Hélène Moffet

Three-dimensional gait analysis in women with a total hip arthroplasty

OBJECTIVES The purposes of this study were: (1) to identify the primary (hip) and secondary (neighboring joints) impairments during gait in subjects with a total hip arthroplasty total hip arthroplasty, (2) to determine which impairments persist when controlling for gait speed and (3) to study the relationships between primary and secondary impairments in order to describe the locomotor strategies used by these patients.DESIGN. This cross-sectional study compared the gait patterns of women with a total hip arthroplasty to those of healthy women.BACKGROUND. Several studies have reported residual hip impairments in the sagittal plane during gait after a total hip arthroplasty. There is, however, a substantial lack of knowledge in regard to the changes at the neighboring joints and in the other planes of movement.METHODS. Subjects have been examined during a gait laboratory testing session including the simultaneous recording of three-dimensional kinematics and ground reaction forces on one side, and bilateral activation of six lower limb muscles.RESULTS. A significant decrease of 20% in the hip extensor moment of force during the early stance phase was correlated (R(2)=43%) with a significant decrease of 14% in gait speed. Moreover, a significant decrease of 59% in the range of hip extension at the end of the stance phase was observed together with secondary impairments such as a significant increase in the anterior pelvic rotation, in knee flexion and in ankle dorsiflexion. Lastly, a significant increase in ipsilateral bending of the trunk during the single limb support on the operated limb was concomitant with a significant decrease in the hip abductor moment of force.CONCLUSIONS. The decrease in gait speed and the persistence of abnormal gait patterns one year after the total hip arthroplasty were associated respectively with a decrease in the hip extensor moment of force and with a decrease in the range of hip extension (sagittal plane) or in the hip abductor moment of force (frontal plane). RelevanceThe data provided in this paper may serve as guidelines to establish rehabilitation programs designed to restore optimal locomotor function.

A randomized controlled trial of home telerehabilitation for post-knee arthroplasty

We compared the effectiveness of home telerehabilitation with conventional rehabilitation following knee replacement surgery (total knee arthroplasty, TKA). Forty-eight patients (mean age 66 years) who received TKA were recruited prior to discharge from hospital after surgery and were randomly assigned to telerehabilitation or usual care. Telerehabilitation sessions (16 per participant over two months) were conducted by trained physiotherapists using videoconferencing to the patients home via an Internet connection (512 kbit/s upload speed). Disability and function were measured using standardized outcome measures in face-to-face evaluations at three times (prior to and at the end of treatment, and four months after the end of treatment). Clinical outcomes improved significantly for all subjects in both groups between endpoints. Some variables showed larger improvements in the usual care group two months post-discharge from therapy than in the telerehabilitation group. Home telerehabilitation is at least as effective as usual care, and has the potential to increase access to therapy in areas with high speed Internet services.

Effect of motor control and strengthening exercises on shoulder function in persons with impingement syndrome: a single-subject study design.

The aim of the study was to evaluate the effect of an intervention including shoulder control and strengthening exercises on function in persons with shoulder impingement. Eight subjects with shoulder impingement were evaluated weekly during the nine weeks of this single-subject design study. The study was divided into three phases (A(1)-B-A(2)) and involved repeated measures of shoulder pain and function (Shoulder Pain And Disability Index (SPADI) questionnaire), painful arc of motion, peak torque and 3-dimensional scapular attitudes. During the intervention phase, each subject participated in 12 exercise sessions supervised by a physiotherapist. Measures taken during the intervention and post-intervention phases were compared to pre-intervention values. All subjects showed significant improvement in the SPADI at the end of the study. A disappearance of a painful arc of motion in flexion and abduction (n=6), an increase in isometric peak torque in lateral rotation (n=3) and abduction (n=2), and changes in the scapular kinematics, mainly in the sagittal plane, were also observed. The present results provide preliminary evidence to support the use of shoulder control exercises to reduce pain and improve function of persons with shoulder impingement.

Early and intensive physiotherapy accelerates recovery postarthroscopic meniscectomy: results of a randomized controlled study.

