Estimation of the body center of mass velocity during gait of people with transfemoral amputation from force plate data integration.

BACKGROUND: Body Center Of Mass velocity assessment is a prerequisite for several applications in prosthetic control and rehabilitation monitoring. Force plate data integration is a promising alternative to full-body quantitative analysis of segmental kinematics to estimate the velocity. Still, it remains to be implemented and validated for people with transfemoral amputation. METHODS: Two methods were used (force plate based and pelvic markers based) for Body Center Of Mass velocity estimation in a clinical context. The two methods were comparatively assessed on overground walking data of eight people with transfemoral amputation in a laboratory equipped with a motion capture system and force plates compared to reference estimation derived from a full body segmental gait analysis. The 'Methods' agreement with the reference was quantified from the Bland and Altman procedure. FINDINGS: The estimation of Body Center Of Mass velocity from force plate data integration was considered acceptable in terms of limits of agreement. In addition, the hypotheses used to determine integration constants were evaluated and shown to be reasonable as far as the walking direction is well controlled. INTERPRETATION: Results demonstrate the possibility to use the force plate method to assess the Body Center Of Mass velocity of people with transfemoral amputation for straight walking on level ground. An estimation from the velocity of pelvic markers can also be a relevant alternative as soon as the walking velocity remains low. Further investigation will deal with the impact of the errors on the computation of derived parameters such as individual limb power.

Microprocessor prosthetic ankles: comparative biomechanical evaluation of people with transtibial traumatic amputation during standing on level ground and slope.

BACKGROUND: The compensations occurrence due to the alteration of the posture and the gait of persons with lower limb amputation is still an issue in prosthetic fitting. Recently, prosthetic feet designed to reproduce the physiological behaviour of the ankle using a microprocessor control have been commercialized to address this issue. OBJECTIVES: Investigate the relevance of these microprocessor prosthetic ankles (MPAs) in the ability of standing on both level and inclined surfaces. METHODS: Six persons with transtibial amputation usually fitted with energy storing and returning (ESR) foot tested three MPAs: Elan® Endolite (MPA1), Meridium® Ottobock (MPA2), ProprioFoot® Ossur (MPA3). Each MPA data acquisition was preceded of a 2 weeks adaptation period at home and followed by a 3-weeks wash-out period with their ESR. Lower limb angular position and moment, Centre of Pressure (CoP) position, Ground Reaction Forces (GRF) and functional scores were collected in static, on level ground and 12% inclined slope. RESULTS: MPAs allowed a better posture and a reduction of residual knee moment on positive and/or negative slope compared to ESR. Results also reflect that the MPA2 allows the best control of the CoP in all situations. CONCLUSIONS: An increased ankle mobility is associated with a better posture and balance on slope. Gait analysis would complete these outcomes. CLINICAL RELEVANCE: This study compares three MPAs to ESR analysing static posture. Static analysis on level ground and slope represents the challenging conditions people with amputation have to cope with in their daily life, especially outdoors. Having a better understanding of the three MPAs behaviour could help to adequately fit the prosthesis to each patient. Implications for rehabilitation This is a study comparing three MPAs. The static analysis in standard and constraining conditions (slope) reflects the balance of people with amputation in their daily life, especially outdoors. Having a better understanding of the behaviour of each foot could help to adequately fit the prosthesis to each patient.

Quality of life and satisfaction after multilevel surgery in cerebral palsy: confronting the experience of children and their parents.

OBJECTIVES: If the benefits of single-event multilevel surgery (SEMS) in ambulatory children with cerebral palsy have already been validated, especially in terms of functional outcomes, fewer studies have evaluated SEMS in terms of quality of life and satisfaction with surgical outcomes, especially pertaining to the opinions of children and their family. The objectives of this study were to confront the perceptions of parents and the experience of their operated children in terms of quality of life and surgical outcomes. MATERIALS AND METHODS: This was an observational, descriptive, single-center study conducted in a regional Pediatric Physical Medicine and Rehabilitation (PM&R) center, which is considered a reference center in this region of France. The subjects recruited were ambulatory children with cerebral palsy (CP) who had SEMS between 2009 and 2011, and one of their parents. The specific "child" and "parent" CP-related modules of the DISABKIDS questionnaire were used to assess these children's quality of life post-surgery. Perceptions of parents and children regarding gait evolution and satisfaction with surgical outcomes were analyzed via a questionnaire developed by the author. Regarding quality of life and surgical outcomes, the correlation between the perception of parents and experience of children was estimated using the intraclass correlation coefficient (ICC) or prevalence-adjusted bias-adjusted kappa values (PABAK). RESULTS: Twelve children (83% of them boys) and their parents participated in the study. For the DISABKIDS questionnaire, a moderate correlation was found regarding functional impact (ICC=0.58; P<0.0178) but a high correlation was reported for the communication item of the questionnaire (ICC=0.73; P=0.0025). Regarding satisfaction with surgical outcomes, results showed a good correlation (PABAK=0.64). CONCLUSION: Concerning quality of life and satisfaction with surgical outcomes, our study showed a good or even high correlation between parents' perceptions and their child's experience. It is however essential to privilege the child's opinion whenever possible.

