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The development of European Union of Medical Specialists (UEMS) physical and rehabilitation medicine programmes of care (PRMPC) and physical and rehabilitation medicine care pathways (PRMCP) in France is a good example of the positive interaction between European and national organizations. PRMPC were defined at the European level to offer a robust template for the description and assessment of physical and rehabilitation medicine (PRM) clinical activity in various fields and contexts. An accreditation procedure was organized as a peer review. It has started to provide very informative documents. In France, discussions on this topic began in 2000. At the end of the same decade, the European approach fostered the interest of French PRM organizations in a period of negotiating with public authorities about two crucial issues: specifications required for reimbursement of functional instrumental assessments in PRM practice and funding of PRM care in postacute facilities. The French Society of PRM (SOFMER) decided to describe the PRM scope in a systematic way, emphasizing the best balance between patient needs, rehabilitation goals, relevant means and justified funding. Nine "PRMCP" have been published since 2010 and others are in progress. PRMPC and PRMCP share the same concern about the best response offered by PRM to patients' needs. The first approach is the description of a local organization with respect to both scientific evidence and local conditions. The latter is an outline of PRM intervention related to a multidimensional pattern of patients' situations. Both enhance the role of PRM doctors, whose expertise is necessary for making a synthesis of medical diagnosis and functional assessment, for setting up a patient-centred care strategy and for supervising the rehabilitation team's intervention.

Low back pain represents a major economic and societal challenge due to its high prevalence. Lumbar orthoses are one of the recommended treatments. Even if previous results showed their clinical effects, the detailed mode of action is still poorly known, making the device design difficult. A renewed instrumentation and experimental protocol should bring better insight into the lumbar brace–trunk mechanical interaction. This instrumentation should give detailed information on the basic physical or geometrical parameters: the pressure applied on the trunk, the body shape and the strain in the belt. The principal objective of this study was to propose and validate a new measurement protocol, based on pressure mapping systems and full-field shape and strain measurement. The feasibility of the protocol was tested along with its validity and repeatability. The influence of various parameters, which could cause changes in the measurements, was tested with six different belt configurations on one subject. Measurements were also performed to study the impact of posture on pressure and strain. Both pressure and strain appeared to be asymmetric from left to right. The pressure applied by the lumbar belt on the back varies with breathing and with posture. This study showed that full-field measurements were necessary to render the high variability of pressure or strain around the trunk, under recommendations of their use to guarantee a satisfying repeatability. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine whether the resisted-sprint in overstrength (OSt) or the assisted-sprint in overspeed (OSp) could be efficient training methods to increase 100-m front crawl performance. Thirty-seven (16 men, 21 women) competition-level swimmers (mean [+ or -] SD: age 17.5 [+ or -] 3.5 years, height 173 [+ or -] 14 cm, weight 63 [+ or -] 14 kg) were randomly divided into 3 groups: OSt, OSp, and control (C). All swimmers trained 6 days per week for 3 weeks, including 3 resisted or assisted training sessions per week for the groups OSt and OSp respectively. Elastic tubes were used to generate swimming overstrength and overspeed. Three 100-m events were performed before, during, and after the training period. Before each 100-m event, strength of the elbow flexors and extensors was measured with an isokinetic dynamometer. Stroke rate and stroke length were evaluated using the video-recorded 100-m events. In the OSt group, elbow extensor strength, swimming velocity, and stroke rate significantly increased (p < 0.05), while stroke length remained unchanged after the 3-week training period. In the OSp group, stroke rate significantly increased (p < 0.05) and stroke length significantly decreased (p < 0.05) without changes in swimming velocity. No significant variations in the C group were observed. Both OSt and OSp proved to be more efficient than the traditional training program. However, the OSt training program had a larger impact on muscle strength, swimming performance, and stroke technique than the OSp program. Key Words. exercise, muscular strength, overspeed, overstrength, performance

To assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. A multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. People with hemiparesis with chronic post stroke lower limb spasticity (N=40). Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. Forty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (−0.7, P =.049 in the soleus muscles; −0.8, P =.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P =.005) in the sway area occurred in the treatment group (−3.11±6.92) in comparison with the placebo group (+0.27±3.57). Treating spasticity by injecting botulinum toxin into people's lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose. [ABSTRACT FROM AUTHOR]

