F. Michel

Effectiveness of functional electrical stimulation of gait. Evaluating of modifications to the center of pressure for a hemiparetic patient

Introduction/Background Drop foot is the principal ambulatory anomaly impacting hemiplegic patients. The effectiveness of Functional Electric Stimulation (FES) on gait parameters in hemiplegics has been demonstrated over the medium and long term. Clinical evaluation of this setup and its’ effectiveness is not always easy; changes in gait parameters being difficult to measure solely by observation. Ideally, the application of FES should be done along with a 3-D analysis of the patients gait, which can be a time-consuming procedure. The goal of this study is to evaluate dynamic changes in the center of pressure (COP), measured using an instrumented walkway, when applying FES. Material and method A mono-paretic patient, stable after frontal tumor surgery, was treated with FES of the fibularis communis nerve. The evaluation of gait, at a comfortable walking pace, was realized using an analysis of both spatio-temporal parameters and COP, obtained using the GAITRite walkway. The evaluation was conducted, immediately before and after application of FES. Results Spatio-temporal gait parameters (walking speed, stride length, cadence) were not modified by FES. Our analysis confirms an immediate ‘posteriorization’ of the COP upon initial application of FES. Net postero-anterior displacement of the COP was increased by FES. Conclusion This study confirms the findings in the referenced literature, where during same-day evaluation, FES is shown to not modify spatio-temporal parameters. These modifications only being manifest during prolonged use. We observed changes in the net displacement of the COP on initial application of FES. This corroborates a recent study, which suggests that FES could have an immediate effect on weight transfer and thus increase gait stability. The evaluation of the displacement in the COP could represent a readily observable parameter in gauging the effectiveness of FES when applied to patients with drop-foot. This parameter could be easily and objectively measured with available tools such as an instrumented walkway.

Évaluation IRM des modifications morphologiques du muscle piriforme après injection de toxine botulinique

avec une profondeur de 4,8 cm pour la face superficielle du muscle et une epaisseur moyenne de 1,9 cm (sur la plus grande epaisseur mesuree). Le reperage scanographique permet de valider le positionnement de l’aiguille dans la partie proximale proche de la base du triangle defini precedemment, de meme que les coupes anatomiques realisees sur cadavre. Conclusion.– Les injections de toxine botulinique pour les sites difficiles ou profonds beneficient des progres de l’imagerie et en particulier de l’echographie qui couplee a l’electromyographie donne une analyse interessante et securisante du muscle injecte. Cette association, meme si elle necessite une formation prealable, reste facile a mettre en place, non irradiante et merite certainement d’etre diffusee.

Clinical, ultrasonographic and CT markers for botulinum toxin injections into the piriformis muscle

Results.– Amnesic effect on pain may occur during mobilization. Flexion: 958 active. Pain: 0/10 at rest and walking. Improving the quality of walking with a smooth and not increase walking speed without technical assistance. Resumption of his previous 26 months work after the diagnosis of CRPS-I. Scintigraphy: net regression process CRPS-I detected in his right knee in 2010. Regularization of all households hyperactive. Discussion and conclusion.– This would be for the benefit of nitrous oxide in the mobilization of a stiff joint including CRPS-I through a permitting algofunctional improvement and joints that enabled our patient to return to his previous work. References [1] Collado V, Nicolas E, Faullks D, Hennequin M. A revue of the safety of 50 % nitrous oxyde/oxygen on conscious sedation. Expert Opin Drug Saf 2007;6(5):559–71. [2] http://www.cnrd.fr/IMG/pdf/RCP_KALI.pdf.