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- Parkinson’s disease and cognitive-motor dual-task: is motor prioritization possible in the early stages of the disease?Publication . Fernandes, Ângela; Sousa, Andreia S. P.; Rocha, Nuno; Tavares, João Manuel R. S.The authors aimed to compare the postural phase ofgait initiation under single-task (gait initiation) and dual-task (gaitinitiation plus Stroop test) conditions in healthy subjects and insubjects with Parkinson’s disease (PD) in the early stages (Hoehnand Yahr scale<3). The postural phase of gait initiation wasassessed through the centre of pressure in single and dual task in10 healthy subjects and 9 with PD. The analysis indicated that inthe early stages of PD, an additional cognitive task did not affectthe displacement of the gait initiation. No significant effectsoccurred between the groups and within-subjects (p>.05). Also,no interaction was found between the groups and the conditions(single- and dual-task). Differences were found in the duration ofthe mediolateral postural phase (pD.003), which was higher inPD subjects than in healthy subjects. The findings suggest thatsubjects in the early stages of PD prioritize gait initiation, as theirmotor performance was similar to that of healthy subjects.
- Antagonist coativation in stroke vs healthy subjects during sit-to-standPublication . Silva, Augusta; Sousa, Andreia S. P.; Silva, Cláudia; Santos, Rubim; Tavares, João Manuel R. S.; Calheno, Teresa; Sousa, FilipaHigh levels og antagonista coativation is frequently found in post stroke subjects, related with postural control impairments. The bilateral postural control dysfunction expected in post-stroke subjects is due to the bilateral disposal of reticulospinal system.
- 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.
- 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.
- Influence of long-term wearing of unstable shoes on compensatory control of posture: An electromyography-based analysisPublication . Pinheiro De Sousa, Andreia Sofia; Silva, Andreia; Macedo, Rui; Santos, Rubim; Tavares, João ManuelThis study investigated the influence of long-term wearing of unstable shoes (WUS) on compensatory postural adjustments (CPA) to an external perturbation. Participants were divided into two groups: one wore unstable shoes while the other wore conventional shoes for 8 weeks. The ground reaction force signal was used to calculate the anterior– posterior (AP) displacement of the centre of pressure (CoP) and the electromyographic signal of gastrocnemius medialis (GM), tibialis anterior (TA), rectus femoris (RF) and biceps femoris (BF) muscles was used to assess individual muscle activity, antagonist co-activation and reciprocal activation at the joint (TA/GM and RF/(BF + GM) pairs) and muscle group levels (ventral (TA + RF)/dorsal (GM + BF) pair) within time intervals typical for CPA. The electromyographic signal was also used to assess muscle latency. The variables described were evaluated before and after the 8-week period while wearing the unstable shoes and barefoot. Long-term WUS led to: an increase of BF activity in both conditions (barefoot and wearing the unstable shoes); a decrease of GM activity; an increase of antagonist co-activation and a decrease of reciprocal activation level at the TA/GM and ventral/dorsal pairs in the unstable shoe condition. Additionally, WUS led to a decrease in CoP displacement. However, no differences were observed in muscle onset and offset. Results suggest that the prolonged use of unstable shoes leads to increased ankle and muscle groups’ antagonist co-activation levels and higher performance by the postural control system.
- Interlimb coordination during the stance phase of gait in subjects with strokePublication . Sousa, Andreia S. P.; Silva, Augusta; Santos, Rubim; Sousa, Filipa; Tavares, João ManuelTo analyze the relation between contralesional and ipsilesional limbs in subjects with stroke during step-to-step transition of walking. Observational, transversal, analytical study with a convenience sample. Physical medicine and rehabilitation clinic. Participants: Subjects (nZ16) with poststroke hemiparesis with the ability to walk independently and healthy controls (nZ22). Interventions: Not applicable. Main Outcome Measures: Bilateral lower limbs electromyographic activity of the soleus (SOL), gastrocnemius medialis, tibialis anterior, biceps femoris, rectus femoris, and vastus medialis (VM) muscles and the ground reaction force were analyzed during double-support and terminal stance phases of gait. The propulsive impulse of the contralesional trailing limb was negatively correlated with the braking impulse of the leading limb during double support (rZ .639, PZ.01). A moderate functional relation was observed between thigh muscles (rZ .529, PZ.035), and a strong and moderate dysfunctional relation was found between the plantar flexors of the ipsilesional limb and the vastus medialis of the contralesional limb, respectively (SOL-VM, rZ .80, P<.001; gastrocnemius medialis-VM, rZ .655, PZ.002). Also, a functional moderate negative correlation was found between the SOL and rectus femoris muscles of the ipsilesional limb during terminal stance and between the SOL (rZ .506, PZ.046) and VM (rZ .518, PZ.04) muscles of the contralesional limb during loading response, respectively. The trailing limb relative impulse contribution of the contralesional limb was lower than the ipsilesional limb of subjects with stroke (PZ.02) and lower than the relative impulse contribution of the healthy limb (PZ.008) during double support. The findings obtained suggest that the lower performance of the contralesional limb in forward propulsion during gait is related not only to contralateral supraspinal damage but also to a dysfunctional influence of the ipsilesional limb.
