Laurent Ballaz

Gillette Gait Index in adults

Gillette Gait Index (GGI) is a very useful tool to assess gait abnormalities. However, it seems that it has only been validated in children with cerebral palsy. Nevertheless, the parameters used to compute GGI are not specific to children population. Our aim is to demonstrate that GGI could also be used to evaluate adults gait abnormalities. 44 adults (25 healthy and 19 pathological) participated to this study. Pathological subjects had a diagnosis of central nervous system pathology (6 with spinal cord injury and 13 with brain injury). We first, compared the kinematic parameter values of our healthy adult group to healthy children group in previous studies. It appears that those parameters variability is a bit lower in adults, which makes the GGI more sensitive. Moreover, the GGI in adults is too much dependent on one parameter among the 16 proposed by Schutte et al. (2000), the Time of Peak Flexion. Finally, the Edinburgh Visual Gait Score (EVGS) is correlated to GGI in children. To emphasize the relevance of GGI in adults, we have evaluated the correlation between EVGS and GGI in our pathological group. Those two parameters are indeed highly correlated. All these results allow us to conclude that the GGI computed with the 15 remaining parameters is a useful tool to assess gait abnormalities in adults.

Group aquatic training improves gait efficiency in adolescents with cerebral palsy

Purpose.u2003To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system. Method.u2003Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45u2009min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function. Results.u2003Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures. Conclusions.u2003Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.

Peripheral vascular changes after home-based passive leg cycle exercise training in people with paraplegia: a pilot study.

OBJECTIVEnTo determine the hemodynamic adaptations after home-based passive leg cycle exercise training in person with paraplegia.nnnDESIGNnA randomized controlled trial (small cohort).nnnSETTINGnUniversity department of physical medicine and rehabilitation.nnnPARTICIPANTSnA volunteer sample of people with paraplegia (N=17).nnnINTERVENTIONnSubjects within the experimental group performed 36 passive cycling sessions at home.nnnMAIN OUTCOME MEASURESnBefore and after training, we measured heart rate and maximal and minimal femoral artery blood flow velocity at rest and immediately after a 10-minute session of passive cycling by using a quantitative duplex Doppler ultrasound. For each condition, we calculated the mean blood flow velocity and velocity index (VI), used as an indicator of peripheral resistance.nnnRESULTSnAt rest, after training, mean blood flow velocity (P=.08) and VI did not differ significantly in the experimental group compared with the pretraining values (nonparametric analysis). However, in this group, the postexercise mean blood flow velocity and VI are respectively increased and decreased after training (P<.05) compared with the pretraining values. No changes were noted in the control group.nnnCONCLUSIONSnSix weeks of home-based passive cycling training have no significant effect on the rest hemodynamic values but increase the hemodynamic response to acute passive cycling exercise.

Effect of forced use therapy on posture in children with hemiplegic cerebral palsy: a pilot study.

OBJECTIVEnTo evaluate the impact of forced use therapy on posture in children with hemiplegic cerebral palsy.nnnDESIGNnSingle group pre- and post-training assessments.nnnSUBJECTSnEight children (mean age 10.5 years (standard deviation 1.26 years)) with hemiplegic cerebral palsy Levels I and II on the gross motor function classification scale.nnnMETHODSnAll participants underwent 12 days (6 h/day) of forced use therapy. Postural asymmetry as well as the centre of pressure range and peak velocity during quiet standing were evaluated before and after the therapy. Upper limb functional level was also assessed using the Bruininks Oseretsky test of Motor Proficiency and the Assisting Hand Assessment.nnnRESULTSnBefore forced use therapy, postural asymmetry tended to decrease when the participants wore the upper limb constraint. After forced use therapy, upper limb functional scores improved significantly, and postural asymmetry tended to decrease, compared with the pre-therapy values. Postural improvement was correlated with postural asymmetry before forced use therapy. No significant differences were observed on the centre of pressure displacement parameters during the quiet standing tests in all conditions.nnnCONCLUSIONnThis pilot study showed that forced use therapy may be an efficient way to improve postural asymmetry in children with hemiplegic cerebral palsy.