A. Thevenon

Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients

OBJECTIVE To evaluate the diagnostic usefulness of provocative tests, Doppler ultrasonography, electrophysiological investigations, and helical computed tomography (CT) angiography in thoracic outlet syndrome (TOS). PATIENTS AND METHODS We prospectively evaluated 48 patients with a clinical suspicion of thoracic outlet syndrome. Standardized provocative tests, an electromyogram and somatosensory evoked responses, a Doppler ultrasonogram, and a helical CT arterial and/or venous angiogram with dynamic maneuvers were done on each patient. The final diagnosis was established by excluding all other causes based on all available data. The agreement between the results of each investigation and the final diagnosis was evaluated. RESULTS Provocative tests had mean sensitivity and specificity values of 72% and 53%, respectively, with better values for the Adson test (positive predictive value [PPV], 85%), the hyperabduction test (PPV, 92%), and the Wright test. Using several tests in combination improved specificity. Doppler ultrasonography visualized vascular parietal abnormalities and confirmed the diagnosis in patients with at least five positive provocative tests. Electrophysiological studies were useful mainly for the differential diagnosis or for detecting concomitant abnormalities. Although helical CT angiography provided accurate information on the location and mechanism of vascular compression, the usefulness of this investigation for establishing the diagnosis of TOS and for obtaining pretherapeutic information remains unclear.

Biomechanics and physiological parameters during gait in lower-limb amputees: A systematic review

OBJECTIVE The purpose of this systematic review was to identify which biomechanical and physiological parameters are the most relevant, commonly used, able to discriminate and/or have specific clinical relevance for the gait analysis of lower-limb amputees (LLA). METHODS We performed an electronic search via the PubMed, EMBASE and ISI Web of Knowledge databases from 1979 to May 2009. Two independent reviewers assessed the title and abstract of each identified study. The quality assessment of the full text was undertaken using a 13-item checklist divided into three levels: A, B, and C. RESULTS The literature search identified 584 abstracts to be considered. After applying the inclusion criteria, we reviewed the full text of a total of 89 articles. The mean article quality was 8±2. No A-level article was found; the primary reason was a negative score in blinded outcome assessment. Sixty-six articles (74%) corresponded to a B-level, and two articles (2%) corresponded to a C-level. Twenty-one articles (24%) did not acquire enough points to be assigned to any level. In this study, we present and discuss the most commonly used and most relevant 32 parameters. Many of the parameters found were not reported in enough studies or in enough detail to allow a useful evaluation. CONCLUSION This systematic review can help researchers compare, choose and develop the most appropriate gait evaluation protocol for their field of study, based on the articles with best scores on the criteria list and the relevance of specific biomechanical and physiological parameters.

Benefits of home visits for falls and autonomy in the elderly: a randomized trial study.

Pardessus V, Puisieux F, Di Pompeo C, Gaudefroy C, Thevenon A, Dewailly P: Benefits of home visits for falls and autonomy in the elderly: A randomized trial study. Am J Phys Med Rehabil 2002;81:247–252. Objective To investigate whether home visits by a occupational therapist reduces the risk of falling and improves the autonomy of older patients hospitalized for falling. Design In this randomized, controlled trial set in a geriatric hospital, 60 patients (mean age, 83.5 yr) who were hospitalized for falling were recruited from the acute medicine department. A home visit from an occupational therapist and an ergotherapist assessed patients’ homes for environmental hazards and recommended modifications. The outcomes measured were falls, autonomy, hospitalization for falling, institutionalization, and death. Results During the follow-up period, the rate of falls, hospitalization for falls, institutionalization, and death were not significantly different between the two groups. Both groups had a loss of dependence at 12 mo. This loss of dependence was significant in the control group but not in the intervention group. Conclusions Home visits from occupational therapists during hospitalization of older patients at risk for falling can help to preserve the patient’s autonomy.

Adherence to, and results of, physical therapy programs in patients with hip or knee osteoarthritis. Development of French clinical practice guidelines.

