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- Biomechanical assessment methods used in chronic stroke: A scoping review of non-linear approachesPublication . Freitas, Marta; Pinho, Francisco; Pinho, Liliana; Silva, Sandra; Figueira, Vânia; Vilas-Boas, João Paulo; Silva, AugustaNon-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.
- Clinical measures for tone assessment in adults with central nervous system disorders—A scoping review in a rehabilitation contextPublication . Pinho, Liliana; Silva, Sandra; Freitas, Marta; Figueira, Vânia; Pinho, Francisco; Cunha, Christine; Sousa, Andreia S. P.; Sousa, Filipa; Silva, AugustaAssessment of muscle tone in a clinical setting is important for the physiotherapist to better analyse and establish appropriate treatments for CNS disorders. This study aims to review and summarise how to assess changes in tone in the context of adult rehabilitation. Secondarily, this study aimed to identify the central nervous system disorders, the respective variable/concept under study, and the testing procedures employed. PRISMA-ScR guidelines were followed using the “population”, “concept”, and “context” to define the eligibility criteria and to delineate the research question. PubMed®, Science Direct®, Web of Science™, and Google Scholar® databases were used to search the literature. The search included studies published between 2011 and March 2023 in Portuguese, English, French, and Spanish that assessed an adult population (>19 years) with CNS injury. Review articles, qualitative studies, conference proceedings, letters to the editor, and editorials were excluded. Initially, 1519 references were identified, of which eight met the eligibility criteria. The measurement instruments included the Modified Ashworth Scale (n = 5), the Modified Modified Ashworth Scale (n = 3), the BioTone™ system (n = 2), the Montreal Spasticity Measurement (n = 1), and the Tone Evaluation Scale (n = 1). The health conditions considered included stroke sequelae (n = 7), multiple sclerosis (n = 4), spinal cord injuries (n = 4), cerebral palsy (n = 2), brain tumour (n = 2), and traumatic brain injuries (n = 3). The concepts of spasticity (n = 7) and muscle tone (n = 2) were explored. Considering the variables spasticity and muscle tone in different CNS disorders, mainly stroke, subjective instruments were preferred compared to objective ones, with the Modified Ashworth Scale being highlighted.
- 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.