Biomechanical Assessment Methods Used in Chronic Stroke: A Scoping Review of Non-Linear Approaches.

Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.

Assessment of calcinosis in Portuguese patients with systemic sclerosis - a multicenter study.

INTRODUCTION/OBJECTIVES: The study aims to define the clinical and subclinical calcinosis prevalence, the sensitivity of radiographed site and clinical method for its diagnosis, and the phenotype of Portuguese systemic sclerosis (SSc) patients with calcinosis. METHOD: A cross-sectional multicenter study was conducted with SSc patients fulfilling Leroy/Medsger 2001 or ACR/EULAR 2013 classification criteria, registered in the Reuma.pt. Calcinosis was assessed through clinical examination and radiographs of hands, elbows, knees, and feet. Independent parametric or non-parametric tests, multivariate logistic regression, and sensitivity calculation of radiographed site and clinical method for calcinosis detection were performed. RESULTS: We included 226 patients. Clinical calcinosis was described in 63 (28.1%) and radiological calcinosis in 91 (40.3%) patients, of which 37 (40.7%) were subclinical. The most sensitive location to detect calcinosis was the hand (74.7%). Sensitivity of the clinical method was 58.2%. Calcinosis patients were more often female (p = 0.008) and older (p < 0.001) and had more frequently longer disease duration (p < 0.001), limited SSc (p = 0.017), telangiectasia (p = 0.039), digital ulcers (p = 0.001), esophageal (p < 0.001) and intestinal (p = 0.003) involvements, osteoporosis (p = 0.028), and late capillaroscopic pattern (p < 0.001). In multivariate analysis, digital ulcers (OR 2.63, 95% CI 1.02-6.78, p = 0.045) predicted overall calcinosis, esophageal involvement (OR 3.52, 95% CI 1.28-9.67, p = 0.015) and osteoporosis (OR 4.1, 95% CI 1.2-14.2, p = 0.027) predicted hand calcinosis, and late capillaroscopic pattern (OR 7.6, 95% CI 1.7-34.9, p = 0.009) predicted knee calcinosis. Anti-nuclear antibody positivity was associated with less knee calcinosis (OR 0.021, 95% CI 0.001-0477, p = 0.015). CONCLUSIONS: Subclinical calcinosis high prevalence suggests that calcinosis is underdiagnosed and radiographic screening might be relevant. Multifactorial pathogenesis may explain calcinosis predictors' variability. Key Points • Prevalence of subclinical calcinosis in SSc patients is substantial. • Hand radiographs are more sensitive to detect calcinosis than other locations or clinical method. • Digital ulcers were associated with overall calcinosis, esophageal involvement and osteoporosis were associated with hand calcinosis, and late sclerodermic pattern in nailfold capillaroscopy was associated with knee calcinosis. • Anti-nuclear antibody positivity may be a protective factor for knee calcinosis.

Automatic Swimming Activity Recognition and Lap Time Assessment Based on a Single IMU: A Deep Learning Approach.

This study presents a deep learning model devoted to the analysis of swimming using a single Inertial Measurement Unit (IMU) attached to the sacrum. Gyroscope and accelerometer data were collected from 35 swimmers with various expertise levels during a protocol including the four swimming techniques. The proposed methodology took high inter- and intra-swimmer variability into account and was set up for the purpose of predicting eight swimming classes (the four swimming techniques, rest, wallpush, underwater, and turns) at four swimming velocities ranging from low to maximal. The overall F1-score of classification reached 0.96 with a temporal precision of 0.02 s. Lap times were directly computed from the classifier thanks to a high temporal precision and validated against a video gold standard. The mean absolute percentage error (MAPE) for this model against the video was 1.15%, 1%, and 4.07%, respectively, for starting lap times, middle lap times, and ending lap times. This model is a first step toward a powerful training assistant able to analyze swimmers with various levels of expertise in the context of in situ training monitoring.

The impact of a single surfing paddling cycle on fatigue and energy cost.

Surfing is one additional sport proposed by the Tokyo 2020 Organizing Committee. Surprisingly, substantial efforts to understand surfing energetics are recent, and the impact of a single surfing paddling cycle on fatigue and energy cost is still not clear. Since surfing paddling technique is highly specific, experiments in real practice conditions are necessary to provide deeper insights. Through a biophysical approach, biomechanical and energetics responses of surfing paddling were quantified and compared from 16 competitive male surfers (23.5 ± 10.0 years old, 65.3 ± 11.4 kg and 1.72 ± 0.01 m) during two sets (PRE and POST) of 10 s all-out tethered paddling plus 20 m sprint paddling, interposed by 6 min of endurance paddling. Faster surfers presented lower energy cost during sprint PRE (r2 = 0.30, p = 0.03) and endurance (r2 = 0.35, p = 0.02) relative surfing paddling velocities. Although the energy cost was higher for a lower velocity at maximal paddling velocity POST, the energy cost of surfing paddling increased with absolute velocity according to a power function (R2 = 0.83). Our results suggest that fatigue seems to occur even following a single surfing paddling cycle. Developing a powerful and endurable metabolic base while reducing energy cost during surfing paddling should be seen as key factors in surfing training programs.

