Correction: Sousa et al. Physical Activity, Readiness, and Cardiovascular Risk Stratification in the Polytechnics Communities of the Northern Region of Portugal Integrated in Mobility as a Service Concept. Healthcare 2023, 11, 3145.

In the published article [...].

Assessing Postural Control From Birth to Adulthood Among Individuals Born Preterm: A Systematic Review.

Premature life exposure, meaning an immature central nervous system, presents a significant challenge for the development of postural control and, in turn, overall motor development. Preventing motor delay thus requires identifying, characterizing, and quantifying deficit in postural control as early as possible. In our study, we reviewed the procedures used in past studies to assess postural control among individuals born preterm, specifically the characterization of participants, the instruments and motor tasks involved, the types of data collected and analyzed, and the outcomes. To that end, we performed a literature search on PubMed, Wiley Online Library, Web of Science, and Scopus using Boolean logic and assessed the quality of the studies with a standardized assessment based on the Strengthening the Reporting of Observational Studies in Epidemiology guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Of 35 potential studies, 24 were included; all evaluated infants born preterm, but six did not include a control group of full-term infants. Although the heterogeneity of measurements, variability of instruments, and divergence in motor tasks examined limit definitive conclusions based on quantitative synthesis and the generalization of the results, most studies revealed dysfunctional postural control among individuals born preterm.

Unlocking the Potential: Increasing Muscle Strength in Lower Limbs of Youth Soccer Players over Five Weeks through Mat Pilates Training-A Pilot Study.

The interest in soccer generally starts during childhood, with children and young people often looking for opportunities in sports. New exercise techniques can be effective in improving training. The aim of this study was to compare the effects on the strength and physical posture of a group practicing Pilates with another not practicing Pilates, both undergoing continuous football training. In this controlled randomized clinical trial, the participants were 15 soccer club members, who had a training frequency of least three times weekly. The sample was divided into a control group (n = 7) of players who did not undergo any therapeutic intervention (only the usual training) and a Pilates group (n = 8) of players who participated in the mat Pilates program. The intervention consisted of fifteen sessions. Postural evaluations were performed using biophotogrammetry and force analysis. Significant improvements were obtained in terms of increased muscle strength (p = 0.001) for the Pilates group, but there were no significant postural alterations when comparing the two groups. Five weeks of mat Pilates was sufficient to increase lower limb muscle strength in young football players. This pilot study indicates that Mat Pilates as a method that could be planned to be included in training.

Physical Activity, Readiness, and Cardiovascular Risk Stratification in the Polytechnics Communities of the Northern Region of Portugal Integrated in Mobility as a Service Concept.

The aim of the study is to characterize physical activity (PA) levels and PA readiness as well as stratify cardiovascular risk among the population of polytechnics community members in the north region of Portugal, including students, academic teachers, and non-teacher staff. An online questionnaire about general sample characterization, PA level, and readiness was applied. Of the 717 respondents, 237 were academic teachers, 143 were non-teacher staff, and 337 were students. Most of the participants had a level of moderate PA, including students, academic teachers, and non-teacher staff (82%). The sedentary behavior was higher in the academic teachers and non-teacher staff groups. A total of 56% of the participants had low cardiovascular risk; the group of students were the population with higher risk. Approximately half of the participants need to consult a qualified professional before increasing their PA. Overall, the participants presented moderate levels of PA, although there is still a considerable number of sedentary people that must be considered.

Long-Term Electrode-Skin Impedance Variation for Electromyographic Measurements.

This study aims to observe the evolution of the electrode-skin interface impedance of surface EMG electrodes over the time taken to determine the time of stabilization. Eight healthy subjects participated in the study. Electrode-skin impedance was evaluated in the rectus abdominal muscle every five minutes, over a total period of 50 min. A reduction of 13.23% in the impedance values was observed in minute 10 (p = 0.007), and a reduction of 9.02% was observed in minute 15 (p = 0.029). No statistically significant differences were observed in the other instants evaluated. The findings obtained in the present study demonstrate a decrease in electrode-skin impedance from minute 5 to minute 15, followed by a stabilization period with a low percentage of variation till minute 50.

