Synergic control of the minimum toe clearance in young and older adults during foot swing on treadmill walking in different speeds.

BACKGROUND: The vertical toe position at minimum toe clearance (MTC) in the swing phase is critical for walking safety. Consequently, the joints involved should be strictly controlled and coordinated to stabilize the foot at MTC. The uncontrolled manifold (UCM) hypothesis framework has been used to determine the existence of synergies that stabilize relevant performance variables during walking. However, no study investigated the presence of a multi-joint synergy stabilizing the foot position at MTC and the effects of age and walking speed on this synergy. RESEARCH QUESTIONS: Is there a multi-joint synergy stabilizing MTC during treadmill walking? Does it depend on the persons' age and walking speed? METHODS: Kinematic data from 23 young and 15 older adults were analyzed using the UCM approach. The participants walked on a treadmill at three speeds: slow, self-selected, and fast. The sagittal and frontal joint angles from the swing and stance legs and pelvis obliquity were used as motor elements and the vertical toe position at MTC was the performance variable. The variances in the joint space that affected (VORT, 'bad' variance) and did not affect (VUCM, 'good' variance) the toe position at MTC and the synergy index (ΔV) were computed. RESULTS: The ΔV>0 was revealed for all subjects. Walking speed did not affect ΔV in older adults, whereas ΔV reduced with speed in young adults. ΔV was higher for older than for young adults at self-selected and fast speeds, owing to a lower VORT in the older group. SIGNIFICANCE: The vertical toe position at MTC was stabilized by a strong multi-joint synergy. In older adults, this synergy was stronger, as they were better at limiting VORT than young adults. Reduced VORT in older adults could be caused by more constrained walking, which may be associated with anxiety due to walking on a treadmill.

The effect of dyskinesia on postural control, balance, gait, and fall risk in people with Parkinson's disease: a systematic review protocol

Dyskinesia affects the limbs, trunk, and head and is more prevalent in people with Parkinson's disease (PD) and a history of falls. More evidence about the effects of dyskinesia on postural control, balance, gait, and fall risk could help improve the quality of life of individuals with PD. This review aims to examine associations between dyskinesia and postural control, balance, gait, and fall risk in individuals with PD. Such information could lead to new approaches to quality of life improvement among individuals with PD. PubMed, CINAHL, PsycInfo, Scopus, and SciELO will be searched for longitudinal, cohort, and case-control studies published in English or Portuguese in any year that investigated the association between dyskinesia and postural control, balance, gait, and fall risk in individuals with PD. Two reviewers will independently evaluate the titles, abstracts, and full texts according to PRISMA guidelines to select eligible studies for the review. Data on participants, dyskinesia, postural control, balance, gait, and fall risk will be extracted and summarized in tables. Two reviewers will independently assess the methodological quality of each study using the Newcastle Ottawa quality assessment scale. Meta-analysis will not be performed. The results of this systematic review will offer insight into the effects of dyskinesia on postural control, balance, gait, and fall risk. Such information could significantly contribute to informed decisions about early motor intervention in individuals with PD. (AU)

Capacity Assessment Instrument - Health: Pilot Study of a New Tool for Adults with Dementia.

OBJECTIVES: This research comprises a pilot study of the CAI-Health, a new tool for the evaluation of decision-making capacity in healthcare. It aims to analyze the instrument's indicators of reliability and internal validity to conclude its final version. METHODS: A total of 89 participants were included, of which 22 had Alzheimer's Disease; 32 had mild cognitive impairment, and 35 were controls. Cronbach's alpha and the intercorrelation matrix were used as indicators of reliability and internal validity as well as to identify items for elimination. Repeated-measures ANOVA allowed for the analysis of differences between the vignettes that comprise CAI-Health. RESULTS: The internal consistency results were acceptable, and no items were proposed for elimination. A repeated-measures ANOVA revealed that the vignettes were unexpectedly equivalent. Despite the procedures used to develop clinical vignettes with increased levels of complexity in assessing decision-making capacity, this study showed no differences in the vignettes' level of demand. CONCLUSIONS: The extensive application of CAI-Health compromises its clinical usefulness and viability. To reduce its length while maintaining a thorough assessment of each ability, it was decided to eliminate two vignettes and retain all interview items. The final version of the CAI-Health comprises a clinical vignette and a capacity interview. CLINICAL IMPLICATIONS: CAI-Health was designed for the assessment of medical decision-making capacity in older adults.