Context: Isokinetic assessment of shoulder internal- (IR) and external-rotator (ER) strength is commonly used with many different postures (sitting, standing, or supine) and shoulder positions (frontal or scapular plane with 45° or 90° of abduction). Objective: To conduct a systematic review to determine the influence of position on the intersession reliability of the assessment of IR and ER isokinetic strength, to identify the most reliable position, and to determine which isokinetic variable appears to be most stable in intersession reliability. Evidence Acquisition: A systematic literature search through MEDLINE and Pascal Biomed databases was performed in October 2009. Criteria for inclusion were that studies be written in English or French, describe the isokinetic evaluation methods, and describe statistical analysis. Evidence Synthesis: Sixteen studies meeting the inclusion criteria were included. Variable reliability of ER and IR peak torque (PT) were generally reported for all assessment positions; intraclass correlation coefficients were .44-.98 in the seated position with 45° of shoulder abduction, .09-.77 in the seated position with 90° of shoulder abduction, .86-.99 (coefficient of variation: 7.5-29.8%) in the supine position with 90° of shoulder abduction, .82-.84 in the supine position with 45° of shoulder abduction, and .75-.94 in standing. The ER:IR ratio reliability was low for all positions. Conclusions: The seated position with 45° of shoulder abduction in the scapular plane seemed the most reliable for IR and ER strength assessment. The standing position or a shoulder posture with 90° of shoulder abduction or in the frontal plane must be used with caution given the low reliability for peak torque. Good reliability of ER and IR PT was generally reported, but ER:IR ratio reliability was low. [ABSTRACT FROM AUTHOR]

Lower back pain is a major public health problem. Despite claims that lumbar belts change spinal posture due to applied pressure on the trunk, no mechanical model has yet been published to prove this treatment. This paper describes a first model for belt design, based on the one hand on the mechanical properties of the fabrics and the belt geometry, and on the other hand on the trunk geometrical and mechanical description. The model provides the estimation of the pressure applied to the trunk, and a unique indicator of the belt mechanical efficiency is proposed: pressure is integrated into a bending moment characterizing the belt delordosing action on the spine. A first in-silico clinical study of belt efficiency for 15 patients with 2 different belts was conducted. Results are very dependent on the body shape: in the case of high BMI patients, the belt effect is significantly decreased, and can be even inverted, increasing the lordosis. The belt stiffness proportionally increases the pressure applied to the trunk, but the influence of the design itself on the bending moment is clearly outlined. Moreover, the belt/trunk interaction, modeled as sticking contact and the specific way patients lock their belts, dramatically modifies the belt action. Finally, even if further developments and tests are still necessary, the model presented in this paper seems suitable for in-silico pre-clinical trials on real body shapes at a design stage. [ABSTRACT FROM AUTHOR]

Knee orthotic devices are commonly prescribed by physicians and medical practitioners for preventive or therapeutic purposes on account of their claimed effect: joint stabilisation and proprioceptive input. However, the force transfer mechanisms of these devices and their level of action remain controversial. The objectives of this work are to characterise the mechanical performance of conventional knee braces regarding their anti-drawer effect using a finite element model of a braced lower limb. A design of experiment approach was used to quantify meaningful mechanical parameters related to the efficiency and discomfort tolerance of braces. Results show that the best tradeoff between efficiency and discomfort tolerance is obtained by adjusting the brace length or the strap tightening. Thanks to this computational analysis, novel brace designs can be evaluated for an optimal mechanical efficiency and a better compliance of the patient with the treatment. [ABSTRACT FROM AUTHOR]

Knee orthotic devices are commonly prescribed by physicians and medical practitioners for preventive or therapeutic purposes with the aim of supporting, aligning or immobilising the joint. However, the evaluation of these devices relies on few biomechanical studies or therapeutic trials and the level of their mechanical actions remain unclear. The objectives of this work are to develop and validate an experimental testing machine regarding its realism as compared to a standardised human limb by using a finite element approach, and then to use this machine to characterise the efficiency of different categories of orthoses under different pathological kinematics and investigate the influence of various design characteristics. It was found that the measured mechanical actions should be corrected to compensate for the rigid design of the test machine. Experimental results showed that the tested orthoses highly differed in their ability to restrain motions and that the stiffening effects of these devices may be able to compensate for deficient internal structures only under low load. Although results remain to be confronted to clinical evidence, this approach paves the way to a standardised procedure for evaluating knee orthoses and developing new designs. [ABSTRACT FROM AUTHOR]

