João Paulo Branco

Sarcopenia is a progressive skeletal muscle disorder associated with impaired physical function and adverse outcomes in older adults. Burn injury imposes profound hypermetabolic and catabolic stress that may compromise muscle mass, strength, and physical function, particularly in individuals with reduced baseline muscle reserve. This narrative review integrates current evidence on sarcopenia and muscle dysfunction in older adults with burn injuries, addressing baseline vulnerability, burn-related muscle deterioration, diagnostic challenges, clinical implications, and therapeutic strategies. Patients may present with pre-existing sarcopenia or reduced muscle reserve, develop acute sarcopenia during or after burn-related illness, or experience worsening of pre-existing sarcopenia, potentially resulting in an acute-on-chronic trajectory. However, substantial burn-related muscle wasting, weakness, and functional impairment may occur without fulfilling diagnostic criteria for sarcopenia and represent distinct, clinically relevant manifestations of impaired muscle health. Sarcopenia assessment in burn patients is challenging and should be individualized according to clinical context and stage of recovery. Preservation and recovery of muscle health should be addressed throughout burn care through individualized nutritional support, early mobilization, and progressive exercise, with pharmacological strategies playing an adjunctive role. Prospective longitudinal studies are needed to characterize muscle-health trajectories, distinguish sarcopenia from other forms of post-burn muscle dysfunction, and determine their prognostic significance and response to interventions, including effects on functional recovery, independence, and quality of life.

Musculoskeletal (MSK) conditions are the leading cause of disability worldwide and, in European Union countries, account for up to 17% of years lived with disability and around 2% of gross domestic product (GDP) in direct and indirect costs. Despite universal health coverage and a doubling of public rehabilitation prescriptions in the past decade, unmet rehabilitation needs persist in Portugal, alongside growing regional disparities, long waiting times, and a heavy reliance on private services for physical rehabilitation. These factors undermine both clinical and economic outcomes. International and national evidence indicates that rehabilitation delivered through AI-enabled programmes is feasible and potentially effective, can be deployed at scale, and may reduce barriers related to geography, scheduling, and limited rehabilitation facilities. Such solutions may help improve continuity of care, shorten waiting times, and address unmet needs, but large-scale adoption requires robust frameworks for clinical evaluation and validation, patient selection, professional training, and outcome monitoring, often within hybrid models of care. By explicitly addressing potential benefits, risks, limitations, and clinical criteria, the rehabilitation community can facilitate responsible and ethical integration of AI-supported and digital models into rehabilitation practice and research, while managing the organisational and cultural changes needed to incorporate these models as complementary interventions within health systems. Drawing on WHO and OECD recommendations and on recent Portuguese implementation experience, this perspective examines how AI-driven rehabilitation may support more equitable, timely, and efficient responses to MSK rehabilitation needs, particularly for physician-prescribed care delivered under medical supervision in the home setting.

Genetics and biomarkers are emerging as key tools in precision rehabilitation, enabling more accurate prediction of recovery and individualized therapeutic planning. Genetic factors such as polymorphisms in BDNF, ApoE, and genes related to dopaminergic and serotonergic systems significantly influence neuroplasticity, cognitive reserve, and functional outcomes after neurological injuries like stroke and traumatic brain injury. For example, the BDNF Val66Met variant is associated with reduced neural plasticity and poorer recovery, while the ApoE4 allele correlates with worse prognosis in brain injury. Biomarkers, including molecular, physiological, and neuroimaging indicators, provide measurable insights into disease mechanisms, treatment response, and prognosis. Proteins such as S100β, genetic/epigenetic markers, functional neuroimaging, and electrophysiological measures allow for patient stratification, early prognosis, dynamic monitoring, and real-time treatment adjustments. By integrating genetic insights with biomarker analysis, rehabilitation medicine can move from generalized protocols toward tailored, patient-centered interventions, improving efficiency, adherence, and long-term outcomes. Despite challenges such as high costs, limited standardization, and ethical concerns, combining genetics and biomarkers with digital health and artificial intelligence holds strong potential to transform rehabilitation into a fully personalized model of care.

Introduction: Knee injuries are increasingly common in the pediatric population, with anterior cruciate ligament (ACL) ruptures standing out due to their rising incidence in children and adolescents. These injuries are associated with significant clinical and functional consequences, such as the need for surgical intervention, lengthy rehabilitation, low return-to-sport rates, high re-injury risk, and early-onset osteoarthritis. They may also impact school performance. This study aims to evaluate the effectiveness of neuromuscular training (NMT) programs in preventing ACL injuries in young populations and to identify the most effective protocols, components, and contributing factors. Methods: A systematic review was conducted following PRISMA guidelines using PubMed, Embase, and Web of Science, covering studies from 2014 to 2024. The selection followed the PICO framework, focusing on individuals under 18 years old receiving neuromuscular or proprioceptive training, compared to control groups or studies analyzing biomechanical risk factors. Only peer-reviewed articles in English or Portuguese were included. Two independent reviewers screened studies, extracted data, and assessed quality. Outcomes evaluated were ACL injury incidence and biomechanical risk factors. Results: Of the 64 initially identified articles, 9 met the inclusion criteria3 systematic reviews and 6 original studies. The systematic reviews highlighted significant reductions in ACL injury rates and emphasized the influence of sport type and external factors. The original studies reported improvements in neuromuscular and biomechanical control following NMT protocols. Conclusions: NMT was shown to be effective, particularly when introduced early in youth. Key factors for successful implementation include exercise variety, sensory feedback, and professional supervision. Additionally, unstructured play may contribute to natural protective adaptations. Future research should refine and personalize preventive strategies.

