Autonomic nervous system response to remote ischemic conditioning: heart rate variability assessment.

BACKGROUND: Remote ischemic conditioning (RIC) is a procedure applied in a limb for triggering endogenous protective pathways in distant organs, namely brain or heart. The underlying mechanisms of RIC are still not fully understood, and it is hypothesized they are mediated either by humoral factors, immune cells and/or the autonomic nervous system. Herein, heart rate variability (HRV) was used to evaluate the electrophysiological processes occurring in the heart during RIC and, in turn to assess the role of autonomic nervous system. METHODS: Healthy subjects were submitted to RIC protocol and electrocardiography (ECG) was used to evaluate HRV, by assessing the variability of time intervals between two consecutive heart beats. This is a pilot study based on the analysis of 18 ECG from healthy subjects submitted to RIC. HRV was characterized in three domains (time, frequency and non-linear features) that can be correlated with the autonomic nervous system function. RESULTS: RIC procedure increased significantly the non-linear parameter SD2, which is associated with long term HRV. This effect was observed in all subjects and in the senior (> 60 years-old) subset analysis. SD2 increase suggests an activation of both parasympathetic and sympathetic nervous system, namely via fast vagal response (parasympathetic) and the slow sympathetic response to the baroreceptors stimulation. CONCLUSIONS: RIC procedure modulates both parasympathetic and sympathetic autonomic nervous system. Furthermore, this modulation is more pronounced in the senior subset of subjects. Therefore, the autonomic nervous system regulation could be one of the mechanisms for RIC therapeutic effectiveness.

Exploring the use of wearable sensors for assessing risk factors during orthopedic surgeries: A protocol for data collection.

During orthopedic surgeries, surgeons are generally exposed to prolonged periods of standing, awkward and sustained body postures, and forceful movements, which can increase the likelihood of developing work-related musculoskeletal disorders (WRMSD). Therefore, this study proposes a protocol to measure parameters related to physical risk factors contributing to lower limb WRMSD, during orthopedic surgery procedures. The protocol development was preceded by an initial phase of understanding and specifying the context of use, followed by pre-tests in laboratory environment. It integrates a motion capture system, using inertial measurement units (IMU) to collect posture data from hip, knee, and ankle, and electromyography system (EMG) to measure and record data from muscle activity of biceps femoris, rectus femoris, and gastrocnemius lateralis. Pre-tests provided insights for protocol optimization, estimating a 3-hour data collection session per surgery due to sensor battery limitations, streamlining the process by placing EMG sensors before IMU and refining thigh sensor placement strategies. The protocol presents an opportunity for a real-time and quantitative approach to monitor surgeon's exposure to risk factors contributing to lower limb WRMSD while performing surgical procedures. Two months after pre-tests, the protocol implementation began in a real work context. The study's final outcomes fall outside the paper's scope.

Multi-activity 3D printed assistive technology in children: a case study.

Congenital limb defects occur when a limb does not develop normally during pregnancy. The quality of each person's everyday life is significantly impacted by any of these defects and there is no concrete treatment. 3D modeling and printing, enables the creation and customization of precise virtual and/or physical models, including models of the human anatomy. These technologies provide a novel method of producing new devices with optimized design and production time, improving adaptability, and incorporating functionality. To this end, we propose a method of designing and producing 3D printed assistive devices and we also present an example of an assistive device, done in the 3D Printing Center for Health, as well as its impact on the patient's daily life. With this device, the patient became able to play the guitar and hold a knife, thus helping on these two activities.

Electrophysiological effects of mindfulness meditation in a concentration test.