Background: Deficiencies in both afferent proprioceptive information and efferent motor responses have been independently reported in patients with recurrent anterior shoulder instability. We used a validated force platform method to analyze the association between the stabilometric parameters of the upper limb as representative of the shoulder's sensorimotor control and clinical glenohumeral joint instability. Methods: We enrolled 32 patients with unilateral recurrent anterior post-traumatic shoulder dislocation, on the dominant side in 13 patients (DIG) and the non-dominant side in 19 patients (NDIG) and 16 healthy nonathletic subjects (CG). Displacements of the Center of Pressure were measured by a Win-Posturo® Medicapteurs force platform in the upper limb weight-bearing position with the lower limbs resting on a table up to the anterior superior iliac spines. The association between stabilometric values and clinical shoulder instability was analyzed by side-to-side comparisons and comparisons to a control group. Results: For CG and NDIG, there were no side-to-side differences. For DIG, stabilometric values were significantly higher on the dominant pathological shoulder side than on the healthy contralateral non-dominant side (P < .01). The percentage of side-to-side differences was higher in DIG than CG (P < .01). Conclusion: Sensorimotor control deficiency was associated with recurrent anterior shoulder instability, especially in patients with the pathological shoulder on their dominant side. Using a force platform to assess sensorimotor control of the shoulder is feasible in patients with shoulder instability, and can allow assessment of the global sensorimotor control deficiency present in unstable shoulders. [Copyright &y& Elsevier]

BACKGROUND: Adaptations to Internal (IR) and external (ER) rotator shoulder muscles improving overhead throwing kinematics could lead to muscular strength imbalances and be considered an intrinsic risk factor for shoulder injury, as well as modified shoulder range of motion (RoM). OBJECTIVE: To establish profiles of internal and external rotation RoM and isokinetic IR and ER strength in adolescent- and national-level javelin throwers. METHODS: Fourteen healthy subjects were included in this preliminary cross-sectional study, 7 javelin throwers (JTG) and 7 nonathletes (CG). Passive internal and external rotation RoM were measured at 90° of shoulder abduction. Isokinetic strength of dominant and non-dominant IR and ER was evaluated during concentric (60, 120 and 240°/s) and eccentric (60°/s) contractions by Con-Trex® dynamometer with the subject in a seated position with 45° of shoulder abduction in the scapular plane. RESULTS: We reported significantly lower internal rotation and significantly higher external rotation RoM in JTG than in CG. Concentric and eccentric IR and ER strength were significantly higher for the dominant shoulder side in JTG (P < 0.05), without significant differences in ER/IR ratios. CONCLUSIONS: The main finding of this preliminary study confirmed static and dynamic shoulder stabilizer adaptations due to javelin throw practice in a population of adolescent- and national-level javelin throwers. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the appropriate characteristics of ankle-foot orthoses for patients with Charcot-Marie-Tooth disease. The study analyzes the levels of sensory and muscular deficits and posture and gait capacities of 26 subjects while wearing ordinary or plastic and elastic orthoses. The results show the importance of ankle-foot orthosis in enhancing the patients' posture and gait performance.

Background: In track and field, the load of impact, the coordination and the constraints on the ankle could result in adaptations of the ankle dynamic stabilization. These constraints could play a strengthening role and increase invertor and evertor strength also after a previous history of lateral ankle sprain. Objective: To compare the ankle invertor and evertor isokinetic strength in track and field athletes (i) with functional ankle instability (FAI), (ii) with history of lateral ankle sprain but without functional ankle instability, and (iii) without any history of lateral ankle sprain. Methods: Twenty-five track and field athletes (5 female and 20 male, 22 ± 5 years) were included in this cross-sectional controlled study, and divided into 3 groups for comparison: (i) athletes with FAI, (ii) athletes with a previous history of lateral ankle sprain, and (iii) a control group of healthy athletes. The dominant side ankle invertor and evertor isokinetic strength were evaluated concentrically at 120 and 30°/s while the evertor strength was also tested eccentrically at 30°/s. Results: No significant differences were indicated between the muscle strength of the three groups, except for the concentric evertor peak torque and the evertor-to-invertor ratio (EIR) at 30°/s (P < 0.05). The concentric evertor peak torque and EIR at 30°/s were significantly lower in the group of athletes with a previous history of ankle sprain than in the control group (P <0.05). Conclusion: Functional ankle instability and/or history of lateral ankle sprain in track and field athletes were not associated with strength weakness of the invertor or evertor muscles. However, as the EIRs were higher than 1.0 for the healthy track and field athletes and those with FAI, it is suggested that the track and field constraints result in adaptations of the ankle dynamic stabilization and then influence invertor and evertor strength balance. [ABSTRACT FROM AUTHOR]

