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Résumé: Objectifs. – Mettre en évidence les asymétries chronométriques, cinétiques et cinématiques de l''initiation de la marche chez un sujet hémiplégique ayant un pied varus équin. Méthode. – Nous avons réalisé chez un sujet hémiplégique une analyse cinétique, avec deux plateformes de force AMTI® et cinématique, avec un système optoélectronique ELITE® de l''initiation de la marche. Résultats. – Les durées des phases de l''initiation de la marche étaient asymétriques. La phase d''appui monopodale était plus courte en appui sur le membre inférieur hémiplégique qu''en appui sur le côté sain. La propulsion longitudinale était réalisée essentiellement par le membre inférieur sain. La répartition du poids du corps sur les membres inférieurs était asymétrique. Le membre inférieur sain supportait une charge plus importante que l''autre membre inférieur. L''extension maximale de cheville du côté hémiplégique se produisait pendant la phase oscillante. Le passage du pas se faisait en levant le genou plus haut pour éviter l''accrochage du pied. L''attaque du pas était plantigrade. Conclusion. – Cette étude préliminaire a permis de montrer que l''initiation du pas est asymétrique chez le sujet hémiplégique. L''analyse cinématique de l''initiation de la marche chez un sujet hémiplégique n''avait jamais été réalisée dans des études antérieures. L''étude de l''initiation de la marche pourra nous aider à mieux comprendre les stratégies adaptatives de contrôle de la posture et du mouvement chez les sujets hémiplégiques. [Copyright &y& Elsevier]

The use of posture and movement analysis methods has developed during the past 15 years. These methods are of special interest in the field of sport sciences and have allowed to improve the understanding of physiology of posture and movement in athletes. More recently these methods have been used in the field of sport medicine. In some cases, they have helped to identify abnormalities which cannot be seen on standard clinical examination and to understand the mechanism of lesions occurring during sport activities. For the future these methods should provide useful information for understanding the physiopathology of lesions, for developing prevention of pathologies related to sport and for elaborating and assessing new treatment protocols in the field of sport medicine. [Copyright &y& Elsevier]

Competing Interests: L. Bensoussan et Y. Berland déclarent n’avoir aucun lien d’intérêts.

Introduction: Physical and rehabilitation medicine physicians commonly see patients with chronic functional ankle instability. The main anatomical structures involved in ankle stability are the peroneus (fibularis) brevis and peroneus longus muscles. Several anatomical muscle-tendon variations have been described in the literature as being sometimes responsible for this instability, the peroneus quartus muscle being the most frequent. The objective of this clinical study is to discuss the implication of the bilateral peroneus quartus muscle in functional ankle instability., Clinical Case: This 26-year-old patient was seen in PM&R consultation for recurrent episodes of lateral ankle sprains. The clinical examination found a moderate hyperlaxity on the right side in bilateral ankle varus. We also noted a bilateral weakness of the peroneus muscles. Additional imaging examinations showed a supernumerary bilateral peroneus quartus. The electroneuromyogram of the peroneus muscles was normal., Discussion: In the literature the incidence of a supernumerary peroneus quartus muscle varies from 0 to 21.7%. Most times this muscle is asymptomatic and is only fortuitously discovered. However some cases of chronic ankle pain or instability have been reported in the literature. It seems relevant to discuss, around the clinical case of this patient, the impact of this muscle on ankle instability especially when faced with lingering weakness of the peroneus brevis and longus muscles in spite of eccentric strength training and in the absence of any neurological impairment. One of the hypotheses, previously described in the literature, would be the overcrowding effect resulting in a true conflict by reducing the available space for the peroneal muscles in the peroneal sheath., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Introduction: The aim of the Physical and Rehabilitation Medicine (PRM) day hospital's short-stay program is to propose a one- or two-day medical and psychosocial assessment to patients with disabilities. The day hospital is run by an interprofessional team, using interdisciplinary cooperation and a hospital/community network., Objectives: To describe a tool for assessing patient satisfaction and to present the results of our survey., Patients and Methods: A self-administered questionnaire about patient satisfaction was created and given to patients coming to the PRM day hospital. The questionnaire included 27 multiple-choice questions, two visual analogic scales, and one free-response question. The survey was conducted over two months. For the 603 annual day hospital sessions, 143 questionnaires on 143 sessions were filled out., Results: Patients found the questionnaire easy to use, but a few needed help to fill it out. It permitted us to highlight the places where the short-stay program performed unsatisfactorily., Conclusions: The self-administered questionnaire seems to be appropriate for assessing patient satisfaction. The highest scores helped to emphasize where the program was functioning correctly, and the lowest scores allowed us to identify the points that needed to be improved., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objective: To compare lateral rotator (LR) and medial rotator (MR) muscle strength of both shoulders in a sport involving asymmetrical movements (tennis), symmetrical movements (swimming), and symmetrical and asymmetrical movements (volley-ball)., Materials and Methods: Retrospective study of 42 healthy elite athletes (18 women: 14 tennis players, 19 swimmers and 9 volleyball players. We evaluated the strength of LR and MR of both shoulders by Cybex Norm isokinetic dynamometer, in the concentric mode, in the modified Davies position, at 2 different speeds (60 degrees and 180 degrees s(-1)) and analysed peak torque of LR and MR and LR/MR ratios., Results: TENNIS: The MR peak torque of the dominant shoulder was significantly higher than that of the non-dominant shoulder. The LR/MR ratio of the dominant shoulder was significantly lower than the non dominant shoulder in women. SWIMMING: The LR strength and LR/MR ratio of the dominant shoulder was higher than the non dominant side in men at 60 degrees/second. Both shoulders showed comparable strength in women. VOLLEYBALL: Shoulder muscular strength was symmetrical., Conclusion: The higher strength of MR muscles in the dominant shoulder of tennis players (asymmetrical movements) has been reported in the literature. Athletes show asymmetrical shoulder strength in swimming, a symmetrical sport and similar LR and MR strength in both shoulders in volleyball, a sport with asymmetrical movements. To our knowledge, these results have never been reported before.

