Search

Background Sensorimotor control of axial segments, which develops during childhood and is not mature until adolescence, is essential for the development of balance control during motor activities. Children with cerebral palsy (CP) have deficits in postural control when standing or walking, including less stabilization of the head and trunk which could affect postural control. Research question Is dynamic stabilization of axial segments during an unstable sitting task deficient in children with CP compared to typically developing children? Is this deficit correlated with the deficit of postural control during standing? Method Seventeen children with CP (GMFCS I-II) and 17 typically-developing children from 6 to 12 years old were rated on the Trunk Control Measurement Scale (TCMS). In addition, posturography was evaluated in participants while they maintained their balance in stable sitting, unstable sitting, and quiet standing, under “eyes open” and “eyes closed” conditions. In sitting tasks, the participants had to remain stable while being prevented from using the lower and upper limbs (i.e. to ensure the involvement of axial segments alone). Results Children with CP compared to TD children had significantly larger surface area, mean velocity and RMS values of CoP displacements measured during the unstable sitting task and the standing task, under both “eyes open” and “eyes closed” conditions. No significant group effects were observed during the stable sitting task. The TCMS total score was significantly lower, indicating trunk postural deficit, in the CP group than in the TD group and was significantly correlated with postural variables in the sitting and standing tasks. Significance Children with CP indeed have a specific impairment in the postural control of axial segments. Since the postural control of axial segments is important for standing and walking, its impairment should be taken into account in rehabilitation programs for children with CP.

International audience; We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.

Patellofemoral pain is likely due to compressive force acting on the patella related in turn to knee extension moment. The latter variable was assumed to be (i) reduced during short-distance free walking in case of patellofemoral pain syndrome and (ii) increased after therapeutic pain reduction. Peak knee extension moment at beginning of stance phase was recorded by three-dimensional gait analysis in 22 controls and in 23 patients with patellofemoral pain syndrome before and after rehabilitation of knee extensors and flexors to reduce the pain. Pain would occur mainly in stressful activities such as stair negotiation or squatting and was quantified by the anterior knee pain scale. Peak knee extension moment was significantly reduced in all the patients before treatment (n = 23) compared to controls, although no one had pain during free walking. In the 17 patients who experienced significant postrehabilitation pain reduction in their stressful activities, the peak knee extension moment was significantly reduced before treatment compared to controls and significantly increased after treatment, reaching values similar to control values. The peak knee extension moment during free walking appears to be a good kinetic variable related to a compensatory mechanism limiting or avoiding anterior knee pain and may be of interest in assessing knee dynamics alteration in patients with PFPS.

Introduction L’AVC desorganise la fonction posturale et l’equilibre affectant la verticalite et les capacites de marche. L’hemicorps sain se trouve privilegie. Posture et mouvement sont intimement associes, comme Sherrington l’evoquait « la posture suit le mouvement comme son ombre ». Comment reintegrer l’hemicorps lese au sein des strategies motrices indispensables a la deambulation ? Bobath [1] ou Brunnstrom [2] evoquent des les annees 1950 l’importance de la fonction posturale dans la structuration et l’organisation de la motricite. Elles proposent des methodes globales s’inspirant du developpement psychomoteur de l’enfant. Plus tardivement les NEM decrits par M. Le Metayer [3] chez l’enfant sont repris chez l’adulte neurologique. L’evolution, entre autre, des connaissances dans le domaine des neurosciences depuis les annees 1980 a fait evoluer la reeducation du patient hemiplegique adulte [4] . Pour autant, certains reeducateurs continuent a s’inspirer des NEM ou positions intermediaires pour leur reeducation. Cette approche therapeutique est-elle toujours d’actualite en 2016 ? Materiel, population et methode Les bases de donnees consultees relevent peu d’articles traitant la question ; pour autant, le recoupement d’informations, les echanges avec des professionnels « experts » du domaine de la neurologie ont permis de retenir 3 publications francaises de F. Laurent [5] , [6] , [7] pour, leurs conclusions et l’importance des echantillons (n = 354) et 2 articles parus en 2015 [8] , [9] . Resultats Les articles concluent a l’amelioration des capacites de marche chez le patient hemiplegique adulte apres entrainement dans des positions intermediaires [5] , [8] . Une forte correlation entre d’une part les capacites segmentaires, capacites posturales et capacites a la marche et d’autre part l’entrainement dans des positions nommees « paliers » [5] est notee. L’etude controlee randomisee de R. Cabanas-Valdes [8] incluant 80 patients met aussi en evidence l’amelioration des capacites a la marche apres realisation d’exercices de gainage dans des positions intermediaires. Conclusion ou discussion Le faible niveau de preuve, le nombre reduit d’etudes, les differences de protocole et de positions utilisees ne permettent pas de proposer aux reeducateurs des situations d’exercices types. Pour autant, les resultats ne peuvent qu’inciter les reeducateurs a s’interesser et a s’inspirer de ces travaux afin d’approfondir la question et demontrer l’interet de ces positions pour l’hemiplegique adulte, et ce, en accord avec les exigences de l’EBP.

