L. Bensoussan

Asymétries chronométriques, cinétiques et cinématiques de l'initiation de la marche chez un sujet hémiplégique

OBJECTIVE To investigate the temporal, kinetic and kinematic asymmetry of gait initiation in one subject with hemiplegia with an equinus varus foot. MATERIAL AND METHODS A kinetic analysis with two AMTI force plates and a kinematic analysis with an ELITE optoelectronic system of gait initiation were performed in one subject with hemiplegia. RESULTS The duration of the gait initiation phases was asymmetrical. The monopodal phase was shorter when the affected lower limb was supporting than when the healthy one was supporting. The propulsion resulted from the force exerted on the healthy lower limb. The distribution of body weight on the lower limbs was asymmetrical. Body weight support was more important on the healthy side than on the affected side. Maximal extension of the ankle on the hemiplegic side occurred during the swing phase. Ground clearance was increased by elevating the knee higher on the affected side than on the healthy side during the swing phase. Initial contact with the floor was performed with the foot flat on the affected side. CONCLUSION This preliminary study has shown that gait initiation in one subject with hemiplegia was asymmetrical in kinetics and kinematics. The results concerning kinematics have not been reported previously for gait initiation in subjects with hemiplegia. The study of gait initiation should allow for better understanding postural and movement control strategies developed by patients with hemiplegia.

Peroneus quartus and functional ankle instability

INTRODUCTION Physical and rehabilitation medicine physicians commonly see patients with chronic functional ankle instability. The main anatomical structures involved in ankle stability are the peroneus (fibularis) brevis and peroneus longus muscles. Several anatomical muscle-tendon variations have been described in the literature as being sometimes responsible for this instability, the peroneus quartus muscle being the most frequent. The objective of this clinical study is to discuss the implication of the bilateral peroneus quartus muscle in functional ankle instability. CLINICAL CASE This 26-year-old patient was seen in PM&R consultation for recurrent episodes of lateral ankle sprains. The clinical examination found a moderate hyperlaxity on the right side in bilateral ankle varus. We also noted a bilateral weakness of the peroneus muscles. Additional imaging examinations showed a supernumerary bilateral peroneus quartus. The electroneuromyogram of the peroneus muscles was normal. DISCUSSION In the literature the incidence of a supernumerary peroneus quartus muscle varies from 0 to 21.7%. Most times this muscle is asymptomatic and is only fortuitously discovered. However some cases of chronic ankle pain or instability have been reported in the literature. It seems relevant to discuss, around the clinical case of this patient, the impact of this muscle on ankle instability especially when faced with lingering weakness of the peroneus brevis and longus muscles in spite of eccentric strength training and in the absence of any neurological impairment. One of the hypotheses, previously described in the literature, would be the overcrowding effect resulting in a true conflict by reducing the available space for the peroneal muscles in the peroneal sheath.

Modulation of human motoneuron activity by a mental arithmetic task.

This study aimed to determine whether the performance of a mental task affects motoneuron activity. To this end, the tonic discharge pattern of wrist extensor motor units was analyzed in healthy subjects while they were required to maintain a steady wrist extension force and to concurrently perform a mental arithmetic (MA) task. A shortening of the mean inter-spike interval (ISI) and a decrease in ISI variability occurred when MA task was superimposed to the motor task. Aloud and silent MA affected equally the rate and variability of motoneuron discharge. Increases in surface EMG activity and force level were consistent with the modulation of the motor unit discharge rate. Trial-by-trial analysis of the characteristics of motor unit firing revealed that performing MA increases activation of wrist extensor SMU. It is suggested that increase in muscle spindle afferent activity, resulting from fusimotor drive activation by MA, may have contributed to the increase in synaptic inputs to motoneurons during the mental task performance, likely together with enhancement in the descending drive. The finding that a mental task affects motoneuron activity could have consequences in assessment of motor disabilities and in rehabilitation in motor pathologies.

Should European PRM residents be taught in English? The experience of the European School Marseille

OBJECTIVE To assess the level of comprehension of the courses taught in English at the annual European school on Physical and Rehabilitation Medicine (PRM) (European School Marseille). MATERIALS AND METHODS The English level of 37 students, mainly from European countries, was tested using three written questionnaires: an initial test of English grammar, a questionnaire about comprehension at the end of a basic PRM class taught in English by a French specialist and a final multiple-choice test (MCT) on the contents of the course. RESULTS We found a difference between the level of English given by the residents and the level shown by the initial test. The overall level of English comprehension of the group was good, an average of 8.2/10 (S.D.: 2.1) on a Visual Analogue Scale. The mean MCT score on the contents of the course was good, an average of 6.1/10 (S.D.: 2.2). For residents with lower levels of English, the level of comprehension for courses taught in English by the French specialist was greater than the level of comprehension for courses taught by native English speakers (p=0.033). CONCLUSION The level of comprehension of most European PRM residents for courses taught in English by French PRM specialists and by English-speaking specialists is good. The level of comprehension is, of course, influenced by the English level of European residents. It thus appears worthwhile to organize programmes taught in English for European PRM residents. Nonetheless, it is important to assess the language skills of the residents and to use specific tools to help the small number of trainees whose English level is to low.

