Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial.

OBJECTIVE: Telemonitoring (TM) has been used in continuous positive airway pressure (CPAP)-treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome. METHODS: Patients diagnosed with moderate to severe obstructive sleep apnea syndrome were prospectively included and randomized to receive usual care (UC) or TM. In both arms, an educational session was scheduled 1 month after CPAP initiation, and medical visits were planned after 1.5 and 3 months. In the TM arm, we added a universal TM unit (T4P) to the CPAP device. RESULTS: Delay to first intervention was significantly shorter in the TM group (29 ± 25 vs 47 ± 30 days, p = 0.02). The first intervention in the TM group was motivated by detection of problems by the TM system in 39% of patients. Compliance at 3 months was significantly better in the TM group (5.7 ± 1.6 vs 4.2 ± 1.9 h/night, p = 0.018). CONCLUSION: This is the first randomized study showing that TM reduces delay to first technical intervention in CPAP-treated patients. This early activation of troubleshooting was associated with improved compliance at 3 months. Since CPAP side effects at 1 month have been shown to predict lower 12-month CPAP compliance, TM seems to be an excellent tool for improvement of long-term CPAP acceptance.

Organization of postural equilibrium in several planes in ballet dancers.

This study analyzed the balance strategies of ballet dancers during postural equilibrium in three single leg balance conditions with and without vision and regard to age. Dancers participating formed two groups of 20 dancers each, one aged between 8 and 16 years (young group) and the other aged between 17 and 30 years (adult group). Ground reaction forces (GRFs) (mediolateral (ML), anteroposterior (AP) components, vertical (V)) were recorded. Results analysis enabled us to extract some spatiotemporal data for each component of the GRF (number of GRF oscillations, variability and impulses). Young dancers are characterized, compared to adult dancers, by an instability combined with an increase of oscillations number and a decrease variability mainly visible on the ML component. In the two groups, the absence of vision implies an increase of AP, ML and V impulsions and GRF variability. Balance with the gesturing limb to the rear increases the age and vision effect compared to balances with the limb forward or to the side. Young dancers are less efficient at controlling their balance than adult dancers. This observation may be related to the number of hours practicing dance, which differs between groups. The dancers have a visual dependence to control the postural balance.

Gait initiation reflects the adaptive biomechanical strategies of adolescents with idiopathic scoliosis.

BACKGROUND: The dynamics behavior of patients with idiopathic scoliosis obviously requires some biomechanical compensatory strategies. Our objective is to analyze the ground reaction forces (GRF) exerted during gait initiation in order to determine the dynamic consequences of idiopathic scoliosis. METHODS: Ten adolescent girls suffering from idiopathic scoliosis with a right thoracic curvature (Cobb>15°) and 15 healthy adolescents participated in this study. Two force plates were used to record the ground force evolution for the right and left limbs tested during gait initiation. RESULTS: Whichever limb was used to initiate gait, gait initiation duration was found to be significantly longer in persons with scoliosis than in healthy subjects. In the scoliosis group (SG), the impulses, occurrences and forces values were also greater than in healthy subjects. Under the stance foot, the anteroposterior and vertical forces were always increased. Under the swing foot, the SG showed the same characteristics associated to decreased mediolateral impulses parameters. Even greater differences were observed between these two groups in terms of peak occurrences during left-limb gait initiation. The intragroup comparisons only unveiled very few differences between the two limbs for the control group (CG), whereas significantly higher values were recorded for the group of scoliosis patients when gait was initiated with the left limb rather than with the right one. CONCLUSION: For patients with scoliosis specific dynamic behavior adjustment are made during gait initiation patterns, for both limbs in order to maintain balance during gait to compensate for their spine deformation. Patients with scoliosis always showed slower dynamic patterns than healthy controls. These results show the importance of including specific evaluation and dynamic physical rehabilitation for patients with idiopathic scoliosis.

Lateral steps reveal adaptive biomechanical strategies in adolescent idiopathic scoliosis.

INTRODUCTION: Adolescent idiopathic scoliosis (characterized by a morphological deformation of the trunk) prompts the development of new postural control strategies. This adaptation has an influence on the dynamics of motor behaviour. The present study analysed ground reaction forces during lateral stepping in order to highlight the dynamic consequences of idiopathic scoliosis. MATERIAL AND METHODS: Ten adolescents suffering from idiopathic scoliosis with right thoracic curvature (Cobb angle>or=15 degrees) and 15 healthy adolescents participated in the study. We used two force platforms to record ground reaction forces for the right and left legs during large and small lateral steps (LSs). RESULTS: Our results revealed intergroup and interlimb differences for both types of step. For small LSs, right-side (i.e. convexity side) initiation induced a significant increase in the ground reaction force impulse during the postural phase for the scoliotic group, when compared with the control group. For large LSs, left-side (i.e. concavity side) initiation induced a significant increase in ground reaction force impulse during the landing phase only. Patients always displayed slower dynamic behaviour than healthy controls. For both stepping sides, the asymmetry index (AI) was higher in the scoliotic group than in the control group (0.2or=85 in the scoliotic group versus 0.124.4 in the control group). Furthermore, the scoliotic group showed a significant increase in the variability of the dynamic parameters (>8%). CONCLUSION: In scoliotic subjects, lateral stepping prompts specific dynamic behaviour affecting both limbs, in order to maintain balance during movement despite spinal deformation. This stepping task could be used in future studies to identify specific motor strategies.