Publications by authors named "Emerson Fachin-Martins"

28 Publications

  • Page 1 of 1

A Novel Framework for Quantifying Accuracy and Precision of Event Detection Algorithms in FES-Cycling.

Sensors (Basel) 2021 Jul 3;21(13). Epub 2021 Jul 3.

National Institute for Research in Computer Science and Automation (Inria), Camin Team, 34090 Montpellier, France.

Functional electrical stimulation (FES) is a technique used in rehabilitation, allowing the recreation or facilitation of a movement or function, by electrically inducing the activation of targeted muscles. FES during cycling often uses activation patterns which are based on the crank angle of the pedals. Dynamic changes in their underlying predefined geometrical models (e.g., change in seating position) can lead to desynchronised contractions. Adaptive algorithms with a real-time interpretation of anatomical segments can avoid this and open new possibilities for the automatic design of stimulation patterns. However, their ability to accurately and precisely detect stimulation triggering events has to be evaluated in order to ensure their adaptability to real-case applications in various conditions. In this study, three algorithms (Hilbert, BSgonio, and Gait Cycle Index (GCI) Observer) were evaluated on passive cycling inertial data of six participants with spinal cord injury (SCI). For standardised comparison, a linear phase reference baseline was used to define target events (i.e., 10%, 40%, 60%, and 90% of the cycle's progress). Limits of agreement (LoA) of ±10% of the cycle's duration and Lin's concordance correlation coefficient (CCC) were used to evaluate the accuracy and precision of the algorithm's event detections. The delays in the detection were determined for each algorithm over 780 events. Analysis showed that the Hilbert and BSgonio algorithms validated the selected criteria (LoA: +5.17/-6.34% and +2.25/-2.51%, respectively), while the GCI Observer did not (LoA: +8.59/-27.89%). When evaluating control algorithms, it is paramount to define appropriate criteria in the context of the targeted practical application. To this end, normalising delays in event detection to the cycle's duration enables the use of a criterion that stays invariable to changes in cadence. Lin's CCC, comparing both linear correlation and strength of agreement between methods, also provides a reliable way of confirming comparisons between new control methods and an existing reference.
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http://dx.doi.org/10.3390/s21134571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272114PMC
July 2021

Intra- and inter-rater reliability for the measurement of the cross-sectional area of ankle tendons assessed by magnetic resonance imaging.

Acta Radiol 2021 Jul 11:2841851211003284. Epub 2021 Jul 11.

Graduate Program in Physical Education Sciences, University of Brasília (UnB), Brasília, Brazil.

Background: The cross-sectional area (CSA) records make an essential measurement for determining the mechanical properties of tendons, such as stress and strength. However, there is no consensus regarding the best method to record the CSA from different tendons.

Purpose: To determine intra- and inter-rater reliability for CSA measures from magnetic resonance imaging (MRI) of the following tendons: tibialis anterior; tibialis posterior; fibularis longus and brevis; and Achilles.

Material And Methods: We designed an observational study with repeated measures taken from a convenience sample of 20 participants diagnosed with acute or chronic ankle sprain. Two independent raters took three separate records from the CSA of ankle tendon images of each MRI slice. The intra-class correlation coefficient (ICC) and 95% limits of agreement (LoA) defined the quality (associations) and magnitude (differences), respectively, of intra- and inter-rater reliability on the measures plotted by the Bland-Altman method.

Results: Data showed very high intra- and inter-rater correlations for measures taken from all tendons analyzed (ICC 0.952-0.999). It also revealed an excellent agreement between raters (0.12%-2.3%), with bias no higher than 2 mm and LoA in the range of 4.4-7.9 mm. The differences between repeated measures recorded from the thinnest tendons (fibularis longus and brevis) revealed the lowest bias and narrowest 95% LoA.

Conclusion: Reliability for the CSA of ankle tendons measured from MRI taken by independent rates was very high, with the smallest differences between raters observed when the thinnest tendon was analyzed.
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http://dx.doi.org/10.1177/02841851211003284DOI Listing
July 2021

Physiotherapy interventions for the treatment of spasticity in people with spinal cord injury: a systematic review.

Spinal Cord 2021 Mar 9;59(3):236-247. Epub 2021 Feb 9.

John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, C/- Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.

Study Design: Systematic review.

Objective: To determine the effectiveness of physiotherapy interventions for the treatment of spasticity in people with spinal cord injuries.

Setting: Not applicable.

Methods: A comprehensive search was undertaken to identify all randomised controlled trials of physiotherapy interventions that included an assessor-reported (objective) or participant-reported (subjective) measure of spasticity. Only trials that provided a physiotherapy intervention on more than one occasion were included. The susceptibility to bias of each trial was rated on the PEDro scale. Data were extracted to derive mean between-group differences (95% CI) for each trial.

Results: Twenty-eight trials were identified but only 17 provided useable data. Seven trials compared a physiotherapy intervention to no intervention (or a sham intervention) and 10 trials compared one physiotherapy intervention to another physiotherapy intervention. The median (IQR) PEDro score of the 17 trials was 6/10 (6-8). The most commonly used assessor- and participant-reported measures of spasticity were the Ashworth scale and Spinal Cord Injury Spasticity Evaluation Tool, respectively. Only one trial demonstrated a treatment effect. This trial compared continuous passive motion of the ankle to no treatment on the Ashworth scale. The remaining 16 trials were either inconclusive or indicated that the treatment was ineffective for reducing spasticity.

