Characterization of upper limbs movements of healthy and poststroke adults.

Introdução: O comprometimento motor do membro superior afeta muitos sobreviventes pós-AVC em todo o mundo e a sua recuperação é lenta e complexa. A evidência de comprometimento bilateral após AVC está a crescer, levando à necessidade de desenvolver uma referência saudável para a qualidade do desempenho motor, em vez dos dados do membro superior ipsilesional. Objetivos: Caracterizar o movimento dos membros superiores de adultos saudáveis e pós-AVC, através da análise cinemática, durante o desempenho das tarefas "beber" e "acender a luz". Métodos: 63 adultos saudáveis e 5 pacientes pós-AVC foram elegíveis para desempenhar as tarefas "beber" e "acender a luz" com os dois membros superiores. Os pacientes pós-AVC foram avaliados no início da fase sub-aguda e no início da fase crónica. Os movimentos das tarefas foram captados por um sistema de captura de movimento 3D, variáveis cinemáticas da mão e articulares foram analisadas e foram feitas comparações entre tarefas e entre adultos saudáveis e pós-AVC. Resultados: A tarefa beber teve cinco fases com diferentes habilidades motoras e estratégias cinemáticas que foram influenciadas principalmente pela idade e pelo sexo. Acender a luz tem menor exigência manual, quando comparada com o beber. Os formatos diferentes dos alvos e a interação diferente parecem ser responsáveis por diferenças nas estratégias cinemáticas entre as duas tarefas executadas pelos adultos saudáveis. Foram encontradas diferenças entre as estratégias cinemáticas usadas pelos adultos pós-AVC e as usadas pelos adultos saudáveis. Todos os pacientes pós-AVC apresentaram alterações cinemáticas bilaterais em ambas as tarefas. Conclusão: Foi feita uma análise abrangente das estratégias cinemáticas das tarefas beber e acender a luz, de modo a obter uma referência do desempenho de atividades da vida diária com diferentes exigências de manualidade para adultos pós-AVC. Todos os pacientes estudados apresentaram alterações cinemáticas bilaterais, o que suporta a implementação de uma avaliação bilateral e a necessidade de ter uma referência saudável para a qualidade do desempenho motor. A severidade inicial do AVC e a idade dos pacientes parecem ter sido as informações mais importantes para explicar a extensão das alterações cinemáticas, mas a localização do AVC parece ter condicionado a especificidade dos défices, bem como a recuperação.PALAVRAS-CHAVE: ACIDENTE VASCULAR CEREBRAL; MEMBROS SUPERIORES; RECUPERAÇÃO MOTORA; AVALIAÇÃO DA QUALIDADE DA PERFORMANCE MOTORA; ANÁLISE CINEMÁTICA.Introduction: Upper limb (UL) motor impairment affects numerous poststroke survivors worldwide and its recovery is slow and complex. Evidence of bilateral impairment after stroke is growing, which creates the need to have a healthy reference for the quality of motor performance instead of ipsilesional UL data. Currently, kinematic analysis is considered one of the best ways to improve the understanding about the mechanisms that drive motor recovery, but a set of methodological flaws is hampering this knowledge. Aims: To characterize the ULs movement of healthy and poststroke adults, through kinematic analysis, during the performance of drinking and turning on the light tasks. Methods: 63 healthy adults and 5 poststroke patients were eligible to perform drinking and turning on the light tasks with both ULs. Poststroke patients were assessed in early sub-acute phase and in the beginning of chronic phase. Tasks movements were captured by a 3D motion capture system, end-point and joint kinematics were analysed and comparisons between tasks and healthy and poststroke adults were made. Results: Drinking task has five phases with different motor skills and kinematic strategies that were mainly influenced by age and sex. Turning on the light has a lower handling requirement, when compared to drinking. The different target formats and the different interaction with them seemed to be responsible for differences in kinematic strategies between both tasks performed by healthy adults. Differences were found between the kinematic strategies used by poststroke adults and those of healthy adults. All poststroke patients presented bilateral kinematic alterations in both tasks. Conclusion: A comprehensive analysis of kinematic strategies of drinking and turning on the light were made, in order to obtain a reference of the performance of activities of daily living with different handling requirement for poststroke adults. All studied patients showed bilateral kinematic alterations, which supports the implementation of a bilateral assessment and the need to have a healthy reference for the quality of motor performance. Initial severity of stroke and patients' age appear to have been the most important information to explain the extent of kinematic alterations, but stroke location seemed to have conditioned the specificity of deficits as well as the recovery