Breaking Barriers: Artificial Intelligence Interpreting the Interplay between Mental Illness and Pain as Defined by the International Association for the Study of Pain.

Low back pain is one of the main causes of motor disabilities and psychological stress, with the painful process encompassing sensory and affective components. Noxious stimuli originate on the periphery; however, the stimuli are recombined in the brain and therefore processed differently due to the emotional environment. To better understand this process, our objective was to develop a mathematical representation of the International Association for the Study of Pain (IASP) model of pain, covering the multidimensional representation of this phenomenon. Data from the Oswestry disability index; the short form of the depression, anxiety, and stress scale; and pain catastrophizing daily questionnaires were collected through online completion, available from 8 June 2022, to 8 April 2023 (1021 cases). Using the information collected, an artificial neural network structure was trained (based on anomaly detection methods) to identify the patterns that emerge from the relationship between the variables. The developed model proved to be robust and able to show the patterns and the relationship between the variables, and it allowed for differentiating the groups with altered patterns in the context of low back pain. The distinct groups all behave according to the main finding that psychological and pain events are directly associated. We conclude that our proposal is effective as it is able to test and confirm the definition of the IASP for the study of pain. Here we show that the fiscal and mental dimensions of pain are directly associated, meaning that mental illness can be an enhancer of pain episodes and functionality.

Health-Related Telemonitoring Parameters/Signals of Older Adults: An Umbrella Review.

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.

Indicators and Instruments to Assess Components of Disability in Community-Dwelling Older Adults: A Systematic Review.

The epidemiological demands of aging point to the need for characterizing older adults regarding health and disability. This systematic review aims to summarize the indicators (instruments) identifying different components of disability as a result of aging exposition in community-dwelling older adults, considering the International Classification of Functioning, Disability, and Health framework. Taking the PRISMA 2020 recommendations as a reference, studies with community-dwelling older adults, reporting the development and/or age disability modifications were included. Two reviewers analyzed the observational studies searched in the MEDLINE, CINAHL, Web of Science, Scopus, and Embase databases. Of the 137 potentially eligible studies, 49 were included in this review. Several indicators (instruments) demonstrated older adults' disabilities according to the different domains of the ICF. Objective measures assessed Body Structures, Body Functions, and Environmental Factors and included handgrip strength (dynamometry, n = 8), cognitive function (Mini-Mental State examination, n = 7), gait speed (walk test, n = 6), and endurance (Chair stand-test, n = 4). Self-reported measures assessed Activities and Participation, but not the Body Structures, and included the basic and instrumental activities of daily living (ADL) (the Katz Index of ADL, n = 4 studies, the Lawton and Brody Instrumental ADL, n = 4 studies). The summary of the measures gathered can guide researchers and health professionals to select indicators (instruments) to assess and monitor older adults' disabilities resulting from aging exposition, to support the development of new wearables, and to provide improvements to the existing ones, allowing the tailored assessment of different health and disability dimensions.

Effects of Abdominal Microcurrent in the Consumption and Proportion of Energy Substrates during Aerobic Exercise: A Pilot Study.

Microcurrent therapy can increase lipolytic activity. However, it is unknown if the increased availability of lipids can influence the selection of energy substrates during a single session of aerobic exercise. We aimed to analyze the effect of microcurrent application to the abdominal region in the consumption of lipids and carbohydrates, and respiratory exchange ratio (RER) during a single session of moderate aerobic exercise in young adults. A pilot study was conducted in which participants were allocated to intervention (IG) or placebo (PG) groups. In both groups, 40 min of microcurrent application with two frequencies (25 and 10 Hz) followed by 50 min of moderate-intensity aerobic exercise (45−55% of heart rate reserve) on a cycloergometer were performed. The microcurrent application was performed without intensity in the PG. A portable gas analyzer (K4b2) was used during exercise in both groups. Thirty-eight participants (20.6 ± 1.8 years; 18 in IG and 20 in PG) were enrolled. There were no significant differences in the consumption of substrates or RER between the groups during exercise (p > 0.05). Microcurrent application seems to be insufficient to influence the consumption of energy substrates and RER during a single session of aerobic exercise in young adults.