Conclusions: There is no high-quality evidence to indicate that physiotherapy interventions decrease spasticity but this may reflect a lack of research on the topic. Future trials should focus on participant-reported measures of spasticity that distinguish between the immediate, short-term and long-term effects of any physiotherapy intervention.
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http://dx.doi.org/10.1038/s41393-020-00610-4DOI Listing
March 2021

Standardizing fatigue-resistance testing during electrical stimulation of paralysed human quadriceps muscles, a practical approach.

J Neuroeng Rehabil 2021 01 21;18(1):11. Epub 2021 Jan 21.

INRIA - LIRMM, Université de Montpellier, Montpellier, France.

Background: Rapid onset of muscular fatigue is still one of the main issues of functional electrical stimulation (FES). A promising technique, known as distributed stimulation, aims to activate sub-units of a muscle at a lower stimulation frequency to increase fatigue-resistance. Besides a general agreement on the beneficial effects, the great heterogeneity of evaluation techniques, raises the demand for a standardized method to better reflect the requirements of a practical application.

Methods: This study investigated the fatigue-development of 6 paralysed quadriceps muscles over the course of 180 dynamic contractions, evaluating different electrode-configurations (conventional and distributed stimulation). For a standardized comparison, fatigue-testing was performed at 40% of the peak-torque during a maximal evoked contraction (MEC). Further, we assessed the isometric torque for each electrode-configuration at different knee-extension-angles (70°-170°, 10° steps).

Results: Our results showed no significant difference in the fatigue-index for any of the tested electrode-configurations, compared to conventional-stimulation. We conjecture that the positive effects of distributed stimulation become less pronounced at higher stimulation amplitudes. The isometric torque produced at different knee-extension angles was similar for most electrode-configurations. Maximal torque-production was found at 130°-140° knee-extension-angle, which correlates with the maximal knee-flexion-angles during running.

Conclusion: In most practical applications, FES is intended to initiate dynamic movements. Therefore, it is crucial to assess fatigue-resistance by using dynamic contractions. Reporting the relationship between produced torque and knee-extension-angle can help to observe the stability of a chosen electrode-configuration for a targeted range-of-motion. Additionally, we suggest to perform fatigue testing at higher forces (e.g. 40% of the maximal evoked torque) in pre-trained subjects with SCI to better reflect the practical demands of FES-applications.
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http://dx.doi.org/10.1186/s12984-021-00805-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818559PMC
January 2021

Pain mapping and health-related conditions in relation to forearm crutch usage: A cross-sectional study.

Assist Technol 2020 Oct 13:1-7. Epub 2020 Oct 13.

NTAAI - Núcleo De Tecnologia Assistiva, Acessibilidade E Inovação, Universidade De Brasília, Brasília, Brazil.

To explore pain complaints and health-related conditions, verifying if permanent or temporary usage of forearm crutches could be associated with them. We designed a cross-sectional study from a sample who answered a five-month public call. We organized data into five domains: (1) diseases, signs and symptoms; (2) personal factors related to age, sex, marital status, and paid occupation; (3) body structure and functional components defined by body mass index, arterial pressure, mental state, and pain; (4) activities and participation assessed by satisfaction with Assistive Technology; (5) and environmental factors focused on medicines and forearm crutch usage. The sample was geo-referenced by address, and the frequency of the codified health conditions was distributed according to ICD-10's chapters. We recruited three times more permanent than temporary users dealing with chronic and external causes of diseases. Pain mapping suggested different pattern of complaints between permanent and temporary users. Women who were temporary users seemed more likely to be injured because of external causes. Moreover, both users reported intense (31%) and moderate (53%) levels of pain. In contrast, mild pains were only reported by permanent users (16%), suggesting a distinction between acute and chronic pain according to the kind of forearm crutch usage.
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http://dx.doi.org/10.1080/10400435.2020.1819914DOI Listing
October 2020

Responsiveness of the Motor Capacities Scale to upper limb reconstructive surgery in persons with tetraplegia due to cervical spinal cord injury.

Spinal Cord 2020 Sep 1;58(9):1004-1014. Epub 2020 Apr 1.

NTAAI - Núcleo de Tecnologia Assistiva, Acessibilidade e Inovação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil.

Study Design: Psychometric Study.

Objectives: To assess responsiveness of the Motor Capacities Scale (MCS) in people with tetraplegia who have undergone upper limb reconstructive surgery.

Settings: Rehabilitation clinics in France.

Methods: The MCS is an arm/hand function test with 31 basic tasks, subdivided into four sub-categories (MCS A, MCS B, MCS C, and MCS D). Data were recorded preoperatively and following full completion of the surgical program. The Functional Independence Measure (FIM) and a ten-point numeric scale related to patients' satisfaction with the overall surgical result were included. Data were analyzed using responsiveness measures-the effect size (ES), the standardized response mean (SRM), and the minimal clinically important difference (MCID).

