Gilles Caty

ABILOCO : a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients

OBJECTIVE To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain). DESIGN Prospective study and questionnaire development. SETTING A faculty hospital. PARTICIPANTS Adult stroke patients (N=100) (age, 64+/-15y). The time since stroke ranged from 1 to 260 weeks. INTERVENTION A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model. MAIN OUTCOME MEASURE The ABILOCO questionnaire. RESULTS The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test. CONCLUSIONS The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.

Effect of Upper Limb Botulinum Toxin Injections on Impairment, Activity, Participation, and Quality of Life Among Stroke Patients

Background and Purpose— The purpose of this study was to study the effect of Botulinum toxin type A (BoNT-A) injections in spastic upper limb muscles on impairment, activity, participation and quality of life in chronic stroke patients. Methods— BoNT-A (Dysport) was injected into several upper limb spastic muscles in a group of 20 patients. Neurological impairment (muscle tone and strength, dexterity, SIAS), activity (ABILHAND), participation (SATIS-Stroke), and quality of life (SF36) were assessed before and 2 months after the injections. Results— BoNT-A injections improved muscle tone, but had no impact on dexterity, manual ability, social participation, and quality of life. Conclusions— In this study, BoNT-A injections in spastic upper limbs significantly reduced neurological impairments, but had no functional impact.

The effect of botulinum toxin injections on gait control in spastic stroke patients presenting with a stiff-knee gait.

INTRODUCTION Botulinum toxin type A (BoNT-A) injections are known to improve walking impairments and activity in spastic hemiparetic stroke patients presenting with a stiff-knee gait [Caty GD, Detrembleur C, Bleyenheuft C, Deltombe T, Lejeune TM. Effect of simultaneous botulinum toxin injections into several muscles on impairment, activity, participation, and quality of life among stroke patients presenting with a stiff knee gait. Stroke 2008;39(October (10)):2803-8]. The aim of the present study was to understand how the improvement of mechanical variables during gait is controlled by the central nervous system after BoNT-A injections. Therefore, we used Kinematic Segmental Coordination (KSC), i.e. the kinematic covariation law of elevation angles between lower limb segments, to assess their effect on gait control. As far as we know, this has never been studied before. METHODS Twenty chronic hemiparetic stroke patients presenting with a stiff-knee gait performed an instrumented gait analysis at the same walking speed before and 2 months after BoNT-A injection in several spastic muscles. We used the kinematic recordings previously obtained by Caty et al. [Caty GD, Detrembleur C, Bleyenheuft C, Deltombe T, Lejeune TM. Effect of simultaneous botulinum toxin injections into several muscles on impairment, activity, participation, and quality of life among stroke patients presenting with a stiff knee gait. Stroke 2008;39(October (10)):2803-8] and computed KSC following Borgheses methodology. The treatment effect was tested using a repeated measures ANOVA. RESULTS BoNT-A injections allowed a statistically significant improvement in KSC of both lower limbs (p=0.004). Moreover, the unaffected side KSC reached normal values after BoNT-A injections. CONCLUSION AND DISCUSSION BoNT-A allowed an improvement in KSC of the affected lower limb and a normalization of KSC of the unaffected limb. This improvement could either be due to a mechanical effect or a central effect of BoNT-A via the spinal central pattern generators (CPGs).

ABILOCO-Kids: a Rasch-built 10-item questionnaire for assessing locomotion ability in children with cerebral palsy.

OBJECTIVE To develop a questionnaire (ABILOCO-Kids) based on the Rasch measurement model that assesses locomotion ability in children with cerebral palsy. DESIGN Prospective study and questionnaire development. SUBJECTS A total of 113 children with cerebral palsy (10 (standard deviation 2.5) years old). METHODS A 41-item questionnaire was developed based on existing scales and on the clinical experience of professionals in the field of rehabilitation. This questionnaire was tested separately on the 113 children with cerebral palsy and their parents. Their responses were analysed using the Rasch model (RUMM-2020) to select items that had an ordered rating scale and that fit a unidimensional model. RESULTS The final ABILOCO-Kids scale consisted of 10 locomotion activities, of which difficulty was rated by the parents. The parents gave a more precise assessment of their childrens ability than the children themselves, leading to a wider range of measurement that was well-targeted on the sample population and that had good reliability (r=0.97) and reproducibility (intraclass correlation coefficient=0.96). Item calibration did not vary with age, sex or clinical presentation (hemiplegia, diplegia, quadriplegia). The concurrent validity of the ABILOCO-Kids questionnaire was also shown by its correlation with the Gross Motor Function Classification System. CONCLUSION The ABILOCO-Kids questionnaire has good psychometric qualities for measuring a wide range of locomotion abilities in children with cerebral palsy.