OBJECTIVE To develop recommendations regarding adherence to physical therapy programs by patients with hip or knee osteoarthritis. METHODS We used the method recommended by the French Society for Physical and Rehabilitation Therapy (SOFMER), which combines a systematic literature review, a practice survey, and validation by a multidisciplinary panel of experts. RESULTS When setting up exercise programs for patients with lower limb osteoarthritis, measures should be taken to increase effectiveness by optimizing adherence. Patient selection is among these measures, as exercise programs are more likely to succeed in patients with a history of being physically active, a positive view of the suggested program, and/or favorable social and material conditions. Regardless of the type of exercise, the program should be tailored to exercise capacity and pain level (professional consensus). Patient adherence can be improved by explaining the expected results to the patient, asking the patient to keep a self-evaluation diary, conducting long-term evaluations (by phone or mail), and providing follow-up visits. CONCLUSION Studies of adherence according to the type of exercise are needed. The relevance of widely used incentives in patients with hip or knee osteoarthritis should be evaluated in new therapeutic trials.

Gait pattern classification of healthy elderly men based on biomechanical data

OBJECTIVES To distinguish the gait patterns of young subjects from those of elderly men using three-dimensional (3D) gait data, to determine if elderly subjects displayed other than a typical gait pattern, and to identify which parameters best describe them. DESIGN Nonrandomized study in which video and force plate data were collected at the subjects own free walking speed and used in a 3D inverse dynamic model. Cluster analysis was chosen to identify the gait families, and analyses of variance were performed to determine which parameters were different. SETTING A gait laboratory. PARTICIPANTS The sample of convenience involved a single but mixed group consisting of 16 able-bodied elderly subjects (mean age, 62yrs) and 16 able-bodied young subjects aged between 20 and 35 years. MAIN OUTCOME MEASURES Phasic and temporal gait parameters, as well as the 3D muscle powers developed in the joints of the right lower limb during the gait cycle. RESULTS The walking patterns in elderly subjects were found to be different from those of the young adults. Three elderly gait families or groups forming a specific gait pattern were identified, and differences were found in the phasic and temporal parameters as well as in 6 peak muscle powers. Four of the peak powers occurred in the sagittal plane, and half of them were related to the hip. CONCLUSIONS Biomechanical parameters can be used to classify the gait patterns of young and elderly men using cluster analysis rather than age alone. The muscle powers in elderly subjects are perturbed throughout the gait cycle and not only at push-off. It appears that the plane in which the peak powers occurred was related to their occurrence in the gait cycle. Variability in the gait patterns of elderly subjects could reflect natural adaptations or compensations. These should not be indicative of a deficient gait or be misconstrued as some age-related pathology.

Effects of training and detraining on the static and dynamic balance in elderly fallers and non-fallers: A pilot study

Purpose. The aim of this study was to evaluate the effects of training based on static and dynamic balance in single and dual task conditions in order to analyse the effects of detraining on static and dynamic balance in healthy elderly fallers and non-fallers. Method. A group of 16 subjects were trained: eight fallers aged 71.1 ± 5.0 years and eight non-fallers aged 68.4 ± 4.5 years. The subjects were evaluated 3 months before the training period, 2 days before the training period, 2 days after the end of the training period and 3 months after the training period. All subjects performed a unipedal test with eyes open and eyes closed. Gait parameters were analysed under single-task and dual motor-task conditions. Results. This study demonstrated a loss of physical capacities over 3 months for stride time, single support time for fallers in both conditions. Physical training significantly improves static and dynamic balance under single and dual task conditions. Lastly, after 3 months of detraining, a loss of the physical training effects were measured for fallers and non-fallers on the different walking parameters in the two conditions and on the unipedal tests. Conclusions. The absence of stimulation before the trained period shows a negative effect of ageing on walking and falls whereas training permits an improvement in static balance and the pattern of walking under single and dual task conditions, which could be due to an increase in muscular strength and a better division of attention. On the other hand, 3 months of detraining inhibited the effects of training, which showed the speed of the decline caused by ‘natural’ ageing.

Comparison of maximal and spontaneous speeds during walking on dry land and water

The aim of this study was to quantify spontaneous and maximal speeds on dry land and in water, in four modalities of walking [forward (F), backward (B) and lateral walking (L)], with chest immersion level. Lateral walking was studied with the upper limbs of the subject alongside the body with hands placed on the lateral face of the thighs (L1) and upper limbs tightened behind the back with the hands joined (L2). 16 males (age 22.8+/-1.8 years, height 178.1+/-6.1cm, body mass 73.5+/-6.6 kg) and 15 females (age 22.8+/-2.1 years, height 171.5+/-5.8 cm, body mass 69.2+/-9.3 kg) were evaluated using the four modalities of walking on dry land and in water. The speed increments between spontaneous and maximal speeds on dry land for F, B and L1 and L2 were 60.2%, 60.9%, 64.3% and 65.3% for males and 47.3%, 48.3%, 44.5% and 53.1% for females. In the water, these variation values for F, B, L1 and L2 for males were 44.6%, 26.1%, 48.8%, and 42.1%. The values for females were 31.7%, 21.6%, 32.8%, and 34.6%. Spontaneous and maximal speeds of walking were substantially reduced in water with the chest immersed, compared to speeds on dry land for the four modalities and the two genders. These findings may be used by therapists who utilize the various modalities of walking in aquatherapy.

