Escola Superior de Saúde do Alcoitão

OBJECTIVE: To evaluate the 3D kinematics of the scapula and trunk during a kneeling anterior/posterior movement in asymptomatic adults, (a) without resistance and (b) with two complementary resistance arrangements integrating the kinetic chain. DESIGN: A controlled laboratory study using within-group comparisons. METHODS: Thirty-six healthy young adults of both sexes, and without shoulder or lower quadrant problems, participated in this study. Three-dimensional scapular kinematics were recorded with an electromagnetic tracking device during shoulder elevation for both the unloading (active) and loading (resisted) conditions. Data for scapular and trunk kinematics were analyzed at 15°, 30°, 60°, 90°, and 120° of humerothoracic elevation and lowering. A repeated measures ANOVA was conducted to investigate different interactions between resistance, phase, and humerothoracic elevation for scapular and trunk kinematics. RESULTS: There was an effect of resistance on internal/external rotation and anterior/posterior tilt, and an effect of phase on anterior/posterior tilt. Trunk motion and resistance influenced axial rotation and lateral flexion, while phase impacted lateral flexion and extension. The scapula exhibited an interaction between phase-by-humerothoracic elevation at 60° of internal rotation during the lowering phase and between resistance-by-humerothoracic elevation at 15° and 60° for upward rotation. Increased resistance induced an anterior tilt of the scapula during the arm raising phase. The trunk exhibited an interaction between phase-by-humerothoracic elevation range 15-30° of lowering phase. There were no significant differences in scapulohumeral rhythm. CONCLUSION: Increased resistance impacted scapular and trunk kinematics, significantly enhancing stability but not altering scapulohumeral rhythm.

Introdução: Os erros de refração visual (ERV) e fatores externos podem influenciar a postura ao longo do ciclo da vida. Objetivos: Identificar alterações posturais em crianças com ERV e analisar se estas dependem do tipo de erro de refração e do sexo. Além disso, investigar a relação entre o tempo de uso de ecrãs, a prática de atividade física (AF) e as alterações posturais. Métodos: Estudo transversal com 30 crianças (6-12 anos), de ambos os sexos. A avaliação postural foi realizada pelo SAPO, e os pais responderam a um questionário sobre o estilo de vida dos filhos. O teste de Mann-Whitney comparou as alterações posturais entre os diferentes tipos de ERV, e a correlação de Spearman analisou a relação entre o alinhamento postural, o tempo de uso de ecrãs e a prática de AF (frequência e duração). Resultados: Foram identificadas alterações posturais, como anteriorização da cabeça, báscula anterior da pelve, hiperextensão dos joelhos, possível escoliose e projeção anterior do centro de gravidade, independentemente do tipo de ERV. Observou-se relação entre a prática de AF e o alinhamento das espinhas ilíacas no plano frontal, e verificou-se maior prevalência de joelho valgo nas raparigas. Conclusão: Crianças com ERV apresentam alterações posturais independentemente do tipo de ERV. Além disso, a prática de AF está associada ao alinhamento pélvico e dos joelhos. No entanto, as relações identificadas são limitadas devido ao delineamento transversal do estudo.

The presence of pragmatic language difficulties can be lifelong for children with autism spectrum disorder (ASD) and developmental language disorder (DLD). Implementing evidence-based practices integrates the best research evidence, the clinical expertise of the professionals delivering the intervention and the perspectives of parents/caregivers. Nevertheless, research on parents' and early childhood educators' perspectives on the perceived effectiveness of pragmatic language interventions is scarce. This study aims to analyse parents' and early childhood educators' perceptions after the implementation of the Pragmatic Intervention Programme (PICP) to preschool-age children with ASD and children with DLD. As a part of a broad research project, a survey was conducted using an adaptation of a satisfaction survey. Data from 72 participants among parents (n = 36) and early childhood educators (n = 36) were collected immediately after the implementation of the PICP. The survey includes 11 statements, individually scored between 1 (totally disagree) and 7 (totally agree). The average score obtained from the parents' perspective about the intervention impact was 6.83 ± 0.29. For early childhood educators, the average score was 6.60 ± 0.49. The results indicate that parents and early childhood educators considered this intervention appropriate and effective for improving the pragmatic language skills of preschool-age children with ASD and DLD.