In this paper, we evaluate the effects of mindfulness meditation training in electrophysiological signals, recorded during a concentration task. Longitudinal experiments have been limited to the analysis of psychological scores through depression, anxiety, and stress state (DASS) surveys. Here, we present a longitudinal study, confronting DASS survey data with electrocardiography (ECG), electroencephalography (EEG), and electrodermal activity (EDA) signals. Twenty-five university student volunteers (mean age = 26, SD = 7, 9 male) attended a 25-h mindfulness-based stress reduction (MBSR) course, over a period of 8 weeks. There were four evaluation periods: pre/peri/post-course and a fourth follow-up, after 2 months. All three recorded biosignals presented congruent results, in line with the expected benefits of regular meditation practice. In average, EDA activity decreased throughout the course, -64.5%, whereas the mean heart rate displayed a small reduction, -5.8%, possibly as a result of an increase in parasympathetic nervous system activity. Prefrontal (AF3) cortical alpha activity, often associated with calm conditions, saw a very significant increase, 148.1%. Also, the number of stressed and anxious subjects showed a significant decrease, -92.9% and -85.7%, respectively. Easy to practice and within everyone's reach, this mindfulness meditation can be used proactively to prevent or enhance better quality of life. 25 volunteers attended a Mindfulness-Based Stress Reduction (MBSR) course in 4 evaluation periods: Pre/Peri/Post-course and a fourth follow-up after two months. A Depression, Anxiety and Stress State (DASS) survey is completed in each period. Electrodermal Activity (EDA), Electrocardiography (ECG) and Electroencephalography (EEG) are also recorded and processed. By integrating self-reported surveys and electrophysiological recordings there is strong evidence of evolution in wellbeing. Mindfulness meditation can be used proactively to prevent or enhance better quality of life.

OrthoRehab: Development of a New Methodology for the Comparison Study Between Different Types of Ankle-Foot Orthoses in Foot Dysfunction.

Foot dysfunction is one of the most likely consequences of rheumatoid arthritis and stroke. It is characterized by severe changes in the gait pattern due to a significant increase in the plantar flexion. Some of these dysfunctions can be compensated by using an ankle-foot orthosis. However, the clinical decision about which orthosis best suits the patient creates a real problem for physicians/therapists. Purpose: The main goal of this paper is to present a quantitative support tool that can assist the physicians/therapists in deciding which orthosis is most suitable for each subject. Methodology: In order to achieve such goal, a platform named OrthoRehab was developed, and it was tested in three conditions: without any orthosis and with two different ankle-foot orthoses. The data were acquired in the Gait Laboratory of Rehabilitation Medicine Center of Alcoitão using a VICON NEXUS 1.8.5® motion capture system that allows the capturing of kinematic and kinetic data. Results: The results reveal that OrthoRehab is a user-friendly, easy to apply tool that analyzes very relevant data for the clinical staff. Conclusion: The developed decision support tool, OrthoRehab, offers a quantitative analysis and provides insight to which orthosis achieves the best performance in comparison with the patient's gait pattern with no orthosis.

Serious games for upper limb rehabilitation: a systematic review.

The aim of this research is to carry out a systematic review of the use of technological gaming platforms with serious games in the upper limb rehabilitation of patients with neuromotor disorders. Through a systematic review, the first two authors defined the inclusion criteria and extracted the data, resulting in 38 studies collected from B-On, PubMed and Medline. Ninety-two per cent of the selected articles were published since 2010. This review documents 35 different gaming platforms types. Twenty-one of the 38 articles included in this review conducted a clinical trial and of those only eight report improvements in the target population following the use of the games and platforms. This review concludes that a new paradigm is emerging in the rehabilitation field, characterized by the systematic use of technological gaming platforms with serious games in/for rehabilitation. The use of this approach seems to be beneficial. However, to facilitate the full integration of these platforms, it is necessary to conduct more research in this area, explore new approaches and carry out in-depth clinical studies into the benefits of these platforms. Implications for rehabilitation This review states that the use serious games and gaming platforms for upper limb rehabilitation are starting a new paradigm in the rehabilitation. For a full integration of this technologies in the rehabilitation field more studies are needed.

Development and clinical application of Vertebral Metrics: using a stereo vision system to assess the spine.

