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Abstract: 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° of internal rotation (IR) or by 6° 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. [Copyright &y& Elsevier]

Degenerative osteoarthritis in the subtalar and mid-tarsal joints occurring after tibio-talar arthrodesis is thought to be a consequence of abnormal foot dynamics. We hypothesized that the forward tilt of the tibia during stance induces early heel-off and alteration of the progression of ground reaction force (GRF) after ankle arthrodesis. Three-dimensional gait analysis was performed on nine patients who had an ankle arthrodesis fused in a neutral position and on ten control subjects. Patients walking barefoot were compared to controls. The GRF progression was shifted forward during mid-stance, heel-off occurred earlier and was associated with less anterior tilt of the tibia and a more posterior position of the GRF with reference to the metatarsal heads. The GRF progression, heel-off and tibial tilt were not significantly different between patients and controls when walking in shoes but the GRF was still more posterior at heel-off. Increasing the walking speed worsened the anomalies of foot dynamics. These alterations of foot dynamics are thought to be associated with pathogenic stresses applied to the mid-foot. [Copyright &y& Elsevier]

Equinus and toe walking are common locomotor disorders in children with cerebral palsy (CP) walking barefoot or with normal shoes. We hypothesized that, regardless of the type of footwear, the plantar flexors do not cause early equinus upon initial foot contact but decelerate ankle dorsiflexion during weight acceptance (WA). This latter action promoted by early flat-foot contact is hypothesized to be functional. Hence, we performed an instrumented gait analysis of 12 children with CP (Gross Motor Function Classification System class: I or II; mean age: 7.2 yr) and 11 age-matched typically developing children. The participants walked either barefoot, with unmodified footwear (4° positive-heel shoes), or with 10° negative-heel shoes (NHSs). In both groups, wearing NHSs was associated with greater ankle dorsiflexion upon initial foot contact, and greater tibialis anterior activity (but no difference in soleus activity) during the swing phase. However, the footwear condition did not influence the direction and amplitude of the first ankle movement during WA and the associated peak negative ankle power. Regardless of the footwear condition, the CP group displayed 1) early flattening of the foot and ample dorsiflexion (decelerated by the plantar flexors) during WA and 2) low tibialis anterior and soleus activities during the second half of the swing phase (contributing to passive equinus upon foot strike). In children with CP, the early action of plantar flexors (which typically decelerate the forward progression of the center of mass) may be a compensatory mechanism that contributes to the WA's role in controlling balance during gait. NEW & NOTEWORTHY Adaptation to walking in negative-heel shoes was similar in typically developing children and children with cerebral palsy: it featured ankle dorsiflexion upon initial contact, even though (in the latter group) the soleus was always spastic in a clinical examination. Hence, in children with cerebral palsy, the early deceleration of ankle dorsiflexion by the plantar flexors (promoted by early flattening of the foot, and regardless of the type of footwear) may have a functional role. [ABSTRACT FROM AUTHOR]

Maintaining forward walking during human locomotion requires mechanical joint work, mainly provided by the ankle–foot in non-amputees. In lower-limb amputees, their metabolic overconsumption is generally attributed to reduced propulsion. However, it remains unclear how altered walking patterns resulting from amputation affect energy exchange. The purpose of this retrospective study was to investigate the impact of self-selected walking speed (SSWS) on mechanical works generated by the ankle–foot and by the entire lower limbs depending on the level of amputation. 155 participants, including 47 non-amputees (NAs), 40 unilateral transtibial amputees (TTs) and 68 unilateral transfemoral amputees (TFs), walked at their SSWS. Positive push-off work done by the trailing limb (W StS +) and its associated ankle–foot (W ankle - f o o t +), as well as negative collision work done by the leading limb (W StS -) were analysed during the transition from prosthetic limb to contralateral limb. An ANCOVA was performed to assess the effect of amputation level on mechanical works, while controlling for SSWS effect. After adjusting for SSWS, NAs produce more push-off work with both their biological ankle–foot and trailing limb than amputees do on prosthetic side. Using the same type of prosthetic feet, TTs and TFs can generate the same amount of prosthetic W ankle - f o o t + , while prosthetic W StS + is significantly higher for TTs and remains constant with SSWS for TFs. Surprisingly and contrary to theoretical expectations, the lack of propulsion at TFs' prosthetic limb did not affect their contralateral W StS - , for which a difference is significant only between NAs and TTs. Further studies should investigate the relationship between the TFs' inability to increase prosthetic limb push-off work and metabolic expenditure. [ABSTRACT FROM AUTHOR]

Keywords: Prosthetic; arm amputation; movement-based control; motor coordination EN Prosthetic arm amputation movement-based control motor coordination S445 S447 3 01/29/21 20191002 NES 191002 1. For comparison, the participants performed the reaching task with a conventional dual-site myoelectric elbow control mode, and with the automatic elbow control mode. [Extracted from the article]

Background and objective Phantom limb pain (PLP) is a major problem after limb amputation. Mirror therapy (MT) is a non-pharmacological treatment using representations of movement, the efficacy of which in reducing PLP remains to be clarified. Here, we present the first systematic review on MT efficacy in PLP and phantom limb movement (PLM) in amputees (lower or upper limb). Methods A search on Medline, Cochrane Database and Embase, crossing the keywords “Phantom Limb” and “Mirror Therapy” found studies which were read and analyzed according the PRISMA statement. Results Twenty studies were selected, 12 on the subject of MT and PLP, 3 on MT and PLM, 5 on MT and both (PLP and PLM). Among these 20 studies, 5 were randomized controlled trials (163 patients), 6 prospective studies (55 patients), 9 case studies (40 patients) and methodologies were heterogeneous. Seventeen of the 18 studies reported the efficacy of MT on PLP, but with low levels of evidence. One randomized controlled trial did not show any significant effect of MT. As to the effect of MT on PLM, the 8 studies concerned reported effectiveness of MT: 4 with a low level of evidence and 4 with a high level of evidence. An alternative to visual illusion seems to be tactile or auditory stimulation. Conclusion We cannot recommend MT as a first intention treatment in PLP. The level of evidence is insufficient. Further research is needed to assess the effect of MT on pain, prosthesis use, and body representation, and to standardize protocols. [ABSTRACT FROM AUTHOR]

After limb amputation, patients often wake up with a vivid perception of the presence of the missing limb, called “phantom limb”. Phantom limbs have mostly been studied with respect to pain sensation. But patients can experience many other phantom sensations, including voluntary movements. The goal of the present study was to quantify phantom movement kinematics and relate these to intact limb kinematics and to the time elapsed since amputation. Six upper arm and two forearm amputees with various delays since amputation (6 months to 32 years) performed phantom finger, hand and wrist movements at self-chosen comfortable velocities. The kinematics of the phantom movements was indirectly obtained via the intact limb that synchronously mimicked the phantom limb movements, using a Cyberglove® for measuring finger movements and an inertial measurement unit for wrist movements. Results show that the execution of phantom movements is perceived as “natural” but effortful. The types of phantom movements that can be performed are variable between the patients but they could all perform thumb flexion/extension and global hand opening/closure. Finger extension movements appeared to be 24% faster than finger flexion movements. Neither the number of types of phantom movements that can be executed nor the kinematic characteristics were related to the elapsed time since amputation, highlighting the persistence of post-amputation neural adaptation. We hypothesize that the perceived slowness of phantom movements is related to altered proprioceptive feedback that cannot be recalibrated by lack of visual feedback during phantom movement execution. [ABSTRACT FROM AUTHOR]