The efficacy of an early, intensive, supervised rehabilitation program to accelerate knee strength recovery in the first 3 weeks postmeniscectomy by arthroscopy was evaluated using a randomized controlled trial design. The maximal voluntary isokinetic strength of 31 men, randomly allocated to either a treatment (EXP) or a control (CTL) group, was measured twice by a blind rater: preoperatively (pretest) and 3 weeks postsurgery (posttest), using a computer-controlled Kin-Com dynamometer (Chattecx Corporation, Chattanooga, TN). Strength deficits of the operated leg at the pretest and posttest were established in percent of the values obtained for the sound leg at the pretest. In the interval between the surgery and the posttest, the patients of the EXP group (n = 15) received nine supervised treatments combined to home exercises whereas patients of the control group (n = 16) had no specific physiotherapy treatment but were given instructions in postsurgical management and prescribed exercises by the orthopedic surgeons. Patients of the EXP group had better knee extensor strength recovery than patients of the CTL group (ANCOVA, p < 0.001). The size of the strength difference (3 weeks postsurgery) between EXP and CTL subgroups (n = 8) matched according to preoperative deficits was as large as 26% and the residual deficits of the untreated patients were two to three times larger than those of the treated patients. The results of this study highlight the importance of instituting an early intensive and supervised rehabilitation program, especially for workers returning to a strenuous job requiring good knee extensor muscle function.

Comparison of transcranial magnetic stimulation measures obtained at rest and under active conditions and their reliability.

Transcranial magnetic stimulation (TMS) studies investigating motor cortex reorganization in clinical populations use a variety of measurements, with some performed at rest and others with the muscle slightly contracted. Surprisingly there are still a limited number of studies focusing on relationship between TMS-measures obtained at rest and during active muscle contraction in healthy individuals. The purpose of this study was to: (1) compare resting and active TMS-measures and assess their association; (2) determine their respective short- and long-term reliability. Motor threshold (MT), motor evoked potentials (MEP) amplitude, map area, normalized map volume, map center of gravity (CoG) and short-interval intracortical inhibition (SICI) of the first dorsal interosseous (FDI) muscle were assessed in 12 healthy subjects. Subjects were tested three times (with a short (four days) and a long (>1 month) inter-session interval). No significant difference was found between resting and active measures, except for MT. Active MT was on average at 82% of resting MT. Good short- and long-term reliability were found for MT and CoG (in resting and active conditions), for the SICI and MEP amplitude at rest and for the normalized map volume under active condition. In conclusion, maps of FDI muscle obtained at rest and during active contraction are very similar to each other in healthy individuals when differences in MT are taken into account. Most TMS measures present good reliability when obtained under the appropriate condition, with comparable short-term and long-term reliability.

Influence of laptop computer design and working position on physical exposure variables

OBJECTIVE To evaluate the impact of two laptop designs (with or without palm rest) and two work situations (on desk or lap) on neck and upper limb posture, muscle activity and productivity. DESIGN AND METHODS Eight healthy subjects performed a standardized typing task of 15 min duration. During the last 5 min of each test, the neck, upper arm and trunk postures were captured by a three-dimensional video system, wrist motion was measured by a biaxial electrogoniometer and muscle activity of four neck and upper limb muscles was recorded. RESULTS Only minor differences in postures, wrist positions and productivity were observed when comparing the two laptop designs in the same situation. Larger differences were found when comparing the two situations (desk or lap). In the desk situation, the subjects bent their heads forward less, had less backward trunk inclination and wrist extension, but more elevation of the upper arm. Higher electromyographic (EMG) levels in the trapezius and deltoid muscles and lower EMG levels in the wrist extensors were also found in the desk situation. CONCLUSIONS Our findings do not favor one particular laptop design because only small differences in physical exposure were found. However, the workstation set up influenced the physical exposure variables, and was pinpointed as the main determinant to be considered when doing laptop work even-though no ideal situation was found. Greater physical (muscular and articular) constraints seem to be imposed to the shoulder region in the desk situation whereas the head-neck and wrist segments appear to be more stressed in the lap situation. RELEVANCE Laptop computers are often used although the physical exposure in laptop work and the impact of different laptop designs have not been systematically assessed. A better understanding of these factors may help formulate some recommendations for laptop users.

