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International audience; Voluntary phantom movements are systematically associated with muscle contractions in the residual limb. These latter are specific to the type of movement and can be classified by pattern recognition algorithms. However, phantom mobility generates fatigue that could impact classification metrics. This study explored whether daily phantom movement training at home with no other feedback than inherent somatosensory information can impact the classification success rate. Kinematics and muscle activity were compared between before and after a two-month home training in six major upper limb amputees. Surface EMG patterns were classified to quantify a potential change in the features space with training. Our results showed that this type of training induces faster, smoother, and richer phantom mobility. However, classification metrics did not change with training. When including the new types of movements achievable after training, accuracy did not decrease, indicating that muscle activation patterns associated with these movements were sufficiently different not to interfere with the already existing movement classes. Thus, although phantom training with only somatosensory feedback increases the overall phantom movement capacity, it does not increase the classification success rate. Yet, it is possible that paired with other forms of feedback, phantom training could improve this success rate.

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.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).Multicenter, unblinded, randomized, controlled, cross-over study.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.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 (p0.01). Short Form 36 questionnaire physical scores and Short Form 36 questionnaire mental scores were 68.5 ± 19.5 vs. 62.1 ± 19.6 (p0.01) and 72.0 ± 20.8 vs. 66.2 ± 20.9 (p0.01) 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).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.

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.

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; 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.

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.

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.

ObjectiveThis 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.MethodsFor 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'O2max). We considered two groups of patients based on 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 ResultsWe 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'O2max measured during the exercise test and 1MSTS repetitions displayed a positive slope [r = 0.401 (95% CI 0.114–625)].ConclusionThis study demonstrated a moderate relationship between 1MSTS and V'O2max for patients with chronic disease. 1MSTS did not permit the precise determination of physical activity capacities in this sample.

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

International audience; We conducted a pilot study to evaluate the potential and feasibility of back-support exoskeletons to help the caregivers in the Intensive Care Unit (ICU) of the University Hospital of Nancy (France) executing Prone Positioning (PP) maneuvers on patients suffering from severe COVID-19-related Acute Respiratory Distress Syndrome. After comparing four commercial exoskeletons, the Laevo passive exoskeleton was selected and used in the ICU in April 2020. The first volunteers using the Laevo reported very positive feedback and reduction of effort, confirmed by EMG and ECG analysis. Laevo has been since used to physically assist during PP in the ICU of the Hospital of Nancy, following the recrudescence of COVID-19, with an overall positive feedback.

International audience; With their advanced mechatronics, myoelectric upper-limb prostheses now have many motion possibilities. Yet, the latter are not fully employed because of the inconvenient control and prostheses wearers often use their device as a rigid tool while achieving hand positioning and orientation with compensatory movements. In this paper, we propose to take advantage of this natural human behaviour to control prosthesis motions: the user is in charge of the end-effector while the devices role is to correct the human posture when necessary. We here apply this concept to control a prosthetic wrist pronosupination. A Rolyan clothespin test performed by two transradial amputees shows that the proposed control is as efficient as myoelectric control while requiring no learning.

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.

International audience

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.

Objective Microprocessor-controlled knees are generally prescribed and reimbursed for active amputees. Recent studies suggested that this technology could be useful for amputees with moderate activity level. We compared the efficiency of a microprocessor-controlled knee (MPK, Kenevo, Otto Bock) and non-MPKs (NMPKs) in these indications. Methods A multi-centric randomized crossover trial was conducted in 16 hospitals from 3 European countries. Participants were randomized to an MPK-NMPK sequence, testing the MPK for 3 months and the NMPK for 1 month, or to an NMPK-MPK sequence, testing the NMPK for 1 month and the MPK for 3 months. Dynamic balance, the main criteria, was assessed with the Timed-Up and Go test (TUG), functional mobility with the Locomotor Capability Index (LCI-5), quality of life with the Medical Outcomes Study Short Form 36 v2 (SF-36v2) and satisfaction with the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0. The occurrence of falls was monitored during the last month of trial. Analysis was by intent-to-treat and per-protocol (PP). Results We recruited 35 individuals with transfemoral amputation or knee disarticulation (27 males; mean age 65.6 years [SD 10.1]). On PP analysis, dynamic balance and functional mobility were improved with the MPK, as shown by a reduced median TUG time (from 21.4 s [Q1–Q3 19.3–26.6] to 17.9 s [15.4–22.7], P = 0.001) and higher mean global LCI-5 (from 40.4 [SD 7.6] to 42.8 [6.2], P = 0.02). Median global satisfaction score increased (from 3.9 [Q1–Q3 3.8–4.4] to 4.7 [4.1–4.9], P = 0.001) and quality of life was improved for the mental component summary of the SF-36v2 (median score from 53.3 [Q1–Q3 47.8–60.7] to 60.2 [51.6–62.6], P = 0.03) and physical component summary but not significantly (mean score from 44.1 [SD 6.3] to 46.3 [7.0], P = 0.08). Monitoring of adverse events including falls revealed no differences between both assessed devices. Conclusion This study enhances the level of evidence to argue equal opportunity for all individuals with transfemoral amputation or knee disarticulation, regardless of their mobility grade, to be provided with appropriate prostheses.

