Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, ...especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed
, Web of Science
, Institute of Electrical and Electronics Engineers
, Science Direct
and Google Scholar
. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.
Wearables offer a promising solution for simultaneous posture monitoring and/or corrective feedback. The main objective was to identify, synthesise, and characterise the wearables used in the ...workplace to monitor and postural feedback to workers. The PRISMA-ScR guidelines were followed. Studies were included between 1 January 2000 and 22 March 2023 in Spanish, French, English, and Portuguese without geographical restriction. The databases selected for the research were PubMed
, Web of Science
, Scopus
, and Google Scholar
. Qualitative studies, theses, reviews, and meta-analyses were excluded. Twelve studies were included, involving a total of 304 workers, mostly
(n = 8). The remaining studies covered
(n = 2), in the
(n = 1), and
(n = 1). For assessment purposes, most studies used
(n = 5) or
(n = 5) characterised as
(n = 7),
(n = 2) or
(n = 3). The most common source of feedback was the
(n = 6) or
(n = 4).
was the most prevalent (n = 6), followed by
(n = 5) and
(n = 3). Most studies employed prototype wearables emphasising kinematic variables of human movement. Healthcare professionals were the primary focus of the study along with haptic feedback that proved to be the most common and effective method for correcting posture during work activities.
Antagonist co-activation represents a neuronal command for the modulation of muscle synergies with postural control purposes
1
, probably assuming a key role in the characterisation of tonus ...dysfunction in post-stroke subjects. This study aims to evaluate the ankle antagonist co-activation during different functional tasks in post-stroke subjects.
A cross-sectional study was performed in eight participants (age = 43.00 ± 10.63 years; median ± interquartile range) who had a subcortical ischaemic stroke in the middle cerebral artery territory for at least 6 months. The study was approved by the local ethics committee and implemented in a research centre. Antagonist co-activation between tibialis anterior (TA) and soleus (SOL) and between TA and gastrocnemius medialis (GM) of the ipsilesional (IPSI) and contralesional (CONTRA) limbs was calculated through electromyographic signals collected during upright standing and postural phases of gait initiation and stand-to-sit, according to the methods proposed by Ribeiro
2
.
The CONTRA limb presented decreased values in TA/SOL pair during upright standing and increased values in both muscle pairs during gait initiation compared to the IPSI limb (
Table 1
). No significant differences were found between tasks (
Table 1
).
The IPSI and CONTRA limbs presented increased antagonist co-activation when an adequate antigravity function and the coordination of the tibia forward rotation are required, respectively. The comparison of these values with that obtained by healthy subjects
3
,
4
seems to point to a bilateral postural control dysfunction in post-stroke subjects related to tonus modulation deficits that should be addressed in neurorehabilitation. Future studies with a higher sample are required to extend the results.
Reliable biomechanical methods to assess interlimb coordination during the double-support phase in post-stroke subjects are needed for assessing movement dysfunction and related variability. The data ...obtained could provide a significant contribution for designing rehabilitation programs and for their monitorisation. The present study aimed to determine the minimum number of gait cycles needed to obtain adequate values of repeatability and temporal consistency of lower limb kinematic, kinetic, and electromyographic parameters during the double support of walking in people with and without stroke sequelae. Eleven post-stroke and thirteen healthy participants performed 20 gait trials at self-selected speed in two separate moments with an interval between 72 h and 7 days. The joint position, the external mechanical work on the centre of mass, and the surface electromyographic activity of the tibialis anterior, soleus, gastrocnemius medialis, rectus femoris, vastus medialis, biceps femoris, and gluteus maximus muscles were extracted for analysis. Both the contralesional and ipsilesional and dominant and non-dominant limbs of participants with and without stroke sequelae, respectively, were evaluated either in trailing or leading positions. The intraclass correlation coefficient was used for assessing intra-session and inter-session consistency analysis. For most of the kinematic and the kinetic variables studied in each session, two to three trials were required for both groups, limbs, and positions. The electromyographic variables presented higher variability, requiring, therefore, a number of trials ranging from 2 to >10. Globally, the number of trials required inter-session ranged from 1 to >10 for kinematic, from 1 to 9 for kinetic, and 1 to >10 for electromyographic variables. Thus, for the double support analysis, three gait trials were required in order to assess the kinematic and kinetic variables in cross-sectional studies, while for longitudinal studies, a higher number of trials (>10) were required for kinematic, kinetic, and electromyographic variables.
Objective: To identify and summarize biomechanical assessment approaches in interlimb coordination on poststroke gait. Introduction: Interlimb coordination involves complex neurophysiological ...mechanisms that can be expressed through the biomechanical output. The deepening of this concept would have a significant contribution in gait rehabilitation in patients with an asymmetric neurological impairment as poststroke adults. Inclusion criteria: Poststroke adults (>19 years old), with assessment of interlimb coordination during gait, in an open context, according to the Population, Concept, Context framework. Methods: A literature search was performed in PubMed, Web of Science™, Scopus, and gray literature in Google Scholar™, according to the PRISMA-ScR recommendations. Studies written in Portuguese or English language and published between database inception and 14 November 2021 were included. Qualitative studies, conference proceedings, letters, and editorials were excluded. The main conceptual categories were “author/year”, “study design”, “participant’s characteristics”, “walking conditions”, “instruments” and “outcomes”. Results: The search identified 827 potentially relevant studies, with a remaining seven fulfilling the established criteria. Interlimb coordination was assessed during walking in treadmill (n = 3), overground (n = 3) and both (n = 1). The instruments used monitored electromyography (n = 2), kinetics (n = 2), and kinematics (n = 4) to assess spatiotemporal parameters (n = 4), joint kinematics (n = 2), anteroposterior ground reaction forces (n = 2), and electromyography root mean square (n = 2) outcomes. These outcomes were mostly used to analyze symmetry indices or ratios, to calculate propulsive impulse and external mechanical power produced on the CoM, as well as antagonist coactivation. Conclusions: Assessment of interlimb coordination during gait is important for consideration of natural auto-selected overground walking, using kinematic, kinetic, and EMG instruments. These allow for the collection of the main biomechanical outcomes that could contribute to improve better knowledge of interlimb coordination assessment in poststroke patients.
Introduction Congenital toxoplasmosis (CT), despite being mostly subclinical at birth, can cause disabling disease in the fetus and lead to long-term sequelae. It is an important cause of ...chorioretinitis in infants and adolescents. Data on postnatal treatment are controversial, and there is a lack of universal guidelines. Methods A cross-sectional study of newborns with suspected CT was conducted between January 2007 and December 2021. Results Seventy-one patients with suspected CT were included. During pregnancy, 64 (90.1%) of the mothers underwent therapy, of which 59 (83.1%) with spiramycin. Amniocentesis identified one positive polymerase chain reaction assay. Most newborns were asymptomatic with normal laboratory, ophthalmological, and hearing screening. There was one case of hyperproteinorrachia. Fifty-seven patients (80.3%) started treatment: 42 (73.7%) with spiramycin, seven (12.3%) with pyrimethamine, sulfadiazine, and folinic acid (P+S+FA), and eight (14%) with P+S+FA intercalated with spiramycin. Adverse effects were found in 11 (19.3%) cases, mainly neutropenia. After investigation, we found three confirmed CT cases corresponding to 4.2% of suspected cases and an incidence of 0.4 per 10,000 births. All had normal clinical and laboratory exams in the neonatal period and started P+S+FA, fulfilling 12 months of therapy. During the follow-up, all presented normal psychomotor development without any long-term sequelae. Conclusion The lower incidence in our study, compared to the incidence in Europe, may be related to the decline in the prevalence of toxoplasmosis as well as the effectiveness of measures to prevent primary infection and a well-established program of antenatal screening, followed by the early initiation of treatment during pregnancy to prevent vertical transmission.
Neonatal encephalopathy (NE) is a condition of neurologic dysfunction with heterogeneous severity. The terms hypoxic-ischemic encephalopathy (HIE) and NE are often used interchangeably, although the ...differential diagnosis is vast. We aimed to evaluate the etiologies behind NE in newborns (NB) treated with therapeutic hypothermia (TH) for a presumed diagnosis of HIE. A retrospective analysis between January 2012 and July 2020 was conducted. Demographic data, information regarding pre- and perinatal factors, systemic dysfunction parameters, neuroimaging and neurologic sequelae were collected. A comparative analysis between the group considered with hypoxic-ischemic versus non-hypoxic-ischemic NE was performed. Forty-six NB were included. HIE was confirmed in 29 (63.0%) patients (group 1). There was no evidence of perinatal asphyxia in 17 (37.0%) patients (group 2). In the latter group, intracranial hemorrhage was the most frequent etiology (7; 15.2%), followed by infection (5; 10.9%). In group 1, there was a higher prevalence of emergency cesarean section (p = 0.013), clinical seizures at admission (p = 0.048) and a higher encephalopathy severity (p = 0.027). In this group, amplitude-integrated electroencephalogram improvement at 48 hours of TH was less frequent (p = 0.027) and major neurologic sequelae were more prevalent at 12 (p = 0.006) and 24 months (p = 0.041). HIE was the main cause of NE. Despite the clinical overlap, clinicians should recognize other etiologic factors beyond anoxic events. Our findings might help to prospectively differentiate between HIE and NE from different etiologies early after birth, ideally prior to initiation of TH, in the future.
This study aims to analyse the coactivation of antagonist muscles of the thigh and ankle during the sit-to-stand task in post-stroke subjects, specifically during forward and antigravity sub-phases. ...A group of 18 healthy subjects and another with 18 subjects with a history of stroke participated voluntarily in this study. Bilateral surface electromyography (EMGs) of the soleus, gastrocnemius medialis, tibialis anterior, rectus femoris and biceps femoris muscles were collected synchronously with ground reaction forces (GRF) during the sit-to-stand task. The magnitude of electromyographic (EMG) activity was analysed during forward translation and antigravity sub-phases which were determined through GRF signals. The coactivation was calculated to quantify the degree of antagonist coactivation according to the role of the muscles during the task. Statistically significant values were found between antagonist coactivation on both sub-phases of the sit-to-stand task when comparing healthy and post-stroke subjects (healthy with ipsilesional (IPSI); healthy with contralesional (CONTRA); and healthy with IPSI and with CONTRA limbs) in all muscle pairs analysed (p < 0.01), except on thigh muscles (p > 0.05), in the antigravity sub-phase. When comparing IPSI with CONTRA sides in post-stroke subjects, no statistically significant differences were found. Increased values of antagonist coactivation were observed in post-stroke subjects compared to healthy subjects (both IPSI and CONTRA limb) in the two sub-phases analysed. The forward sub-phase CONTRA limb showed higher antagonist coactivation compared to IPSI, while in the antigravity sub-phase, IPSI antagonist coactivation was higher than in the CONTRA. In conclusion, post-stroke subjects presented an antagonist coactivation more dysfunctional at the ankle joint muscles compared to the thigh segment. So, it seems that the distal segment could express more accurately the central nervous system dysfunction in post-stroke subjects, despite the need for further studies to achieve a better spatiotemporal understanding of the variability on coactivation levels.
Blueberry muffin syndrome (BMS) in neonates, characterized by widespread nodular lesions, presents diagnostic challenges due to its diverse etiologies. Hyperleukocytosis, with leukocyte counts ...exceeding 100,000/μL, is a rare phenomenon associated with severe complications in neonates. Congenital leukemia (CL), a rare diagnosis within the first month of life, is linked to high mortality. This case report presents a unique case of BMS with hyperleukocytosis as the initial presentation of CL. A full-term male newborn, born after an uncomplicated pregnancy, except for Kell isoimmunization, with an Apgar score of 9/10, and an irrelevant family history, showed widespread purple nodules consistent with BMS at birth. Laboratory workup revealed mild anemia, hyperleukocytosis with immature granulocytes on peripheral blood (PB) smear, positive direct antiglobulin test, and elevated alanine aminotransferase and lactate dehydrogenase, without hyperbilirubinemia. Empirical antibiotics and hyperhydration were started, and the neonate was transferred to a level 3 neonatal intensive care unit for further evaluation. A comprehensive etiological investigation was conducted, comprising infectious, immunological, metabolic, and neoplastic factors. A skin nodule biopsy revealed an infiltrate of blast cells, indicative of leukemia cutis, and a bone marrow aspirate confirmed acute myeloid leukemia (AML). The patient successfully completed the NOPHO-DBH-2012 chemotherapy protocol at five months and remains in complete remission at nine months. This case report contributes to the literature by highlighting the diagnostic approach and management strategies for CL presenting with BMS and hyperleukocytosis. This case aims to enhance awareness and understanding of BMS as an initial manifestation of CL. Additionally, the challenges of treating leukemia in neonates, coupled with the lack of specific guidelines for this age group, further underscore the complexities in managing such patients.
Pericardial effusion (PCE) is a rare condition in neonates. The most common cause is iatrogenic due to central venous catheters (CVCs) and symptoms vary from asymptomatic to more severe ...presentations, such as cardiac tamponade. Treatment of this condition in neonates remains controversial. The authors present a case report of a preterm neonate with a PCE and a review of the literature. A preterm infant was born at 26 weeks of gestation and with a birth weight of 690 grams. A peripherally inserted central catheter (PICC) was inserted on day 4, which was uneventful. Due to a hemodynamically significant patent ductus arteriosus with no response to two cycles of treatment with ibuprofen, she was submitted to surgical ligation on day 38. In the postoperative echocardiogram, the tip of the PICC was seen in the right ventricle and the catheter was retracted. An echocardiogram was performed on day 55, showing a PCE with a slight diastolic compromise of the right atrium. The catheter was withdrawn and diuretic therapy with furosemide was initiated. PCE presented a gradual reduction until complete resolution within 3 weeks. A review of the literature about postnatal PCE was performed. A final sample of 34 articles was included. The main PCE causes were iatrogenic (due to CVCs, and postoperative of major cardiac surgery) and infection. Management of this condition was variable between cases ranging from clinical surveillance in asymptomatic newborns with small effusions to pericardiocentesis in large effusions with signs of hemodynamic instability. In conclusion, PCE is a condition that is often underdiagnosed in neonates. The most common cause, as occurred in the case presented above, is a mispositioned CVC. Management of this condition is still controversial and further studies are needed to establish therapeutic protocols in neonates.
PDF