Montreal Cognitive Assessment in Mild Cognitive Impairment: Relationship with Cerebrospinal Fluid Biomarkers and Conversion to Dementia.

BACKGROUND: Mild cognitive impairment (MCI) is considered a prodromal state of dementia. Abnormal values of cerebrospinal fluid Alzheimer's disease biomarkers (CSF-AD-b) have been associated with a higher risk of conversion to dementia (due to Alzheimer's disease), but studies evaluating the ability of Montreal Cognitive Assessment (MoCA) in this task are lacking. OBJECTIVE: This study aims to investigate the relationship between MoCA and CSF-AD-b, as well as the ability of those tools to predict conversion to dementia. METHODS: Taking advantage of our MCI cohort with biological characterization on longitudinal follow-up (180 patients followed for 62.6 months during which 41.3% converted), we computed MoCA and MMSE z-scores, using Portuguese normative data. The performance in MoCA z-score was correlated with CSF-AD-b and the relative time to conversion and risk according to baseline characteristics were analyzed using Kaplan-Meier analysis and Cox regression models. RESULTS: MoCA z-scores were correlated with Aß42 (p = 0.026), t-tau (p = 0.033), and p-tau (p = 0.01). Impaired MMSE (p < 0.001) and MoCA z-scores (p = 0.019), decreased Aß42 (p < 0.001) and increased t-tau (p < 0.001) and p-tau (p < 0.001) were associated with shorter estimated time of conversion. Aß42 (p < 0.001) and MMSE z-scores (p = 0.029) were independent predictors of conversion. For those with at least 9 years of education, MoCA z-score (p = 0.004) (but not MMSE) was an independent predictor of conversion as well as Aß42. CONCLUSIONS: This study confirms the role of CSF-AD-b, namely Aß42, in predicting conversion from MCI to dementia and suggests the utility of MoCA in predicting conversion in highly educated subjects, supporting its use in the evaluation of MCI patients.

Montreal Cognitive Assessment (MoCA): An update normative study for the Portuguese population.

The Montreal Cognitive Assessment (MoCA) is a brief cognitive screening instrument that is known for its good psychometric properties and sensitivity to detect mild cognitive impairment (MCI). After ten years, it became relevant to update the previous Portuguese normative study due to changes in the population and some limitations present in the study itself. The study sample was composed of 860 cognitively healthy adults, stratified according to verified distribution of the Portuguese population across several sociodemographic variables. All participants completed a neuropsychological assessment battery, in which the MoCA was included. The analysis of the relationships between the sociodemographic variables and the MoCA show that age and educational level had a significant effect on MoCA scores, with educational level being the better predictor. These results foster the consideration of age and educational level in the development of normative data. The present study contributes to a reliable update of the normative data of MoCA. The new age groups and more stratified norms comply with the natural changes on the Portuguese population, providing an increase of power and clinical accuracy. The presented norms consider the cognitive domains subscores, consequently improving the comprehension and utility of the results obtained from the MoCA test.

Montreal Cognitive Assessment (MoCA): A validation study among prisoners.

BACKGROUND: There are numerous scales for screening cognitive performance and thus identification of any potential deficits, but in spite of the vulnerability of the prison population to such problems, there has been no adequate validation of screening tools specifically for use with prisoners or others in the criminal justice system. AIM: To validate the Montreal Cognitive Assessment (MoCA) for use with prisoners. METHODS: 100 adult prisoners in one Portuguese prison were randomly invited by clinicians to take part in this study. A same size sample of community-living adult non-offenders of similar age was selected from the MoCA's normative study database in Portugal. For both groups, the key inclusion criterion was fluency in the Portuguese language. All participants completed the Mini Mental State Examination (MMSE) and the MoCA, both in Portuguese translation. Cronbach's alpha coefficient was calculated as an index of internal consistency and Pearson's r correlations calculated. Group performances were compared using independent samples t-test. Covariance analysis (ANCOVA) was computed with level of education as covariate. To measure the magnitude of the effect, η p 2 ${\eta }_{p}^{2}$ was used. A receiver operating characteristics curve analysis was computed to evaluate the discriminatory accuracy of MoCA and MMSE. RESULTS: The MoCA showed a 'reasonable' internal consistency index (α = 0.75) as well as positive and significant correlations with the MMSE. As a cognitive measure, however, the MoCA showed consistently superior psychometric properties and higher discriminatory accuracy (MoCA = 89%) than the MMSE (65%). According to the Youden index, the optimal cut-off point for the MoCA is below 24 points, whereas for the MMSE, it is below 27. CONCLUSIONS: The MoCA is a valid cognitive screening tool for use with prisoners. Further validations against detailed cognitive evaluation would be a useful next step.