Background and Purpose— Intensive physical therapy (PT) facilitates motor recovery when provided during a subacute stage after stroke. The efficiency of very early intensive PT has been less investigated. We aimed to investigate whether intensive PT conducted within the first 2 weeks could aid recovery of motor control. Methods— This multicentre randomized controlled trial compared soft PT (20-min/d apart from respiratory needs) and intensive PT (idem+45 minutes of intensive exercises/day) initiated within the first 72 hours after a first hemispheric stroke. The primary outcome was change in motor control between day (D) 90 and D0 assessed by the Fugl–Meyer score. Main secondary outcomes were number of days to walking 10 m unassisted, balance, autonomy, quality of life, and unexpected medical events. All analyses were by intent to treat. Results— We could analyze data for 103 of the 104 included patients (51 control and 52 experimental group; 64 males; median age overall 67 [interquartile range 59–77], 67 right hemispheric lesions, 80 ischemic lesions, National Institutes of Health Stroke Scale score ≥8 for 82%). Fugl–Meyer score increased over time ( P P =0.29) or interaction between treatment and time ( P =0.40). The median change in score between D90 and D0 was 27.5 (12–40) and 22.0 (12–56) for control and experimental groups ( P =0.69). Similar results were found for the secondary criteria. Conclusions— Very early after stroke, intensive exercises may not be efficient in improving motor control. This conclusion may apply to mainly severe stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01520636.

Most transhumeral amputated individuals deplore the lack of functionality of their prosthesis due to control-related limitations. Commercialized prosthetic elbows are controlled via myoelectric signals, yielding complex control schemes when users have to control an entire prosthetic limb. Limited control causes the development of compensatory strategies. An alternative control strategy associates residual limb motions to automatize the prosthetic elbow motion using a model of physiological shoulder/elbow synergies. Preliminary studies have shown that elbow motion could be predicted from residual limb kinematic measurements, but results with transhumeral amputated individuals were lacking. This study focuses on the experimental assessment of automatic prosthetic elbow control during a reaching task, compared to conventional myoelectric control, with six transhumeral amputated individuals, among whom, three had an osseointegrated device. Part of the recruited participants had an osseointegrated prosthetic device. The task was achieved within physiological precision errors with both control modes. Automatic elbow control reduced trunk compensations, and restored a physiologically-like shoulder/elbow movement synchronization. However, the kinematic assessment showed that amputation and prosthesis wear modifies the shoulder movements in comparison with physiological shoulder kinematics. Overall, participants described the automatic elbow control strategy as intuitive, and this work highlights the interest of automatized prosthetic elbow motion.

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.

Purpose To assess health-related quality of life (HRQOL) following rehabilitation of amputees suffering symmetric peripheral gangrene (SPG) after septic shock. Material and methods A retrospective cohort study was conducted in nine French specialized rehabilitation centers. Thirty-two ICU adult patients hospitalized between 2005 and 2015 for septic shock who additionally presented with SPG resulting in at least two major amputations were enrolled. HRQOL was assessed by EQ-5D-3 L questionnaire. Results All patients (mean ICU length of stay 39 ± 22d, SAPS II 58 ± 18) had both lower limbs amputated and 84% were quadruple amputees. HRQOL, assessed 4.8 ± 2.8 years after amputation, was inferior to the French reference. However, patients' self-rated health status was similar to the reference at the time of HRQOL assessment. The main factor of impaired HRQOL was intense phantom pain, not the mobility or self-care dimensions of EQ-5D. All patients except one preferred to be treated again for SPG despite disability. Conclusion ICU survivors referred to rehabilitation centers after SPG-related amputations had impaired HRQOL. At the time of HRQOL assessment, they considered themselves in good health and preferred to be treated again despite disability. Appraisal of long-term functional outcome should not be used to guide end-of-life decision-making in this situation.