The biomechanical changes in the spinal column are considered to be the main responsible for rachialgia. Although radiological techniques use ionizing radiation, they are the most applied tools to assess the biomechanics of the spine. To face this problem, non-invasive techniques must be developed. Vertebral Metrics is an ionizing radiation-free instrument designed to detect the 3D position of each vertebrae in a standing position. Using a stereo vision system combined with low intensity UV light, recognition is achieved with software capable of distinguishing fluorescent marks. The fluorescent marks are the skin projection of the vertex of the spinal processes. This paper presents a major development of Vertebral Metrics and its evaluation. It performs a scan in less than 45 s with a resolution on the order of 1 mm, in each spatial direction, therefore, allowing an accurate analysis of the spine. The instrument was applied to patients without associated pathology. Statistically significant differences between consecutive scans were not found. A positive correlation between the 3D positions of each vertebra and the homologous position of the other vertebrae was observed. Using Vertebral Metrics, innovative results can be obtained. It can be used in areas such as orthopedics, neurosurgery, and rehabilitation. Graphical abstract ᅟ.

[Translation, adaptation and psychometric evaluation of the instrument Activity Record (ACTRE)]. / Tradução, adaptação e avaliação psicométrica do questionário Activity Record (ACTRE).

OBJECTIVE: To perform the cultural adaptation of the instrument Activity Record (ACTRE) and evaluate its psychometric qualities. METHOD: Six steps were followed:1) translation of the original instrument, 2) back-translation, 3) formal equivalence assessment, 4) evaluation by an expert in Portuguese language, 5) final critique by experts in the field and 6 ) applying the questionnaire to 53 pregnant women, aged between 18 and 39 years, at two different moments with an interval time of two hours aimed to evaluate the reliability level of temporal stability (test-retest) using the the Intraclass Correlation. RESULTS: The results of the Intraclass Correlation at the level of test / retest reliability ranged between 0.88 and 1.00. The Cronbach's alpha, calculated for all the questions in the activities most often mentioned, was 0.77, we obtained a further significant correlations between the various issues together in this set of activities. CONCLUSION: The Portuguese version of the ACTRE was easily understood by all pregnant women and revealed a high reliability.

B-cell phenotype and IgD-CD27- memory B cells are affected by TNF-inhibitors and tocilizumab treatment in rheumatoid arthritis.

BACKGROUND: The use of TNF-inhibitors and/or the IL-6 receptor antagonist, tocilizumab, in rheumatoid arthritis (RA) have pleiotropic effects that also involve circulating B-cells. The main goal of this study was to assess the effect of TNF-inhibitors and tocilizumab on B-cell phenotype and gene expression in RA. METHODS: Blood samples were collected from untreated early RA (ERA) patients, established RA patients under methotrexate treatment, established RA patients before and after treatment with TNF-inhibitors and tocilizumab, and healthy donors. B-cell subpopulations were characterized by flow cytometry and B-cell gene expression was analyzed by real-time PCR on isolated B-cells. Serum levels of BAFF, CXCL13 and sCD23 were determined by ELISA. RESULTS: The frequency of total CD19+ B cells in circulation was similar between controls and all RA groups, irrespective of treatment, but double negative (DN) IgD-CD27- memory B cells were significantly increased in ERA and established RA when compared to controls. Treatment with TNF-inhibitors and tocilizumab restored the frequency of IgD-CD27- B-cells to normal levels, but did not affect other B cell subpopulations. TACI, CD95, CD5, HLA-DR and TLR9 expression on B-cells significantly increased after treatment with either TNF-inhibitors and/ or tocilizumab, but no significant changes were observed in BAFF-R, BCMA, CD69, CD86, CXCR5, CD23, CD38 and IgM expression on B-cells when comparing baseline with post-treatment follow-ups. Alterations in B-cell gene expression of BAFF-R, TACI, TLR9, FcγRIIB, BCL-2, BLIMP-1 and ß2M were found in ERA and established RA patients, but no significant differences were observed after TNF-inhibitors and tocilizumab treatment when comparing baseline and follow-ups. Serum levels of CXCL13, sCD23 and BAFF were not significantly affected by treatment with TNF-inhibitors and tocilizumab. CONCLUSIONS: In RA patients, the use of TNF-inhibitors and/ or tocilizumab treatment affects B-cell phenotype and IgD-CD27- memory B cells in circulation, but not B-cell gene expression levels.

