Ricardo Miguel Ferreira

Abstract

Abstract
Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction relies on the precise identification of perforator vessels supplying blood to transferred tissue. Traditional manual mapping from preoperative imaging is timeconsuming and subjective. To address this, AVA, a semi-automated perforator detection algorithm, was developed to analyze angiography images. AVA follows a three-step process: automated anatomical segmentation, manual annotation of perforators, and segmentation of perforator courses. This approach enhances accuracy, reduces subjectivity, and accelerates the mapping process while generating quantitative reports for surgical planning. To streamline integration into clinical workflows, AVA has been embedded into PACScenter, a medical imaging platform, leveraging DICOM encapsulation for seamless data exchange within a Vendor Neutral Archive (VNA). This integration allows surgeons to interactively annotate perforators, adjust parameters iteratively, and visualize detailed anatomical structures. AVA-PACScenter integration eliminates workflow disruptions by providing real-time perforator analysis within the surgical environment, ultimately improving preoperative planning and intraoperative guidance. Currently undergoing clinical feasibility testing, this integration aims to enhance DIEP flap reconstruction efficiency by reducing manual inputs, improving mapping precision, and facilitating long-term report storage within Dicoogle. By automating perforator analysis, AVA represents a significant advancement toward data-driven, patient-centered surgical planning.

Abstract
The Hoffmann reflex is a is a neurophysiological test that provides insight into the functioning of the human nervous system. It is commonly used in clinical and research settings to evaluate the modulation of the monosynaptic spinal reflex. This paper focus the analysis of the Hoffmann reflex in the trapezius muscle, a muscle of particular interest for researchers and clinicians due to its importance in upper limb function and dynamic stability. However, the Hoffmann reflex analysis of this muscle bring some challenges as the need of applicating burst of electrical square impulses in each current intensity. A web-based smart dashboard, implemented in Python, which allows the user to visualize and analyze the Hoffmann reflex using various signals acquired through a constant current stimulator. The dashboard provides an intuitive and user-friendly interface that facilitates the selection of muscle signals of interest, analysis cycles, and start and end points for the signals. The visualizations offered by the dashboard, including overlapped and mean signal graphics, provide valuable insights into the Hoffmann reflex and its properties. Preliminary experiments with field experts and physiotherapists have yielded positive feedback on the usefulness of this tool, as they seek to gain a deeper understanding of the Hoffmann reflex, and we plan to further improve its capabilities in the future by employing machine learning techniques to automate the reflex detection. © 2023 ITMA.

Abstract
Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.

Abstract
In chronic shoulder pain, adaptations in the nervous system such as in motoneuron excitability, could contribute to impairments in scapular muscles, perpetuation and recurrence of pain and reduced improvements during rehabilitation. The present cross-sectional study aims to compare trapezius neural excitability between symptomatic and asymptomatic subjects. In 12 participants with chronic shoulder pain (symptomatic group) and 12 without shoulder pain (asymptomatic group), the H reflex was evoked in all trapezius muscle parts, through C3/4 nerve stimulation, and the M-wave through accessory nerve stimulation. The current intensity to evoke the maximum H reflex, the latency and the maximum peak-to-peak amplitude of both the H reflex and M-wave, as well as the ratio between these two variables, were calculated. The percentage of responses was considered. Overall, M-waves were elicited in most participants, while the H reflex was elicited only in 58-75% or in 42-58% of the asymptomatic and symptomatic participants, respectively. A comparison between groups revealed that the symptomatic group presented a smaller maximum H reflex as a percentage of M-wave from upper trapezius and longer maximal H reflex latency from the lower trapezius (p < 0.05). Subjects with chronic shoulder pain present changes in trapezius H reflex parameters, highlighting the need to consider trapezius neuromuscular control in these individuals' rehabilitation.