Recent advances in mechatronics and robotics have led to the production of prostheses with a growing number of active degrees of freedom (DoFs). Unfortunately, the gap is growing between this impro...

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.

International audience; Decoding finger and hand movements from sEMG electrodes placed on the forearm of transradial amputees has been commonly studied by many research groups. A few recent studies have shown an interesting phenomenon: simple correlations between distal phantom finger, hand and wrist voluntary movements and muscle activity in the residual upper arm in transhumeral amputees, i.e., of muscle groups that, prior to amputation, had no physical effect on the concerned hand and wrist joints. In this study, we are going further into the exploration of this phenomenon by setting up an evaluation study of phantom finger, hand, wrist and elbow (if present) movement classification based on the analysis of surface electromyographic (sEMG) signals measured by multiple electrodes placed on the residual upper arm of five transhumeral amputees with a controllable phantom limb who did not undergo any reinnervation surgery. We showed that with a state-of-the-art classification architecture, it is possible to correctly classify phantom limb activity (up to 14 movements) with a rather important average success (over 80% if considering basic sets of six hand, wrist and elbow movements) and to use this pattern recognition output to give online control of a device (here a graphical interface) to these transhumeral amputees. Beyond changing the way the phantom limb condition is apprehended by both patients and clinicians, such results could pave the road towards a new control approach for transhumeral amputated patients with a voluntary controllable phantom limb. This could ease and extend their control abilities of functional upper limb prosthetics with multiple active joints without undergoing muscular reinnervation surgery.

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 phantom limb pain (PLP) and phantom limb movement (PLM) in amputees (lower or upper limb). Material/Patients and methods A search on MEDLINE, COCHRANE DATABASE and EMBASE, crossing the key words “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. Only 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. Discussion/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.

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.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.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.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, P0.001), satisfaction (QUEST score 4.6 vs. 3.7, P0.001) and physical quality of life (SF-36 physical component summary score 51.1 vs. 45.3, P0.001). 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.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.

Contexte Les lesions de l’epaule liees au travail exposent les candidats a la chirurgie a des arrets de travail de longue duree. Selon les etudes, des durees d’arrets moyennes variant entre 7,4 et 9,8 mois ont ete observees. De plus, le retour au travail (RAT) ne survient pas dans 40 % des cas, l’echec etant lie au resultat fonctionnel post-operatoire dans 16 % des cas. Si on sait aujourd’hui que la nature de la lesion n‘explique pas l’allongement de la duree d’arret de travail postoperatoire (DATPost), peu de travaux portent sur les autres facteurs l’influencant. Ce travail vise a presenter des facteurs predictifs (FP) de duree d’arret de travail identifies dans le cadre d’une etude prospective, depuis le stade preoperatoire jusqu’a 1 an apres RAT. Methode Cents dix participants candidats a la chirurgie de l’epaule ont ete inclus entre 2015 et 2018. Les donnees collectees comportent notamment l’âge, le sexe, les durees moyennes d’arret de travail pre (DATPre) et postoperatoires, le caractere sollicitant du poste de travail (CSPT) evalue par le chercheur; la sante generale (SF-12 survey); la sante musculo-squelettique (questionnaire nordique (QN), DASH, Score de constant (SC), bilan fonctionnel 400 points); la sante psychosociale (HADS, Questionnaire de Karasek [QK], Questionnaire de Tampa [QT]); les perceptions sur la capacite de travail (WAI) et sur la preparation au retour au travail (RRTWS). Les FP de la DATPost sont notamment identifies par analyse de survie univariee, multivariee et regressions de Cox. Resultats La DATPre s’elevait a 4,9 mois ± 5,1 ; la DATPost a 6,8 mois ± 4,4. En analyse univariee, de nombreuses variables etaient significatives, qui portaient sur la sante (notamment QN, sante percue, depression), le travail (notamment le fait de travailler jusqu’a la chirurgie, le CSPT, certaines variables du QK) et la preparation au retour au travail (WAI et RRTWS). Une analyse multivariee considerant uniquement des donnees pouvant etre recueillies en service de sante de travail a permis d’identifier le CSPT, le nombre de regions douloureuses ou genantes du corps entier sur les 12 derniers mois (QN) et le pronostic dans 2 ans sur le maintien dans l’emploi selon la sante percue (WAI) comme FP influencant significativement la DATPost. Conclusion Ces resultats permettent d’identifier des FP utiles a un reperage des patients potentiellement vulnerables lors du RAT, notamment lors de la visite de pre-reprise. L’etude se poursuit par l’analyse des donnees recueillies apres le retour au travail, qui devrait preciser des predicteurs pre et post-operatoires d’une absence de retour au travail, d’un retour au travail durable ou non, ainsi que des profils « types » de retour au travail.