Postural control during turn on the light task assisted by functional electrical stimulation in post stroke subjects.

Postural control mechanisms have a determinant role in reaching tasks and are typically impaired in post-stroke patients. Functional electrical stimulation (FES) has been demonstrated to be a promising therapy for improving upper limb (UL) function. However, according to our knowledge, no study has evaluated FES influence on postural control. This study aims to evaluate the influence of FES UL assistance, during turning on the light task, in the related postural control mechanisms. An observational study involving ten post-stroke subjects with UL dysfunction was performed. Early and anticipatory postural adjustments (EPAs and APAs, respectively), the weight shift, the center of pressure and the center of mass (CoM) displacement were analyzed during the turning on the light task with and without the FES assistance. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists' and patients' perspectives. The ANOVA repeated measures, Paired sample t and McNemar tests were used to compare postural control between the assisted and non-assisted conditions. When the task was assisted by FES, the number of participants that presented APAs increased (p = 0.031). UL FES assistance during turning on the light task can improve postural control in neurological patients with UL impairments.

Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review.

Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.

Optimal multi-field functional electrical stimulation parameters for the "drinking task - reaching phase" and related upper limb kinematics repeatability in post stroke subjects.

BACKGROUND: No specific guidelines for the management of functional electrical stimulation (FES) parameters in post stroke patients have been defined yet, despite its frequent use. The purpose of this study is to characterize the optimal FES parameters that assist the reaching phase of drinking task ("drinking task - reaching phase") on post stroke subjects and to analyze the related upper limb (UL) movement quality indicators repeatability. METHODS: An observational study with a test and re-test design involving ten post stroke subjects with UL dysfunction was performed. End-point and joint kinematics of contralesional UL were assessed during the "drinking task - reaching phase" with FES through a test and retest design. FES parameters were adjusted to improve UL function according to a consensus between physiotherapists and patients' perspective. FINDINGS: It was possible to establish reliable FES parameters that assisted the "drinking task - reaching phase". All FES parameters presented high to very high repeatability and led to moderate to very high repeatability in almost UL movement quality indicators during the "drinking task - reaching phase". INTERPRETATION: These findings show that the main characteristics of FES parameters that improves patient perception of change are quite stable, which facilitate its implementation in clinical practice by allowing consistence between intervention sessions.

Systematic Review on the Applicability of Principal Component Analysis for the Study of Movement in the Older Adult Population.

Principal component analysis (PCA) is a dimensionality reduction method that has identified significant differences in older adults' motion analysis previously not detected by the discrete exploration of biomechanical variables. This systematic review aims to synthesize the current evidence regarding PCA use in the study of movement in older adults (kinematics and kinetics), summarizing the tasks and biomechanical variables studied. From the search results, 1685 studies were retrieved, and 19 studies were included for review. Most of the included studies evaluated gait or quiet standing. The main variables considered included spatiotemporal parameters, range of motion, and ground reaction forces. A limited number of studies analyzed other tasks. Further research should focus on the PCA application in tasks other than gait to understand older adults' movement characteristics that have not been identified by discrete analysis.

Optimal Multifield Functional Electrical Stimulation Parameters for the "Turn on the Light" Task and Related Upper Limb Kinematics Repeatability in Poststroke Subjects.