- Influence of wearing an unstable shoe on thigh and leg muscle activity and venous response in upright standingPublication . Pinheiro De Sousa, Andreia Sofia; Tavares, João Manuel; Macedo, Rui; Rodrigues, Albano; Santos, RubimPurpose: To quantify the effect of unstable shoe wearing on muscle activity and haemodynamic response during standing. Methods: Thirty volunteers were divided into 2 groups: the experimental group wore an unstable shoe for 8 weeks, while the control group used a conventional shoe for the same period. Muscle activity of the medial gastrocnemius, tibialis anterior, rectus femoris and biceps femoris and venous circulation were assessed in quiet standing with the unstable shoe and barefoot. Results: In the first measurement there was an increase in medial gastrocnemius activity in all volunteers while wearing the unstable shoe. On the other hand, after wearing the unstable shoe for eight weeks these differences were not verified. Venous return increased in subjects wearing the unstable shoe before and after training. Conclusions: The unstable shoe produced changes in electromyographic characteristics which were advantageous for venous circulation even after training accommodation by the neuromuscular system.
- Postural adjustments during single leg droplanding in subjects with chronic ankle unstabilityPublication . Sousa, Andreia; Ribeiro, Rui; Nunes, Ana Rita; Sarmento, Leonor; Gouveia, AnaChronic ankle instability (CAI) involves deregulation of postural control mechanisms and is estimated to occur in 70% of the individuals after ankle SPRAIN.
- Cross-cultural adaptation and measurement properties of the Portuguese version of the Ankle Instability InstrumentPublication . Silva, Diogo C. F.; Vilas-Boas, J. Paulo; Mesquita, Cristina; Maia, José; Santos, Rubim; Peixoto, Tiago André Teixeira; Brito, Nuno; Pinheiro De Sousa, Andreia SofiaChronic ankle instability is one of the most common clinical conditions in the general population, especially in adult athletes. The cross-cultural adaptation of self-reported questionnaires that identify and classify this condition contribute to criteria standardization in research but also in rehabilitation. Aim of Study. To validate the Ankle Instability Instrument to the Portuguese population and to investigate its psychometric properties. Material and Methods. Linguistic and semantic equivalence of the original version of the Ankle Instability Instrument to the Portuguese population was firstly performed. The Portuguese version of the Ankle Instability Instrument was then applied to 81 higher education adult students, with (n = 59) and without history of ankle sprain (n = 22). Participants were evaluated two times with an interval of one week to assess the psychometric properties of the Portuguese version of the Ankle Instability Instrument. Results. In the reliability of binary responses based on the test retest, the tetrachoric correlation coefficient ranged from 0.99 to 1.00. In addition, the Kuder–Richardson coefficient was 0.79 suggesting good internal consistency. Conclusions. Test-retest showed an almost perfect match in all answers between the two moments, which seem to be related to sample characteristics. The internal consistency value was similar to the one obtained in the original version. The Portuguese version of the Ankle Instability Instrument is highly reliable and can be used in clinical practice.
- Influence of prolonged wearing of unstable shoes on upright standing postural controlPublication . Pinheiro De Sousa, Andreia Sofia; Macedo, Rui; Santos, Rubim; Sousa, Filipa; Silva, Andreia; Tavares, João M. R. S.To study the influence of prolonged wearing of unstable shoes on standing postural control in prolonged standing workers. The participants were divided into two groups: one wore unstable shoes while the other wore conventional shoes for 8 weeks. Stabilometry parameters related to centre of pressure (CoP), rambling (RM) and trembling (TR) as well as the total agonist/antagonist muscle activity, antagonist co-activation and reciprocal activation were evaluated during upright standing, before and after the 8 week period. In both moments, the subjects were evaluated wearing the unstable shoes and in barefoot. The unstable shoe condition presented increased CoP displacement related variables and decreased co-activation command compared to barefoot before and after the intervention. The prolonged wearing of unstable shoes led to: (1) reduction of medial-lateral CoP root mean square and area; (2) decreased anteroposterior RM displacement; (3) increased anteroposterior RM mean velocity and mediolateral RM displacement; (4) decreased anteroposterior TR RMS; and (5) increased thigh antagonist co-activation in the unstable shoe condition. The unstable shoe condition is associated to a higher destabilizing effect that leads to a selection of more efficient and accurate postural commands compared to barefoot. Prolonged wearing of unstable shoes provides increased effectiveness and performance of the postural control system, while wearing of unstable shoes in upright standing, that are reflected by changes in CoP related variables and by a reorganization of postural control commands.