International audience; 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.

International audience; Purpose: Beyond promising experimental results of sensory passive stimulations in spatial cognition disorders, some questions still remain regarding interests of these stimulations during the daily activities in neglect. The aim of this case-study was to evaluate the effects of a protocol combining left neck-muscle vibration with daily simple movements, like arm pointing movements, on perceptivo-locomotor deficits in a left spatial neglect patient.Materials and methods: Two neuropsychological tests, one subjective straight-ahead pointing (SSA) test and one wheelchair navigation test were carried out before the combination protocol, immediately after, 1 h later, and 24 h later.Results: The results showed a reduction of neglect spatial bias following the protocol lasted at least 24 h in all the tests (except for the SSA test due to the unavailability of the pointing device).Conclusions: The range of improvements in the symptoms of spatial neglect suggests that this therapeutic intervention based on the combining neck-muscle vibration to voluntary arm movements could be a useful treatment for this condition. One of future investigation axes should be the development of a vibratory tool in order to facilitate the combining this proprioceptive stimulation to daily activities. Implications for rehabilitation Spatial neglect is a perplexing neuropsychological syndrome, affecting different domains of spatial cognition and impacting also the functional domain. The treatments based on neck-muscle vibration are simple to use, non-invasive and requires none active participation of patient. A therapeutic intervention based on the combining left neck-muscle vibration and voluntary arm movements in a left-spatial-neglect show a lasting reduction of symptoms especially in daily activities. The combination of treatments based on the Bottom-Up approach opens innovative perspectives in rehabilitation.

Knee osteoarthritis (KOA) can generate postural control impairments which can increase fall risk. Land-based exercise (LBE) and balneotherapy are two modalities currently prescribed, but the impact of the latter on balance control has not been studied. This study aimed to compare two programs of balneotherapy with or without LBE to improve postural control, looking at frequency and duration of treatment. A total of 236 KOA patients (mean age = 64 years) were included in this prospective and randomized study: 122 patients went through 3 weeks of standardized continuous balneotherapy (high frequency/short duration) program (Gr1) and 114 went through 3 weeks of discontinuous (low frequency) balneotherapy program followed by 3 weeks of LBE (Gr2). The total number of treatment sessions was the same for both groups. Posturography was carried out before balneotherapy (W0) and at 3 (W3), 6 (W6), and 12 (W12) weeks after the beginning of treatment. Postural control increased in Gr1 from W0 to W3 and from W0 to W12 and in Gr2 from W0 to W6 and from W3 to W6. The improvement was greater in Gr1 from W0 to W3 and from W6 to W12 and in Gr2 from W3 to W6. High-frequency intensive balneotherapy improved posture control at 3 weeks, while low-frequency balneotherapy did not. This improvement persisted over a 12-week assessment period at the same level. LBE generated an improvement that did not persist over time. Sustained improvement of postural control requires high-frequency repetition of consecutive balneotherapy sessions.

There is an increasing need to extend the control possibilities of upper limb amputees over their prosthetics, especially given the development of devices with numerous active joints. One way of feeding pattern recognition myoelectric control is to rely on the myoelectric activities of the residual limb associated with phantom limb movements (PLM). This study aimed to describe the types, characteristics, potential influencing factors and trainability of upper limb PLM. Seventy-six below- and above-elbow amputees with major amputation underwent a semi-directed interview about their phantom limb. Amputation level, elapsed time since amputation, chronic pain and use of prostheses of upper limb PLM were extracted from the interviews. Thirteen different PLM were found involving the hand, wrist and elbow. Seventy-six percent of the patients were able to produce at least one type of PLM; most of them could execute several. Amputation level, elapsed time since amputation, chronic pain and use of myoelectric prostheses were not found to influence PLM. Five above-elbow amputees participated in a PLM training program and consequently increased both endurance and speed of their PLM. These results clearly encourage further research on PLM-associated muscle activation patterns for future PLM-based modes of prostheses control.