A 47-year-old male ultramarathon runner presented with persistent discomfort in the anterior region of the left leg. The patient reported a snapping sensation in his left leg four weeks earlier while running an ultramarathon, followed by ecchymosis and functional impairment the next day. Physical examination revealed a palpable area of fibrosis in his anterior left leg. Ultrasound of the left leg identified a partially organized rupture of the distal third of the tibialis anterior muscle. The rupture had an extension of 36 x 10 x 27mm with associated muscle edema. The patient was treated non-surgically with a customized rehabilitation program and later returned to ultramarathon running. This case illustrates the importance of proper differential diagnosis and individualized rehabilitation programs to achieve optimum clinical and functional results.

Introduction: The pandemic Coronavirus Disease 2019 (COVID-19) strongly affected the organization and functioning of Physical and Rehabilitation Medicine (PRM) departments in Europe, posing specific challenges in the management of diseases and their consequences. We aim to evaluate the changes suffered by Portuguese PRM departments in the scope of assistance, organization, training and research. Methods: A self-administered, cross-sectional online questionnaire was sent to 41 Portuguese PRM departments, regarding the assistance provided to patients with COVID-19, organizational changes and difficulties experienced on team management, training and research. Results: The survey had a response rate of 82.9%. The majority of the PRM departments assisted patients with COVID-19, mainly in the context of inpatient general ward care and intensive care units. Changes in the assistance activity and accessibility were reported by almost all PRM departments, mainly affecting the outpatient consultation. There was a reduction on the number of healthcare professionals reported, especially by transfer to other areas, and almost all used remote procedures, especially for patient reassessment, counseling, and monitoring. The majority of PRM departments highlighted the pandemic’s impact on the training availability, as well as in the applied research and publications. Conclusions: The pandemic triggered a complete overhaul of rehabilitation departments with significant changes in assistance activity, changing routines and programmed procedures, with a strong negative impact on scientific research and training. Outpatient consultations was the most affected area, while support for hospitalization and internal consultations remained mostly operational. The use of remote procedures was high, particularly in follow-up and counseling.

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

Stroke is a major cause of short-term functional impairment, but the recovery timeframes are not well-established. This study aims to evaluate the progression of functional recovery during the first 24 weeks after acute ischemic stroke, to determine the timeframes for motor, cognitive, and overall recovery. Prospective observational study. Tertiary care center; 12-week inpatient period, followed by 12-week outpatient period. A group of 131 patients with acute stroke in the territory of the middle cerebral artery with age 18-85 years-old. Patients received treatment according to routine clinical practice and underwent a closely-controlled rehabilitation program for 24 weeks. Functionality assessments were conducted at 48 hours, 3 weeks, 12 weeks, and 24 weeks after acute stroke and included the modified Rankin Scale (mRS), the Functional Independence Measure (FIM), and the Stroke Upper Limb Capacity Scale (SULCS). Over the study period, patient functionality improved significantly (P<0.001) as measured by all scales. Assessment scores improved significantly from 48 hours to 3 weeks for all scales; the same occurred from 3 weeks to 12 weeks, except for C-FIM. From 12 weeks to 24 weeks, there were no statistically significant functional improvements for any scale. In comparative terms, cognitive impairment was less severe than motor disability in the acute phase. C-FIM scores at 48 hours were significantly higher than M-FIM and mRS scores. Upper limb functioning measured by SULCS, showed a intermediate degree of disability compared to the C-FIM, M-FIM, and mRS. Functional recovery occurs at least until 24 weeks after acute stroke, but most of the functional gains tend to be achieved during the first 12 weeks. Cognitive function tends to improve earlier than motor function, with the most substantial gains occurring within the first three weeks. From 12 to 24 weeks there are observable numerical gains in patient functionality, highlighting the need to maintain an adequate rehabilitation program. This study provides insight into the recovery timeframe for stroke patients, which can support the development of more effective rehabilitation programs.

Objective: To evaluate the potential of neuroimaging, serum biomarkers, stroke etiology, and clinical characteristics as predictors of upper limb functioning 12 weeks after stroke. Methods: This was a prospective, observational study of patients (18–85 years-old) hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery. Patients were hospitalized at a stroke rehabilitation center, where they underwent a standardized rehabilitation program. Clinical, imagiology, laboratory (biomarkers: C-reactive protein, D-dimer, and fibrinogen, and S100 calcium binding protein β [S100β]), and functionality assessments were conducted four different times: within 24 hours, and at 48 hours, 3 weeks, and 12 weeks after acute stroke. Results: Upper limb functioning at 12 weeks was significantly associated with Alberta Stroke Program Early CT Score (ASPECTS) score (OR:2.012 [CI:1.349–3.000]; P = 0.001) and S100β protein levels (OR:0.997 [CI:0.994–0.999]; P = 0.007). Advanced age was associated with poor upper limb functioning. S100β protein levels < 140.5 ng/L at 48 hours and ASPECTS scores ≥ 7.5 within 24 hours of admission predicted good hand functioning at 12 weeks. Upper limb functioning and general functioning were significantly correlated (P < 0.001), with strong negative correlations (all correlation coefficients ≤–0.586) for all comparisons. Conclusion: ASPECTS score ≥ 8 within 24 hours and S100β protein < 140.5 ng/L at 48 hours predict better upper limb functioning, while advanced age predicts worse upper limb functioning 12 weeks after stroke.