Equimetrix Device: Criteria Based Validation and Reliability Analysis of the Center of Mass and Base of Support of a Human Postural Assessment System.

Human postural control is a fundamental ability for static and dynamic tasks, especially in hiper- and hipo-functional populations, such as the elderly. The Equimetrix is a clinical device developed to assess both the base of support (BoS) and the center of mass (CoM) dynamics, thus allowing their use as new evaluation and training tools. This study aims to perform a criteria based validation of Equimetrix by comparing the BoS and CoM data with gold-standard equipment. A motion capture system, force platform, and pressure mat were used to calculate the CoM, center of pressure (CoP) and BoS during bipedal, unipedal, feet together and full tandem stances. Results demonstrate an excellent reliability of Equimetrix in terms of spatial accuracy of the CoM, although over-estimating the CoM height. Differences were found when comparing Mean velocity Path with the CoM, but not with the CoP, indicating a lower reliability in time-based parameters. The Equimetrix presents a tendency to overestimate the BoS, with mixed reliability values, which may be related to the different size of sensing elements between the Equimetrix and the pressure sensing mat. These are encouraging results that should be further explored during dynamic tasks.

Post-swim oxygen consumption: assessment methodologies and kinetics analysis.

OBJECTIVE: This study aimed at comparing different recovery-based methods to assess the highest exercise oxygen uptake value ([Formula: see text]O2peak) when swimming at low-moderate, heavy and severe intensities. Complementarily, the different recovery curve kinetics were analysed. APPROACH: Eighteen competitive swimmers performed a 5 × 200 m front crawl intermittent protocol (0.05 m · s-1 increments and 3 min intervals), with respiratory gas exchange being continuously measured breath-by-breath during and post-exercise using a portable gas analyser. The directly determined [Formula: see text]O2peak ([Formula: see text]O2dir) was compared with the values obtained by linear and exponential backward extrapolations (of different intervals) and the recovery curve mathematical modelling. MAIN RESULTS: [Formula: see text]O2dir rose with intensity increase: 41.96 ± 6.22, 46.36 ± 6.89 and 50.97 ± 7.28 ml · kg-1 min-1 for low-moderate, heavy and severe swims. Linear and exponential regressions applied to the first 20 s of recovery presented the [Formula: see text]O2peak values closest to [Formula: see text]O2dir at low-moderate (42.80 ± 5.54 vs 42.88 ± 5.58 ml kg-1 min-1), heavy (47.12 ± 4.91 vs 47.48 ± 5.09 ml kg-1 min-1) and severe intensity domains (51.24 ± 6.89 vs 53.60 ± 8.54 ml kg-1 · min-1, respectively; r = 0.5-0.8, p < 0.05). The mono-exponential function was the best fit at low-moderate and heavy intensities, while the bi-exponential function better characterized the severe exercise domain (with a slow component amplitude, time delay and time constant of 6.2 ± 2.3 ml kg-1 min-1, 116.6 ± 24.3 and 39.9 ± 15.2 s, respectively). SIGNIFICANCE: The backward extrapolation of the first 20 s of recovery is the best method to assess the [Formula: see text]O2peak for a large spectrum of swimming intensities. Complementarily, intensity increases imply different recovery curve kinetics, particularly a mono-exponential behaviour for low-moderate and heavy exertions and a bi-exponential dynamics for severe paces.

5 km front crawl in pool and open water swimming: breath-by-breath energy expenditure and kinematic analysis.

PURPOSE: Breath-by-breath energy expenditure during open water swimming has not yet been explored in an ecological environment. This study aimed to investigate and compare energetics and kinematics of 5 km swimming, in both swimming pool and open water conditions. METHODS: Through four independent studies, oxygen uptake ([Formula: see text]2) kinetics, heart rate (HR), blood lactate concentration ([La-]) and glucose level (BGL), metabolic power ([Formula: see text]), energy cost (C) and kinematics were assessed during 5 km front crawl trials in a swimming pool and open water conditions. A total of 38 competitive open water swimmers aged 16-27 years volunteered for this four part investigation: Study A (pool, ten females, 11 males), Study B (pool, four females, six males), Study C (pool case study, one female) and Study D (open water, three females, four males). RESULTS: In the swimming pool, swimmers started with an above average swimming speed (v), losing efficiency along the 5 km, despite apparent homeostasis for [La-], BGL, [Formula: see text]2, [Formula: see text] and C. In open water, swimmers started the 5 km with a below average v, increasing the stroke rate (SR) in the last 1000 m. In open water, [Formula: see text]2 kinetics parameters, HR, [La-], BGL, respiratory exchange ratio and C were affected by the v and SR fluctuations along the 5 km. CONCLUSIONS: Small fluctuations were observed for energetic variables in both conditions, but changes in C were lower in swimming pool than in open water. Coaches should adjust the training plan accordingly to the specificity of open water swimming.