Hip dynamics in the intact limb during the beginning of stance phase in unilateral trans-tibial amputees (TTA) was studied to evaluate its contribution to compensatory function. We hypothesized (1) an increase in hip total work during H1 power phase (0-30% of gait cycle) including an initial negative phase and (2) an intensification of the hip work in response to uncomfortable gait induced by prosthesis misalignment. Three-dimensional gait analysis was conducted in 17 unilateral TTA and 15 healthy subjects walking at the same self-selected speed in three prosthetic alignments: initial alignment (IA); IA altered either by 6 degrees of internal rotation (IR) or by 6 degrees of external rotation. Patients reported best comfort of gait in IA condition and discomfort mainly in IR condition. During the H1 power phase, in intact limbs a consistent initial flexion movement of the hip (0-8% gait cycle) was associated to negative work and was followed by hip extension and positive work whereas in both prosthetic and control limbs only hip extension and positive work occurred (except in one healthy individual). Absolute value of hip work during H1 phase was significantly higher in intact and prosthetic limbs compared to control limbs in IA condition and was further significantly increased in IR condition only in intact limbs demonstrating a compensatory function of the latter. In intact limbs, early hip negative work contributed to energy absorption in addition to the knee joint probably to compensate the lower energy absorption exerted by the prosthetic limbs.

Resume Objectifs Exposer la place de l'exploration situationnelle de l'activite locomotrice et l'interet des methodes d'analyse ambulatoire. Decrire les capteurs, les variables mesurees, les systemes de monitorage a disposition. Materiel et methode Revue de la litterature et experience personnelle. Pour chaque methode et technique d'exploration ambulatoire, les principes, les objectifs et les limites sont decrits. Resultats Les monitorages d'activites d'origine accelerometriques tendent a s'imposer compte tenu de la richesse des informations contenues dans la variable « acceleration », de leur fiabilite et des applications aujourd'hui developpees. Leur pertinence clinique est accrue lorsque les resultats sont associes a un monitorage d'effort (frequence cardiaque). Les podometres et actimetres, d'utilisation plus simple, peuvent apporter des reponses quantifiees et resultantes de l'activite locomotrice. Leur choix et leur modalite d'utilisation doivent etre adaptes au probleme prealablement defini avec precision. Conclusion Les monitorages d'activite et de longue duree constituent un progres considerable en parfaite coherence avec la medecine physique et de readaptation : mesurant la performance ils sont les temoins de l'activite et de la participation. La connaissance simultanee des conditions environnementales de l'activite en ameliorerait l'interpretation.

Resume Introduction. – Les resultats fonctionnels des reimplantations apres amputation traumatique de main sont consideres comme bons en depit des frequents troubles de mobilite des doigts longs et des troubles de la sensibilite quasi constants. Objectifs. – Evaluer la recuperation et les compensations mises en œuvre a l’origine des performances de la prehension. Materiel et methodes. – Etude prospective de huit sujets masculins droitiers amputes distaux du membre superieur gauche reimplante depuis plus de deux ans. Groupe temoin de huit sujets apparies selon l’âge, le sexe, la lateralite. Evaluation des recuperations sensitive (monofilaments), motrice (TAM) et fonctionnelle (Box and Blocks test et 400 points) et de la reinsertion socioprofessionnelle. Evaluation cinematique par systeme opto-electronique et cube dynamometrique : sequences temporelles de la prehension lors d’une tâche de saisie–transport, deplacements du tronc et des membres (bras, avant-bras, main). Etudes des correlations entre les resultats fournis par les epreuves cliniques et fonctionnelles et les donnees cinematiques. Resultats. – La replantation se caracterise par une recuperation remarquable de la duree absolue et relative des differentes phases decrites lors de la prehension physiologique. Seule la phase de saisie est significativement allongee chez les reimplantes en rapport avec les difficultes motrices et sensitives residuelles comme en temoignent les correlations avec les tests cliniques. La dependance au controle visuel est accrue, probablement en raison des troubles sensitifs superficiels et profonds. Les compensations portent sur une deviation globale de l’ensemble du membre superieur reimplante, semblant a rapporter principalement a une deviation du tronc dans le plan lateral. Conclusion. – Le patient ampute et reimplante de main developpe une strategie de deplacement homogene du tronc et de la ceinture scapulaire de facon a compenser le raccourcissement et la reduction de la mobilite active de la main. Cette amplification d’une strategie observee chez le sujet sain aboutit a une compensation efficace, respectant les caracteristiques des phases de la prehension normale.