Aiming Movement After Stroke: Do Time-Since-Injury and Impairment Severity Influence Ipsilateral Performance?

In this cross-sectional study, we evaluated post-stroke ipsilesional (less affected) upper limb aiming movement in individuals whose strokes were either 2-5 months (n = 16) or >6 months (n = 17) prior to our testing; we also compared both stroke groups to a control group of healthy individuals (n = 14). We evaluated the participants' level of movement impairment in the contralateral upper limb from the site of the cerebrovascular lesion as an indicator of the severity of the participants' impairment. Participants were asked to move a stylus on a tablet with their ipsilesional upper limb according to a visual stimulus seen on a monitor. Those who had experienced more recent strokes showed poorer movement planning and execution, regardless of their impairment level. Since the stroke occurred, the amount of time was significantly associated with the ipsilesional aiming movement, and improvement over time brought performance levels closer to that of healthy controls.

Toulouse-Piéron Cancellation Test: Normative scores for the portuguese population.

The Toulouse-Piéron Cancelation Test (TP) is a classic psychometric tool for the assessment of selective/sustained attention, processing speed and visuo-perceptual abilities. It is commonly used in neurological disorders such as epilepsy, multiple sclerosis or Alzheimer's disease. It encompasses two main indexes: Work-Efficiency (WE) and Dispersion-Index (DI). The aim of this study is to provide normative scores for the TP in a sample of Portuguese healthy adults. The TP was administered to a convenience sample of 357 cognitively-dwelling subjects aged between [45 and 86] years old, following a standard assessment protocol. The normative scores were adjusted for age and education. Education was the main predictor of TP-WE (R2 = .310), whereas the influence of age on this score was lower (R2 = .191). These two variables explained 50.1% of the variance of the results. Regarding TP-DI, education was also the main predictor of the results (R2 = .039), whereas age was responsible for R2 = .011 and together, they explained 5% of the variance of TP-DI. TP performances are strongly influenced by age and education. This is the first study focused on the establishment of normative data after the age of 45 in the Portuguese population, allowing a reliable assessment in both clinical and research contexts.

Exploring the ability of strength and dexterity tests to detect hand function impairment in individuals with Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) can affect hand function since the beginning of the motor symptoms. OBJECTIVE: To compare the ability of different hand function tests to: 1) distinguish individuals with PD from healthy controls; 2) differentiate stages of the disease; and 3) indicate changes over time due to disease progression. METHODS: Twenty-four individuals with PD (Hoehn and Yahr: I-III) and 24 age- and sex-matched controls performed the Jebsen-Taylor Hand Function Test (JTHFT), the Nine-Hole Peg Test (9HPT), and the maximum grip and the maximum pinch strength tests using their right and left hands. Eight individuals with PD (six females and two males) were reassessed after 18 months. The ROC analyses and Mann-Whitney U tests (for disease progression) using the average performance of the hands were done. RESULTS: Individuals with PD presented worse test performances than controls, except for the writing subtest of the JTHFT and the grip strength test. The JTHFT without the writing subtest (JTHFTnoW) was the most accurate to discriminate PD from controls (AUC = 0.899; sensitivity 75% and specificity 95.8%). The 9HPT and the simulated feeding and moving large, light objects JTHFT subtests were sensitive to distinguish stages, while the 9HPT, the moving small, common objects JTHFT subtest, and the grip strength were sensitive to changes with disease progression. CONCLUSION: The JTHFTnoW was highly discriminative of the hand function impairments in PD. TwoJTHFT subtests were the most sensitives to distinguish PD stages (i.e. simulated feeding JTHFT subtest) and disease progression (i.e. moving small, common objects JTHFT subtest).