Résumé La réparation des tendons fléchisseurs des doigts peut être compliquée par la survenue de ruptures et d’adhérences péritendineuses. Le traitement des ruptures repose souvent sur des greffes et les adhérences péritendineuses peuvent nécessiter de recourir à des ténolyses. Dans les suites de ces deux gestes chirurgicaux, il existe un risque de nouvelles adhérences et de rupture. La rééducation après cette chirurgie secondaire est basée sur un protocole adapté et une surveillance attentive. Les protocoles utilisés par l’équipe de médecine physique et réadaptation de l’Institut régional de réadaptation de Nancy, en collaboration avec l’équipe de chirurgie plastique et reconstructrice, SOS main du Centre chirurgical Emile-Gallé de Nancy, sont décrits. Cette collaboration étroite entre les chirurgiens et l’équipe de rééducation est primordiale. Après greffe, la prise en charge repose sur des mobilisations précoces protégées permettant de mobiliser d’emblée la greffe tout en la protégeant. Après ténolyse, la rééducation immédiate pluriquotidienne et prolongée est le garant du maintien des mobilités obtenues en cours d’intervention. Elle est réalisée en structure de rééducation spécialisée pendant les trois premières semaines postopératoires. L’objectif est d’éviter la formation de nouvelles adhérences tout en tenant compte de la fragilité tendineuse. The repair of the finger flexor tendons can be complicated by the appearance of ruptures and peritendinous adhesions. Ruptures are often treated with tendon grafts. Peritendinous adhesions can require tenolysis. Following these two surgical procedures, there is a risk of new adhesions and rupture. Rehabilitation after this secondary surgery consists of a tailored, closely supervised protocol. Protocols used by the team at the Physical Medicine and Rehabilitation Department of the Regional Rehabilitation Institute and the team at the Plastic and Reconstructive Surgery Department of the Emile-Gallé Surgical Center of Nancy (France) are described. A close collaboration between these teams of surgeons and physical therapists is essential. After tendon grafting, protected early motion helps to move the transplant immediately while still protecting it. After tenolysis, immediate (several times a day) and extended rehabilitation ensures that the mobility obtained intraoperatively is maintained. It is performed in a specialized rehabilitation center during the first three postoperative weeks. The goal is to prevent new adhesions from forming while taking into account tendon's fragility. [ABSTRACT FROM AUTHOR]

Résumé La rééducation après réparation primaire des tendons fléchisseurs des doigts a évolué depuis l’utilisation de sutures plus solides, essentiellement à la phase précoce. L’objectif de cet article est d’énoncer les principes généraux de cette rééducation, de donner les indications des différentes techniques de mobilisation précoce et de décrire de façon précise le protocole de rééducation utilisé par l’équipe de médecine physique et réadaptation de l’Institut régional de réadaptation en collaboration avec l’équipe de chirurgie plastique et reconstructrice, SOS main du Centre chirurgical Émile-Gallé de Nancy. Ce protocole est utilisé principalement pour une population adulte. Il se déroule sur douze semaines en quatre étapes. Il s’appuie sur l’apprentissage d’une autorééducation active précoce protégée réalisée durant les quatre premières semaines postopératoires en l’absence de contre-indications. Il comprend un suivi multidisciplinaire codifié jusqu’à la phase de réadaptation socioprofessionnelle pour garantir au mieux la récupération fonctionnelle. Rehabilitation after primary repair of flexor tendons, particularly in the early phase, has changed due to more solid suture repairs. The objectives of this article are to outline the general principles surrounding this rehabilitation, set out the indications for various early mobilization techniques and describe in detail the physiotherapy protocol used by the Physical Medicine and Rehabilitation Department of the Regional Institute of Rehabilitation in collaboration with the Plastic and Reconstructive Surgery Department of the Émile-Gallé Surgical Center in Nancy, France. This protocol is mainly used for adult patients and carried out in four stages over a 12-week period. If there are no contraindications, the patient learns protected early active self-rehabilitation during the first four postoperative weeks. The protocol includes standardized multidisciplinary follow-up until the social and occupational rehabilitation phase to ensure the best chance of functional recovery. [ABSTRACT FROM AUTHOR]

Objectives If the benefits of single-event multilevel surgery (SEMS) in ambulatory children with cerebral palsy have already been validated, especially in terms of functional outcomes, fewer studies have evaluated SEMS in terms of quality of life and satisfaction with surgical outcomes, especially pertaining to the opinions of children and their family. The objectives of this study were to confront the perceptions of parents and the experience of their operated children in terms of quality of life and surgical outcomes. Materials and methods This was an observational, descriptive, single-center study conducted in a regional Pediatric Physical Medicine and Rehabilitation (PM&R) center, which is considered a reference center in this region of France. The subjects recruited were ambulatory children with cerebral palsy (CP) who had SEMS between 2009 and 2011, and one of their parents. The specific “child” and “parent” CP-related modules of the DISABKIDS questionnaire were used to assess these children's quality of life post-surgery. Perceptions of parents and children regarding gait evolution and satisfaction with surgical outcomes were analyzed via a questionnaire developed by the author. Regarding quality of life and surgical outcomes, the correlation between the perception of parents and experience of children was estimated using the intraclass correlation coefficient (ICC) or prevalence-adjusted bias-adjusted kappa values (PABAK). Results Twelve children (83% of them boys) and their parents participated in the study. For the DISABKIDS questionnaire, a moderate correlation was found regarding functional impact (ICC = 0.58; P < 0.0178) but a high correlation was reported for the communication item of the questionnaire (ICC = 0.73; P = 0.0025). Regarding satisfaction with surgical outcomes, results showed a good correlation (PABAK = 0.64). Conclusion Concerning quality of life and satisfaction with surgical outcomes, our study showed a good or even high correlation between parents’ perceptions and their child's experience. It is however essential to privilege the child's opinion whenever possible. [ABSTRACT FROM AUTHOR]

Abstract: Numerous studies have recently been published on improving upper-limb motor function after stroke. There has been a particular interest in brain stimulation techniques, which could promote brain plasticity. In this review, transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS) are presented as techniques that could be relevant in Physical Medicine and Rehabilitation (PM&R) centers in the future. We are presenting a comprehensive literature review on the studies using tDCS or rTMS for upper-limb rehabilitation after a stroke. Both techniques have shown their ability to modify cortical excitability and to transitorily improve upper-limb function after one single stimulation session. The first placebo-controlled, blinded therapeutic trials, which included repeated daily sessions, seem quite promising, and deserve to be validated by further trials. [Copyright &y& Elsevier]

Abstract: 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 post-rehabilitation 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. [Copyright &y& Elsevier]

