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- Differences in trapezius muscle h-reflex between asymptomatic subjects and symptomatic shoulder pain subjectsPublication . Melo, Ana; Taylor, Janet L.; Ferreira, Ricardo; CUNHA, BRUNO; Ascenção, Manuel; Sousa, Vítor; Cruz, Eduardo B.; Vilas-Boas, J. Paulo; Sousa, Andreia S. P.In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58–75% or in 42–58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals’ rehabilitation.
- Smartphone-based video analysis for guiding shoulder therapeutic exercises: concurrent validity for movement quality controlPublication . Lopes, Maria; Melo, Ana S. C.; Cunha, Bruno; Sousa, Andreia S. P.Neuromuscular re-education through therapeutic exercise has a determinant role in chronic shoulder pain rehabilitation. Smartphones are an interesting strategy to extend the rehabilitation to a home-based scenario as it can increase the attraction and involvement of users by providing feedback. Objective: To analyze the concurrent validity of a smartphone’s application based on 2D video analysis against the gold-standard 3D optoelectronic system for assessing movement quality during upper limb therapeutic exercises. Methods: Fifteen young adults were evaluated while executing two different shoulder exercises with a smartphone’s 2D video and a 3D optoelectronic system simultaneously in two conditions: (1) with the supervision and instructions of a physiotherapist (guided exercise), and (2) without the feedback of the physiotherapist (non-guided exercise). The data obtained during the guided and non-guided exercises were compared to calculate the movement quality index based on the approximation of the non-guided exercise to the guided exercise for the head, trunk, and shoulder’s range of movement. The agreement of the movement quality index assessed with the smartphone application and the optoelectronic system was carried out through Bland–Altman analysis. Results: The Bland–Altman analysis indicates the range of agreement and bias tendency. This tendency demonstrates that the percentage of difference between the two methods increases as the movement quality index decreases. Conclusions: There is agreement between the movement quality evaluated by a gold-standard method and the developed application, although the proposed method appears to have less sensitivity for evaluating movements with lower quality index.
- Smart dashboard for Hoffmann reflex analysisPublication . Cunha, Bruno; Ferreira, Ricardo; Carneiro, Ana Sofia; Sousa, AndreiaThe Hoffmann reflex is a is a neurophysiological test that provides insight into the functioning of the human nervous system. It is commonly used in clinical and research settings to evaluate the modulation of the monosynaptic spinal reflex. This paper focus the analysis of the Hoffmann reflex in the trapezius muscle, a muscle of particular interest for researchers and clinicians due to its importance in upper limb function and dynamic stability. However, the Hoffmann reflex analysis of this muscle bring some challenges as the need of applicating burst of electrical square impulses in each current intensity. A web-based smart dashboard, implemented in Python, which allows the user to visualize and analyze the Hoffmann reflex using various signals acquired through a constant current stimulator. The dashboard provides an intuitive and user-friendly interface that facilitates the selection of muscle signals of interest, analysis cycles, and start and end points for the signals. The visualizations offered by the dashboard, including overlapped and mean signal graphics, provide valuable insights into the Hoffmann reflex and its properties. Preliminary experiments with field experts and physiotherapists have yielded positive feedback on the usefulness of this tool, as they seek to gain a deeper understanding of the Hoffmann reflex, and we plan to further improve its capabilities in the future by employing machine learning techniques to automate the reflex detection.
- Home-based rehabilitation of the shoulder using auxiliary systems and artificial intelligence: an overviewPublication . Cunha, Bruno; Ferreira, Ricardo; S. P. Sousa, AndreiaAdvancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.