Accelerometry calibration in people with class II-III obesity: Energy expenditure prediction and physical activity intensity identification.

BACKGROUND: Almost all accelerometer calibration studies were developed for non-obese people, which hampers an accurate prediction of energy expenditure (EE) and induces a misclassification of sedentary activity (SA) and physical activity intensities (PAI) in class II-III obese people. RESEARCH QUESTION: The purpose of this study was to develop regression equations to predict EE and cut-points to classify SA and PAI in severe obese people based on several metrics obtained from hip and back accelerometer placement data. METHODS: 43 class II-III obese participants performed a protocol that included sitting and standing positions and walking at several speeds. During the protocol participants wore an accelerometer at hip and back, and respiratory gas exchange was measured by indirect calorimetry. Accelerometer metrics analyzed were: activity counts, mean amplitude deviation and euclidean norm minus one. EE was predicted through linear mixed models while cut-points to classify SA and PAI were obtained applying receiver operating characteristic curves. Leave-one-out cross-validation data was used to calculate Bland-Altman plots, prediction accuracy, Kappa statistic and percent agreement. RESULTS: All prediction models presented a quadratic equation that had as predictors body mass and one of the accelerometer metrics. Predicted EE indicated a good agreement and a root mean square error below 1.02 kcal min-1. Global classification agreement from developed cut-points was categorized as almost perfect with a percent agreement above 84 %. Prediction accuracy and classification agreement were similar among accelerometer metrics in each position and between them in hip and back placement. SIGNIFICANCE: Hip and back accelerometer data collected in severe obese people allow to accurately estimate EE and to correctly classify SA and PAI. These results enable future studies to adopt appropriate regression equations and cut-points developed for class II-III obese people rather than those established for non-obese people.

Differences in kinematics and energy cost between front crawl and backstroke below the anaerobic threshold.

PURPOSE: The purpose of this study was to determine kinematic and energetic differences between front crawl and backstroke performed at the same aerobic speeds. METHODS: Ten male competitive swimmers performed front crawl and backstroke at a pre-determined sub-anaerobic threshold speed to assess energy cost (through oxygen uptake measurement) and kinematics (using three-dimensional videography to determine stroke frequency and length, intra-cycle velocity fluctuation, three-dimensional wrist and ankle speeds, and vertical and lateral ankle range of motion). For detailed kinematic analysis, resultant displacement, the duration, and three-dimensional speed of the wrist during the entry, pull, push, and release phases were also investigated. RESULTS: There were no differences in stroke frequency/length and intra-cycle velocity fluctuation between the swimming techniques, however, swimmers had lower energy cost in front crawl than in backstroke (0.77 ± 0.08 vs 0.91 ± 0.12 kJ m-1, p < 0.01). Slower three-dimensional wrist and ankle speeds under the water (1.29 ± 0.10 vs 1.55 ± 0.10 and 0.80 ± 0.16 vs 0.97 ± 0.13 m s-1, both p < 0.01) and smaller ankle vertical range of motion (0.36 ± 0.06 vs 0.47 ± 0.07 m, p < 0.01) in front crawl than in backstroke were also observed, which indirectly suggested higher propulsive efficiency in front crawl. CONCLUSION: Front crawl is less costly than backstroke, and limbs motion in front crawl is more effective than in backstroke.

Reconstruction Accuracy Assessment of Surface and Underwater 3D Motion Analysis: A New Approach.

This study assessed accuracy of surface and underwater 3D reconstruction of a calibration volume with and without homography. A calibration volume (6000 × 2000 × 2500 mm) with 236 markers (64 above and 88 underwater control points--with 8 common points at water surface--and 92 validation points) was positioned on a 25 m swimming pool and recorded with two surface and four underwater cameras. Planar homography estimation for each calibration plane was computed to perform image rectification. Direct linear transformation algorithm for 3D reconstruction was applied, using 1600000 different combinations of 32 and 44 points out of the 64 and 88 control points for surface and underwater markers (resp.). Root Mean Square (RMS) error with homography of control and validations points was lower than without it for surface and underwater cameras (P ≤ 0.03). With homography, RMS errors of control and validation points were similar between surface and underwater cameras (P ≥ 0.47). Without homography, RMS error of control points was greater for underwater than surface cameras (P ≤ 0.04) and the opposite was observed for validation points (P ≤ 0.04). It is recommended that future studies using 3D reconstruction should include homography to improve swimming movement analysis accuracy.

