Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation

Background: The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming. Methods: We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire. Results: In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p <.001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p=.074), significantly shorter travel distance (p <.001), higher movement efficiency (p <.001) and higher performance scores (p <.001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance. Conclusions: Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.

Health in Madeira: a comprehensive study of aging, body composition, physical activity and functional fitness

Physical Activity (PA) and functional fitness (FF) are predictors of a healthy and independent lifestyle in older adults. The purpose of this study was: (1) to construct reference values for FF; (2) to describe sex- and age-related changes in FF, balance, gait, PA, body composition, and bone health/strength; and (3) to determine their variation and co-variation with respect to PA. This cross-sectional study included 401 males and 401 females aged 60-79 years old. FF was assessed using the Senior Fitness test and balance by the Fullerton Advance Balance scale (FAB). Gait parameters: gait velocity (GV), stride length (SL), cadence and gait stability ratio (GSR) were measured. Femoral strength index (FSI) and bone mineral density (BMD) of the total body, lumbar spine, hip region and total lean tissue mass (TLTM) and total fat mass (TFM) were determined by dual-energy x-ray absorptiometry-DXA. PA was assessed during face-to-face interviews using the Baecke questionnaire. Demographic and health history information were obtained by structured telephone interview. In both sexes, a significant main effect for age-group was found for FF parameters, balance scores, gait performances, TLTM and hip, LS and total BMD and FSI. Likewise there were significant main effects for age-group for total PA in women and sports related PA in men. Men scored significantly better than women in FF (except in upper- and lower-body flexibility), balance, GV, SL, GSR and had higher BMD and TLTM compared with women. Active subjects scored better in FF, balance, and gait than their average and non-active peers. PA and FF exerted only a minor influence in the differentiation of BMD and FSI among the elderly while constitutive factors like age, height, body mass, TLTM and TFM entered as the most significant contributors. This study gives scientific support to public policies at the community level, targeted to increase PA, FF and TLTM, thereby contributing to improved quality of life in older adults.

Nematicidal activity of Solanum nigrum and S. sisymbriifolium extracts against the root-lesion nematode Pratylenchus goodeyi and its effects on infection and gene expression

The control of Pratylenchus goodeyi a common nematode parasite of banana crop in Madeira Island can benefit from searching for natural nematicides through plants extracts. With this aim we submitted Solanum nigrum and S. sisymbriifolium dried plants to a sequential extraction in the solvent sequence of dichloromethane, acetone, ethanol and water, and to na aqueous extraction of the fresh and dried plants. Analyses with the extracts at several concentrations were used to assess mobility and mortality on P. goodeyi. Results showed that the water extract and aqueous extracts from both plants at a concentration of 10 mg/mL affected nematode mobility and caused mortality but the acetone extract from S. nigrum was the most efficient, causing 100% mortality whereas dichloromethane had no effect on P. goodeyi. Determination of the lipophilic and phenolic compounds present in the two most effective Solanum extracts (acetone and water) and in dichloromethane extract revealed that some of these compounds had nematicidal activity. S. nigrum acetone extract (10 mg/mL) was used to find out the nematicidal potential following the effect at gene expression level and nematode behaviour. Genes coding for calreticulin and beta-1,4- endoglucanase related to parasitism and translocon-associated protein putatively connected to stress were obtained and its relative expression assessed in nematodes exposed to the extract. Results revealed that expression of Pg-CRT decreased showing to influence the infection, Pg-ENG remained steady and Pg-TRAPδ was induced over time exposure. Biological assays showed that P. goodeyi mobility and ability to infect the banana roots were affected as a decrease in the number of nematodes that reached the roots was obtained with the increased exposure time to the extract being implicated in the infection success. The information obtained from this thesis showed that S. nigrum has potential to be used for the development of a new control strategy against plant-parasitic nematodes.