Cognitive decline complaints scale (CDCS): validation and normative studies for the adults and older adults Portuguese population.

OBJECTIVES: Subjective Cognitive Complaints, which result from the self-perception of Subjective Cognitive Decline, are frequently reported by older adults. The Cognitive Decline Complaints Scale (CDCS) assesses subjective complaints of cognitive decline in several cognitive domains through three levels of severity. This study aims to psychometrically validate this instrument considering the Classical Test Theory, and to establish preliminary normative data of the CDCS for adults and older adults of the Portuguese population. METHODS: The community-based sample consisted of 199 cognitively healthy Portuguese participants, aged 50 years or older, stratified according to several sociodemographic variables. In addition to the CDCS, all participants responded to an extensive neuropsychological assessment protocol. RESULTS: The psychometric characteristics of the CDCS were generally adequate for this community sample (e.g. Cronbach's alpha = .936). As for the sociodemographic variables analyzed, only the geographic region showed differences in the CDCS scores, which were more significant in the Azores. There were no significant correlations or differences between the CDCS scores and age and educational level and, therefore, normative data were explored considering the total sample. CONCLUSION: As a scale, the CDCS allows for the detailed assessment of subjective cognitive complaints and the determination of whether or not such complaints are considered normative, which will facilitate an empirically based understanding of this dimension of psychological functioning and also provide indications as to the need for a more extensive neuropsychological assessment.

Direitos da pessoa com estomias: manual de orientações / Rights of people with ostomies: guidance manual

Este Manual tem como objetivo fornecer orientações sobre os direitos garantidos por leis a pessoa com estomia, assim como os familiares, cuidadores, equipe de enfermagem, equipe multiprofissional e gestores de saúde. Dessa forma espera-se que durante a leitura sejam esclarecidas as dúvidas e auxiliem na busca pelos direitos à assistência à saúde e melhor qualidade de vida da pessoa com estomia

Healthcare decision-making capacity in old age: A qualitative study.

Objectives: Research about decision-making capacity has been growing in the last decades. That relates to more concerns regarding patients' autonomy, and an increase in diseases that can negatively impact capacity. This research aims to: explore perceptions, legal aspects, and assessment procedures related to healthcare decision-making capacity in older adults with cognitive impairment; and study the first version of a new assessment instrument of this capacity. Method: Nine focus groups were conducted, including healthcare, law and justice, nursing home professionals, institutionalized older adults, and dwelling older adults. Focus group discussions followed semi-structured interview scripts, specifically developed for each group. After group discussions, the assessment instrument was presented, and participants were asked to evaluate each item relevance and comprehensibility. Qualitative coding of the transcriptions was performed with resource to MAXQDA, using direct content analysis. Results: Six primary themes emerged from the qualitative analysis: Decision-making capacity features; Abilities implied in decision-making; Factors influencing decision-making; Obstacles to decision-making; Legal aspects; and Assessment procedures. Discussion: Results corroborate previous theoretical formulations of capacity. Generally, research results have implications for clinical and assessment practices, as well as preventive strategies that can improve older adult's decision-making capacity. Assessment procedures of capacity should include a thorough protocol for the assessment of cognition, functionality, depressive symptoms, and decision-making abilities. In this respect, the need for an assessment tool that can provide valid information during evaluation processes is highlighted. Concerning the strategies to promote decision-making capacity, these rely on improving older adult's health literacy and healthcare providers communication skills, as well as conduct actions to reduce stigma toward people with dementia.

Synergic control in asymptomatic welders during multi-finger force exertion and load releasing while standing.