Abstract: Objectives: Evaluate the inter-rater and test-retest reproducibility of the “400 Points assessment”, a measurement of the functional ability of the hand. The scale included four tests: function of the hand, prehension strengths, handling and displacement of things, and function with both hands. Methods: Thirty patients with hand injuries were participated. The inter-rate agreements were examinated between three occupational therapists. The First rater was an experienced user of this instrument (observer 1), the second one was a novice user (observer 2), the last rater is a student who had never used it before (observer 3). Subjects were tested twice by the same raters independently, with 30minutes intervals between tests. Statistical analysis was done by calculating average differences and intraclass correlation coefficient. Results: (i) The difference between the three raters agreements was small for the two measurements, except for function with both hands in the second period. Every intraclass correlation coefficient was higher than 0.95. (ii) Difference between the two measurements was small for every observer. These differences are not significant except for function with both hands. Intraclass correlation coefficients are all higher than 0.82 even than 0.90 for the total score. The difference between the two periods for the overall test is small, from 5% to 10% for seven patients and from 10 to 15% for two patients. Differences at two times had the same agreement for the three observers. Conclusion: “400 Points assessment” is reproducible (inter-rater and test-retest reproductibility). The test “function with both hands” requires more experience of the assessment. [Copyright &y& Elsevier]

Abstract: Although post-stroke exercise training programmes improve aerobic capacity and functional capacities in the short-term, the impact on exercise performance at home has not been established. Objectives: To assess compliance with prescribed physical activity by hemiplegic stroke patients. To compare the patients’ stated activity with their actual activity. Patients and methods: This was a prospective pilot study of nine hemiplegic patients following an exercise training programme. Each patient''s activity was measured using an activity monitor (the ActivPAL™) before, during and immediately after the programme and then 3months after the end of the programme. The activity actually performed was compared with the levels recommended after a stroke (at least 30minutes of non-stop activity three times a week). Three months after the end of the programme, the patient''s stated and actual activities (in terms of frequency and duration) were compared. Results: Activity patterns changed immediately after the end of the programme. Short-term compliance was good for four patients. However, 3months later, only one patient was performing regular activity in accordance with the guidelines. Hence, medium-term compliance was poor. Most patients overestimated both the duration and frequency of their activity sessions. Conclusion: Three months after the end of the supervised training programme, compliance with physical activity guidelines was low. The ActivPAL™ activity monitor is easy to use and performs satisfactorily. It can be used as a tool for activity assessment and education intervention. The use of an actimeter may increase the efficacy of health education interventions, which promote physical activity. [Copyright &y& Elsevier]

Abstract: Objectives: Retrospective analysis of the efficiency of a protocol for care of chronic vegetative states (CVS) and minimally conscious state (MCS) in Lorraine. Material and method: Two indicators are used: protocol activity (number of patients hospitalized between 1988 and 2006, number of admissions per year, of requests per year, origin of requests, waiting time) and the epidemiological data (age, sex ratio, etiology, length of stay, geographic origin, number of deaths, number of hospital discharges). The number of CVS and MCS and patients having progressed towards arousal is specified as well as the technical procedures (orthopedic surgery, number of tracheotomies). Results: Forty-seven patients (30 males and 17 females) were hospitalized in a 12-bed unit. The number of admissions per year was 2.4, and the annual number of requests varied between five and 15. Hospitalization times ranged from six to 18 months. The average length of hospitalization was 41 months. Eighty-eight percent of the cases were residents of Lorraine. The etiology was traumatic (53%), vascular (38% including 12% anoxia), miscellaneous (9%). Fifteen percent rate of return to arousal (average time period: 28.41 months, traumatic etiology) with hospital discharge in four cases. Conclusion: The protocol is managed as part of a local scheme and enables an appropriate response to a specific clinical profile by providing up-to-date multidiscipline follow-up care and a rapid solution should intercurrent events occur (signs of arousal, orthopedic deterioration, change of environment). Typical limitations are geographical remoteness and difficulties with family support care. [Copyright &y& Elsevier]

Abstract: 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° of internal rotation (IR) or by 6° 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 <0.05) in IR condition than IA condition whereas these were not altered across conditions in prosthetic limbs. In trans-tibial amputees, inducing uncomfortable gait by internally rotating the prosthetic foot did not alter the knee kinetics of the prosthetic limb, which suggests a protective mechanism. Knee kinetics of the intact limb did alter, which suggests a compensatory mechanism. [Copyright &y& Elsevier]

Abstract: Objective: The objective of this article is to review anatomical, histological and physiological muscle changes following below-knee amputation. Materials and Methods: We searched the PubMed and Reedoc databases for studies evaluating modifications of the below-knee stump and changes over time in its anatomy, volume and histology. We also looked at postamputation modifications in gait and balance. Results: Below-knee amputees show muscular atrophy on both the amputated side and nonamputated side, with fewer and smaller muscle fibres (particularly slow-twitch fibres). This amyotrophy varies in magnitude and distribution and can reach about 25% for the quadriceps (predominantly on the medial side), but is nonsignificant for the hamstrings. This amyotrophy results from the anatomical consequences of the surgical act. The loss of one or more of a muscle''s insertions or reimplantation into a nonphysiological site prompts greater atrophy. Changes in muscle activation patterns also lead to atrophy. The hamstrings replace the triceps as the main muscles for propulsion and the remaining stump muscles contract so as to ensure a good fit with the prosthesis. The below-knee amputee must adapt to a new muscular state: gait symmetry is altered, energy expenditure for walking is higher and training is needed in order to achieve optimal balance control. [Copyright &y& Elsevier]

Abstract: Lower limb amputee have lower exercise capacities, proportionally to the delay necessary to use their well-fitted prosthesis. Exercise training is a valid therapeutic to improve local factors (residual limb), muscle strength and endurance, locomotor performance and to decrease the cardiovascular risk factors. The programs for exercise training used for amputees are derivate from the vascular diseases and adapted (upper limb ergometer, cycloergometer with intact limb, pharmacological stress). Exercise training must be personalised because the population with lower limb amputation is very heterogeneous for deficiency and capacity (orthopaedic, vascular and cardiac) and for their socioprofessional project. [Copyright &y& Elsevier]

Introduction/Background Gliomas are the most common primary brain tumors in adults. Physical activity is proposed as an associated care in multiple cancers with proven benefits but has not been often and specifically evaluated for gliomas. The main objective of our study was to assess the feasibility and the potential effectiveness of exercise training in patients with high and low-grade gliomas. Material and method Twenty-eight patients (mean age 49 years, 16 high grades and 12 low-grades, minimal Karnofksy Performance Status at 70%) were addressed by the neuro-oncology for fatigue complaint. They were first screened by a physiatrist and then included a program of individual exercise training. A Six-Minute-Walking-Test was realized before and after the training. Results On the 17 patients included, 14 finished the program (7 high grade and 7 low-grade gliomas). Only 2 patients were excluded for a clinical degradation and only 1 patient did not finish it for a reason linked to his tumor. Mean number of sessions was 8; no major sides effects were reported. After the program, a statistically significant increase of the 6-Minute-Test was found ( P = 0.0007). Conclusion In this population, this kind of program seems to be feasible and efficient. However, our results cannot be extended to all gliomas patients due to the good general state of our population and the inner limits of the Six-Minute-Walking-Test. Further studies are needed to assess the possible benefits in larger sample. [ABSTRACT FROM AUTHOR]