Results: Twenty-seven participants were included. Fourteen patients underwent unilateral surgery and 13 bilateral surgery. ES and SRM were moderate or good (ES/SRM of MCS B = 0.76/0.81, ES/SRM MCS C = 0.68/0.77, and ES/SRM MCS D = 0.77/0.88). For MCS A and FIM, both SRM and ES showed a small degree of responsiveness. For the MCS total score, the ES value indicated a moderate degree of responsiveness while SRM was excellent. Total MCS score, MCS C subscore and MCS D subscore showed significantly higher ES values in the "bilateral surgery" group than in the "unilateral group". The estimation of MCIDs showed low threshold values of MCS scores changes (total score and subscores) beyond which the satisfaction rate is >6.

Conclusions: This study provides evidence of acceptable responsiveness of the MCS to changes using the SRM following upper limb reconstruction in patients with tetraplegia.
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http://dx.doi.org/10.1038/s41393-020-0456-0DOI Listing
September 2020

Cross-cultural adaptation and reliability of the Brazilian version of the wheelchair skills test-questionnaire 4.3 for manual wheelchair users.

Assist Technol 2019 Dec 11:1-7. Epub 2019 Dec 11.

Department of Occupational Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil.

The Wheelchair Skills Test-Questionnaire form for Manual Wheelchairs Operated by Wheelchair Users (WSTQ-M-WCU 4.3) assesses wheelchair skills that may influence users' occupational performance in their daily activities. The purpose of this study was to cross-culturally adapt the WSTQ-M-WCU 4.3 to Brazilian Portuguese and to examine the inter-rater and test-retest reliabilities. This is a methodological study of cross-cultural adaptation and psychometric properties of reliability. The agreement achieved in the cross-cultural adaptation concerning idiomatic, cultural, conceptual and semantic aspects was 100%, 99.2%, 100% and 96.18%, respectively. We analyzed the test-retest and inter-rater reliabilities in a convenience sample of 46 manual wheelchair users using Cronbach's Alpha and Bland-Altman plots. The Brazilian version has excellent internal consistency (α > 0.9) and strong inter-rater reliability ( < .05). This instrument can guide practitioners in training wheelchair skills, thus contributing to the planning of interventions and for evidence-based practice in Assistive Technology.
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http://dx.doi.org/10.1080/10400435.2019.1697906DOI Listing
December 2019

Assisted Grasping in Individuals with Tetraplegia: Improving Control through Residual Muscle Contraction and Movement.

Sensors (Basel) 2019 Oct 18;19(20). Epub 2019 Oct 18.

INRIA, University of Montpellier, 34095 Montpellier, France.

Individuals who sustained a spinal cord injury often lose important motor skills, and cannot perform basic daily living activities. Several assistive technologies, including robotic assistance and functional electrical stimulation, have been developed to restore lost functions. However, designing reliable interfaces to control assistive devices for individuals with C4-C8 complete tetraplegia remains challenging. Although with limited grasping ability, they can often control upper arm movements via residual muscle contraction. In this article, we explore the feasibility of drawing upon these residual functions to pilot two devices, a robotic hand and an electrical stimulator. We studied two modalities, supra-lesional electromyography (EMG), and upper arm inertial sensors (IMU). We interpreted the muscle activity or arm movements of subjects with tetraplegia attempting to control the opening/closing of a robotic hand, and the extension/flexion of their own contralateral hand muscles activated by electrical stimulation. Two groups were recruited: eight subjects issued EMG-based commands; nine other subjects issued IMU-based commands. For each participant, we selected at least two muscles or gestures detectable by our algorithms. Despite little training, all participants could control the robot's gestures or electrical stimulation of their own arm via muscle contraction or limb motion.
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http://dx.doi.org/10.3390/s19204532DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832396PMC
October 2019

Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients.

PLoS One 2019 27;14(6):e0219057. Epub 2019 Jun 27.

Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil.

Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571-1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219057PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597100PMC
February 2020

Functional mobility assessment is reliable and correlated with satisfaction, independence and skills.

Assist Technol 2019 Jul 16:1-7. Epub 2019 Jul 16.

Department of Occupational Therapy, Universidade Federal de São Carlos (UFSCar) , São Carlos , Brazil.

Mobility is essential for activities of daily living and therapists should give priority to evaluate its effects in their client's performance. We aimed to ascertain the intra- and inter-rater reliability of Functional Mobility Assessment (FMA) and to identify correlations among satisfaction, independence, and skills in 44 users of manual wheelchairs and three users of powered wheelchairs. We analyzed the test-retest and inter-rater reliability of the FMA in a sample of 47 wheelchair users using the Cronbach's Alpha. For correlations with FMA were used the Quebec User Evaluation of Satisfaction with Assistive Technology, Functional Independence Measure, and Wheelchair Skills Test Questionnaire (manual and powered forms). The test-retest reliability showed good internal consistency (α > 0.9). Associations between functional independence, wheelchair skills, and functional mobility were significant ( < .05). The Brazilian version of the FMA is reliable for use among wheelchair users, and its correlation with other measurements suggests cohesion among assessments related to mobility devices.
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http://dx.doi.org/10.1080/10400435.2019.1629125DOI Listing
July 2019

Intra and inter-raters reliability and agreement of stimulus electrodiagnostic tests with two different electrodes in sedated critically-ill patients.

Physiother Theory Pract 2020 Dec 9;36(12):1447-1456. Epub 2019 Feb 9.

College of Ceilândia, Centro Metropolitano, University of Brasília , Brasília, Federal District, Brazil.

The aim of the present study was to verify the intra- and inter-rater reliability and agreement of the stimulus electrodiagnostic test (SET) measurements obtained by pen and square electrodes in the vastus lateralis and tibialis anterior muscles. An intra- and inter-rater reliability and agreement study was performed for the SET by two independent raters. Two different sizes of cathode electrodes (1 cm and 25 cm) and two muscles were assessed (tibialis anterior and vastus lateralis). Chronaxie did not change according to the different electrodes. A high intra-rater reliability (0.72 ≤  ≤ 0.88) was detected independently of the electrode and muscle assessed. Moreover, moderate and almost perfect agreements (0.51 ≤ Kappa ≤ 1.00) were detected on intra-rater assessment. Similar correlations (0.74 ≤  ≤ 0.79) were found for intra-rater reliability. However, dissimilar inter-rater agreement was detected: Kappa ≤ 0.40 for tibialis anterior and Kappa = 1.00 for vastus lateralis. The SET presented high reliability and moderate agreement in intra-rater evaluations. A fair agreement was found in the inter-rater assessment of the tibialis anterior. Evaluations performed with different electrode sizes did not influence the results. Therefore, the SET should be performed by a unique rater in test retest situations.
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http://dx.doi.org/10.1080/09593985.2019.1567890DOI Listing
December 2020

Effect of electrical stimulation on muscle atrophy and spasticity in patients with spinal cord injury - a systematic review with meta-analysis.

Spinal Cord 2019 Apr 29;57(4):258-266. Epub 2019 Jan 29.

Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, FL, USA.

Study Design: This work is a systematic review with meta-analysis OBJECTIVE: Evaluate the effect of electrical stimulation (ES) on skeletal muscle volume and spasticity in individuals with spinal cord injury (SCI).

Setting: University of Brasilia, Brazil METHODS: Searches were conducted of the Cochrane Library, MEDLINE, CINAHL, PEDro, PsycINFO and EMBASE electronic databases for relevant articles published up to June 2018. No restrictions were imposed regarding the year of publication. The inclusion criteria were randomized controlled trials involving adults with SCI comparing ES to an active or passive control. Two independent reviewers extracted the data from the selected studies and methodological quality was assessed using the PEDro scale.

Results: The initial search led to the retrieval of 164 studies, seven of which met the eligibility criteria, but only six were included in the meta-analysis. The six studies comprised 104 patients with complete or incomplete SCI. In the two studies that investigated the use of ES on muscle volume of the lower limbs, the overall effect was statistically significant in patients with acute SCI (mean difference: 0.86; 95% CI: 0.04 to 1.69; p < 0.04). Among the four studies that examined the use of ES for spasticity of the lower limb, the overall effect was non-significant (mean difference: 0.55; 95% CI: -0.31 to 1.41; p = 0.21).

Conclusions: Electrical stimulation was found to be an effective method for increasing muscle volume in SCI patients, but had no effect on spasticity. Further investigation of the effect of ES on spasticity in SCI is needed.
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http://dx.doi.org/10.1038/s41393-019-0250-zDOI Listing
April 2019

Overview of FES-Assisted Cycling Approaches and Their Benefits on Functional Rehabilitation and Muscle Atrophy.

Adv Exp Med Biol 2018;1088:561-583

NTAAI - Núcleo de Tecnologia Assistiva, Acessibilidade e Inovação, Campus de Ceilândia, Universidade de Brasília, Brasília, Brazil.

Central nervous system diseases include brain or spinal cord impairments and may result in movement disorders almost always manifested by paralyzed muscles with preserved innervations and therefore susceptible to be activated by electrical stimulation. Functional electrical stimulation (FES)-assisted cycling is an approach mainly used for rehabilitation purposes contributing, among other effects, to restore muscle trophism. FES-assisted cycling has also been adapted for mobile devices adding a leisure and recreational benefit to the physical training. In October 2016, our teams (Freewheels and EMA-trike) took part in FES-bike discipline at the Cybathlon competition, presenting technologies that allow pilots with spinal cord injury to use their paralyzed lower limb muscles to propel a tricycle. Among the many benefits observed and reported in our study cases for the pilots during preparation period, we achieved a muscle remodeling in response to FES-assisted cycling that is discussed in this chapter. Then, we have organized some sections to explore how FES-assisted cycling could contribute to functional rehabilitation by means of changes in the skeletal muscle disuse atrophy.
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http://dx.doi.org/10.1007/978-981-13-1435-3_26DOI Listing
July 2019

Inter-rater and test/retest reliabilities of the isokinetic measurements: assessing strength and endurance of the trunk muscles in two different protocols for able-bodied and post-stroke hemiparesis.

Top Stroke Rehabil 2018 09 20;25(6):424-431. Epub 2018 Jul 20.

b PPGCTS - Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, UnB - Campus de Ceilândia , Universidade de Brasília , Brasília , Brazil.

Background Stroke represents the largest cause of chronic disability resulting in muscle weakness and instability in the trunk muscles. Despite the reliable measures from isokinetic devices for upper/lower limb muscles, there is a lack of measures for trunk muscles in post-stroke hemiparesis. Objectives To investigate the reliability of the strength and endurance measures from an isokinetic dynamometer for able-bodied and post-stroke hemiparesis people. Methods The measures were taken from both groups (control/hemiparesis) performing antagonistic movements (flexion/extension) during different protocols (seated-compressed and semi-standing) to assess strength (60º/s) and endurance (120º/s). The intra-class correlation coefficient (ICC) and limits of agreement (LOA) defined the quality and magnitude of reliability on the measurements plotted with 95% confidence interval (95% CI) by Bland-Altman method. Results ICC ranged from 0.58 to 0.99, with few ICC values classified as moderate when repeated by raters during test and a single value during retest. The total work was the only variable to present LOA higher than the limits. Conclusion Results indicate acceptable reliability, in two different protocols, confirming the repeatability of the isokinetic measures for trunk muscles in able-bodied and post-stroke hemiparesis.
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http://dx.doi.org/10.1080/10749357.2018.1481568DOI Listing
September 2018

Training with FES-assisted cycling in a subject with spinal cord injury: Psychological, physical and physiological considerations.

J Spinal Cord Med 2020 05 12;43(3):402-413. Epub 2018 Jul 12.

Institut National de Recherche en Informatique et Automatique, CAMIN Université de Montpellier, France.

Context: People with spinal cord injury (SCI) experience the effects of a sedentary lifestyle very early on. Literature data suggest that programs using FES-assisted cycling would contribute to reduce the consequences of physical inactivity. The objective was to assess the feasibility of 12-month training on a FES-assisted bike of a subject with paraplegia for 21 years, T3, Asia Impairment Scale (AIS) A. An evaluation of morbidity, self-esteem, satisfaction, quality of life and duration of pedaling was performed. The impact on pain, cardiorespiratory function, body composition and bone metabolism were also assessed.

Findings: The acceptability score of the training constraints increased from 51 to 59/65 and satisfaction was high around 8/10. The pedaling duration increased from 1' to 26' on the recumbent bike and from 1' to 15' on open terrain. No significant changes were found with BMD and cardiorespiratory measures during exercise tests. SF 36 showed significant improvement of more than 10% and the Rosenberg Self Esteem score rapidly improved from 36 to 39/40. At the end of the training, the patient reached the objective of the Cybathlon 2016 by covering 750 m in less than 8 minutes, at an average speed of 5.80 km/hr.

Conclusion/clinical Relevance: A person with high and complete level of SCI for more than 20 years can undertake this type of challenge if the prerequisites are met; this training is without danger if the safety precautions are respected; the challenge of participating in a competition had a powerful impact on JP's self-esteem and perceived quality of life.
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http://dx.doi.org/10.1080/10790268.2018.1490098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249253PMC
May 2020

Computer assistive technology and associations with quality of life for individuals with spinal cord injury: a systematic review.

Qual Life Res 2018 Mar 7;27(3):597-607. Epub 2018 Feb 7.

NTAAI - Núcleo de Tecnologia Assistiva, Acessibilidade e Inovação, Universidade de Brasília, Brasília, Distrito Federal, Brazil.

Study Design: Systematic review.

Objective: The purpose of the study was to identify and organize evidence regarding quality of life influenced by assistive technology related to computers for people with traumatic and non-traumatic spinal cord injury (SCI).

Setting: Distrito Federal, Brazil.

Methods: A search strategy was conducted on the PubMed, PEDro, LILACS, PsycINFO, and SCIELO. All types of study designs considering assistive technology to improve quality of life for individuals with SCI were included. After search strategy procedures, ten references were included to review. The methodologic quality of each study was evaluated using the Level of Evidence proposed by the Oxford Centre for Evidence-based Medicine.

Results: Most of the studies showed that devices for computer access improve the quality of life of people with SCI, regardless of the level of injury and type of resource. However, the positive outcomes in the quality of life should be interpreted with caution, as several methodological limitations were observed in the articles.

Conclusions: Despite the scarcity of studies and their methodological limitations, there is evidence that assistive technology for computer access favors the quality of life of people with tetraplegia due to SCI, since it improves participation, independence, and self-esteem.
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http://dx.doi.org/10.1007/s11136-018-1804-9DOI Listing
March 2018

Comparison of strategies and performance of functional electrical stimulation cycling in spinal cord injury pilots for competition in the first ever CYBATHLON.

Eur J Transl Myol 2017 Dec 5;27(4):7219. Epub 2017 Dec 5.

Sensory-Motor Systems Lab, ETH Zurich, Switzerland.

Functional Electrical Stimulation (FES) can elicit muscular contraction and restore motor function in paralyzed limbs. FES is a rehabilitation technique applied to various sensorimotor deficiencies and in different functional situations, e.g. grasping, walking, standing, transfer, cycling and rowing. FES can be combined with mechanical devices. FES-assisted cycling is mainly used in clinical environments for training sessions on cycle ergometers, but it has also been adapted for mobile devices, usually tricycles. In October 2016, twelve teams participated in the CYBATHLON competition in the FES-cycling discipline for persons with motor-complete spinal cord injury. It was the first event of this kind and a wide variety of strategies, techniques and designs were employed by the different teams in the competition. The approaches of the teams are detailed in this special issue. We hope that the knowledge contained herein, together with recent positive results of FES for denervated degenerating muscles, will provide a solid basis to encourage improvements in FES equipment and open new opportunities for many patients in need of safe and effective FES management. We hope to see further developments and/or the benefit of new training strategies at future FES competitions, e.g. at the Cybathlon 2020 (www.cybathlon.ethz.ch).
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http://dx.doi.org/10.4081/ejtm.2017.7219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745381PMC
December 2017

FES Bike Race preparation to Cybathlon 2016 by EMA team: a short case report.

Eur J Transl Myol 2017 Dec 5;27(4):7169. Epub 2017 Dec 5.

NTAAI, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil.

FES-assisted cycling has been recommended to people struggling to emerge from a disability to more functioning life after spinal cord injury. Recommendations issued by a gowing number of scientific papershas promised toimprove body composition and physical activity levels, as well as to controlinvoluntary muscle response; favoring activity and participation which break new grounds in expanding locomotion, leisure and occupational options for people with paraplegia and tetraplegia. In this report we described our experience to select and prepare a pilot to compete in the FES Bike Race modality at Cybathlon 2016 in Kloten (Zurick). He was a man, 38 years old, with a complete spinal cord injury, level T9, three years of injury. He took part in a two preparation phases lasting respectively 18 and 12 weeks each: (1st) pre-FES-cycling and a (2nd) FES-cycling. The 1st phase aimed to explore electrical stimulation response in the quadricps, hamstrings and gluteus muscles; searching for a standard muscular recruitment enable to propel the pedals of a trike. Following, in the 2nd phase, stationary to mobile FES-cycling was performed at the same time the development of the automation and control systems were being incorporated in the trike. We adapted a commercial tadpole trycicle anda pilot controlled system. Although we had planned a three session by week protocol, for reasons of term and time to finish the trike development and be prepared to compete, in the last two weeks before the Cybatlhon an intense level of exercise was maintained. After the race, we noticedinflammatory signs on the left knee which later revealed a patella fracture. The video footage analysis confirmed ithappened during the race's first lap.
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http://dx.doi.org/10.4081/ejtm.2017.7169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5745387PMC
December 2017

Cross-cultural adaptation to Brazilian Portuguese of the Waterloo Footedness Questionnaire-Revised: WFQ-R-Brazil.

Arq Neuropsiquiatr 2017 Oct;75(10):727-735

Universidade de Brasília, Faculdade de Ceilândia, Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Brasília DF, Brasil.

Post-stroke hemiparesis causes compensated postures, which can modify the footedness established before the impairment. Recently, a paresis severity-modulated dominance hypothesis stated that measures to detect footedness become crucial to float new ideas for neurorehabilitation strategies. The Waterloo Footedness Questionnaire-Revised (WFQ-R) represents the most acceptable measure but it had not yet been cross-culturally adapted for Portuguese spoken in Brazil. Our aim was to cross-culturally adapt the WFQ-R to Brazilian Portuguese, verifying its reliability. We completed the essential steps to cross-culturally adapt one version, tested in 12 patients with post-stroke hemiparesis and 12 able-bodied individuals, sampled by convenience, to verify reliability. Measurements were taken by two independent raters during the test and by one of them at the one-week retest. No great semantic, linguistic or cultural differences were found, and acceptable reliability was recorded. The WFQ-R-Brazil is reliable and ready for use in the Brazilian able-bodied and post-stroke hemiparesis population.
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http://dx.doi.org/10.1590/0004-282X20170139DOI Listing
October 2017

Cadence Tracking and Disturbance Rejection in Functional Electrical Stimulation Cycling for Paraplegic Subjects: A Case Study.

Artif Organs 2017 Nov;41(11):E185-E195

NTAAI - Núcleo de Tecnologia Assistiva, Acessibilidade e Inovação and Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil.

Functional electrical stimulation cycling has been proposed as an assistive technology with numerous health and fitness benefits for people with spinal cord injury, such as improvement in cardiovascular function, increase in muscular mass, and reduction of bone mass loss. However, some limitations, for example, lack of optimal control strategies that would delay fatigue, may still prevent this technology from achieving its full potential. In this work, we performed experiments on a person with complete spinal cord injury using a stationary tadpole trike when both cadence tracking and disturbance rejection were evaluated. In addition, two sets of experiments were conducted 6 months apart and considering activation of different muscles. The results showed that reference tracking is achieved above the cadence of 25 rpm with mean absolute errors between 1.9 and 10% when only quadriceps are activated. The disturbance test revealed that interferences may drop the cadence but do not interrupt a continuous movement if the cadence does not drop below 25 rpm, again when only quadriceps are activated. When other muscle groups were added, strong spasticity caused larger errors on reference tracking, but not when a disturbance was applied. In addition, spasticity caused the last experiments to result in less smooth cycling.
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http://dx.doi.org/10.1111/aor.13055DOI Listing
November 2017

Electrical Stimulation to Reduce the Overload in Upper Limbs During Sitting Pivot Transfer in Paraplegic: A Preliminary Study.

Eur J Transl Myol 2016 Sep 5;26(4):6223. Epub 2016 Aug 5.

NTAAI, Faculdade de Ceilândia, Universidade de Brasília , Brasília, Brazi.

Transfer is a key ability and allows greater interact with the environment and social participation. Conversely, paraplegics have great risk of pain and injury in the upper limbs due to joint overloads during activities of daily living, like transfer. The main goal of this study is to verify if the use of functional electrical stimulation (FES) in the lower limbs of paraplegic individuals can assist the sitting pivot transfer (SPT). The secondary objective is to verify if there is a greater participation of the lower limbs during lift pivot phase. A preliminary study was done with one complete paraplegic individual. Temporal parameters were calculated and a kinetic assessment was done during the SPT. The preliminary results showed the feasibility of FES for assisting the SPT.
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http://dx.doi.org/10.4081/ejtm.2016.6223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5220218PMC
September 2016

Towards Parameters and Protocols to Recommend FES-Cycling in Cases of Paraplegia: A Preliminary Report.

Eur J Transl Myol 2016 Jun 13;26(3):6085. Epub 2016 Jun 13.

NTAAI, Faculdade de Ceilândia, Universidade de Brasília , Brasília, Brazil.

Functional Electrical Stimulation assisted cycling (FES-Cycling) is increasingly becoming an alternative option recommended to people with spinal cord injury struggling with paraplegia and interested in practicing sports. In order to propose preconditions to guide FES-Cycling recommendation, we aimed to investigate some features and their potential relationships with responsiveness to Neuromuscular Electrical Stimulation (NMES). Fourteen volunteers attended a public recruitment forum to be assessed about their responsiveness through the 16-sessions of NMES. Volunteers were separated in two groups (responsive and non-responsive to NMES) which were investigated in the light of some personal, clinical, structural and functional features. Fifty seven percent of the initial sample responded to electrical stimulation with a visual contraction. This responsive group was predominantly composed by subjects presenting traumatic spinal cord injuries above T12 vertebral level. Only two subjects became responsive at the 3rd and 16th sessions. Among the observed features, the etiology and level of injuries seems to be more associated to responsiveness. Our observations seem to indicate that subjects with traumatic spinal cord injury above T12 level were the best potential candidates for FES-cycling.
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http://dx.doi.org/10.4081/ejtm.2016.6085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128972PMC
June 2016

Cross-cultural adaptation to Brazilian Portuguese of the Michigan Neuropathy Screening Instrument: MNSI-Brazil.

Arq Neuropsiquiatr 2016 Aug;74(8):653-61

Universidade de Brasília, Faculdade de Ceilândia, Programa de Pós-Graduação em Ciências e Tecnologias em Saúde, Brasília DF, Brasil;

Since 1994, the University of Michigan Diabetes Research and Training Center proposed an instrument to measure neuropathies not yet adapted to use in Brazil. Then, this study aimed to adapt cross-culturally the Michigan Neuropathy Screening Instrument (MNSI) into Brazilian Portuguese, verifying its reliability. Thirty diabetic patients were initially evaluated with the adapted version after completed the essential steps to accomplish the cross-cultural adaptation. Twenty-two of them completed the procedures to repeat the measured scores after day 1 (trial 0). The repeated measurements were tested at days 2 or 3 (trial 1) by another rater (inter-rater reliability) and retested at day 20 (trial 2) by one of the attended raters (inter-test reliability). There were not great semantics, linguistics or cultural differences between two versions and excellent reliability was confirmed by intra-class correlation coefficient above 0.840. It was concluded that MNSI in the Brazilian version is reliable and it is ready to use.
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http://dx.doi.org/10.1590/0004-282X20160094DOI Listing
August 2016

Could be the predominantly-used hemibody related to the weight bearing distribution modified by the chronic hemiparesis after stroke?

Med Hypotheses 2015 Nov 17;85(5):645-9. Epub 2015 Aug 17.

Post-Graduation Program of Health Sciences and Technologies, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil; Centre of Research in Assistive Technology, School of Physical Therapy, Faculty of Ceilândia, Campus of Ceilândia, University of Brasília, Brasília, Brazil. Electronic address:

Since the first Broca publications issued from 1970s, lateralized functions in the human brain have urged the researchers to postulate hypothesis based in the right-left asymmetries and, according to some theories, the lateralization of the voluntary motor control could represent a solution to avoid redundant process optimizing space and time. Supported by this idea, the clinicians and researchers tend to concept that the chronic hemiplegic stroke patients learn to use predominantly the non-affected hemibody after stroke in which is more convenient to execute their daily life activities, modifying their natural preference in some cases. Although could seems reasonable conceptualize the non-affected side as the predominantly-used hemibody for motor tasks after stroke (convenience hypothesis), evidences point to exist also hemiplegic patients that developed a predominantly use of the affected side. To float an idea, in terms of weight bearing distribution during upright position, the researchers have found patients overloading the non-affected hemibody, as expected; but also patients overloading the affected hemibody, not presenting necessarily Pusher's syndrome cases. Given the evidences, we could propose a severity-modulated predominance hypothesis which complements the convenience hypothesis. According to our complementary hypothesis, the severity of the motor disability presented in the hemiparesis condition (light, moderate and heavy severity) could determine a predominant use defined by preference (light to moderate severity) or convenience (moderate to heavy severity). In this hypothesis, we postulate ideas from a rehabilitation perspective to be incorporated in treatment programs.
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http://dx.doi.org/10.1016/j.mehy.2015.08.007DOI Listing
November 2015

Reliability of muscle strength assessment in chronic post-stroke hemiparesis: a systematic review and meta-analysis.