Motor synergies, i.e., neural mechanisms that organize multiple motor elements to ensure stability of actions, are affected by several neurological condition. Asymptomatic welders showed impaired synergy controlling the stability of multi-finger action compared to non-welders and this impairment was associated with microstructural damage in the globus pallidus. We further explored the effect of welding-related metal exposure on multi-finger synergy and extended our investigation to posture-stabilizing synergy during a standing task. Occupational, MRI, and performance-stabilizing synergies during multi-finger accurate force production and load releasing while standing were obtained from 29 welders and 19 age- and sex-matched controls. R2* and R1 relaxation rate values were used to estimate brain iron and manganese content, respectively, and diffusion tensor imaging was used to reflect brain microstructural integrity. Associations of brain MRI (caudate, putamen, globus pallidus, and red nucleus), and motor synergy were explored by group status. The results revealed that welders had higher R2* values in the caudate (p = 0.03), putamen (p = 0.01), and red nucleus (p = 0.08, trend) than controls. No group effect was revealed on multi-finger synergy index during steady-state phase of action (ΔVZss). Compared to controls, welders exhibited lower ΔVZss (-0.106 ± 0.084 vs. 0.160 ± 0.092, p = 0.04) and variance that did not affect the performance variable (VUCM, 0.022 ± 0.003 vs. 0.038 ± 0.007, p = 0.03) in the load releasing, postural task. The postural synergy index, ΔVZss, was associated negatively with higher R2* in the red nucleus in welders (r = -0.44, p = 0.03), but not in controls. These results suggest that the synergy index in the load releasing during a standing task may reflect welding-related neurotoxicity in workers with chronic metals exposure. This finding may have important clinical and occupational health implications.

Hemiplegic shoulder pain affects ipsilesional aiming movements after stroke: a cross-sectional study.

BACKGROUND: Hemiplegic shoulder pain (HSP) is common after stroke. The pain perception may exacerbate changes in the motor behavior of the ipsi-lesional upper limb, contributing to the functional decline of an individual's motor performance. OBJECTIVE: This study evaluates the influence of pain perception on the aiming movements performed with the ipsilesional upper limb in individuals with unilateral chronic stroke. METHODS: A cross-sectional study was conducted with 41 participants divided into three groups: 1) stroke with contralesional shoulder pain ≥ 3 by the Visual Numerical Pain Scale (SPSG; n = 13); 2) stroke no shoulder pain (nSPSG; n = 14); and 3) healthy control (CTG; n = 14) matched by sex and age. Individuals with stroke were matched for the severity of sensorimotor impairment by the Fugl-Meyer upper limb subscale and the injured hemisphere side. Stroke groups performed aiming movements with the ipsilesional upper limb and the CTG with the corresponding limb using a pen tip on the sensitive surface of a digitizing tablet. Performance across groups was compared by one-way analysis of variance, considering the time since injury as a covariate. The planning and execution variables of the movement trajectory were analyzed, and the significance was set at 5%. RESULTS: Trajectories of the SPSG were slower (p = .010; η2 = 0.22), were less smooth (p = .002; η2 = 0.30), had more directional error (p = .002; η2 = 0.28), and were less accurate (p = .034; η2 = 0.17) than the CTG. The nSPSG and CTG showed similar performance. CONCLUSIONS: The perception of pain impairs aiming movements performed with the ipsilesional upper limb in individuals with unilateral chronic stroke.

Developing an Upper Limb Kinematics Database of Activities of Daily Living.

Open-access databases can facilitate data sharing among researchers and provide normative data for objective clinical assessment development, robotic design, and biomechanical modeling. However, most existing databases focus on gait, balance, and hand gestures without providing elbow and shoulder kinematics that are required in activities of daily living. Furthermore, the few existing upper limb datasets include small sample sizes without consistent data collection protocols, which hinder robotic engineers' ability to design robotic devices that accommodate the general population. To address the literature gap, an open-access upper limb kinematic database was proposed. Due to the impact of COVID-19 on human research, only data from 16 participants were collected. Clinical Relevance-This provides baseline kinematics for developing objective clinical assessments and rehabilitation robots.

Planning and Executing Aiming Movements in Middle Childhood.