Isokinetic muscle testing for weak patients suffering from neuromuscular disorders: a reliability study.

Precise, sensitive muscle strength testing methods are needed to investigate muscle function in patients with neuromuscular disorders (NMD). Here, we describe an isokinetic knee flexor and extensor testing procedure using the Biodex 3s continuous passive motion (CPM) mode. The torque values recorded during passive isokinetic motion were subtracted from the torque values obtained for the same movement with maximal, concentric effort. The aims of the present study were to (i) evaluate the methods reliability in NMD patients presenting mild to severe muscle weakness and (ii) study the relationship between manual muscle testing (MMT) and isokinetic dynamometry. The fifteen participating patients were tested twice; the respective intraclass correlation coefficients (ICCs) for the two sessions ranged from 0.91 to 0.99 for the peak torque, work and power and from 0.50 to 0.90 for the angle at peak torque. The Spearman rho correlation coefficients comparing isokinetic values and MMT values ranged from 0.67 to 0.74 (p<0.01). This reliable, dynamic method appears to be of great value in NMD evaluation when sensitive strength measurement at the knee is required.

On the quantitative relationships between individual/occupational risk factors and low back pain prevalence using nonparametric approaches.

OBJECTIVES To explore dual quantitative relationships between low back pain (LBP) prevalence and different individual and occupational risk factors, and detect the most important ones which can be used as weighted input data in LBP prediction diagnosis models, providing effective tools to help with the implementation of protection and prevention strategies among hospital staff. METHODS Fourteen predictor individual risk factors (e.g., age, gender, body mass index BMI [kg/m(2)], domestic activity, etc.) and 17 occupational risk factors (e.g., job status, standing hours/day, sufficient break time, job dissatisfaction, etc.) were collected using self-reported questionnaire among the staff of Sacré-Coeur hospital - Lebanon (used as a case study), and correlated with LBP prevalence using Kendalls tau-b bivariate nonparametric approaches. RESULTS This study indicates that among the investigated occupational risk factors, job status, working hours/day, and standing hours/day are the most influencing on LBP prevalence (highly correlated with other factors at 1 and 5% confidence levels). It also shows that strong positive (between 0.25 and 0.65)/negative (from -0.38 to -0.26) statistical correlations to LBP prevalence exist between these risk occupational factors and working days/week, sitting hours/day, job stress, job dissatisfaction, children care, and car driving. The weekly hours of domestic activity, the staff height, and gender type have proven also to be the strongest individual factors in aggravating LBP disease. These individual factors are highly correlated at 1% significance level (ranging between 0.28 and 0.49 for positive correlations, and from -0.49 to -0.25 for negative ones) to children care, weight, extra professional activity, and use of handling techniques. CONCLUSIONS These obtained bivariate correlations can be used successfully by expert physicians in their decision making for LBP diagnosis.

Effects of Backrest Positioning and Gear Ratio on Nondisabled Subjects' Handcycling Sprinting Performance and Kinematics

Backrest position is a significant parameter in handcycling that one must consider when seeking to optimize the user-to-chair interface. We studied the effects of backrest position on handcycle propulsion kinematics. Ten nondisabled partici pants with no handcycle propulsion experience repeated an 8 s sprint with three backrest positions (backrest angle between 45 degrees and 50 degrees to the horizontal, backrest angle between 65 degrees and 70 degrees to the horizontal, and without backrest) and three gear ratios (GRs) (GR22/21 = low, GR32/21 = medium, and GR44/21 = high). We used three-dimensional movement analysis to calculate the average maximal velocity, cycle frequency, and angle parameters for the arms and trunk. Our results showed statistically higher trunk flexion/extension (p < 0.001) and maximal velocity (p < 0.001) when a backrest was not used. Moreover, these differences were accentuated as the GR increased (GR44/21). Our results suggest that handcycle users with unimpaired upper-body and trunk function can improve handcycling performance by removing the backrest. Nevertheless, future studies on specific groups of subjects with spinal cord injury should be conducted.