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- 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.
- Health promotion conceptual evolution and program development: a literature ReviewPublication . Félix, José; Santos, Paula Clara; Baylina, PilarThe World Health Organization defends prevention and health promotion among communities as a driver of economic and social development, where the individual level of health literacy determines health choices such as adopting healthy lifestyles, managing individual healthcare and preventing chronic diseases. Currently, health promotion is guided by a set of values, being these principles essential for identifying needs and priorities, planning, implementing, evaluating and determining the health promotion programs, that can be defined as a set of programmed, integrated and interrelated strategies and actions that aim to promote health, prevent risks, reduce years of life lost due to disability and increase quality of life. There are several models for planning health promotion programs, such as the Precede-Proceed Model, the Multivariate Approach to community Health (MATCH) Model, the Mapped Intervention Model and the Social Marketing Model. A good planning of a health promotion program can effectively reduce the health costs.
- 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.
- Health-related telemonitoring parameters/signals of older adults: An umbrella reviewPublication . Félix, José; Moreira, Juliana; Santos, Rubim; Kontio, Elina; Pinheiro, Ana Rita; Sousa, Andreia S. P.Aging is one of the greatest challenges in modern society. The development of wearable solutions for telemonitoring biological signals has been viewed as a strategy to enhance older adults’ healthcare sustainability. This study aims to review the biological signals remotely monitored by technologies in older adults. PubMed, the Cochrane Database of Systematic Reviews, the Web of Science, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports were systematically searched in December 2021. Only systematic reviews and meta-analyses of remote health-related biological and environmental monitoring signals in older adults were considered, with publication dates between 2016 and 2022, written in English, Portuguese, or Spanish. Studies referring to conference proceedings or articles with abstract access only were excluded. The data were extracted independently by two reviewers, using a predefined table form, consulting a third reviewer in case of doubts or concerns. Eighteen studies were included, fourteen systematic reviews and four meta-analyses. Nine of the reviews included older adults from the community, whereas the others also included institutionalized participants. Heart and respiratory rate, physical activity, electrocardiography, body temperature, blood pressure, glucose, and heart rate were the most frequently measured biological variables, with physical activity and heart rate foremost. These were obtained through wearables, with the waist, wrist, and ankle being the most mentioned body regions for the device’s placement. Six of the reviews presented the psychometric properties of the systems, most of which were valid and accurate. In relation to environmental signals, only two articles presented data on this topic. Luminosity, temperature, and movement were the most mentioned variables. The need for large-scale long-term health-related telemonitoring implementation of studies with larger sample sizes was pointed out by several reviews in order to define the feasibility levels of wearable devices.
- Methodological considerations in assessing interlimb coordination on poststroke gait: a scoping review of biomechanical approaches and outcomesPublication . Couto, Ana G. B.; Vaz, Mário A. P.; Pinho, Liliana; Félix, José; Silva, Sandra; Silva, Augusta; Sousa, Andreia S. P.To identify and summarize biomechanical assessment approaches in interlimb coordination on poststroke gait. Interlimb coordination involves complex neurophysiological mechanisms that can be expressed through the biomechanical output. The deepening of this concept would have a significant contribution in gait rehabilitation in patients with an asymmetric neurological impairment as poststroke adults. Poststroke adults (>19 years old), with assessment of interlimb coordination during gait, in an open context, according to the Population, Concept, Context framework. A literature search was performed in PubMed, Web of Science™, Scopus, and gray literature in Google Scholar™, according to the PRISMA-ScR recommendations. Studies written in Portuguese or English language and published between database inception and 14 November 2021 were included. Qualitative studies, conference proceedings, letters, and editorials were excluded. The main conceptual categories were “author/year”, “study design”, “participant’s characteristics”, “walking conditions”, “instruments” and “outcomes”. The search identified 827 potentially relevant studies, with a remaining seven fulfilling the established criteria. Interlimb coordination was assessed during walking in treadmill (n = 3), overground (n = 3) and both (n = 1). The instruments used monitored electromyography (n = 2), kinetics (n = 2), and kinematics (n = 4) to assess spatiotemporal parameters (n = 4), joint kinematics (n = 2), anteroposterior ground reaction forces (n = 2), and electromyography root mean square (n = 2) outcomes. These outcomes were mostly used to analyze symmetry indices or ratios, to calculate propulsive impulse and external mechanical power produced on the CoM, as well as antagonist coactivation. Assessment of interlimb coordination during gait is important for consideration of natural auto-selected overground walking, using kinematic, kinetic, and EMG instruments. These allow for the collection of the main biomechanical outcomes that could contribute to improve better knowledge of interlimb coordination assessment in poststroke patients.