Introduction/Background Common myoelectric control strategy remains complex to use and produce unnatural gestures since it does not allow simultaneous movements of several joints. This is especially an issue for the transhumeral amputees who can use an active elbow in addition to active prosthetic wrist and hand. Since most transhumeral amputees have a mobile residual limb, an interesting approach aims at utilizing this mobility to control the elbow. We thus developed a simple electronic device relying on an inertial measurement unit, that can be interfaced with existing commercial myoelectric elbows and which convert chosen displacements of the residual limb into control signals, offering an intuitive way of controlling an active elbow prosthesis whilst allowing a simultaneous myoelectric control of the wrist and hand. Material and method We performed an experiment with one transhumeral amputee wearing his myoelectric prosthetic (active elbow, wrist and hand) who was asked to grasp and transfer different objects several times while being recorded with a motion capture system. Theses task were performed twice: with a conventional full myoelectric control and with the proposed movement based control. Several metrics (position error, time, smoothness, along with body compensatory strategies) were used to quantify the performances obtained with these two modes. Results Analyses showed that the participant was able to perform the tasks in both condition, but that the movement based control approach allowed a reduction in task time and in exhibited body compensatory strategies, by offering an easier access to adjustments of the elbow posture compared to the full myoelectric control approach. Conclusion This work illustrates the potential of using residual limb mobility in the control of prosthetics, to make it more natural and intuitive, and how this can have an indirect but positive impact on the whole body compensatory strategies exhibited by amputated subjects. [ABSTRACT FROM AUTHOR]

Background: Recent therapeutic and technological solutions aim to improve the daily living of people with limb amputation by considering various aspects of the phantom limb, in particular painless phantom sensations (PS) and voluntary phantom movements (VPM)., Objective: Although previous research has explored these phenomena mostly without considering the prosthesis, this study investigates the influence of prosthesis wearing on painless PS, painful PS, and VPM, in people with lower-limb amputation., Study Design: Cross-sectional study based on semi-directed interviews., Methods: Semi-directed interviews were conducted with 111 people with major lower-limb amputations. They described their phantom limb without and with the prosthesis, in a static seated position. The influence of the prosthesis wearing on the intensity of painless PS, painful PS, and on VPM ability was classified into 5 categories: disappearance, decrease, modification, increase, and appearance., Results: Prosthesis wearing leads mostly to an increase of painless PS intensity (44%), a decrease of painful PS intensity (44%), and an improvement of VPM ability (47%). The study also highlights the richness of prosthesis-related changes, including modifications in phantom limb position, shape, and size. The influence of prosthesis wearing on phantom phenomena was not related to the presence of referred sensations, the amputation etiology, the level of amputation, the time since amputation, or the use of medication, but might be related to the pressure applied by the socket on the residual limb., Conclusions: This study provides valuable information on the influence of the prosthesis on PS and may allow for better consideration of this relationship in the context of research, engineering, and rehabilitation., (Copyright © 2024 International Society for Prosthetics and Orthotics.)

Background: Pilot studies suggest potential effects of neck muscle vibration (NMV) and prism adaptation (PA) on postural balance disturbances related to spatial cognition., Objectives: To evaluate the effect of 10 sessions of NMV and/or PA on ML deviation. We used the mediolateral centre of pressure position (ML deviation) as a biomarker for spatial cognition perturbation, hypothesising that PA and NMV would improve ML deviation, with a potential synergistic impact when used together., Methods: We conducted a multicentre, single-blind, randomised controlled study. Participants within 9 months of a right-hemisphere supratentorial stroke and with less than 40% body weight supported on the paretic side in standing were randomised into 4 groups (PA, NMV, PA+NMV, or control)., Primary Outcome: ML deviation at Day 14., Secondary Outcomes: force platform data, balance abilities, autonomy, and ML deviation, measured just after the first session (Day 1), at Day 90, and Day 180. A generalised linear mixed model (GLMM) assessed intervention effects on these outcomes, adjusting for initial ML deviation and incorporating other relevant factors., Results: 89 participants were randomised and data from 80 participants, mean (SD) age 59.2 (10.2) years, mean time since stroke 94 (61) days were analysed. At Day 14, a weak time x group interaction (P = .001, omega-squared = 0.08) was found, with no significant between-group differences in ML deviation (P = .12) or in secondary outcomes (P = .08). Between-group differences were found on Day 1 (P = .03), Day 90 (P = .001) and Day 180 (P < .0001) regardless of age and stroke-related data. On Day 1, ML deviation improved in both the PA and NMV groups (P = .03 and P = .01). In contrast, ML deviation deteriorated in the NMV+PA group on Day 90 and Day 180 (P = .01 and P = .01)., Conclusions: The study found no evidence of any beneficial effects of repeated unimodal or combined sessions of NMV and/or PA on ML deviation after stroke., Trial Registration: ClinicalTrials.gov identifier NCT01677091., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: Muscle activity patterns in the residual arm are systematically present during phantom hand movements (PHM) in transhumeral amputees. However, their characteristics have not been directly investigated yet, leaving their neurophysiological origin poorly understood. This study pioneers a neurophysiological perspective in examining PHM-related muscle activity patterns by characterizing and comparing them with those in the arm, forearm, and hand muscles of control participants executing intact hand movements (IHM) of similar types., Methods: To enable rigorous comparison, we developed meta-variables independent of electrode placement, quantifying the phasic profile of recorded surface EMG signals and the specificity of their patterns across electrode sites and movement types., Results: Similar to the forearm and hand muscles during IHM, each signal recorded from the residual upper arm during PHM displays a phasic profile, synchronized with the onset and offset of each movement repetition. Furthermore, the PHM-related patterns of phasic muscle activity are specific not only to the type of movement but also to the electrode site, even within the same upper arm muscle, while these muscles exhibit homogeneous activities in intact arms., Discussion: Our results suggest the existence of peripheral reorganization, eventually leading to the emergence of independently controlled muscular sub-volumes. This reorganization potentially occurs through the sprouting of severed axons and the recapture of muscle fibers in the residual limb. Further research is imperative to comprehend this mechanism and its relationship with PHM, holding significant implications for the rehabilitation process and myoelectric prosthesis control., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Chateaux, Rossel, Vérité, Nicol, Touillet, Paysant, Jarrassé and De Graaf.)

Objective: Sustained return to work after surgery for work-related rotator cuff syndrome (WRRCS) remains quite difficult. The main purpose of the present study was to identify predictive factors of a return-to-work (RTW) trajectory., Methods: A total of 96 workers with WRRCS were identified by 4 surgeons. They were followed prospectively before and after the surgery, until 1 year after RTW, or for 20 months after surgery when they did not. Participants completed a series of standardized questionnaires related to working conditions, health, and beliefs, and performed functional tests at the inclusion time. During the follow-up period, they were regularly asked about their working conditions (present or not at work), activity (normal or lightened physical duties) and schedules (full- or part-time job). Statistical analysis was based on single- and multiple-factor models of prediction of the workers' trajectory., Results: Three trajectories of RTW were distinguished, considering RTW and absenteeism that occurred during the follow-up: stable, unstable, and non-RTW. The median age of the sample was 49.5 [45.0-54.0], with 67.7% of workers employed in highly physically demanding jobs. In the multiple factor model, three factors were highly predictive of the trajectory: perceived health before surgery, having had a repaired ruptured-rotator-cuff tendinopathy, and the level of physical demand of the job., Conclusion: Three easy-to-collect predictive factors of RTW trajectory have been identified. They may be useful for healthcare professionals and care givers to identify vulnerable workers' risk of occupational dropout after arthroscopic surgery for rotator cuff tendinopathy., (© 2023 Wiley Periodicals LLC.)