Repeatability and temporal consistency of lower limb biomechanical variables expressing interlimb coordination during the double-support phase in people with and without stroke sequelae

Reliable 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.info:eu-repo/semantics/publishedVersio

Methodological considerations for kinematic analysis of upper limbs in healthy and poststroke adults Part II: a systematic review of motion capture systems and kinematic metrics

To review the methods used to analyze the kinematics of upper limbs (ULs) of healthy and poststroke adults, namely the motion capture systems and kinematic metrics. 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 (kinematic OR motion OR movement) AND (analysis OR assessment OR measurement). The articles included in this review: (1) had the purpose to analyze objectively three-dimension kinematics of ULs, (2) studied functional movements or activities of daily living involving ULs, 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 articles used optoelectronic systems with markers; however, the presentation of laboratory and task-specific errors is missing. Markerless systems, used in some studies, seem to be promising alternatives for implementation of kinematic analysis in hospitals and clinics, but the literature proving their validity is scarce. Most articles analyzed “joint kinematics” and “end-point kinematics,” mainly related with reaching. The different stroke locations of the samples were not considered in their analysis and only three articles described their psychometric properties. Future research should validate portable motion capture systems, document their specific error at the acquisition place and for the studied task, include grasping and manipulation analysis, and describe psychometric properties.info:eu-repo/semantics/publishedVersio

Optimal Multi-Field Functional Electrical Stimulation Parameters for the “Turn on the Light” Task and Related Upper Limb Kinematics Repeatability in Post Stroke Subjects

To characterize the optimal Functional Electrical Stimulation (FES) parameters that assist the “turn on the light” task (TOTL) on post stroke participants and to analyze the related upper limb (UL) kinematics repeatability.info:eu-repo/semantics/publishedVersio

revista do Mestrado em Teorias da arte da Faculdade de Belas Artes da Universidade de Lisboa

info:eu-repo/semantics/publishedVersio

Cartografia de Sítios da Rede Natura 2000 em Portugal continental

Resumo: No âmbito da Cartografia de Habitats Naturais e Seminaturais e de Flora em 31 Sítios Classificados formou-se uma equipa capaz de responder adequadamente ao caderno de encargos lançado em Concurso Público em julho de 2018. A metodologia definida seguiu diferentes fases de implementação, preparação de campo; trabalho de campo; execução de cartografia e validação da cartografia. Para a cartografia foi efetuada previamente uma exaustiva preparação do trabalho de campo que contemplou o estudo breve da Paisagem do Sítio e a definição de uma amostragem estratificada com base na cartografia do uso do solo, cartografia anterior de habitats e conhecimento de especialista do SIC. Efetuada a preparação do trabalho de campo, procedeu-se ao início da recolha de dados no campo a qual se focou em polígonos de ocorrência provável de habitats e em polígonos com pontos de amostragem (definidos anteriormente na amostragem estratificada), tendo sido preenchidas ficha de amostragem de habitats, com a respetiva recolha de imagens. O trabalho de campo decorreu entre abril de 2019 e novembro de 2020. Posteriormente ao trabalho de campo, a informação obtida foi organizada e tratada com vista à produção de cartografia, a qual foi organizada numa base de dados geográficos (geodatabase) para garantir a qualidade topológica e temática dos resultados. Os diferentes campos da tabela de atributos apresentavam-se com pré-preenchimento de modo a minimizar a produção de erros e a auxiliar o preenchimento dos atributos da cartografia. Apresenta-se uma síntese dos trabalhos realizados e da informação obtida, com especial enfoque nos habitats que desapareceram e nos que foram agora identificados, para alguns dos Sítios. Para habitats previamente selecionados foram avaliados o grau de conservação e as pressões identificadas, bem como efetuada a análise da representatividade de cada um. De modo transversal e ao longo de todo o processo foram executados procedimentos de controle de qualidade

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable