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- Unisensory and multisensory Self-referential stimulation of the lower limb: An exploratory fMRI study on healthy subjectsPublication . Vieira, Ana Isabel; Almeida, Patrícia; Canário, Nádia; Castelo-Branco, Miguel; Nunes, Maria Vânia; Castro-Caldas, AlexandreBackground: The holistic view of the person is the essence of the physiotherapy. Knowledge of approaches that develop the whole person promotes better patient outcomes. Multisensory Selfreferential stimulation, more than a unisensory one, seems to produce a holistic experience of the Self (“Core-Self”). Objectives: (1) To analyze the somatotopic brain activation during unisensory and multisensorial Self-referential stimulus; and (2) to understand if the areas activated by multisensorial Self-referential stimulation are the ones responsible for the “Core-Self.” Methods: An exploratory functional magnetic resonance imaging (fMRI) study was performed with 10 healthy subjects, under the stimulation of the lower limbs with three Self-referential stimuli: unisensory auditory-verbal, unisensory tactile-manual, and multisensory, applying the unisensory stimuli simultaneously. Results: Unisensory stimulation elicits bilateral activations of the temporoparietal junction (TPJ), of the primary somatosensory cortex (S1), of the primary motor cortex (BA4), of the premotor cortex (BA6) and of BA44; multisensory stimulation also elicits activity in TPJ, BA4, and BA6, and when compared with unisensory stimuli, activations were found in: (1) Cortical and subcortical midline structures—BA7 (precuneus), BA9 (medial prefrontal cortex), BA30 (posterior cingulated), superior colliculum and posterior cerebellum; and (2) Posterior lateral cortex—TPJ, posterior BA13 (insula), BA19, and BA37. Bilateral TPJ is the one that showed the biggest activation volume. Conclusion: This specific multisensory stimulation produces a brain activation map in regions that are responsible for multisensory Self-processing and may represent the Core- Self. We recommend the use of this specific multisensory stimulation as a physiotherapy intervention strategy that might promote the Self-reorganization.
- Brain Activity during Lower-Limb Movement with Manual Facilitation: An fMRI StudyPublication . Almeida, Patrícia; Vieira, Ana Isabel; Canário, Nádia; Castelo-Branco, Miguel; Castro-Caldas, AlexandreBrain activity knowledge of healthy subjects is an important reference in the context of motor control and reeducation. While the normal brain behavior for upper-limb motor control has been widely explored, the same is not true for lower-limb control. Also the effects that different stimuli can evoke on movement and respective brain activity are important in the context of motor potentialization and reeducation. For a better understanding of these processes, a functional magnetic resonance imaging (fMRI) was used to collect data of 10 healthy subjects performing lower-limb multijoint functional movement under three stimuli: verbal stimulus, manual facilitation, and verbal +manual facilitation. Results showed that, with verbal stimulus, both lower limbs elicit bilateral cortical brain activation; with manual facilitation, only the left lower limb (LLL) elicits bilateral activation while the right lower limb (RLL) elicits contralateral activation; verbal + manual facilitation elicits bilateral activation for the LLL and contralateral activation for the RLL. Manual facilitation also elicits subcortical activation in white matter, the thalamus, pons, and cerebellum. Deactivations were also found for lower-limb movement. Manual facilitation is stimulus capable of generating brain activity in healthy subjects. Stimuli need to be specific for bilateral activation and regarding which brain areas we aim to activate.
- Verbal fluency tasks: effects of age, gender, and educationPublication . Nogueira, Dália; Reis, Elizabeth; Vieira, Ana IsabelObjectives: This study presents data for semantic fluency, phonemic fluency, action fluency, and alternate fluency. The aim is to provide normative data by age, gender, and education for European Portuguese in each fluency category. Methods: Norms for the verbal fluency task were collected from a volunteer population of 444 healthy Portuguese participants. Multiple regression analysis with age, gender, and education as independent variables was performed for the semantic fluency global score, and these variables were considered separately for each phonemic category. Results: Age, education, and gender significantly affected the semantic global score, as well as scores of names, supermarket, kitchen objects, food, and clothes. No gender effect was observed in the categories “p-words,” animals, transports, verbs, and alternating fluency. This last category was only influenced by years of education. Conclusions: Equivalent scores of verbal fluency tasks are useful in clinical practice, allowing the comparison between the normal and the abnormal performance of language disorders.
- Reliability and validity of the european portuguese version of the social touch questionnairePublication . Vieira, Ana Isabel; Ramos, Ana Vanessa; Cavalheiro, Luís Manuel; Almeida, Patrícia; Nogueira, Dália; Reis, Elisabeth; Nunes, Maria Vânia; Castro-Caldas, AlexandreSocial touch is essential for physical and emotional well-being. However, different meanings can be attributed to physical contact during social interactions and may generate bonding or avoidant behaviors. This personal and unique experience is not usually taken into account in health and social care services. The aim of this study is to produce a valid and reliable European Portuguese version of the Social Touch Questionnaire (STQ, Wilhelm et al. in Biol Psychol 58:181–202, 2001. doi:10.1016/S0301-0511(01)00113-2). The STQ is a self-report questionnaire for adolescents and adults measuring behaviors and attitudes towards social touch. The original version was translated into European Portuguese using a forward-back translation process and its feasibility was examined. To evaluate the psychometric properties, a total of 242 Portuguese university students participated in the study (21.3 ± 3.8 years). The STQ was considered feasible, showed adequate internal consistency (Cronbach’s a = .734), and the test–retest correlation with the STQ items demonstrated a high concordance between the tests over a two-week interval (ICC = .990; n = 50). Validity tests were performed, comparing the total score of the STQ with that of the anxiety and avoidance subscales of the Social Interaction and Performance Anxiety and Avoidance Scale (SIPAAS). A very significant conceptual convergence was confirmed between the STQ and with the SIPAAS-Anxiety (r = .64; p\.0001) and with the SIPAAS-Avoidance (r = .59; p\.0001). The exploratory factor analysis, with Promax rotation, revealed 3 factors: dislike of physical touch, liking of familiar physical touch and liking of public physical touch (Cronbach’s alphas ranged from .68 to .75). Psychometric properties confirmed the adaptation of the STQ to the Portuguese culture. It is a reliable and valid self-report questionnaire and it appears to be a useful tool to assess behaviors and attitudes towards social touch.
- Hand tactile discrimination, social touch and frailty criteria in elderly people: A cross sectional observational studyPublication . Vieira, Ana Isabel; Nogueira, Dália; Reis, Elisabeth de Azevedo; Rosado, Maria Da Lapa; Nunes, Maria Vânia; Castro-Caldas, AlexandreFrailty is a common syndrome among elderly and sensory decline may exacerbate functional decline. The hand function, the manual dexterity, the performance of the daily living skills and the social interactions are determined, in a large degree, by sensory integrity. However, hand tactile sensory deterioration has been little explored in frailty. We performed a cross sectional observational study with 181 of institutionalized elders. From the initial sample we selected 50 subjects (68–99 years) who met the inclusion/exclusion criteria. Our goals were (1) to analyse the relationship between tactile discrimination (TD) of the hand, avoidance behaviours and attitudes towards social touch (BATST) and phenotype frailty criteria (unintentional weight loss, self-perception of exhaustion, decrease grip strength GS, slow walking speed, low level of physical activity), (2) to explore whether other variables can contribute to explain the differences between pre-frail and frail elders. The results showed that increasing age is related to decline of TD of the hand (p = 0.021) and to decrease in GS (p = 0.025); women have significantly lower level of GS (p = 0.001); TD decrease is correlated with higher avoidance BATST (p = 0.000) and with lower GS (p = 0.000); Lower GS corresponds to more avoidance BATST (p = 0.003). Hand TD also can differentiate frail and pre-frail elderly subjects in this sample (p = 0.037). Decreased TD of the hand may have implications on the functionality and on interpersonal relationships. TD of the hand also explains frailty levels in this sample. Hand TD should be used in assessment and intervention protocols in pre-frail and frail elders.
- Educational strategies to increase student knowledge and reflexion about physiotherapy intervention in the context of covid-19Publication . Alves Lopes, António; Santos, Hugo; Vieira, Ana Isabel; Barreto, Guilherme; Lopes, António M F; Baleia, Isabel; Rosado, Maria Da Lapa; Martins, Maria Elisabete; Esteves, José Manuel; Araújo, PauloBackground: In the context of the COVID-19 pandemic, the Alcoitão School of Health Sciences (ESSA) interrupted on March 16, 2020, all classroom activities, including clinical activities. This situation created the need to transfer all activities and classes to an online format (synchronous and asynchronous) and to promote in students new knowledge/skills/attitudes related to the new professional reality. Purpose: To increase students literacy and reflection concerning the pandemic and to adapt, as a profession to the new needs of society, the Department of Physiotherapy decided to implement an online activity that could facilitate this process. Methods: The online activity was created with a duration of 3 weeks integrated into the clinical curricular units. It involved 218 Physiotherapy students from the 4 curricular years, the Department lecturers and guests speakers. This activity included the creation of an updated repository of information related to the pandemic COVID-19, namely national (DGS) and international (WHO) guidelines, professional guidelines (WCPT, APFISIO, Professional Interest Groups) and multimedia material (videos and podcasts). As part of the activity, students were asked to complete the Coronavirus Disease Program developed by Pysiopedia (Physioplus), according to the academic year, in whole or only some of the modules. To support the activity, several online sessions were promoted, where, with the participation of guests, the pandemic and its impact on the various contexts of Physiotherapy were discussed. To evaluate the activity, students were asked to submit certificates of completion of the Coronavirus Disease Program course and an individual reflection on the institutional e-learning platform. To assess the impact on student satisfaction, an online questionnaire with several dimensions (34 questions) was used. Results: 96% of the Students (n= 211) completed this course, submitting the certificates of completion and the individual reflection. Concerning the student satisfaction, with a response rate of 96% distributed evenly across the various academic years, 78.7% considered that the activity, in general, was clear and was well structured, having reached the general objectives of the activity (79.6%), 83.4% also considered that it was an overall positive experience and reinforcing the importance of carrying out this type of activities (76.3%). Conclusion(s): From the results we can conclude that is important to develop updated activities adapted to current needs, using online approaches and involving all the partners in the educational process. It is important that Physiotherapy educators, create and implement activities that facilitate the development of students competencies that allow them to play a proactive role in global and local efforts to reduce the impact health and social effects of this pandemic.
- Avaliação da acessibilidade numa escola secundária: inclusão escolarPublication . Vieira, Ana Isabel; Silva Pinto, ÉliaAs escolas deverão promover condições que garantam o acesso e participação de todos os alunos, independentemente das suas diferenças e das atividades pedagógicas a realizar. Para que haja a oferta de um ensino de qualidade, a inclusão escolar não se pode prender só com questões pedagógicas mas também com o ambiente em que as aprendizagens ocorrem. Só assim será implementado um modelo de ambiente educativo inclusivo. Zelar para que essas condições sejam asseguradas, é um dever de todos. A Escola Superior de Saúde do Alcoitão (ESSA), no âmbito dos projetos de extensão à comunidade, tem contribuído com inúmeras iniciativas para a melhoria das acessibilidades em diversos equipamentos e serviços. Este projeto envolveu uma parceria com o Rotaract Club de Algés e tem como objetivo avaliar as barreiras arquitetónicas da Escola Secundária de Miraflores e elaborar recomendações para a melhoria das acessibilidades. Foram envolvidos 50 alunos, do 3oano, do curso de Fisioterapia, da Escola Superior de Saúde do Alcoitão, com supervisão de 2 professores que validaram os resultados das avaliações e respetivas recomendações. Foi avaliada a acessibilidade de todos os pavilhões da escola e a acessibilidade exterior (entrada da escola e espaços exteriores aos pavilhões). Neste relatório e tendo em conta que alguns dos pavilhões apresentavam características muito semelhantes, demos relevo à acessibilidade exterior, ao pavilhão da biblioteca, ao pavilhão C, ao pavilhão do bar e refeitório e à acessibilidade aos laboratórios. A avaliação foi realizada com base no Decreto-Lei no165/06 publicado em Diário da República a 8 de Agosto.
- Caracterização funcional de uma população idosa: A perspetiva integrada da avaliação em Fisioterapia e em Terapia da FalaPublication . Vieira, Ana Isabel; Nogueira, Dália; Bivar, Isabel; Rosado, Maria Da LapaIntrodução: A fragilidade é uma síndrome multidimensional que aumenta a vulnerabilidade da pessoa, diminui as reservas fisiológicas e aumenta o declínio funcional associado a mudanças das múltiplas funções do corpo. Importa perceber de que modo o declínio das funções motoras e da comunicação -cognição se interligam e de que modo se explicam mutuamente. Objectivos: (1) i) Caracterizar uma população idosa de acordo com as suas variáveis sociodemográficas, cognição, síndrome de fragilidade segundo o fenótipo (força da mão, velocidade da marcha, perda de peso, sensação subjetiva de exaustão e diminuição da atividade física), número de quedas e medo de cair, diadocinésia dos órgãos motores orofaciais, fluência verbal, deglutição e audição ii) Analisar a relação entre as variáveis na perspetiva integrada e multidisciplinar das várias funções do corpo. Método: Estudo observacional, transversal, descritivo e correlacional realizado em três instituições que prestam cuidados a uma população idosa. Foram selecionados, numa primeira fase, cinquenta participantes (de acordo com os critérios de inclusão para avaliação da fragilidade) de entre 181 residentes e aplicados instrumentos de avaliação, de acordo com as variáveis em estudo por fisioterapeutas e terapeutas da fala devidamente treinados para o efeito. Resultados: Os grupos foram definidos, de acordo com os resultados, entre frágeis e pré-frágeis verificando-se uma relação significativa entre a o desempenho diadococinético dos órgãos motores orofaciais e a velocidade da marcha. Conclusões: O estudo revela que existe uma relação significativa entre o desempenho das funções do corpo, aparentemente distintas, remetendo para uma abordagem menos setorial, mais holística e baseada em evidência.
- Use of the PRINCE2 methodology in the development of community projects for the support in post-acute COVID-19 and long COVID contextPublication . Alves Lopes, António; Vieira, Ana Isabel; Azevedo, Vitor Hugo; Santos, JoanaBackground: One of the objectives of ESSAlcoitão’s undergraduate course is that future physiotherapists, in addition to being competent professionals, become autonomous, analytical, creative citizens, who know how to solve problems. To this end, one of the pedagogical strategies used is based on an adaptation of the project management methodology, PRINCE2 (PRojects IN Controlled Environments), applied to the development of community projects. During one semester of the 2020/2021 school year, 2 projects were proposed to the students, focusing on supporting individuals in the COVID-19 context. Project methodology was presented to the students, including the various roles and responsibilities (Project Manager, Team, Customer) and subgroups were created to develop sections of the projects, supported by a group of teachers (Subject Matter Experts). Aim: Assess students’ satisfaction in using PRINCE2 methodology in the development of community projects to support individuals after the acute phase of COVID-19 and Long COVID. Methodology: To assess the impact (satisfaction) within the students, an online questionnaire with several dimensions (12 questions) was used. Results: The online questionnaire delivered a response rate of 52.8%. The data revealed a favourable opinion regarding the methodology used, namely that it helped to clarify the role of the interveners (75% agree/totally agree), and that the selected theme was relevant and important (78.6% agree/totally agree). Finally 82.1% (agree/strongly agree) considered that this activity was important for the development of knowledge and professional skills. Conclusions/Implications for physiotherapy: Based on students' responses, we consider the success of the implementation of PRINCE2 methodology to be relevant, making it feasible and advisable to use this project management methodology for the development of future community projects. In this way, future physiotherapists can proactively play a role in local and global efforts to reduce the impact of modifiable risk factors, and of emerging conditions, such as the COVID-19 pandemic.
- Estratégias educativas para facilitar o conhecimento e a reflexão dos alunos sobre a intervenção do Fisioterapeuta no contexto da COVID-19Publication . Alves Lopes, António; Santos, Hugo; Vieira, Ana Isabel; Barreto, Guilherme; Lopes, António M F; Baleia, Isabel; Rosado, Maria Da Lapa; Martins, Maria Elisabete; Esteves, José Manuel; Araújo, PauloIntrodução e Objetivos: No contexto de pandemia COVID-19 a Escola Superior de Saúde do Alcoitão (ESSA) interrompeu todas as atividades letivas presenciais e atividades clínicas, surgindo a necessidade de transferir as atividades letivas para o formato online (síncrono e assíncrono) e de promover nos alunos novos conhecimentos, competências e atitudes. Material e Métodos: Para atingir esse objetivo foi criado uma atividade online com a duração de 3 semanas integrada nas unidades curriculares clínicas, envolvendo 220 alunos de Fisioterapia dos 4 anos curriculares, docentes do Departamento e oradores convidados. Essa atividade inclui a criação e disponibilização para consulta pelos alunos de um repositório atualizado de informação relacionada com a pandemia. Integrado na atividade foi solicitado a realização pelos alunos, de acordo com o ano lectivo, da totalidade ou de apenas alguns dos módulos, do Curso Coronavirus Disease Programme desenvolvido pela Physioplus. Para suportar toda a atividade foram ainda dinamizadas várias sessões online, onde, com a participação de convidados foi discutido a temática e o seu impacto nos vários contextos da Fisioterapia. Resultados: Para avaliar o impacto (satisfação) junto aos alunos dos 4 anos foi utilizado um questionário online com várias dimensões (34 questões), onde se obteve uma taxa de resposta de 96% (n= 211) distribuído equilibradamente pelos vários anos letivos. Relativamente às respostas, 78,7 % consideraram que atividade no geral era clara e estava bem estruturada tendo sido atingidos os objetivos gerais da atividade (79,6%), 83,4% consideraram ainda que foi globalmente uma experiência positiva e reforçando ainda a importância da realização deste tipo de atividades (76,3%). Conclusões: Face à necessidade de aumentar a literacia relativamente ao contexto pandémico e nos adaptarmos enquanto profissão às novas necessidades da sociedade, é importante que os educadores em Fisioterapia, criem e implementem atividades que facilitem o desenvolvimento nos alunos de competências que lhes permitam desempenhar um papel proativo nos esforços globais e locais para reduzir o impacto dos efeitos sociais dessa pandemia.