Background: Although there have been many studies on isokinetic shoulder exercises in evaluation and rehabilitation programs, the cardiovascular and metabolic responses of those modes of muscle strength exercises have been poorly investigated. Objective: To analyze cardiovascular and metabolic responses during a standardized test used to study the internal (IR) and external (ER) rotators maximal isokinetic strength. Methods: Four days after an incremental exercise test on cycle ergometer, ten healthy subjects performed an isokinetic shoulder strength evaluation with cardiovascular (Heart rate, HR) and metabolic gas exchange (&Vdot;O_{2}) analysis. The IR and ER isokinetic strength, measured in seated position with 45° of shoulder abduction in scapular plane, was evaluated concentrically at 60, 120 and 240°/s and eccentrically at 60°/s, for both shoulder sides. An endurance test with 30 repetitions at 240°/s was performed at the end of each shoulder side testing. Results: There was a significant increase of mean HR with isokinetic exercise (P< 0.05). Increases of HR was 42–71% over the resting values. During endurance testing, increases of HR was 77–105% over the resting values, and corresponded to 85–86% of the maximal HR during incremental test. Increase of &Vdot;O_{2} during isokinetic exercises was from 6–11 ml/min/kg to 20–43 ml/min/kg. Conclusion: This study performed significant cardiovascular and metabolic responses to isokinetic exercise of rotators shoulder muscles. A warm-up should be performed before maximal high-intensity isokinetic shoulder testing. Our results indicated that observation and supervision are important during testing and/or training sessions, especially in subjects with risk for cardiovascular disorders. [ABSTRACT FROM AUTHOR]

Background: Isokinetic testing imposes severe cardiovascular stress which must be taken into consideration particularly when at risk patients are involved. Objective: To assess the effects of isokinetic tests on heart rate (HR) in stable chronic heart failure (CHF) patients. Subjects: Twenty five CHF patients, 23 men, 2 women. Intervention: After a 10-min warm-up on a cycle ergometer, one lower limb was tested isokinetically using 3 successive repetitions of knee flexion-extension at 60 and 180°/s and 20-repetitions at 240°/s. Heart rate was recorded on average over 5 sec and was analyzed at the start and end of each exercise. Peak VO_{2} was assessed during maximal incremental test on the ergometer. Results: Maximal values (117.6 ± 22.0 bpm) of HR were obtained during incremental exercise testing which corresponded to 97.6 ± 14.0% of maximal HR noted at peak VO_{2}. Conclusion: Isokinetic muscle strength testing in CHF patients must be performed under the supervision of an experienced clinician who should judge the value and feasibility of the endurance test. [ABSTRACT FROM AUTHOR]

Objective: To study the influence of gravitational correction on the internal (IR) and external rotators (ER) shoulder strength. Methods: The IR and ER isokinetic strength, measured in 30° scapation, was evaluated concentrically at 60 and 240°/s and eccentrically at 60°/s in 33 healthy volunteers. Strength scores were expressed either by incorporating gravitational correction (GC) or without it. Results: With GC, IR strength was significantly lower and ER strength significantly higher than without incorporation of this procedure. Conclusion: The GC procedure has a significant influence on IR and ER strength and should be incorporated when strength deficits of the rotator cuff are expected. [ABSTRACT FROM AUTHOR]

The article reports on a study on the effectiveness of a lumbar belt in subacute low back pain. The objective of the study is to evaluate the effects of an elastic lumbar belt on functional capacity, pain intensity in low back pain treatment, and the benefits of medical cost. The study concludes that lumbar belt wearing is consequent in subacute low back pain to improve significantly the functional status, pain level, and the pharmacologic treatment.

The article presents a study which determined whether rigid and dynamic ankle-foot orthosis (AFO) could affect comparable gait alterations independent of neurological deficit. An introduction to AFO is offered. In the study, 11 healthy subjects were asked to wear two AFO models and walk on a 12-meter electronic mat. Variables quantified include velocity, step time and step length. Details of the study findings are explained.