Reliability of lower limb kinematics, mechanics and energetics during gait in patients after stroke.

OBJECTIVE To assess the reliability of kinematic, mechanical and energetic gait variables at short (1 day) and medium (1 month) intervals in adult patients after stroke. DESIGN Prospective study. SUBJECTS Ten patients with chronic post-stroke (mean age 53.5 years; age range 25-80 years). METHODS Three-dimensional gait analysis was performed 3 times in these subjects: at baseline (T0), after 1 day (T1) and after 1 month (T2). The reliability of the gait analysis was tested by comparing gait variables measured at T1 and T0 (1 day interval), at T2 and T0 (1 month interval). The inter-session reliability of kinematic, mechanical and energetic variables was calculated by intra-class correlation coefficient (ICC). RESULTS The reliability of kinematic variables ranged from excellent to moderate (ICC >or= 0.51), except for the ankle position at heel strike (ICC = 0.44). The reliability of mechanical and energetic variables ranged from excellent to good (ICC >or= 0.71). The most reliable variable was external mechanical work (ICC = 0.96). The kinematic, mechanical and energetic variables did not change significantly between T0, T1 and T2 (repeated-measures analysis of variance). CONCLUSION Kinematic, mechanical and energetic gait variables present good reliability when measured at 1 day and 1 month intervals in adult patients after stroke.

Aging Reduces the Activation of the mTORC1 Pathway after Resistance Exercise and Protein Intake in Human Skeletal Muscle: Potential Role of REDD1 and Impaired Anabolic Sensitivity

This study was designed to better understand the molecular mechanisms involved in the anabolic resistance observed in elderly people. Nine young (22 ± 0.1 years) and 10 older (69 ± 1.7 years) volunteers performed a one-leg extension exercise consisting of 10 × 10 repetitions at 70% of their 3-RM, immediately after which they ingested 30 g of whey protein. Muscle biopsies were taken from the vastus lateralis at rest in the fasted state and 30 min after protein ingestion in the non-exercised (Pro) and exercised (Pro+ex) legs. Plasma insulin levels were determined at the same time points. No age difference was measured in fasting insulin levels but the older subjects had a 50% higher concentration than the young subjects in the fed state (p < 0.05). While no difference was observed in the fasted state, in response to exercise and protein ingestion, the phosphorylation state of PKB (p < 0.05 in Pro and Pro+ex) and S6K1 (p = 0.059 in Pro; p = 0.066 in Pro+ex) was lower in the older subjects compared with the young subjects. After Pro+ex, REDD1 expression tended to be higher (p = 0.087) in the older group while AMPK phosphorylation was not modified by any condition. In conclusion, we show that the activation of the mTORC1 pathway is reduced in skeletal muscle of older subjects after resistance exercise and protein ingestion compared with young subjects, which could be partially due to an increased expression of REDD1 and an impaired anabolic sensitivity.

Psychophysical and electrophysiological evidence for nociceptive dysfunction in complex regional pain syndrome.

Summary Psychophysical and electrophysiological assessments of nociception using laser stimulation reveal a marked dysfunction of thermo‐nociceptive pathways in the affected limb of patients with chronic complex regional pain syndrome. Abstract The aim of this study was to assess the function of the thermo‐nociceptive system in 25 patients with long‐lasting, medium‐to‐severe refractory complex regional pain syndrome (CRPS)‐1 using behavioral (detection rates and reaction times) and electrophysiological (event‐related brain potentials) responses to brief (50 milliseconds) and intense (suprathreshold for A&dgr;‐nociceptors) carbon dioxide laser stimuli delivered to the affected and contralateral limbs, and by comparing these responses to the responses obtained in the left and right limbs of age‐ and sex‐matched healthy controls. Compared with healthy controls and compared with the contralateral limb, the detection rate of pricking pain related to the activation of A&dgr;‐fibers was markedly reduced at the affected limb. Furthermore, reaction times were substantially prolonged (>100 milliseconds in 84% of patients and >300 milliseconds in 50% of patients). Finally, the N2 and P2 waves of laser‐evoked brain potentials were significantly reduced in amplitude, and their latencies were significantly increased. Taken together, our results show that in the majority of patients with chronic CRPS‐1, thermo‐nociceptive pathways are dysfunctional. A number of pathological mechanisms involving the peripheral nervous system and/or the central nervous system could explain our results. However, the primary or secondary nature of these observed changes remains an open question.