Unilateral spatial neglect (USN) rehabilitation requires the development of new methods that can be easily integrated into conventional practice. The aim of the HEMISTIM protocol is to assess immediate and long-term recovery induced by an innovative association of left-side neck-muscle vibration (NMV) and anodal transcranial Direct Current Stimulation (tDCS) on the ipsilesional posterior parietal cortex during occupational therapy sessions in patients with left USN. Participants will be randomly assigned to four groups: control, Left-NMV, Left-NMV + sham-tDCS or Left-NMV + anodal-tDCS. NMV and tDCS will be applied during the first 15 min of occupational therapy sessions, three days a week for three weeks. USN will be assessed at baseline, just at the end of the first experimental session, after the first and third weeks of the protocol and three weeks after its ending. Our primary outcome will be the evolution of the functional Catherine Bergego Scale score. Secondary outcome measures include five tests that investigate different neuropsychological aspects of USN. Left NMV, by activating multisensory integration neuronal networks, might enhance effects obtained by conventional therapy since post-effects were shown when it was combined with upper limb movements. We expect to reinforce lasting intermodal recalibration through LTP-like plasticity induced by anodal tDCS.

Purpose: In children with cerebral palsy (CP), with impaired trunk control and toe-walking, trunk-focused rehabilitation (TFR) based on postural activities was hypothesized to improve trunk postural control, early trunk deceleration, and ankle dorsiflexion braking during walking. Methods: Seventeen children with CP (5-12 years) walking autonomously were randomly assigned to TFR and then usual rehabilitation (TFR-UR) or vice versa (UR-TFR)., Results: Only after TFR was significant improvements in (i) the Trunk Control Measurement Scale score, postural sway on an unstable sitting device and standing, and (ii) early sternal and sacral decelerations and coupled negative ankle power due to plantar flexors., Conclusion: TFR improves trunk dynamics and consequently improves coupled toe-walking.

The functionalities of myoelectric hooks, such as whether they allow wrist movements, as well as the volume and design of the devices, may impact how fitted transradial amputees use their upper limbs. The aim of the current study was to compare two prosthetic myoelectric hooks in terms of compensatory shoulder movements, functionality and user satisfaction. This monocentric, randomized, controlled, cross-over trial evaluated eight transradial amputees fitted with two prosthetic myoelectric hooks, the Greifer and the Axon-Hook, during two consecutive periods. At the end of each period, shoulder abduction (mean and percentage of time with shoulder abduction > 60°) and manual dexterity were assessed using the Box and Blocks Test (BBT) on both sides, and satisfaction was assessed with the Evaluation of Satisfaction with Assistive Technology questionnaire. For each patient, data obtained with the BBT on the amputated side were compared with those obtained on the non-amputated side. Shoulder abduction was significantly higher with the Greifer (60.9°± 20.3°, p = 0.03) than with the Axon-Hook (39.8°± 16.9°) and also than with the NA side (37.6 ± 19.4°, p = 0.02). Shoulder abduction on the NA side (37.6 ± 19.4°) was close to that of the Axon-Hook (39.8°± 16.9°). The percentage of time spent with shoulder abduction > 60° during the BBT was higher with the Greifer than with the Axon-Hook or with the NA side (53.3 ± 34.4%, 17.6 ± 27.0% and 18.4 ± 34.9%, respectively), but the differences were not significant (p = 0.15). A significant strong negative correlation was found between shoulder abduction and wrist position with the Axon-Hook (r = -0.86; p < 0.01), but not with the Greifer. Manual dexterity and satisfaction did not differ significantly between the two devices. These results revealed compensatory movements, such as shoulder abduction in transradial amputees equipped with hooks, themselves influenced by the prosthetic device settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Touillet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Microprocessor-controlled prostheses are designed to improve mobility and quality of life through better balance and energy restoration in persons with transtibial amputation. Quasi-active microprocessor-controlled ankles (MPA) adapt to variable terrain by ankle angle adjustment., Objectives: To compare energy expenditure, balance, quality of life, and satisfaction of Proprio-foot® (a quasi-active MPA model) with standard prescribed ankle prosthesis (prescribed ankle-foot units [PA]) (standard energy storage and return prosthesis)., Study Design: Multicenter, unblinded, randomized, controlled, cross-over study., Methods: Energy expenditure (primary outcome) was assessed by oxygen uptake (VO2) measured at the maximum level reached with the 2 prostheses during treadmill walking at progressively increasing incline and speed. Balance was assessed by stabilometry in different static positions. Quality of life and satisfaction were assessed by "Short Form 36" questionnaire (0-100) and by Evaluation de la Satisfaction envers une Aide Technique (0-5) questionnaires after wearing each of the 2 prostheses for 34 days., Results: Forty-five patients tested the 2 prostheses. No statistical difference in VO2 was observed. Significant improvement of balance was observed both during standing on an incline or decline with MPA and PA (p < 0.01). Short Form 36 questionnaire physical scores and Short Form 36 questionnaire mental scores were 68.5 ± 19.5 vs. 62.1 ± 19.6 (p < 0.01) and 72.0 ± 20.8 vs. 66.2 ± 20.9 (p < 0.01) in MPA and PA, respectively. Evaluation de la Satisfaction envers une Aide Technique score on the device was not statistically significant between the 2 groups (MPA 4.4 ± 0.5 vs. PA 4.3 ± 0.5, p = 0.360)., Conclusion: Proprio-foot® improved balance, quality of life, and patient satisfaction despite no reduction or increase in energy expenditure in comparison with standard energy storage and return prosthesis., (Copyright © 2022 The Authors. Published by Wolters Kluwer incorporated on behalf of The International Society for Prosthetics and Orthotics.)

The aim of this study was to evaluate the real intensity level of exercise in a sample of patients with chronic disease from obesity, rheumatology, hematology and other departments involved in a hospital-based program of adapted physical activity (APA). For this cross-sectional study, we studied seventy-five patients with chronic disease and no beta-blocker treatment. They systematically performed a cardiopulmonary exercise test before participating in a supervised APA practice using a telemetry wireless system to monitor heart rate (HR) during the first session. Based upon the results of the functional evaluation of exercise performance, we studied two groups of patients: (1) No limitation in exercise performance (maximal oxygen uptake greater than or equal to 80% of the theoretical reference) and (2) limited exercise performance (maximal oxygen uptake less than 80% of the theoretical value). Fifty-two patients (69.3%) were women, mean age was 42.6 (± 13.8), and mean BMI was 36.7 (± 10.6). Most patients had been referred for obesity (57.3%). We found 39 patients with normal exercise capacities and 36 patients with limited exercise performance. There were no significant differences in demographic and clinical characteristics between the two groups. For all populations, the mean and median real intensity levels of exercise in a sample of patients were moderate (55-70% HR max) and were the same for both groups. During the most intensive 15-min bout of the APA session, the HR for patients in both groups was greater than 70% of the actual maximum HR. This study observed a moderate level of APA exercise intensity in patients suffering from various chronic diseases. We found no significant difference in intensity level of exercise between patients' capacities, i.e., with and without limitation of their maximal performance., (© 2022. The Author(s).)