- Fisioterapia na Comunidade: um projeto interdisciplinar - Reflexão crítica de docentes e estudantesPublication . Santos, Paula Clara; Baylina, Pilar; Oliveira, Carla; Barbosa, Pedro Maciel; Mesquita, Cristina; Dores, Artemisa R; Félix, José; Troia, Sara; Moreira, Ana MariaA intervenção comunitária tem crescido de forma relevante, implicando que os curricula académicos se adaptem a esta nova realidade. A unidade curricular (UC) de Fisioterapia na Comunidade, do 3.º ano da licenciatura de Fisioterapia da Escola Superior de Saúde do Politécnico do Porto, visa o desenvolvimento de competências de promoção da saúde. Esta UC envolve uma forte articulação com a comunidade, o que promove a aprendizagem em contexto real e potencia a transferência das competências adquiridas. De entre os objetivos desta UC destaca-se o desenvolvimento de um projeto de intervenção comunitária inovador e de aplicação real, suportado na identificação de necessidades emergentes e considerando o ciclo de vida dos indivíduos e de grupos específicos da população. Por outro lado, o modelo pedagógico Problem-Based Learning (PBL), adotado pela licenciatura em Fisioterapia desde 2009, favorece a forte articulação das diferentes áreas técnico-científicas intervenientes (Fisioterapia; Ciências Sociais e Humanas; Biomatemática, Bioestatística e Bioinformática; Gestão e Administração em Saúde e Terapia da Fala), essenciais para a construção da personalidade individual enquanto futuros terapeutas, e confere ao estudante um papel central na aprendizagem. A análise reflexiva de docentes e estudantes desta UC permite concluir que esta metodologia de ensino tem permitido uma excelente articulação do conhecimento das várias áreas técnico-científicas e a aquisição de competências mais completas por parte dos estudantes. Na perspetiva dos estudantes torna-se evidente também o desenvolvimento de diversas competências transversais, nomeadamente a criatividade, liderança, comunicação, gestão do tempo, trabalho de equipa, relações interpessoais, autonomia e capacidade de decisão.
- Impact of workplace exercise program in the musculoskeletal symptomatology of warehouse workers: randomized control trialPublication . Mesquita, Cristina; Félix, José; Lopes, Sofia; Santos, Paula ClaraIn industrialization sector, musculoskeletal disorders are very frequent and can be considered as one of the main problems. They are associated with pain, discomfort, and functional limitations. Exercise programs can improve the symptomatology and daily life activities. Evaluate the impact of a 21-month exercise program on musculoskeletal symptoms reports of warehouse workers. This study was a randomized controlled trial based on CONSORT guidelines. Sample was 249 male workers, randomized in two groups (96 intervention and 124 control group). The Portuguese version of Nordic Musculoskeletal Questionnaire was used to evaluate the musculoskeletal symptomatology at baseline (M0), after 11 months (M1) and after 21 months (M2). The flexibility, mobility and strengthening exercises were executed at the beginning of the working time, once a day, lasting eight minutes. The data were analyzed in SPSS® 25.0 for Windows® (p<0.05). We verify a higher prevalence of problems in different body regions at both groups. The most common symptom, with higher proportion across all variables, was the low back region, followed by the neck, in both groups Most symptomatology was low back region in both groups before intervention. In the intervention group, was verify decrease of symptoms, “problems in the last 12 months”, at M0/M1 (p=0.005) and M0/M2 (p=0.021); “limitations in the last 12 months”, at M0/M1 (p=0.004) and M0/M2 (p<0.001); and “problems in the last 7 days”, at M0/M1 (p=0.017) and M0/M2 (p=0.02). In the control group was verified an increased symptoms at M0/M2 (p=0.038) in “problems in the last 12 months”. It can be concluded that the implementation of a 21-month workplace exercise program contributes to decrease the report of low back symptoms of warehouse workers.
- 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.
- Electrodermal activity wrist-based systems: A review of validity, reliability, and responsive measuresPublication . Félix, José; Moreira, Juliana; Santos, Rubim; Sousa, AndreiaElectrodermal activity (EDA) can be defined as an electrical property of the skin, measured in the palm and sole, related to the level of conductivity, influenced by the sweat level that may depend on various stimuli. Different equipments have been used to capture EDA with high levels of reliability, validity, and responsiveness, however these values vary according to the site of measurement. The increased use of EDA wrist-based systems highlights the need of characterizing the psychometric properties of these kind of systems. The aim of this chapter is to review the validity, reliability, and responsiveness of EDA measurement in the wrist. Previous studies have demonstrated that wrist measurement present low to moderate correlations, against the gold standard systems, with moderate levels of responsiveness, while no study addressed reliability. Wrist EDA measurement could be therefore an acceptable option, however, more studies are demanded not only to assess related values of reliability, as well to best characterize validity and responsiveness measures.
- Kinematic and Kinetic gait principal component domains in older adults with and without functional disability: a cross-sectional studyPublication . Moreira, Juliana; Cunha, Bruno; Félix, José; Santos, Rubim; Sousa, Andreia S. P.; Pinheiro de Sousa, Andreia Sofia; Rubim Silva Santos, Manuel; Santos Moreira, Juliana; Sousa Félix, José ManuelGait kinematic and kinetic changes have been identified in older adults, highlighting the need to explore the principal age-related components and how these are associated with functional disability. This study aims to perform a factor analysis, including gait kinematic and kinetic parameters in older adults to establish determinant gait domains. Additionally, this study aims to identify which domains differentiate those without and with functional disability. Through a cross-sectional design, older adults aged 60 and over (n = 35 without and n = 25 with functional disability) were analyzed during overground gait. A principal component analysis (PCA) was used to determine principal components from gait parameters previously demonstrated to express age-related effects (spatiotemporal parameters, sagittal ankle moment and power, ground reaction forces peak, and tridimensional lower limb joints range of motion and positions at heel strike and toe-off). Pace, variability, propulsion, hip and knee control, transverse ankle control, asymmetry, sagittal ankle control, frontal ankle control, frontal hip control, and pre-swing control domains explained 83.90% of the total gait variance in older adults. pace and frontal hip control distinguished individuals with disabilities. PCA identified ten gait domains in older adults. Pace and frontal hip control distinguished disabilities, revealing cautious walking patterns and weaker hip abductor strength.