Abstract: Introduction: Randomized and controlled study of clinical evaluation of medical device in healthy subjects. Objective: To evaluate the effect of wearing an elastic lumbar support, frequently used in low-back pain prevention or treatment, on the trunk flexors and extensors muscle strength on healthy subjects. Summary of background data: The long-term use of a lumbar orthosis is still suspected of weakening on the trunk muscles. The results in the existing literature are contradictory but don''t seem to confirm this. Methods: Trunk muscle isokinetic and isometric strength measured before and after the wearing of an elastic orthosis over a period of 21days by healthy subjects with a control group without orthosis. Results: There were 20 healthy subjects using orthosis and 9 controls. No changes in isokinetic and isometric strength were observed except for the endurance parameter on extensors: it was significantly more important before than after the lumbar support use (p =0.033). Conclusion: These results disprove any negative effects on muscle strength and add to the existing literature which argues for a more customized prescription of lumbar orthosis depending on the potential muscle strength of the subject. [Copyright &y& Elsevier]

The article presents a study which aims to assess the recovery in muscle strength and functional capacities in patients with Guillain-Barré syndrome (GBS) for 18 months after onset. The authors state that the slow rate of muscle strength recovery 6 months after onset underscores the need to adapt an appropriate individualized rehabilitation-management program. They conclude that investigations about fatigue and psychological status should be included in the evaluations.

This study assessed the applicability of dynamometric muscle evaluation in scoliosis. Objective: To assess the clinical applicability of the dynamometric muscle evaluation in scoliosis by reliability studies, its relations with the clinical measures, and comparison analysis with healthy subjects. Methods: Thirty five scoliotic female patients and 27 healthy women were evaluated dynamometrically muscle strengths, additionally the scoliotic women were evaluated by clinical measures. To assess the reliability of isokinetic muscle testing 20 scoliotic women were tested twice 1 week apart Results: The ICCs ranged 0.81–0.96, except in the case of the knee extensor strength at 120°/s. Curve angle was weakly correlated to trunk flexor strength at 90°/s (r=0.40), the curve pattern was moderately related to knee muscles' strengths (-0.46 < r < -0.57). Scoliotic women showed weaker isokinetic muscles strengths except the trunk extensors at 90°/s. Conclusion: Isokinetic evaluation of trunk muscle strength may be an additional tool in assessing this patient group. [ABSTRACT FROM AUTHOR]

The article investigates the link between maximal exercise capacity and walking capacity in stroke patients with hemiplegia. Results reveal a significant association between walking capacity and both peak oxygen uptake and maximal power output. In addition, aerobic capacity and walking capacity decline in hemiplegic stroke patients and are correlated with each other. These findings emphasize the need for future research, to confirm the role of fitness in relation to walking capacity, and to evaluate the benefit of integrating aerobic training into more conventional rehabilitation programs following a stroke.

Background: In patients with CHF, physical reconditioning improves exercise tolerance and endurance capacity. However, there is no evidence that endurance training programs affect skeletal muscle strength in such patients. Design: The present study investigates the effects of endurance training on isokinetic skeletal muscle strength and on aerobic capacity in chronic heart failure (CHF) patients. Methods: Eleven stable CHF patients (8 men, mean aged 54.3 yr and women, mean aged 49.3 yr) participated in a classical controlled inhospital 8-week endurance training program. Progressive incremental exercise tests with gas exchange analysis and isokinetic strength measurements of knee flexors and extensors were conducted in all subjects before and after training at different angular velocities (60, 180, 240°/s ). Results: After training, peak &Vdot; O_2 improved significantly (from 16.3 ± 3.3 to 20.7 ± 4.0 ml/kg/min; p < 0.002) as did New York Heart Association (NYHA) functional class (2.2 ± 0.4 to 1.5 ± 0.5; p < 0.001). Conversely, isokinetic strength at all angular velocities studied was unchanged after the training program. Conclusion: Isokinetic muscle strength was not improved in CHF patients participating in a endurance training program. A combined endurance and resistance protocol might be helpful for these patients whose frequently altered muscle strength undoubtedly contributes to their poor quality of life for everyday activities. [ABSTRACT FROM AUTHOR]

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