OBJECTIVE: To characterize the optimal functional electrical stimulation (FES) parameters that assist the turn on the light task (TOTL) on poststroke participants and to analyze the related upper limb (UL) kinematics repeatability. DESIGN: Cross-sectional study. SETTING: Human movement research center. PARTICIPANTS: Poststroke individuals (N=11) with history of a single unilateral stroke that resulted in a motor control dysfunction of the contralesional UL. INTERVENTIONS: FES based on surface multifield technology applied to the contralesional wrist and finger extensors during the TOTL. MAIN OUTCOME MEASURES: FES outcome metrics (virtual electrodes, stimulation duration, intensity) and kinematic metrics (end-point kinematics [absolute and relative duration, mean and peak velocities, relative instant of peak velocity, index of curvature, number of movement units] and joint kinematics [shoulder, elbow, wrist end position and range of movement]). Outcome measures were assessed 2 times with a 72-hour maximum time interval. CONCLUSION: It was possible to establish reliable FES parameters that assisted the TOTL on poststroke participants. These stimulation parameters led to high to very high repeatability in terms of UL kinematics for most of the cases.

Does the cleat model interfere with ankle sprain risk factors in artificial grass?

BACKGROUND: The cleats-surface interaction has been described as a possible risk factor for lateral ankle sprain. However, their interaction is still unknown in individuals with chronic ankle instability. The purpose of this study was to determine the influence of different soccer cleats on kinematic, kinetic and neuromuscular ankle variables on artificial grass in soccer players with and without chronic ankle instability. METHODS: Eighty-two amateur athletes divided in two groups: 40 with chronic ankle instability and 42 without chronic ankle instability. All subjects performed 2 series of 6 consecutive crossover jumps with dominant foot, each one with one of the four models of cleats (Turf, Artificial grass, Hard and Firm ground). Cleat and group main effect and interactions of kinematic, kinetic and neuromuscular variables were analyzed according to factorial repeated measures ANOVA. FINDINGS: No statistically significant cleat and group main effect and interactions were identified in kinematic, kinetic and electromyographic magnitude of the peroneal muscles. A main effect of the group was observed for peroneus longus activation time for TF model (p = 0.010). INTERPRETATION: In soccer players, the contributor variables for ankle sprain were not influenced by the kind of soccer cleat used in a functional jump test on artificial grass. However, players with chronic ankle instability present delayed postural adjustments in peroneus longus with the TF model compared to players without chronic ankle instability.

Reliability of two methods for identifying the timing of medium latency responses in subjects with and without chronic ankle instability.

This study aims to: (1) to compare 2 methods of assessing the timing of medium latency responses (MLR), in regard to intrasession reliability and mean values, in subjects with and without chronic ankle instability (CAI), and (2) to analyze the influence of CAI in timing of MLR and in its reliability. Thirty six athletes with (16) and without (20) CAI participated. Bilateral electromyography of peroneus longus (PL), peroneus brevis (PB), tibialis anterior (TA) and soleus (SOL) muscles was collected during a unilateral sudden inversion perturbation to assess the timing of MLR onset, in both standing and perturbed positions, through a baseline-based method and a peak-response-based method. The group without CAI presented higher relative reliability of SOL and peroneal muscles MLR with the peak response-based method than with the baseline-based method. Compared with the group without CAI and in both methods, the group with CAI presented a delayed and less reliable TA MLR, as well decreased coefficient variation of PL MLR in the uninjured limb. In conclusion, regardless of the method subjects with CAI present delayed and less reliable TA MLR while in subjects without CAI the peak response-based method provides higher reliability.

Different Cleat Models Do Not Influence Side Hop Test Performance of Soccer Players with and Without Chronic Ankle Instability.