Background: This study aimed to evaluate the efficacy of the Six-Minute Walk Test (6MWT) to determine the physical activity capacities of patients with chronic disease. Methods: For this cross-sectional study, we investigated 156 patients with chronic disease and no beta-blocker treatment. They systematically performed a maximal cardiopulmonary exercise test to determine their heart rate peak (HRPeak) and maximal oxygen uptake (V’O2max). We considered two groups of patients based upon the results of the functional evaluation of exercise performance: (1) No limitation in exercise performance (V’O2max greater or equal to 80% of the theoretical reference) and (2) limited exercise performance (V’O2max less than 80% of the theoretical value). All patients also received a 6MWT on the same day as the exercise test. Results: We found 68 (43.6%) patients with normal exercise capacities and 88 (56.4%) patients with limited exercise performance. In this sample, 6MWT mean distances were 510 (87) and 506 (86) m, respectively. There were no significant differences between the two groups for distance and end-test heart rate. The correlation between matrix V’O2max measured during the maximal incremental exercise test and the 6MWT distance displayed a positive slope (r = 0.549 CI95 [0.431−0.656]—p < 0.001). Conclusion: Our results showed a moderate relationship between 6MWT and physical activity capacity for patients with chronic disease.

Objective: This study aimed to evaluate the efficacy of the 1-minute Sit to Stand test (1MSTS) to determine physical activity capacities for patients with chronic disease., Methods: For this cross-sectional study, we studied fifty patients with chronic disease and no beta-blocker treatment. They systematically performed a cardiopulmonary exercise test to determine maximal oxygen uptake (V'O 2 max). We considered two groups of patients based on the results of the functional evaluation of exercise performance: (1) No limitation in exercise performance (V'O 2 max greater or equal to 80% of the theoretical reference) and (2) limited exercise performance (V'O 2 max <80% of the theoretical value). All patients also received an 1MSTS on the same day., Results: We found 22 (44.0%) patients with normal exercise capacity and 28 (56.0%) patients with limited exercise performance. In this sample, mean 1MSTS repetitions were 27.1 (7.1) and 25.2 (8.7), respectively. There were no significant differences between the two groups for repetition and Borg Scale end test. The correlation between V'O 2 max measured during the exercise test and 1MSTS repetitions displayed a positive slope [ r = 0.401 (95% CI 0.114-625)]., Conclusion: This study demonstrated a moderate relationship between 1MSTS and V'O 2 max for patients with chronic disease. 1MSTS did not permit the precise determination of physical activity capacities in this sample., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Allado, Poussel, Albuisson, Paysant, Temperelli, Hily, Moussu, Benhajji, Gauchard and Chenuel.)

Following lower limb amputation, amputees are trained to walk with a prosthesis. The loss of a lower limb deprives them of essential somatosensory information, which is one of the causes of the difficulties of walking with a prosthesis. We here explored whether a solution to this lack of somatosensory feedback could come from natural sensations of the phantom limb, present in most amputees, instead of from substitutive technologies. Indeed, it is known that phantom sensations can be modulated by (i) global mechanical characteristics of the prosthesis socket, and (ii) locally applying a stimulus on an area of the residual limb. The purpose of this pilot study was to verify the feasibility of influencing phantom sensations via such socket modifications in a participant with transfemoral amputation. Four prosthetic interface conditions were studied: a rigid and a semi-rigid socket, each one with and without a focal pressure increase on a specific area of the residual limb. The results show that phantom sensations during walking were different according to the 4 interface conditions. The participant had more vivid phantom sensations in his foot and calf of which some varied as a function of the gait phases. Preliminary gait analysis with wearable sensors shows that these modifications were accompanied by changes in some gait spatiotemporal parameters. This preliminary study of single case demonstrates that phantom sensations can be modulated by the prosthetic interface and can provide natural somatosensory information dynamically varying with gait phases. Although this needs to be confirmed for a larger population of lower limb amputees, it already encourages non-painful phantom sensations to be considered early during the rehabilitation of lower limb amputees., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bachini, Liszez, Mesure, Mahé, Touillet, Loiret, Paysant and De Graaf.)

Controlling several joints simultaneously is a common feature of natural arm movements. Robotic prostheses shall offer this possibility to their wearer. Yet, existing approaches to control a robotic upper-limb prosthesis from myoelectric interfaces do not satisfactorily respond to this need: standard methods provide sequential joint-by-joint motion control only; advanced pattern recognition-based approaches allow the control of a limited subset of synchronized multi-joint movements and remain complex to set up. In this paper, we exploit a control method of an upper-limb prosthesis based on body motion measurement called Compensations Cancellation Control (CCC). It offers a straightforward simultaneous control of the intermediate joints, namely the wrist and the elbow. Four transhumeral amputated participants performed the Refined Rolyan Clothespin Test with an experimental prosthesis alternatively running CCC and conventional joint-by-joint myoelectric control. Task performance, joint motions, body compensations and cognitive load were assessed. This experiment shows that CCC restores simultaneity between prosthetic joints while maintaining the level of performance of conventional myoelectric control (used on a daily basis by three participants), without increasing compensatory motions nor cognitive load.

Background: Return to work (RTW) after surgery for a work-related rotator cuff disorder (WRRCD) is often difficult. The study's purpose was to identify preoperative factors predicting RTW., Methods: Ninety-two workers with a WRRCD were identified by four surgeons. Before surgery, the workers completed a series of standardized questionnaires related to working conditions, health, and health beliefs. They were followed up prospectively for 20 months. Statistical analysis was based on single and multiple-factor Cox models of the duration of absence from the time of surgery until RTW., Results: The median age at inclusion was 49 years (27-62), with 52 women included (57%). Sixty-one subjects (66%) were employed in highly physically demanding jobs. Forty-two (46%) stayed at work until their surgery, whereas preoperative sick leave exceeded 100 days in 20 subjects (21%). Twenty months after surgery, 14 were still not back at work. For the other participants, the mean duration until RTW was 225 days (SD 156). In the fully adjusted model, variables that were significantly predictive of the duration until RTW were: work physical demand levels, preoperative sick leave, the number of body parts causing pain or discomfort in the last 12 months, self-assessed 2-year workability, and the Readiness for RTW (RRTW) Scale., Conclusions: Several physical, psychological, and work-related factors, easily recorded, can be identified preoperatively. They may be predictive of delayed return, loss of employment, or employability as a result of shoulder surgery., (© 2021 Wiley Periodicals LLC.)

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., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Adenosine A 1 receptors (A 1 R) are a potential target for cardiac injury treatment due to their cardioprotective/antihypertrophic actions, but drug development has been hampered by on-target side effects such as bradycardia and altered renal hemodynamics. Biased agonism has emerged as an attractive mechanism for A 1 R-mediated cardioprotection that is haemodynamically safe. Here we investigate the pre-clinical pharmacology, efficacy and side-effect profile of the A 1 R agonist neladenoson, shown to be safe but ineffective in phase IIb trials for the treatment of heart failure. We compare this agent with the well-characterized, pan-adenosine receptor (AR) agonist NECA, capadenoson, and the A 1 R biased agonist VCP746, previously shown to be safe and cardioprotective in pre-clinical models of heart failure. We show that like VCP746, neladenoson is biased away from Ca 2+ influx relative to NECA and the cAMP pathway at the A 1 R, a profile predictive of a lack of adenosine-like side effects. Additionally, neladenoson was also biased away from the MAPK pathway at the A 1 R. In contrast to VCP746, which displays more 'adenosine-like' signaling at the A 2B R, neladenoson was a highly selective A 1 R agonist, with biased, weak agonism at the A 2B R. Together these results show that unwanted hemodynamic effects of A 1 R agonists can be avoided by compounds biased away from Ca 2+ influx relative to cAMP, relative to NECA. The failure of neladenoson to reach primary endpoints in clinical trials suggests that A 1 R-mediated cAMP inhibition may be a poor indicator of effectiveness in chronic heart failure. This study provides additional information that can aid future screening and/or design of improved AR agonists that are safe and efficacious in treating heart failure in patients., Competing Interests: SC, JP and MF are/were employees of Servier, a pharmaceutical company engaged the development of new heart failure therapeutics. As indicated above, this study was partially funded by Servier as a collaborative program between Monash University and Servier to investigate G protein-coupled receptors as therapeutic targets. None of the compounds under study herein are patented by Servier; capadenoson and neladenoson are compounds published by Bayer and VCP746 is a tool compound previously reported by Monash University., (Copyright © 2021 Rueda, Merlin, Chimenti, Feletou, Paysant, White, Christopoulos, Sexton, Summers, Charman, May and Langmead.)

Background: In some countries, the microprocessor-controlled C-LEG knee joint is reimbursed by the national health insurance for transfemoral amputees under certain conditions. However, whether users really benefit from such a technology in their daily life is unknown., Objective: To observe the performance of active C-LEG users in terms of locomotor ability and activities, satisfaction and quality of life after 6 months of wearing the prosthesis in real-life conditions., Methods: This multicenter observational study investigated locomotor ability [Locomotor Capability Index 5 (LCI-5)], satisfaction [Quebec User Evaluation of Satisfaction with Assistive Device 2.0 (QUEST 2.0)] and quality of life [Medical Outcomes Study Short Form 36 (SF-36)] at the beginning (T0) and end (T1) of the C-LEG test period and at 6 months (T2) after the confirmed prescription of the C-LEG. Information was also collected on the use of walking aids, daily wear of the prosthesis, falls and adverse events., Results: We enrolled 102 participants; 81 were assessed at T1 (62 had a previous prosthesis) and 56 were followed up after 6 months (45 had a previous prosthesis). For participants who had previously been fitted with a prosthetic knee, which was mechanical in almost all cases, as compared with baseline, the use of C-LEG significantly improved locomotor ability (LCI-5 52.6 vs. 46.7, P<0.001), satisfaction (QUEST score 4.6 vs. 3.7, P<0.001) and physical quality of life (SF-36 physical component summary score 51.1 vs. 45.3, P<0.001). In addition, daily use of the prosthesis was higher and use of walking aids and frequency of falls were lower as compared with the previous period., Conclusions: Active transfemoral amputees with prescription of the C-LEG knee joint showed improved function, satisfaction and physical quality of life after 6 months of wear as compared with their previous prosthesis., (Copyright © 2020 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Next generation prosthetics will rely massively on myoelectric "Pattern Recognition" (PR) based control approaches, to improve their users' dexterity. One major identified factor of successful functioning of these approaches lies in the training of amputees and in their understanding of how those prosthetics works. We thus propose here an intuitive pattern similarity biofeedback which can be easily used to train amputees and allow them to optimize their muscular contractions to improve their control performance. Experiments were conducted on twenty able-bodied participants and one transradial amputee. Their performance in controlling an interface through a myoelectric PR algorithm was evaluated; before and after a short automatic user training session consisting in using the proposed visual biofeedback for ten participants, and using a generic PR algorithm output feedback for the others ten. Participants who were trained with the proposed biofeedback increased their classification score for the retrained gesture (by 39.4%), without affecting the overall classification performance (which progressed by 10.2%) through over-training and increase of False Positive rate as observed in the control group. Additional analysis indicates a clear change in contraction strategy only in the group who used the proposed biofeedback. These preliminary results highlight the potential of this method which does not focus so much on over-optimizing the pattern recognition algorithm or on physically training the users, but on providing them simple and intuitive information to adapt or change their motor strategies to solve some misclassification issues.

The objective of the study was to demonstrate the non-inferiority of low-frequency spa therapy combined with rehabilitation (Spa-rehab) versus standard spa therapy at 6 months for symptomatic knee osteoarthritis (KOA). A prospective, randomized, monocenter, non-inferiority trial with recruitment of community-based symptomatic KOA patients was performed. Standard spa therapy comprised standardized spa treatment, 6 days a week for 3 weeks, and Spa-rehab therapy comprised spa sessions, 3 days a week for 3 weeks, followed by a dedicated rehabilitation program, 3 days a week for 3 weeks. The primary endpoint was achieving at 6 months a minimal clinically important improvement (MCII) for pain on a visual analog scale and/or an MCII for function on the WOMAC index and no knee surgery (composite MCII). Secondary endpoints were composite MCII at 3 months and achieving a Patient Acceptable Symptom State (PASS) for pain and function at 3 and 6 months. Among 283 patients included, 145 were allocated to standard spa therapy and 138 to Spa-rehab therapy. We could not demonstrate the non-inferiority of Spa-rehab therapy for the primary endpoint: difference for responders - 0.08 [90% CI (- 0.18 to 0.02), p = 0.14]. However, the difference test between the groups was not significant (p = 0.18). Spa-rehab therapy was not inferior to standard spa therapy for the composite MCII at 3 months or the PASS at 3 and 6 months. Spa-rehab therapy can reasonably be proposed to patients with symptomatic KOA. This protocol may be more cost-effective than standard spa therapy and avoid absenteeism from work and accommodation costs for patients who live close to a centre.

Postural control continues to develop during middle childhood as shown by the decrease in body sway in stance between the ages of 5 and 11. Although head and trunk control is crucial for balance control during both static and dynamic activities, evaluating its specific development and its contribution to overall postural control is methodologically challenging. Here, we used an unstable sitting device adapted to ensure that only the axial segments could control the balance of the device and thus the balance of the upper body. This study aimed to assess the development of the postural stabilization of axial body segments during middle childhood. Thirty-six children (in three age groups: 6-7yo, 8-9yo, and 10-11yo) and 11 adults sat on the unstable sitting device and had to stabilize their axial segments under several conditions: a moderate vs. high level of balance challenge, and eyes open vs. eyes closed. Upper-body postural sway (area, mean velocity and root mean square (RMS) of the center of pressure (CoP) displacement) decreased progressively with age (6-7yo > 8-9yo > 10-11yo > adults), and this effect was accentuated when the balance challenge was high (for CoP area) or in the "eyes closed" condition (for CoP area and RMS). The stabilization strategies were assessed by anchoring indexes computed from three-dimensional kinematics. A progressive shift was showed, from an "en bloc" pattern at 6-7 years of age toward a more articulated (i.e. adult-like) pattern at 10-11. A head-on-space stabilization strategy first emerged at the age of 8-9. Middle childhood is an important period for the development of axial segment stabilization, which continues to mature until adulthood. This development might be related to the introduction and progressive mastery of feedforward sensorimotor processes and might contribute strongly to the development of overall postural control., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier B.V.)