Introduction: Identifying risk factors is an essential step in epidemiological surveillance and allows targeted intervention to improve quality of life and prevent disease. Public health nurses have the skills to design the necessary interventions to reduce and prevent risk factors. Objective: to reflect on the importance of epidemiological surveillance in identifying risk factors in the Portuguese community and the intervention of specialist nurses in community nursing and public health. Methods: a bibliographic search was carried out in official databases, documents and websites and a critical-reflective analysis was performed. Results: The concept of risk associated with epidemiology has evolved in close collaboration with the concept of causality, from the perspective of the relationship between exposure to the risk factor and the health consequences. In this context, the importance of the intervention of specialist nurses in community nursing in the area of public health is highlighted. Conclusions: The global burden of disease in Portugal, as well as worldwide and in Europe, is dominated by non-communicable diseases, with the main cause being risk factors in the behavioral domain. In Portugal, cerebrovascular disease is the main cause of death and disability, and the risk factor with the greatest impact on the development of preventable diseases is diet. Keywords: Risk factors; Risk; Epidemiology; Public health nursing.

Background: The overhead squat movement involves various bodily structures, but the interaction with three-dimensional elastic resistance along the kinetic chain approach requires further understanding. Objectives: We aim to describe and compare scapular and trunk kinematics during an overhead squat under different external resistance conditions. Methods: The three-dimensional shoulder and trunk kinematics of 19 male participants were captured at 15-degree intervals, from 30 to 120 degrees, during the overhead squat movement and analyzed by phase. Results: Scapular posterior tilt was significantly affected by resistance during the UNLOAD phase (p = 0.005, η2ₚ = 0.26). Significant resistance-by-arm elevation interactions were found for scapular upward rotation during the LOAD phase (p = 0.003, η2ₚ = 0.19) and UNLOAD phase (p < 0.001, η2ₚ = 0.24); for scapular internal rotation during both the LOAD (p < 0.001, η2ₚ = 0.37) and UNLOAD phases (p = 0.006, η2 = 0.19); and for scapular posterior tilt during both the LOAD (p = 0.003, η2ₚ = 0.26) and the UNLOAD phases (p = 0.006, η2ₚ = 0.21). Trunk flexion/extension showed a significant effect on resistance during the LOAD phase (p = 0.008, η2ₚ = 0.24). Conclusions: Increasing resistance through elastic resistance significantly improves scapular kinematics via the trunk during arm elevation. This underscores the potential of the overhead squat movement as a valuable tool for assessing and treating scapular and trunk dysfunction.

Pelvic floor dysfunction (PFD) is a common problem that occurs among women and increases with age and weight. This study was aimed at cross-culturally adapting and validating the original version of the Australian Pelvic Floor Questionnaire (APFQ) into Portuguese. The process of cultural and linguistic adaptation and validation followed the guidelines. The obtained Portuguese version was assessed by an expert panel of physiotherapists specialized in women's health. Women with pelvic floor dysfunction also participated in a cognitive pre-test (n = 9). A sample of 50 women with PFD completed the questionnaire to evaluate internal consistency, construct validity, reproducibility, floor/ceiling effects assessment, and standard error of measurement. Test-retest was assessed with a 2-week interval. The study was approved by the Ethics Commission and all participants signed an informed consent form. Fifty women with a mean age of 53.90 (± 18.57) years, BMI of 27.5 (± 4.2), 55.6% with a bachelor's degree, and all with at least one child, participated in the study. The psychometric properties of the APFQ showed a high Cronbach's alpha for the four domains: bladder (0.837), bowel and sexual function (0.756), pelvic organ prolapse (0.840), and total score (0.714). In terms of reproducibility, intraclass coefficient domain values ranged from 0.934 to 0.976, with a total score of 0.948. The APFQ was cultural and linguistically adapted and validated for Portuguese. The Portuguese version of the APFQ (APFQ_P) showed acceptable values of validity and good reliability. It can be used in both clinical evaluation and in research on pelvic floor dysfunction.

Children with autism exhibit deficits in fundamental motor skills, which are intensified when associated with attention-deficit/hyperactivity disorder (ADHD). To correlate motor competence in children with autism, autism levels according to the CARS scale, and the association with ADHD. This cross-sectional study assessed motor competence using the Motor Competence Assessment (MCA), the severity of Autism Spectrum Disorder by Childhood Autism Rating Scale (CARS), and the presence of clinical signs for ADHD using Swanson, Nolan, and Pelham (SNAP-IV) questionnaire. A total of 68 children were recruited; however, 23 were not included due to non-acceptance and/or were excluded because of associated pathologies, high autism severity. Consequently, 45 children (11 with ADHD) between the ages of 5 and 11 (Mean: 8.15; ±1.75) with 83.72% being male. Multiple linear regression revealed a significant inverse correlation between MCA scores and raw CARS data (p = 0.01), indicating that greater autism severity is associated with lower motor competence. The correlation was also observed in CARS classifications, with higher autism severity corresponding to lower motor percentiles (p = 0.05). However, the correlation between the presence of ADHD and motor competence in children with ASD did not reach significance. Overall, a significant correlation was observed (p = 0.006) when analyzing all variables (CARS scores, SNAP scores, and CARS classification). Therefore, it is believed that children with autism exhibit deficits in functional motor skills, with severity impacting motor competence. The findings underscore the need for systematic motor skill assessments in children with autism, emphasizing the importance of monitoring and intervention in this aspect of their development.