The lateral ankle sprain is one of the most common sport injury, representing 10-30% of all musculoskeletal disorders. The lateral ankle sprain is induced by sport gestures involving changes of direction and landing manoeuvres and constitutes a risk factor for the occurrence of chronic ankle instability. Although cleat models and performance have been already explored, no study has evaluated this relationship in athletes with chronic ankle instability. Therefore, the purpose of the study was to analyse the influence of different soccer cleat models on Side Hop Test performance of athletes with and without chronic ankle instability. Thirty-nine athletes were divided into two groups, a chronic ankle instability group (n = 20) and a healthy group (n = 19). Each participant performed the Side Hop Test, executing 10 consecutive jumps on dry artificial grass with 4 cleat models. The Qualisys System and two force platforms were used to analyse the test runtime, the distance travelled and the mean velocity. No statistically significant interaction was observed between the group and the cleat model for all variables evaluated. In addition, no differences were observed between models or groups. In this specific test, performance does not seem to be influenced by different cleat models on dry artificial grass in athletes with and without chronic ankle instability.

Anticipatory postural adjustments in the shoulder girdle in the reach movement performed in standing by post-stroke subjects.

After a stroke in middle cerebral artery territory, there is a high probability of dysfunction of the ventromedial pathways, mainly related with postural control mechanisms such as the anticipatory postural adjustments (APAs). According to neuroanatomical knowledge, these pathways have a predominant ipsilesional disposition, which justifies a bilateral postural control dysfunction, often neglected in rehabilitation. In order to assess this bilateral postural control dysfunction, electromyography activity was assessed in eight post-stroke and 10 healthy individuals in the anterior deltoids, the superior and lower trapezius, and the latissimus dorsi as they reached for a bottle with both upper limbs separately at a self-selected velocity and fast velocity while standing associated with trunk kinematics analysis. Through this analysis it was possible to compare the timing of APAs in scapular muscles between sides in post-stroke and with healthy individuals, and to verify if there is a relation between the timing and the displacement of the trunk in the temporal window of the APAs. Indeed, post-stroke individuals show a delayed activation of APAs on scapular girdle muscles on both ipsilesional and contralesional sides, which were not reflected in the trunk displacement.

Bilateral compensatory postural adjustments to a unilateral perturbation in subjects with chronic ankle instability.

BACKGROUND: To evaluate the magnitude of bilateral compensatory postural adjustments in response to a unilateral sudden inversion perturbation in subjects with chronic ankle instability. METHODS: 24 athletes with chronic ankle instability (14 with functional ankle instability, 10 with mechanical ankle instability) and twenty controls participated in this study. The bilateral electromyography of ankle muscles was collected during a unilateral sudden ankle inversion to assess the magnitude of subcortical and voluntary compensatory postural adjustments in both the perturbed and the contralateral limb (support limb). FINDINGS: In the support position, compared to the control group, the group with functional ankle instability presented decreased compensatory postural adjustments of the tibialis anterior in both the injured and the uninjured limbs in the support position and of the soleus in the uninjured limb. In the side of the perturbation, participants with functional ankle instability presented decreased soleus compensatory postural adjustments in the uninjured limb when compared to the control group. Increased values of soleus and peroneal brevis compensatory postural adjustments were observed in the group with mechanical instability when compared to the control group and to the group with functional ankle instability. INTERPRETATION: Subjects with functional ankle instability present bilateral impairment of compensatory postural adjustments of the tibialis anterior in a support position and of the soleus of the uninjured limb regardless of the position. Subjects with mechanical instability present bilateral increase of these adjustments in the peroneal brevis regardless of the position and in the soleus muscle in the side of the perturbation.

The role of the ipsilesional side in the rehabilitation of post-stroke subjects.

Most stroke lesions occur in the middle cerebral artery territory, presenting a high probability of damage of pathways with predominant ipsilesional disposition, mainly related to postural control. Despite the high probability of bilateral postural control dysfunction based on neuroanatomical fundaments, both research and clinical rehabilitation involving stroke subjects have been focused on contralesional side (also named affected side) impairments, while ipsilesional side (also named non-affected side) impairments have been attributed to an adaptive strategy. This paper aims to present a critical understanding about the state-of-the-art that sustains the hypothesis that stroke subjects with middle cerebral artery territory lesion at the subcortical level show an atypical behaviour in the ipsilateral side associated with the lesion itself and the possible implications.