[Vertebral metrics: application of a new mechanical instrument to evaluate the spinal column]. / Métrica vertebral: a aplicação de uma nova tecnologia na análise da coluna vertebral.

OBJECTIVE: To present the results of the first application of the new technology - Vertebral Metrics - the analysis of the 3D position of the vertex of each spinous process in pregnant women. MATERIAL AND METHODS: The Vertebral Metrics was applied to women without associated pathology in four stages of pregnancy (12, 20, 32, 37 weeks gestation). We applied univariate linear models. RESULTS: We found that the differences that occur during pregnancy are more significant at the position y (anteroposterior). It was found also that there is a positive correlation between the biomechanical position of the vertex of each of the vertebrae with the homologous position of rest. DISCUSSION/CONCLUSION: Through Vertebral Metrics innovative results could be obtained in analyzing biomechanics of the spine. A device that has different applications can be easily adopted in areas such as orthopedics, neurosurgery, pediatrics and rehabilitation. It should also be noted that this instrument is not exhausted in the sample of this research because it can be further applied to the general population.

Objectivo: Apresentar os resultados da primeira aplicação da nova tecnologia ­ Métrica Vertebral ­ na análise da posição 3D do vértice de cada uma das apófises espinhosas, em mulheres grávidas.Material e Métodos: O Métrica Vertebral foi aplicado a mulheres, sem patologia associada, em quatro momentos da gravidez (12, 20, 32, 37 semanas de gestação). Aplicaram-se modelos lineares univariados.Resultados: Observou-se que as diferenças que ocorrem ao longo da gravidez são mais significativas ao nível da posição y (anteroposterior). Verificou-se, igualmente, que existe uma correlação biomecânica positiva entre a posição do vértice de cada uma das vértebras com a posição homóloga das restantes.Discussão/Conclusão: Através do Métrica Vertebral foi possível obter resultados inovadores na análise biomecânica da colunavertebral. É um dispositivo que tem diferentes aplicações podendo ser facilmente adoptado em áreas como ortopedia, neurocirurgia, pediatria e reabilitação. É de realçar ainda que este instrumento não se esgota na amostra da presente investigação pois pode ser futuramente aplicada à população em geral.

Back pain during pregnancy: a longitudinal study.

OBJECTIVE: The goal of the present study was to evaluate the prevalence of back pain during four different periods of pregnancy and its action on each woman during this stage. METHODS: The sample comprises of a group of 49 pregnant women aged between 20 and 39 years. The presence of back pain symptoms and severity were evaluated at 12, 20, 32 and 37 weeks of gestation in each woman, using one question of the NIH Record Activity (ACTRE). RESULTS: The ANOVA for repeated measures was used to compare the four moments of evaluation (12 weeks, 20 weeks, 32 weeks and 37 weeks) in relation to back pain. A significant difference between the pain scores over the four moments were observed, being that higher pain scores were noted at 12, 32 and 37 weeks of gestation. We also verified that at 12 weeks of gestation 71.4% of women had back pain, while at 20 weeks only 16.3% confirmed pain. At 32 weeks 91.7% of women reported pain and at 37 weeks, 98% reported the same. CONCLUSION: We found that back pain is prevalent during pregnancy and its intensity varies throughout this period.

Comparative evaluation of the tridimensional spine position measured with a new instrument (Vertebral Metrics) and an optoelectronic system of stereophotogrammetry.

We designed and built a non-invasive instrument, called Vertebral Metrics, to measure the x, y, and z positions of each spinous process of the spine on a standing position. In the present study, we perform a comparative evaluation of Vertebral Metrics, by comparing the results obtained from this instrument with those from a validated optoelectronic system of stereophotogrammetry, with 10 infrared cameras. The sample was composed of 11 women aged between 14 and 39 years. After marking the various points on the spinal column, from the first cervical vertebra to the first sacral vertebra, they were measured first with the new instrument (Vertebral Metrics) and then by means of the optoelectronics system. Afterwards, the results were subjected to a thorough comparison. The statistical comparison of the results was performed using an ANOVA model with three factors (Instrument, Subject, and Vertebra) for the intervertebral distance.