Haematoma of pectineus muscle after total hip arthroplasty.

The complications of total hip arthroplasty (THA) during the immediate postoperative period consist mainly in dislocation of the prosthesis, haematomas under antocoagulants, early infections, dismantling of osteotomy, neurological injury, heterotopic ossification and delayed restoration of the range of motion of the hip joint. We present here an infrequently described case of haematoma of the pectineus muscle following THA. Haematomas are not described in literature except in rare cases of compressive haematoma associated with neurological injury. In our case, the intraoperative blood losses were not particularly massive, there were no anticoagulation accident or postoperative trauma and no secondary deglobulinization. The question to be considered is that of a possible stretching of the pectineus during hip dislocation, and possibly during the surgical procedures for the implementation of the prosthesis with increased length, as it is the case here. Haematomas of the pectineus are probably underdiagnosed as they imitate other, more known, symptomatologies.

Suprascapular nerve entrapment in a patient with a spinal cord injury.

STUDY DESIGN: Case report. OBJECTIVES: To describe a case of suprascapular nerve entrapment (SNE) in a patient with a spinal cord injury (SCI) as a cause of shoulder pain. SETTING: Physical Medicine and Rehabilitation Institute, Nancy, France. REPORT: Six months after the occurrence of acute paraplegia T9 ASIA, a 45-year-old man complained of pain in the posterior and lateral areas of the left shoulder. A clinical assessment found an atrophy of the infraspinatus muscle and a muscular weakness during external shoulder rotation. SNE was suggested as a cause of pain and confirmed by nerve conduction recording. Magnetic resonance imaging excluded any compressive cyst. SNE at the spinoglenoid notch, related to upper limb overuse, was suggested. A gluco-corticoid injection in the proximity of the suprascapular nerve eliminated the pain in a few hours. Two months after the injection, the pain had not reappeared, the infraspinatus muscle atrophy was resolved, and supraspinal nerve conduction was normalized. CONCLUSION: Shoulder pain is common in individuals with paraplegia, but this is the first time that SNE has been reported as a cause of pain. This micro-traumatic pathology, well known in athletes, is probably under-diagnosed in patients with SCI who overuse their upper limbs for wheelchair propulsion and body transfers.

[Functional outcome of tuberculous arthiritis of the knee in a male Moroccan patient]. / Regard fonctionnel sur l'arthrite tuberculeuse de genou, chez un homme d'origine marocaine.

PURPOSE: The purpose of this article is to present a case of tuberculous arthritis of the knee and discuss the importance of early diagnosis and rehabilitatin in management outcome. CASE REPORT: A 57-year-old Moroccan man with no medical history presented with a mass in the left knee associated with pain and fever. Analysis of aspirated fluid demonstrated sterile inflammatory liquid. Presumptive antibiotic therapy was ineffective. Diagnosis of tuberculous arthritis was made based on positive tuberculin skin test and interferon-release assays. Diagnosis was confirmed by arthroscopic biopsy. Physiotherapy allowed improvement in both function and analytical test findings. DISCUSSION: Tuberculous arthritis is rare occurring in only 2 to 5% of people with tuberculosis. It can be very destructive. Diagnosis is often delayed leading to joint pain, tissue damage, and functional disability (e.g. inability to walk). Since prompt treatment (antibiotics then physiotherapy) can limit complications, early diagnosis is necessary and often requires deep biopsy, except endemic zones. In the acute phase, immobilization of the extremity in a functional position is necessary. When inflammatory signs subside, physiotherapy can be undertaken in short but frequent sessions without excessive weight or resistance. CONCLUSION: The functional outcome of tuberculous arthritis depends on early multidisciplinary care involving the rheumatologist, infectious disease specialist, orthopedic surgeon and attending physician.

A 24-year-old patient with paraplegia and acquired urethral diverticulum: a case report.

Urethral diverticulum is a rare pathology in male patients. It is most often encountered in patients with paraplegia due to iterative catheterizations. The diagnosis of a large diverticulum is easy to make when faced with clinical symptoms, such as: repeated urinary tract infections, perineal pain and especially when there is penile swelling. We report the case of a 24-year-old patient with paraplegia and urethral diverticulum. In this case, the issue lies in the therapeutic possibilities.

The chronic neuropathic pain of spinal cord injury: which efficiency of neuropathic stimulation?

OBJECTIVE: Determine the efficacy of spinal cord stimulation (SCS) for treating neuropathic pain in spinal cord injury (SCI) patients. MATERIAL AND METHODS: We proceeded with a data analysis of the French and English medical literature with the following keywords: chronic neuropathic pain, spinal cord stimulation. The quality of every selected article was analyzed according to criteria established by the French National Health Authority (HAS). RESULTS: Eighty-three articles were read, 27 of them report clinical studies on SCS on at least one SCI patient. No article had a level of proof lower than 4. CONCLUSION: There is no significant level of proof to recommend the use of this technique in this indication. Conducting further studies, either physiological or clinical, could help to promote this technique with very minor adverse effects in an indication which, to this day, has no gold standard.