Background: Hand rehabilitation needs valid evaluation tools; the 400-point Hand Assessment (HA) is an exhaustive but not standardised tool. The aim of this study was to validate a standardised version of this test., Methods: A modified version and a standardised prototype was made for this prospective validation study (four centres, three countries). Psychometric properties studied: reliability (intra-rater and inter-rater, standard error of measurement [SEM], minimum detectable change [MDC],internal consistency); content validity, construct validity with Jebsen Taylor hand function test, QuickDASH, MOS-SF 36 and pain; responsiveness, using an anchor-based approach (ROC curve with area under curve, mean response change) with calculation of MCID. For SEM, MDC and responsiveness, QuickDASH was used for comparison., Results: One hundred and seventy-six patients with hand/wrist injuries were included between May 2013 and February 2015. One hundred and seventy were available for final analysis: 67% men; mean age 43.4 ± 13.2 years; both manual and office workers (46, 5% of each); 37% had a hand or wrist fracture. Reliability: ICC intra-rater = 0.967 [0.938-0.982]; inter-rater = 0.868 [0.754-0.932]. Distribution-based approach: for 400-point HA/QuickDASH: SEM = 3.48/4.52, MDC = 9.065/12.53, internal consistency of 400-point HA: Cronbach α = 0.886., Validity: Content validity was good according to COSMIN guidelines. Construct validity: correlation coefficient: Jebsen-Taylor hand function test = - 0.573 [- 0.666-0.464], QuickDASH = - 0.432 at T0 [- 0.545-0.303], - 0.551 at T3 [- 0.648-0.436]; MOS-SF 36 physical component = 0.395 [0.263-0.513]; no correlation with MOS-SF 36 mental component = 0.142 [- 0.009 + 0.286] and pain = - 0.166 [- 0.306 + 0.018]. Responsiveness: Anchor-based approach: AUC Δ400-point HA = 0.666 [0.583-0.749], AUC ΔQuickDASH = 0.556 [0.466-0.646]. MCID (optimal ROC curve cut-off): 6.07 for 400-point HA, - 2.27 for QuickDASH. MCID with mean response change + 12.034 ± 9.067 for 400-point HA and - 8.03 ± -9.7 for QuickDASH. The patient's global impression of change was only correlated with the Δ400-point HA., Conclusions: The 400-point HA standardised version has good psychometric properties. For responsiveness, we propose an MCID of at least 12.3/100. However, these results must be confirmed in other populations and pathologies., Trial Registration: This study was retrospectively registered into ISCTRN registry (Number ISRCTN25874481) the 07/02/2019.

Background : The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. Our aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F). Methods: Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations. Construct validity was assessed by measuring the correlation between ABIS-F or ABIS-R-F scores and quality of life, pain, anxiety, and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability. Results: A highest body image disturbance was associated with lowest quality of life, higher pain, and higher anxiety, and depression. Cronbach's α was 0.91/0.89 (ABIS-F/ABIS-R-F). The standard error of measurement was 5.35/2.28 (ABIS-F/ABIS-R-F). The smallest detectable change was 14.82/6.31 (ABIS-F/ABIS-R-F). The mean difference in ABIS-F score was -3.90 with limits of agreement from -18.71 to 10.92. For ABIS-R-F, the mean difference was -2.12 with limits of agreement from -8.43 to 4.19. Intraclass correlation was 0.87/0.82 (ABIS-F/ABIS-R-F). Conclusions : The French versions ABIS-F and ABIS-R-F share similar psychometric properties, both are as reliable, but ABIS-R-F has a better response structure and is more feasible.Implications for rehabilitationThe quality of life of amputees is impacted by their satisfaction with body imageThe Amputee Body Image Scale questionnaire measures this perception and is available for French-speaking amputeesThe Standard Errors of Measurement proposed could be useful for clinical and research purposesBoth ABIS and ABIS-R showed satisfactory construct validity, internal consistency, and reliabilityThe shortened version has a better response structure and is more readily feasible.

Background: The Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) is a self-administered questionnaire to measure multidimensional adjustment to a prosthetic limb. Our aim was to assess the validity and reliability of the French version of the TAPES-R (TAPES-R-F)., Materials and Methods: The cross-cultural adaptation was performed according to the recommendations. Factor analysis and Rasch analysis were also performed to allow comparison with the original English version. Construct validity was assessed by measuring the correlations between TAPES-R-F subscores and quality of life, pain, body image satisfaction, anxiety and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability., Results: No major difficulties were encountered throughout the trans-cultural adaptation process. The final version of the TAPES-R-F was well accepted and understood by the patients. According to the factor analysis, the satisfaction scale should be treated as a one-dimensional construct when used by French-speaking people and should not be separated into two separate subscales, functional and aesthetic, as is the case in the original English version. Our study confirmed that there is a strong relationship between biopsychosocial factors and adjustment to amputation. Cronbach's α > 0.8 for all the subscales. Reliability was good to excellent for all the subscales (ICCs between 0.61 and 0.89). The smallest detectable changes were 0.7, 0.8, 1.3, 0.4, and 1.8 (general adjustment, social adjustment, adjustment to limitation, activity restriction, and global satisfaction with the prosthesis)., Conclusions: The TAPES-R-F is a valid and reliable instrument to assess multidimensional adjustment of French-speaking lower limb amputees. This questionnaire can be used for both clinical assessment and research purposes., Competing Interests: The authors have declared that no competing interests exist.

Background: Amputee gait is known to be asymmetrical, especially during loading of the lower limb. Monitoring asymmetry could be useful in quantifying patient performance during rehabilitation. Wearable insoles can provide normal ground reaction force asymmetry in real-life conditions., Objectives: To characterize the validity of Loadsol ® insoles versus force plates in quantifying normal ground reaction force and gait asymmetry. To determine the influence walking speed has on loading asymmetry in transfemoral amputees., Study Design: This is a prospective study., Methods: Six transfemoral amputees, wearing Loadsol ® insoles, walked at three self-selected speeds on force plates. Validity was assessed by comparing normal ground reaction force data from the insoles and force plates. The Absolute Symmetry Index was used to calculate gait loading asymmetry at each speed., Results: Normalized root mean square errors for the normal ground reaction forces were 6.6% (standard deviation = 2.3%) and 8.9% (standard deviation = 3.8%); correlation coefficients were 0.91 and 0.95 for the prosthetic and intact limb, respectively. The mean error for Absolute Symmetry Index parameters ranged from -2.67% to 4.35%. Loading asymmetry increased with walking speed., Conclusion: This study quantified the validity of Loadsol ® insoles in assessing loading asymmetry during gait in transfemoral amputees. The calibration protocol could be improved to better integrate it into a clinical setting. However, our results support the relevance of using such insoles during the clinical follow-up of transfemoral amputees., Clinical Relevance: This is the first study to validate Loadsol ® insoles versus force plates and report on loading asymmetry during gait at three different speeds in transfemoral amputees. Loadsol ® insoles, which provide visual and audio feedback, are clinically easy to use and could have beneficial application in the amputee's rehabilitation and follow-up.