Validation of the French version of the World Health Organization quality of life HIV instrument

Purpose Quality of life is a key element in the follow-up of people living with HIV/AIDS. The main purpose of this study was to validate the French version of the WHOQOL-HIV instrument by comparing this instrument to a generic questionnaire. The second objective was to test the reproducibility of this questionnaire. Method The WHOQOL-HIV and SF-36 questionnaires were filled out by 50 patients on two separate occasions with a time interval of 2 weeks. The internal consistency, validity and reliability of the WHOQOL-HIV were evaluated. Results The internal consistency was acceptable for the different domains, with Cronbach’s alpha ranging from 0.937 to 0.944. The facet-domain correlations were all statistically significant (p<0.001). There was a correlation between the domains from the WHOQOL-HIV and SF-36 questionnaires, with coefficients ranging from 0.349 to 0.763 (p<0.05 for all), except for the Spirituality domain. The test-retest reliability was suitable for all domains and facets, with statistically significant intra-class coefficients between 0.615 and 0.931. Conclusion This study demonstrated that the French translation of the WHOQOL-HIV instrument is a valid and reproducible tool for the evaluation of the quality of life for HIV-infected patients.

Influence of Ambient Music on Perceived Exertion During a Pulmonary Rehabilitation Session: A Randomized Crossover Study

BACKGROUND: Pulmonary rehabilitation is a key element in the treatment of COPD. Music has been shown to have a positive effect on parameters related to a decrease in exercise tolerance. The aim of this study was to evaluate the effect of listening to ambient music on perceived exertion during a pulmonary rehabilitation session for COPD subjects. METHODS: COPD subjects randomly performed a session of pulmonary rehabilitation with or without ambient music. Perceived exertion (Borg scales), anxiety (Hospital Anxiety and Depression Scale-Anxiety Subscale), dyspnea (visual analog scale), and cardiorespiratory parameters were compared at the end of both sessions. RESULTS: Forty-one subjects were analyzed. The characteristics of the COPD subjects were as follows: age, 70.5 ± 8.4 y; body mass index, 22.7 ± 3.9 kg/m2; and FEV1, 38.6 ± 12.5 % predicted. Perceived exertion was not modified by ambient music, but anxiety was improved (P = .02). Dyspnea, fatigue and cardiorespiratory parameters were not influenced by music during a typical session of the pulmonary rehabilitation program. CONCLUSIONS: This study demonstrates that perceived exertion during one pulmonary rehabilitation session was not influenced by ambient music. However, a positive effect on anxiety was observed. (ClinicalTrials.gov registration NCT01833260.)

Learning and Encouragement Effects on Six-Minute Walking Test in Children.

Objectives To evaluate learning and encouragement effects on the 6‐minute walk test in children between 6 and 12 years of age. Study design Two 6‐minute walk tests separated by a 10‐minute resting period were performed by healthy children between 6 and 12 years of age to evaluate the learning (part 1) and encouragement effects (part 2; randomization with and without encouragement). Distance and cardiorespiratory variables were used as outcomes. Results 148 children were recruited. The intraclass correlation coefficient estimates were 0.927 (95% CI, 0.893‐0.951; part 1) and 0.844 (95% CI, 0.744‐0.907; part 2). The test‐retest agreement was verified for distance (P = .679) with a bias of 1.1 m (95% CI, −4 to 6), but the increase in distance with encouragement was significantly and clinically relevant (P < .001; +41 m; 95% CI, 33‐50). Conclusion No training is required for the 6‐minute walk test in children, in contrast with adults, but there was an encouragement effect on the walked distance in these children. Guidelines should take these results into account. Trial registration ClinicalTrials.gov: NCT03276299.