International audience; Transhumeral amputees face substantial difficulties in efficiently controlling their prosthetic limb, leading to a high rate of rejection of these devices. Actual myoelectric control approaches make their use slow, sequential and unnatural, especially for these patients with a high level of amputation who need a prosthesis with numerous active degrees of freedom (powered elbow, wrist, and hand). While surgical muscle-reinnervation is becoming a generic solution for amputees to increase their control capabilities over a prosthesis, research is still being conducted on the possibility of using the surface myoelectric patterns specifically associated to voluntary Phantom Limb Mobilization (PLM), appearing naturally in most upper-limb amputees without requiring specific surgery. The objective of this study was to evaluate the possibility for transhumeral amputees to use a PLM-based control approach to perform more realistic functional grasping tasks. Two transhumeral amputated participants were asked to repetitively grasp one out of three different objects with an unworn eight-active-DoF prosthetic arm and release it in a dedicated drawer. The prosthesis control was based on phantom limb mobilization and myoelectric pattern recognition techniques, using only two repetitions of each PLM to train the classification architecture. The results show that the task could be successfully achieved with rather optimal strategies and joint trajectories, even if the completion time was increased in comparison with the performances obtained by a control group using a simple GUI control, and the control strategies required numerous corrections. While numerous limitations related to robustness of pattern recognition techniques and to the perturbations generated by actual wearing of the prosthesis remain to be solved, these preliminary results encourage further exploration and deeper understanding of the phenomenon of natural residual myoelectric activity related to PLM, since it could possibly be a viable option in some transhumeral amputees to extend their control abilities of functional upper limb prosthetics with multiple active joints without undergoing muscular reinnervation surgery.

Introduction/Background There is a gap between the technical capability of upper limb prostheses, and the control strategy (commonly sequential myoelectric control) used to actuate the motorized joints. Surprisingly, the control method is the same for prosthetic hands and hand/wrist/elbow systems, which leads to a complex utilization. Research groups are investigating new control strategies to make the prosthetic control easier. Most studies are focusing on the task achievement, but it is nonetheless essential to assess the achievement method, especially since high-level amputees are prone to develop compensation-related musculoskeletal disorders. The study aims to show that body kinematics can be used to compare different control strategies, or prosthetic equipments. Material and method Transhumeral amputees performed a reaching task with different prosthetic parameters (different sockets, different control strategies). They performed the task with a prosthesis prototype that could be adapted to any socket, and implemented with any control strategy. They were equipped with motion capture sensors in order to record their body kinematics. The body motion analysis included the trunk and shoulder displacements, as well as the weight deviation. Results We could observe that each transhumeral amputee had a unique utilization of their prosthesis, and that they had their own residual capabilities. All the participants performed the task with the two tested control strategies successfully. However, the kinematic analysis showed differences between the control strategies in terms of coordination restauration, that the participants described but that the task assessment (success or not) could not provide. Conclusion Differences could be highlighted between control strategies that the standard assessment method could not show. Hence the whole body kinematics can be a substantial source of information, especially given the potential severity of compensatory strategies in upper limb prosthesis utilization.

In the literature, several studies on Trans-tibial amputee (TTA) gait focused on kinematics of lower limbs variables. Former studies confirm the essential role of shoulder movement in the human gait. In the horizontal plane, a counter-rotation of pelvis and scapulae girdles occurred characterizing certain gait pathologies’. The purpose of this study is to enhance the compensation strategies of TTA individuals during walking, by analysing the kinematics of pelvis and scapulae girdle’s movements in the sagittal and the horizontal planes. Twenty healthy human subjects (HS) and nineteen TTA participated in this study. A three-dimensional gait analysis with an optoelectronic VICON device were used. In the sagittal plane, the shoulder’s movements are significantly higher during TTA gait. Two counter-rotations of the scapulae and pelvis girdles intervene in the early and in the middle of gait cycle. The kinematic analysis of the scapulae and pelvis girdles during walking showed that TTA have a specific character of gait.

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.