Top Stroke Rehabil 2016 Feb 5;23(1):26-36. Epub 2015 Aug 5.

College of Ceilândia, University of Brasília , Brasília, Brazil.

Background: Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque.

Objective: To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis.

Data Sources: Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase).

Study Selection: Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis.

Data Extraction: We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data.

Results: Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85).

Conclusion: Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.
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http://dx.doi.org/10.1179/1945511915Y.0000000008DOI Listing
February 2016

Reliability of the measures of weight-bearing distribution obtained during quiet stance by digital scales in subjects with and without hemiparesis.

Physiother Theory Pract 2015 May 26;31(4):288-92. Epub 2014 Dec 26.

Faculty of Ceilandia, University of Brasília , Brasília , Brazil.

Described as an alternative way of assessing weight-bearing asymmetries, the measures obtained from digital scales have been used as an index to classify weight-bearing distribution. This study aimed to describe the intra-test and the test/retest reliability of measures in subjects with and without hemiparesis during quiet stance. The percentage of body weight borne by one limb was calculated for a sample of subjects with hemiparesis and for a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-test reliability. This analysis was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. The intra-test analysis showed significant differences, only observed in the hemiparesis group, between the measures obtained by single and triple trials. Excellent and moderate ICC values (0.69-0.84) between test and retest were observed in the hemiparesis group, while for control groups ICC values (0.41-0.74) were classified as moderate, progressing from almost poor for measures obtained by a single trial to almost excellent for those obtained by triple trials. In conclusion, good reliability ranging from moderate to excellent classifications was found for participants with and without hemiparesis. Moreover, an improvement of the repeatability was observed with fewer trials for participants with hemiparesis, and with more trials for participants without hemiparesis.
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http://dx.doi.org/10.3109/09593985.2014.994248DOI Listing
May 2015

Reliability of the Functional Reach Test and the influence of anthropometric characteristics on test results in subjects with hemiparesis.

NeuroRehabilitation 2012 ;31(2):161-9

Faculty of Ceilandia, University of Brasilia, Brazil.

First designed as an alternative method of assessing balance and susceptibility to falls among elderly, the Functional Reach Test (FR) has also been used among patients with hemiparesis. Then this study aimed to describe the intra- and inter-rater and the test/re-test reliability of the FR measure in subjects with and without hemiparesis while verifying anthropometric influences on the measurements. The FR was administered to a sample of subjects with hemiparesis and to a control group that was matched by gender and age. A two-way analysis of variance was used to verify the intra-rater reliability. It was calculated using the differences between the averages of the measures obtained during single, double or triple trials. The intra-class correlation coefficient (ICC) was utilized and data plotted using the Bland-Altman method. Associations were analyzed using Pearson's correlation coefficient. In general, the intra-rater analysis did not show significant differences between the measures for the single, double or triple trials. Excellent ICC values were observed, and there were no significant associations with anthropometric parameters for the hemiparesis and control subjects. FR showed good reliability for patients with and without hemiparesis and the test measurements were not significantly associated with the anthropometric characteristics of the subjects.
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http://dx.doi.org/10.3233/NRE-2012-0786DOI Listing
February 2013

Is it correct to always consider weight-bearing asymmetrically distributed in individuals with hemiparesis?

Physiother Theory Pract 2011 Nov 3;27(8):566-71. Epub 2011 Jul 3.

Faculty of Ceilandia, University of Brasilia, Brazil. [email protected] unb.br

Injuries may cause unilateral deterioration of brain areas related to postural control resulting in lateralized motor disability with abnormal asymmetry in weight-bearing distribution. Although overloading toward the nonaffected limb has been described as the preferred posture among individuals with hemiparesis, characterization of the weight-bearing asymmetry is poorly and indirectly described. Therefore, this study aimed to describe weight-bearing distribution during upright stance, establishing criteria to consider asymmetry in hemiparesis when analyzed within the limits defined by controls matched by age and gender. Forty subjects with (n = 20) or without hemiparesis (n = 20) were included in procedures to record weight-bearing values between hemibodies, and these values were used to calculate a symmetry ratio. Control presented 95% confidence interval (CI) of the mean for symmetry ratio ranging from 0.888 to 1.072, defining limits to symmetry. Four subjects with hemiparesis (20%) had symmetry ratios inside limits defined by controls (i.e., weight-bearing symmetrically distributed), and 11 (55%) subjects without hemiparesis showed symmetry ratios outside the limits, suggesting asymmetrical weight-bearing distribution. It was concluded that asymmetry, when present in a control group, was more frequently overloading nonpredominantly used hemibody (nondominant side), differing from a hemiparesis group commonly forced to assume the nonaffected side as the predominantly used hemibody and where the overload was observed.
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http://dx.doi.org/10.3109/09593985.2011.552312DOI Listing
November 2011
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