Anaerobic alactic energy assessment in middle distance swimming.

To estimate the anaerobic alactic contribution in a 200 m middle distance swimming trial by means of two different methods based: (1) on the fast component of the VO2 off-kinetics (Ana recovery) and (2) on the kinetics of maximal phosphocreatine splitting in the contracting muscle (Ana pcr). Ten elite male swimmers performed a 200 m front crawl trial at maximal velocity during which VO2 was directly measured using a telemetric portable gas analyser; during the recovery period VO2 data were collected until baseline values were reached. No significant differences between the two methods were observed; mean ± SD values were 31.7 ± 2.5 and 32.6 ± 2.8 kJ, for Ana pcr and Ana recovery, respectively. Despite the existence of some caveats regarding both methods for estimation of the anaerobic alactic contribution, data reported in this study indicate that both yield similar results and both allow to estimate this contribution in supra-maximal swimming trials. This has important implications on swimming energetics, since the non-inclusion of the anaerobic alactic contribution to total metabolic energy expenditure leads to an underestimation of the energy cost at supra-maximal speeds.

Intracyclic velocity variation and arm coordination assessment in swimmers with Down syndrome.

This study examined the differences in intracycle velocity variation and arm coordination in front crawl in swimmers with Down syndrome in three breathing conditions. International swimmers with Down syndrome (N = 16) performed 3 × 20 m front crawl at 50 m race speed: without breathing, breathing to the preferred side, and breathing to the nonpreferred side. A two dimensional video movement analysis was performed using the APASystem. Breathing conditions were compared using Repeated Measures ANOVA. Swimming velocity was higher without breathing and intracyclic velocity variation was higher while breathing. Swimmers tended to a catch up arm coordination mode for both breathing conditions and a superposition mode when not breathing. These data reflect arm coordination compromising swimming performance, particularly when comparing with non disabled swimmers in literature. The physical and perhaps cognitive impairment associated with Down syndrome may result in a disadvantage in both propulsion and drag, more evident when breathing.

Relation between efficiency and energy cost with coordination in aquatic locomotion.

The aim of this study was to establish the relationships between the intracycle velocity variation (IVV) and Froude efficiency (η(T)), energy cost (C), and index of coordination (IdC) throughout a 200-m freestyle race. Ten male international level swimmers performed a maximum 200 m front crawl swim. Performance was recorded with four below- and two above-water synchronized cameras. Oxygen consumption was measured continuously during the effort, and blood samples were collected before and after the test. IdC, body center of mass' IVV (x, y and z), and η(T) were also calculated. For assessing C swimmers performed also 50, 100 and 150 m at the same pace as in the 200-m splits to capture blood lactate samples after each 50-m lap of the 200-m effort. Swimmers attained a stable IVV (x, y, and z), as fatigue development along the 200-m effort induced a decrease in velocity, stroke length, stroke frequency, η(T), and an increase of IdC. Direct relationships between C and IdC for the second and fourth lap were found: R = 0.63 and R = 0.69 (P < 0.05), respectively. Computing partial correlation, also IdC and η(T) in the first lap were significantly correlated (R = -0.63, P < 0.05). IdC and η(T) showed to be significant for the within-subjects correlation (R = -0.45, P = 0.01), and IdC and C for the between-subjects correlation (R = 0.66, P = 0.04). Patterns of coordination modified during the 200-m event in response to the task constraints, observed by the changes in the other studied parameters, and allowing the IVV stability along the effort.

Energy cost and body centre of mass' 3D intracycle velocity variation in swimming.

The purpose of this study was to examine the relationship between the energy cost (C) and the 3D intracycle velocity variation (IVV; swimming direction--x, vertical--y and lateral--z axes) throughout the 200 m front crawl event. Ten international level swimmers performed a maximal 200 m front crawl swim followed by 50, 100 and 150 m bouts at the same pace as in the 200 m splits. Oxygen consumption was measured during the bouts and blood samples were collected before and after each one. The C was calculated for each 50 m lap as the ratio of the total energy expenditure (three energy pathways) to the distance. A respiratory snorkel and valve system with low hydrodynamic resistance was used to measure pulmonary ventilation and to collect breathing air samples. Two above water and four underwater cameras videotaped the swim bouts and thereafter APAS was used to assess the centre of mass IVV (x, y and z components). The increase in the C was significantly associated with the increase in the IVV in x for the first 50 m lap (R = -0.83, P < 0.01). It is concluded that the IVV relationship with C in a competitive event does not present the direct relationship found in the literature, revealing a great specificity, which suggests that the relation between these two parameters could not be used as a performance predictor in competitive events.