Objective: To investigate the temporal, kinetic and kinematic asymmetry of gait initiation in one subject with hemiplegia with an equinus varus foot., Material and Methods: A kinetic analysis with two AMTI force plates and a kinematic analysis with an ELITE optoelectronic system of gait initiation were performed in one subject with hemiplegia., Results: The duration of the gait initiation phases was asymmetrical. The monopodal phase was shorter when the affected lower limb was supporting than when the healthy one was supporting. The propulsion resulted from the force exerted on the healthy lower limb. The distribution of body weight on the lower limbs was asymmetrical. Body weight support was more important on the healthy side than on the affected side. Maximal extension of the ankle on the hemiplegic side occurred during the swing phase. Ground clearance was increased by elevating the knee higher on the affected side than on the healthy side during the swing phase. Initial contact with the floor was performed with the foot flat on the affected side., Conclusion: This preliminary study has shown that gait initiation in one subject with hemiplegia was asymmetrical in kinetics and kinematics. The results concerning kinematics have not been reported previously for gait initiation in subjects with hemiplegia. The study of gait initiation should allow for better understanding postural and movement control strategies developed by patients with hemiplegia.

Introduction: The Authors report the case of a 50-Year-old man with myotonic dystrophy, who developed severe bilateral capsulorhexis contracture after uneventful cataract surgery., Observation: Phacoemulsification was performed in both eyes with implantation of intraocular lenses. The patient came to complain of decreased vision in both eyes (4/10 Parinaud 4). Visual acuity initially improved after surgery to 8/10 P2 in each eye. After 7 months for the right eye and 3 Months for the left eye, the patient presented with dramatically reduced vision, caused by a severe capsulorhexis contracture. Anterior capsulotomies with the Nd:YAG laser were performed in both eyes to treat this complication. It was sufficient on the left eye but the right eye required a surgical anterior capsulectomy to remove the IOL and the bag and put in an Artisan lens., Discussion: Capsulorhexis contracture results from fibrous metaplasia of lens epithelial cells from the anterior capsule. Myotonic dystrophy appears to predispose to the development of severe capsulorhexis contracture after phacoemulsification.

Measurement of arterial flow is a very old practice, and intra-arterial recordings of pressure and flow have long served as a reference for experimental studies (fig. 1). The definition of a hemodynamic state is inconceivable unless these two parameters are associated. The electromagnetic method using an intra-arterial sensor measures pulsatile flow. Now, technological advances have led to the appearance of other methods providing measurement of mean (plethysmography) and nonpulsatile flow. As a result, there has been considerable confusion between mean arterial and pulsatile arterial flow (Fig. 2). Various studies have emphasized the physiological importance of pulsatile arterial flow and thus the interest in measuring it. The recording of mean flow has often proved disappointing because values are comparable in groups of normal subjects and those with arterial disease. Mean arterial flow can be measured by isotopic methods and plethysmography. Xenon-133 clearance is the isotopic method most often used. Since determination of microcirculatory flow at rest proved of no use, it was necessary to add a hyperemia test reactive to ischemia to differentiate patients with artery disease from normal subjects. Methods involving technetium and thallium have been little used since they require the presence of a nuclear medicine center and are not easily reproducible. There are numerous plethysmographic methods, but only those are studied here which allow measurement of arterial flow. Plethysmography by venous occlusion measures arterial flow by recording the increase in limb volume. The sensor is a mercury strain gauge.(ABSTRACT TRUNCATED AT 250 WORDS)