, vertical handling tasks (VHT), including lifting and lowering, are very common and can cause a significant muscular overload for the involved workers. During these tasks, muscular activity may be considerably affected by workers' body conditions. This study aims to analyze and compare the muscular activity in subjects with different obesity levels, using surface electromyography (EMG), during predefined VHT. Six different VHT (combining 5, 10 and 15 kg loads with two task styles) were performed. EMG data normalization was based on the percentage of Maximum Contraction during each Task (MCT%). The results show that obesity influences MCT%, which in turn increases the muscular effort during VHT. The current investigation demonstrates that obesity is a relevant musculoskeletal risk factor regarding VHT. The engineering analysis and design implications of this work can thus be perceived.
- Manual dexterity and palmar grip strength of ipsilesional upper limb of post-stroke adultsPublication . Lopes, Alfredo; Alves, Katia; Fiúza, Carolina; Mesquita, InêsStroke is the most common cause of long-term disability in adults and the motor impairment is the most common deficit. More than 80% of stroke patients experience acute motor dysfunction of the contralesional upper limb (UL), which becomes chronic for more than 40% of the patients
- Muscle loading and psychophysical effects of obesity during vertical handling tasksPublication . Colim, Ana; Arezes, Pedro; Flores, Paulo; Monteiro, Pedro; Mesquita, InêsIt has been recognized by many researchers that the prevalence of obesity is a serious public health problem. Several physical problems are associated with obesity, which can negatively affect the individuals’ work performance. In occupational contexts, vertical handling tasks, including lifting and/or lowering loads, are common and produce significant muscle loading. For these reasons, Surface electromyography (EMG) data were collected bilaterally from muscles recruited during these tasks. Additionally, the participants reported physical loading by using the Rated Perceived Exertion scale (RPE). These techniques sought to analyze the physical loading during vertical handling tasks. The obtained results indicate that obesity seem to increase the muscle loading during vertical handling tasks. However, obesity level does not seem to influence the RPE values.
- 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.
- Obesity and physical loading during manual liftingPublication . Colim, Ana; Arezes, Pedro; Flores, Paulo; Monteiro, Pedro; Mesquita, InêsManual lifting greatly increases the risk of developing work-related musculoskeletal disorders (WRMSD). Muscle loading related to manual tasks may be significantly influenced by workers’ body conditions, being obesity one of them. In the present study, different tasks of manual lifting were performed by 14 participants with different obesity levels, defined in terms of individuals’ fat mass percentage. Surface electromyography (EMG) data were collected bilaterally from 3 muscles recruited during this type of tasks. EMG data normalization was based on the percentage of maximum contraction during each task (MCT). Furthermore, the participants reported physical loading by using the Rated Perceived Exertion scale (RPE). These techniques sought to analyze the physical loading during manual lifting tasks. The obtained results indicate that obesity level influenced the MCT percentage, which in turn increases the muscle loading during manual lifting tasks. However, obesity level does not seem to influence the RPE values. In this context, further studies based on biomechanical approaches are required to provide a more complete understanding of the obesity effects on musculoskeletal loading during manual lifting.
- Could socks play an active role in ankle sprain prevention? A preliminary investigationPublication . Torres, Rui; Mesquita, InêsAnkle sprain represents about 10% to 30% of all recorded musculoskeletal injuries, and is one of the most prevalent injuries in sports. Thus, any type of intervention based on prevention is extremely important to reduce its incidence. Aim of Study. To compare the immediate effect of three different types of socks, namely standard, compression, and Prevent Sprain Technology (PST) socks, on the dynamic unipodal balance and ankle joint position sense in healthy participants. Forty-two healthy adults, aged 20.34 ± 1.69 years old, volunteered to participate in the study. Participants were randomly assessed using three different sock models. The main measured outcomes selected for this study were the dynamic balance using the Biodex Balance System®, and the active ankle joint repositioning movement through the Biodex System Pro 4®. We used the Friedman test to compare the variables under study among the three conditions, with Dunn’s post-hoc analysis and a significance level of 0.05. In the Biodex Balance System® the participants had a lower Global Instability Index value with the PST socks compared to compression socks (p = 0.031), and standard socks (p = 0.005), but only lower anteroposterior (p = 0.042) and mediolateral (p = 0.026) instability indices when compared to standard socks. Regarding the ankle joint position sense, subjects with PST socks revealed lower absolute errors compared to standard socks (p = 0.007), smaller minimum errors compared to compression socks (p = 0.049), and smaller maximum errors compared to compression socks (p = 0.049) and standard socks (p = 0.008). Analysis of relative errors revealed a significant miss regarding the target joint position at higher inversion angles only with standard socks (which is potentially more dangerous) when compared to PST socks (p = 0.031), which error tends to be at lower inversion angles (which is potentially less dangerous). The PST socks seem to have a global positive influence on the mechanisms underlying the dynamic unipodal balance and active joint position sense, which could be an important tool for ankle sprain prevention.
- 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.
- 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.