Upper limb motor strategies in persons with and without shoulder impingement syndrome across different speeds of movement

BACKGROUND Activities requiring repetitive arm movements, including high velocity actions, have been identified as a risk factor for shoulder impingement. However, the effect of speed on upper limb motor strategies has yet to be evaluated for individuals with shoulder impingement. The aims of this study were to characterize upper limb motor strategies in individuals with and without shoulder impingement during reaching at natural speed and to evaluate their adaptation to higher speeds of movement. METHODS Twenty healthy individuals and 33 individuals with shoulder impingement took part in one evaluation session. They performed reaching at natural and fast speeds, toward targets located at 90 degrees of arm elevation in two different planes. Reaching speed, upper limb kinematics and shoulder muscular activity were used to characterize motor strategies. FINDINGS Individuals with shoulder impingement present altered motor strategies during reaching tasks. However, changes with speed were comparable in both groups, showing similar adaptation to speed. Larger intergroup differences were found when individuals with shoulder impingement were separated into groups presenting higher or lower than normal clavicular elevation. In the frontal plane, increased clavicular elevation for individuals with impingement was associated with more trunk rotation, less elbow flexion and upper trapezius electromyographic activity during reaching, and a more anterior plane of shoulder elevation at the end of reaching as compared to the healthy individuals. INTERPRETATION The present results demonstrate that not all individuals with shoulder impingement present the same abnormal motor strategy. Therefore, characterizing motor strategies before implementing rehabilitation intervention is essential.

Corticomotor control of deep abdominal muscles in chronic low back pain and anticipatory postural adjustments.

Contralateral transversus abdominis muscle (cTrA) is known to be anticipatory to rapid focal movement. The activation of ipsilateral TrA (iTrA) follows cTrA, but their anticipatory interaction in healthy subjects seems to be delayed in low back pain (LBP) patients. TrA delay in LBP is linked with reorganization of the primary motor cortex (M1), thus supporting that cortical changes underlie the altered postural control. Our study tested whether differences in postural adjustments were present in LBP for TrA onsets and co-activation, and whether these differences were paralleled by cortical motor changes. Thirteen chronic LBP patients and 9 healthy Controls were enrolled. Surface recordings of cTrA/internal oblique (IO) and iTrA/IO were collected during a rapid shoulder flexion task while standing. Transcranial magnetic stimulation of M1 tested TrA/IO corticospinal excitability, active motor threshold and short-interval intracortical inhibition (SICI). In LBP compared to Controls, iTrA/IO activation was delayed, co-activation was absent, timing between TrA/IO onsets was impaired, and SICI was missing. Between-outcomes correlations observed in one group were not significant in the other. Delay of iTrA/IO and the lacking co-activation were not explained by between-group differences of transcranial magnetic stimulation outcomes. TrA/IO co-activation is present during rapid focal movement in healthy subjects only. LBP patients displayed an important alteration of the control of spine stability that can be explained by altered mechanisms of M1 motor programming.

In home telerehabilitation for older adults after discharge from an acute hospital or rehabilitation unit: A proof-of-concept study and costs estimation

Purpose.The purpose of this study is to investigate rehabilitation through teletreatment as an alternative to a physical home-care visit to deliver services to individuals at home following discharge from an acute hospital or rehabilitation unit. Method.Four community-living elderly people were recruited for telerehabilitation services prior being discharged from an acute-care hospital and a geriatric rehabilitation unit. Once the patient returned home, an appointment was made for the assessing therapist to take the clinical measurements (T1) in a face-to-face session. Four clinical variables were used (functional autonomy, balance, locomotor performance in walking and lower-body strength). Telerehabilitation sessions with the participants were conducted with trained personnel in the individuals home. The system used to support telerehabilitation services for this proof of concept was built around network-attached remotely-controlled pan/tilt/zoom cameras with MJPEG compression, media displays and hands-free phones. Before the patient was discharged from the physiotherapy program, the same assessing therapist visited the subject again to take the T2 measurements in a face-to-face session. The satisfaction of the health-care professional was determined for each session with the homemade questionnaire. Costs related to telerehabilitation were compared to theoretically home visits. Results.All four subjects improved on the four clinical variables. Mean costs for the telerehabilitation program, comprising 12 sessions over 4 weeks was

In-Home Telerehabilitation Compared with Face-to-Face Rehabilitation After Total Knee Arthroplasty: A Noninferiority Randomized Controlled Trial.

487. Conclusion.Telerehabilitation seems to be a practical alternative for dispensing rehabilitation services after patients are discharged from an acute hospital or rehabilitation unit.