Return to surfing using an adapted prosthesis: A case report:

Background: Surfing with transfemoral knee prosthesis requires flexion of the hip, knee, and ankle and balance between flexibility and stiffness of the prosthetic limb. We report on Mr D, a transfemoral amputee, who wanted to surf again. Case Description and Methods: Technical specifications were based on Mr D’s complaint. The prosthesis is salt water resistant and combines a shock absorber associated with elastic tendons to permit the knee to bend easily and to facilitate eccentric braking. Surfing was observed using videos of movements and subjective analysis of compensations. Findings and Outcomes: Mr D uses this prosthesis for surfing with good results and got back to his former level using compensations. During the takeoff, he cannot shorten his left leg. He makes a circumduction movement to put his leg in front of the board. Conclusion: This prosthesis is adapted for surfing and allows precise adjustments to surfing conditions. Clinical relevance Appropriate prosthesis design can enable return to surfing for a transfemoral amputee.

Long-term functional improvement in hemiplegic patients after stroke: A series of case

from C5 to C8 and absent in the lower limbs. Two months later, a motor control on the left hand was observed. Discussion.– For this patient, the relevance of the MEP in sub-acute stage of brainstem infarct was initially discussed because of the presence of a beginning of motor control but they were finally performed with two objectives: try to better predict functional recovery and mainly to contribute to the announcement of the disability. Further reading Bembenek JP., et al. The prognostic value of MEP in motor recovery and functional outcome after stroke-a systematic review. Funct Neurol 2012; 27: 79–84.

Census study of the students with disabilities and of the compensations implemented by the Handicap Mission within the Aix-Marseille University

P503-e Census study of the students with disabilities and of the compensations implemented by the Handicap Mission within the Aix-Marseille University M. Prats a,∗, B. Delorge b, M. Kerzoncuf a, L. Bensoussan a, J.M. Viton a, A. Delarque a a CHU La Timone, Service de Médecine Physique Réadaptation, Marseille, France b Responsable de la Vie étudiante et handicap de l’université d’Aix Marseille, Marseille, France ∗Corresponding author.

Central effects of botulinum toxin: Neurophysiological study in post-stroke patients with lower limb spasticity

Conclusions.– This suggests that BoNT-A induces spinal plasticity leading to the recovery of reciprocal inhibition, which is likely to be due to the withdrawal of inhibitory control from Renshaw cells directly blocked by BoNT-A. This could help in limiting ankle muscle cocontractions in the transition phase from stance to swing, to assist dorsiflexion. Further readings Aymard C, Giboin LS, Lackmy-Vallée A, Marchand-Pauvert V. Spinal plasticity in stroke patients after botulinum neurotoxin A injection in ankle plantar flexors. Physiol Rep 2013. Marchand-Pauvert V, Aymard C, Gibouin LS., Dominici F, Rossi A. Mazzocchio R. Depression of spinal recurrent inhibition after botulinum toxin A, J Physiol 2013.

Suivi sur dix années de l’évolution qualitative et quantitative de la marche d’une patiente atteinte d’une maladie de Charcot-Marie-Tooth et porteuse de chaussures orthopédiques

Mots clés : Charcot-Marie-Tooth ; varus ; Pied creux ; Toxine botulinique Introduction.– La maladie de Charcot-Marie-Tooth (CMT) s’accompagne de déformations progressives des pieds dues à un déséquilibre entre muscles agonistes et les antagonistes et qui ont un retentissement sur la posture et la marche. La prévention de ces déformations est un objectif important de la prise en charge. Observation.– Nous rapportons le cas d’une jeune patiente de 11 ans atteinte d’une CMT de type 2 qui présente un pied creux varus statique du pied gauche auquel s’ajoutait une adduction dynamique d’avant pied lors de la marche. Cette déformation entraîne une usure précoce des chaussures orthopédiques, des douleurs du bord latéral du pied et un inconfort de port des orthèses de posture nocturne. L’examen baropodométrique lors de la marche (plateforme Zebris FDM, Zebris Inc.) confirmait un hyperappui latéral majeur en regard de la base du cinquième métatarsien. À l’examen clinique, le varus était partiellement réductible, la force du muscle tibial postérieur (principal muscle varisant) était normale tandis que les fibulaires (antagonistes) étaient très déficitaires (2/5). Une injection intramusculaire de 50 unités de toxine botulinique (Botox) a été réalisée par voie échoguidée dans le muscle tibial postérieur gauche. Après l’injection (évaluations réalisées à 15 jours et trois mois), la résistance passive à la correction du varus était cliniquement diminuée. La déformation en varus du pied était légèrement amélioré lors de la marche (analyse vidéo 2D) et on notait une nette baisse de l’hyperappui plantaire externe (–35 % à j15,–46 % à M3). Sur le plan cinétique, l’affaiblissement du tibial postérieur, fléchisseur plantaire accessoire, n’entraînait pas de baisse de la composante verticale de la force de propulsion à gauche, les paramètres spatio-temporels de marche (évalués par tapis Gaitrite) n’étaient pas modifiés. Discussion.– En limitant le déséquilibre musculaire entre le muscle tibial postérieur et les muscles éverseurs déficitaires, le traitement par toxine botulinique a limité la déformation en varus et l’hyperappui externe qui y était secondaire, et a permis une nette diminution des douleurs à la marche. Une étude à plus grande échelle paraît nécessaire, notamment pour évaluer son rôle préventif à long terme.