Harmonious voluntary movements require efficiency in their planning and execution. Throughout middle childhood structural changes in the central nervous and musculoskeletal systems influence these processes and resultant motor behavior. In this study, we evaluated the characteristics of the motor planning and executing of aiming movements directed at targets located in different positions in space in children aged 7, 9, and 11 years. We divided 43 right-handed children, into three age groups and instructed them to perform aiming movements directed at targets using a stylus on a digital tablet. The children performed the movement with their dominant upper limbs from a starting point towards targets positioned ipsilaterally or contralaterally to this dominant limb. We analyzed temporal and spatial variables of motor performance. Younger (7-year-old) children made more errors in the initial movement direction and more frequently corrected their movements during task execution when compared to 9- and 11-year-old children who did not differ from each other. All age groups were similar in movement accuracy and precision. Movements toward contralateral targets were slower and more accurate than movements toward ipsilateral targets for all groups. These results show that performing aiming movements develop with the onset of middle childhood.

The Assessment of Cognitive Reserve: A Systematic Review of the Most Used Quantitative Measurement Methods of Cognitive Reserve for Aging.

The cognitive reserve (CR) is widely accepted as the active ability to cope with brain damage, using preexisting cognitive and compensatory processes. The common CR proxies used are the number of formal years of education, intelligence quotient (IQ) or premorbid functioning, occupation attainment, and participation in leisure activities. More recently, it has employed the level of literacy and engagement in high-level cognitive demand of professional activities. This study aims to identify and summarize published methodologies to assess the CR quantitatively. We searched for published studies on PubMed, ScienceDirect, and Web of Science between September 2018 and September 2021. We only included those studies that characterized the CR assessment methodology. The search strategy identified 1,285 publications, of which 25 were included. Most of the instruments targeted proxies individually. The lack of a gold standard tool that incorporates all proxies and cognitive tests highlights the need to develop a more holistic battery for the quantitative assessment of CR. Further studies should focus on a quantitative methodology that includes all these proxies supported by normative data to improve the use of CR as a valid measure in clinical contexts.

Effects of restraining measures due to COVID-19: Pre- and post-lockdown cognitive status and mental health.

The COVID-19 pandemic has prompted all countries to adopt restraining measures to mitigate the spread of the disease. Usually, large-scale disasters tend to be accompanied by significant increases of psychological distress, depression and anxiety. Confinement measures imposed during the COVID-19 pandemic are likely to have similar consequences. In the present study we aim to evaluate how COVID-19 affected the overall psychological functioning of Portuguese individuals by providing a comparison of current data with status prior to the COVID-19 pandemic. The study sample was composed of 150 cognitively healthy participants. Results show an overall maintenance of cognitive capacities, although subjective cognitive decline complaints significantly increased during the pandemic. Regarding mental health, restraining measures culminated in an aggravation of depressive and decrease of the perceived quality of life, associated with feelings of loneliness and perceived social isolation. Finally, higher levels of pre-COVID-19 quality of life seem to play a protective role against depression and anxiety and predict less difficulties in emotion regulation, feelings of solitude and cognitive complaints. In sum, confinement due to COVID-19 implied an aggravation of the mental health of the Portuguese population, which appears to have been attenuated in those with higher pre-pandemic levels of perceived quality of life.

Decision-Making Capacity in Healthcare: Instruments Review and Reflections About its Assessment in the Elderly with Cognitive Impairment and Dementia.

The prevalence of neurodegenerative diseases has been significantly increasing in the last decades, and it is expected to continue to grow. These health disorders can impair patients' decision-making capacity in healthcare. The capacity to make healthcare decisions is a fundamental pillar of informed consent, therefore, it should be carefully assessed. Clinicians' assessment, when not supported by a standardized tool, has revealed to be unreliable, so the recourse to an instrument of capacity assessment is crucial. The present paper aims to identify and summarize published instruments of healthcare decision-making capacity. To do so, a search of peer-reviewed articles in English, Portuguese and Spanish was conducted. A total of eighteen articles, detailing seventeen assessment instruments were selected. Instruments differ on format, structure, assessed abilities and psychometric properties. Likewise, instruments' targeted population also varies, with a few being specifically developed for patients with dementia. Although a high number of instruments were found, there is still no gold standard for healthcare decision-making capacity assessment. The lack of a gold standard highlights the need for more research in this field, as well as an effort to develop guidelines and normative data, in order to improve clinical practices.