Objective Postural control and standing balance involve visual, vestibular, proprioceptive and exteroceptive afferents. The role of the position of the eyes in posture in people with orthopedic disorders of the trunk and/or lower limbs is studied in correlation with the podal supports. Material/patients and methods In a medical consultation for orthopedic disorders, patients were selected over a continuous period. A standing stabilometry (platform of force with 4 quadrants-51sec-feet at 15°), performed by fixing the right gaze in front measures the distribution of the supports right/left. In frontal photographs, the vertical alignment of the pupils with the center of the intermalleolar line, the centers of the tibiotarsal joints and the inclination of the biscapular line with the horizontal line were analyzed. Results Of the 99 patients studied (62 scoliosis 7 scoliotic attitudes), the intemalleolar center was aligned vertically with the right eye ( n = 57) or the left eye ( n = 42). The bipodal supports were symmetrical for these two groups. When the right eye was vertically aligned with the intermalleolar center, the left eye was aligned with the left tibiotarsus for 88% of cases with a marked biscapular inclination. When the left eye was aligned with the intermalleolar center, the right eye was aligned with the right tibiotarsus in 79% of cases with a moderate average biscapular inclination. Discussion, conclusion Remarkably, the intermalleolar center constantly aligns vertically with one eye, with a frequent alignment of the second eye with the center of the homolateral tibiotarsal joint, in people with orthopedic disorders affecting the trunk and/or the lower limbs. This postural asymmetry, however, is associated with symmetric loading on feet. Why does the subject not detect this postural shift centered on an eye as fixed point? The role of the action of the eye in this configuration with permanent shift action on the body is source of distance stresses, pain and deformations (Wolf and Delpech's laws and soft tissue adaptation-retraction). The choice of a director's eye organizing the posture is discussed. This might explain correlations between the alignment of the second eye on the left and scoliosis in women.

Resume La consommation d'O2 et la quantite totale d'O2 consommee ont ete mesurees en continu au cours d'une epreuve eprouvante de marche en pente chez quatre sujets jeunes amputes de jambe d'origine traumatique. Le test consistait en une epreuve de 18 minutes de marche en imposant a deux reprises une pente de 12 a 15%, selon le niveau de performance du sujet. Un pied prothetique classique Sach a ete compare a une prothese Copy III. La quantite d'O2 consommee etait systematiquement plus faible avec le pied Copy III. Les differences etaient d'autant plus nettes que la consommation d'O2 etait elevee. Ces resultats suggerent la necessite d'utiliser des tests de marche relativement intense pour evaluer le benefice d'un nouveau type de prothese puis l'interet des pieds a restitution d'energie chez les sujets jeunes ayant des activites physiques regulieres.

Les techniques de reeducation et de readaptation a la marche beneficient de l’avancee des connaissances dans les domaines de la plasticite de la fonction motrice et aussi des explorations de la posture et du mouvement. L’objectif principal est d’apporter le maximum d’informations sensorimotrices necessaires au schema locomoteur et d’assurer une capacite d’adaptation de marche pour des projets dans des environnements varies. L’amelioration des performances locomotrices s’appuie sur les techniques recentes associant marche avec allegement du poids du corps, marche par mouvements induits par la contrainte, mobilites passive et active aidee motorisees. Complementairement, l’usage d’environnements divers permet de faire emerger des coordinations naturelles plus efficientes et economiques energetiquement. Les techniques d’apprentissage, essentielles en medecine de readaptation, doivent s’appliquer sur les deux agents principaux de la plasticite de la fonction motrice que sont l’activite et l’environnement. Les perspectives de realite virtuelle interactive sont particulierement interessantes en raison de la possibilite de production d’informations sensorimotrices controlees et reproductibles.

This study evaluated the asymmetry of knee kinetics during uncomfortable gait induced by prosthesis misalignment to further demonstrate the compensatory function of the knee joint of the intact limb during gait. Three-dimensional gait analysis including knee kinematics and kinetics at the beginning of stance phase was conducted in 15 healthy subjects and 17 unilateral trans-tibial amputees (TTA) walking at self-selected speed in three conditions of prosthetic alignment: initial alignment (IA); initial alignment altered either by 6 degrees of internal rotation (IR) or by 6 degrees of external rotation (ER) applied on the pylon. Patients reported best comfort of gait in IA condition and discomfort mainly in IR condition. Maximum knee flexion and knee total work at power phases K0-K2 were significantly higher in intact limbs compared to prosthetic and control limbs. In intact limbs, these variables had significantly higher values (+10-35%, p

The difficulties confronted by amputees during overground walking are rarely investigated. In this study, we evaluated, in real-world situations, the influence of ground surface on walking in young, active amputees by measuring temporal and spatial gait parameters (free walking speed [FWS], step length [SL], step rate), energy expenditure (EE) (e.g., oxygen uptake, oxygen cost [O(2)C]), and Rating of Perceived Exertion (RPE). Ten active transtibial amputees and ten nondisabled control subjects walked at self-selected speeds on three types of ground surface (asphalt, mown lawn, and high grass). No significant differences were observed between the two groups on asphalt and mown lawn. Differences between nondisabled subjects and amputees occurred for FWS (p = 0.03) and O(2)C (p = 0.04) on asphalt and mown lawn and for all variables in high grass. When amputees (even though very active) were exposed to a particularly difficult environment, their FWS decreased (p = 0.008) and their EE and RPE increased (p = 0.005) compared with nondisabled subjects. In high grass, both groups reduced their self-selected speeds (-15% for control subjects and -16% for amputees). Control subjects reduced their velocity by reducing both SL (-8.7%) and cadence (-7.1%), whereas amputees reduced their velocity by reducing SL (-17%) only.