Background:Osteoarthritis poses a high global burden and impact, which is expected to continue rising over the next few years. Exercise seems to be one of the most effective strategies for the management and prevention of functional decline in people with hip and knee osteoarthritis (HKOA). Current literature suggests that for an adequate and tailored exercise prescription, it is crucial to evaluate patients’ physical performance, through functional objective tests. However, evidence on the best combination of instruments for this purpose is still lacking. On the other hand, literature also highlights the lack of adherence by physiotherapists to use assessment tools in their clinical practice, but this problem is being scarcely explored. This study is part of the development of Split.OA, a structured and tailored exercise programme informed by behaviour change, that includes the Split.OA physical performance tests battery to assess people with HKOA.Objectives:This study aims to assess the interrater and intra-rater reliability of Split.OA battery for people with HKOA and explore barriers and facilitators to its implementation by physiotherapists. This study will help understand the reliability of Split.OA battery and if it is adapted to the context in which intends to be implemented.Methods:A convergent mixed methods study was carried out in two sequential phases. In the quantitative phase, the Split.OA battery was applied to people with HKOA (6 Minute Walk Test, 40 meter Fast Paced Walk Test, 30sec Chair Stand Test, Sit-and-Reach Test, Modified Thomas Test e o Star Excursion Balance Test) in two moments. The first included the assessment for the interrater reliability, by two physiotherapists. Then, 7 to 14 days after the first assessment, the Split.OA battery was once again applied for intra-rater reliability, by only one of those physiotherapists. This was analysed with Interclass Correlation Coefficient (ICC). For the qualitative phase, 2 focus groups were conducted by videoconference with 11 physiotherapists, selected from the collaborating physiotherapists of the quantitative phase and physiotherapists with experience in Split.OA battery tests. Focus groups were moderated by a researcher with experience in qualitative studies and co-moderated by another researcher. The deductive analysis was carried out by two investigators independently. The interview guide and deductive content analysis were guided by the Capacity, Opportunity, Motivation – Behaviour (COM-B) model.Results:In total, 21 participants with HKOA were included. The interrater and intra-rater reliability analysis of the tests showed moderate to excellent ICC values (ICC1,1 0,726-0,986; ICC1,k 0,925-0,966) and (ICC3,1 0,699-0,995; ICC3,k 0,890-0,975), respectively. The deductive analysis revealed 14 barriers and 16 facilitators, within 5 domains of COM-B. The physiotherapists considered that factors such as their knowledge and the need for training, the necessary resources, their contexts and work teams, beliefs about patients’ expectations and communication with them, their beliefs about benefits, the professional responsibility, their confidence and emotions, were highly important for the implementation of the physical performance battery.Conclusion:This study provides a contribution about the intra-rater and interrater reliability of a physical performance battery of tests for people with HKOA, showing that even when applied together, physical tests maintain their reliability levels. Additionally, the barriers and facilitators identified will inform possible strategies to be adopted in the future training of physiotherapists and optimise the implementation of Split.OA battery. It may also contribute to the implementation of other performance test batteries in clinical practice.REFERENCES: NIL. Acknowledgements:NIL.Disclosure of Interests:None declared.

ABSTRACT The alveolar lateral is phonetically and phonologically complex. Previous studies have shown that /l/ is one of the last segments to be acquired by typically developing Portuguese children. However, little is known about how Portuguese children with atypical development acquire /l/. In this paper, we investigate the acquisition of /l/ by Portuguese children with protracted phonological development (DLD; SSD). We explore the effect of syllable structure and segmental properties in the acquisition of /l/ and describe mismatches used for target /l/, thus contributing empirical evidence to the ongoing discussion on differential diagnoses for children with primary phonological disorders. Our results show that the lateral is more problematic in SSD than in DLD, with the manner of articulation being more problematic than its place. A syllable-segment interface effect was attested. Mismatches showed a preference for [w, ɾ, ø]. The results are discussed considering their implications for clinical practice and the role of target phonetic and phonological properties in the /l/ acquisition path.