Concentric and eccentric isokinetic assessment of flexor-extensor torque ratios at the hip, knee, and ankle in a sample population of healthy subjects.

OBJECTIVE: To establish the relationship between the flexor/extensor torque ratios in the hip, knee, and ankle. DESIGN: Case series. SETTING: Laboratory of a university rehabilitation department. PARTICIPANTS: From a group of 158 healthy volunteers, 138 subjects completed all the tests in concentric mode, and 65 in eccentric mode. MAIN OUTCOME MEASURE: The flexor/extensor torque ratios of the hip, knee, and ankle were analyzed by means of isokinetic concentric and eccentric tests. Analysis of variance was carried out to compare the mean values of the ratios obtained between the male and female populations and between the right and left sides, and correlation analysis between the values of the joints. RESULTS: The flexor/extensor torque ratios differed significantly according to sex and angular velocities, but not according to side except for the ankle. No significant relationship was found between the flexor/extensor torque ratios in the hip, knee, and ankle joints. CONCLUSIONS: The flexor-extensor torque ratio of the knee and hip can be used as a reference point during rehabilitation of the contralateral side. Our results demonstrating the absence of correlation between the flexor/extensor torque ratio in each joint of the same limb, however, call for further longitudinal studies to be made under specific circumstances, such as training or immobilization of one joint, to follow the course of agonist/antagonist ratios and the synergistic activity between the joints.

Quality of life of the spouses of stroke patients: a preliminary study.

To study the global quality of life (QOL) of spouses of chronic stroke patients, and to determine its most pertinent factors, we assessed nine stroke patients and their spouses, using the Barthel index, the Functional Independence Measure (FIM), the Montgomery and Asberg Depression Rating Scale (MADRS), the Reintegration to Normal Living Index (RNLI), and a 10-cm visual analogue scale (VAS) to evaluate spouses' QOL. Correlation analysis was performed with the Spearman rank correlation analysis. Mean age of spouses was 53.6 +/- 11.3 years (male:female ratio, 8:1). The mean interval from stroke was 17.6 +/- 10.6 months. The spouses' median QOL score was 4.9, with a significant correlation between spouses' QOL scores and patients Barthel index scores, FIM global scores, and FIM locomotion scores. Spouses complained of the physical burden, but psychological, social, economic and marital consequences of the stroke were also reported. This study confirms the constant impact of stroke on the QOL of the spouses, and demonstrates the role of patients' physical disability. However, the VAS allows only a global approach. A self-administered composite index, exploring the consequences of the stroke on the spouses' daily life, would be a useful complement.

A review of the role of the agonist/antagonist muscle pairs ratio in rehabilitation.

Based on a review of the literature, this article analyses the application of measurement of the agonist/antagonist ratio of muscular strength in functional rehabilitation. According to many authors this ratio constitutes an element of functional specificity of a joint, but it is subject to numerous factors of variation: the joint considered, dominance, sex, age, physical activity and velocity of movement. Despite these various factors, the ratio may constitute a clinical element in the functional analysis of the joint, providing either an index of the risk of developing certain traumatic sports lesions, or a guide control in the modalities of rehabilitation.

Relationship between mean habitual daily energy expenditure and maximal oxygen uptake.

A population of 120 healthy voluntary subjects of both genders aged 16-88 was studied using the QAPSE (Saint-Etienne Physical Activity Questionnaire) with the purpose of investigating the factors influencing the relation between MHDEE (mean habitual daily energy expenditure) and VO2max (maximal oxygen uptake) to elucidate the factors accounting for individual variation. The mean of MHDEE obtained was 12,181.9 +/- 4041.9 kJ.d-1. The mean VO2max obtained was 39.9 +/- 13.8 ml.kg-1.min-1. A strong relationship between MHDEE and VO2max (r = 0.916; N = 120; P < 0.0001) was found. Further, MHDEE seemed to be the greater determinant in the variation of VO2max (89.35%). Other variables were found to be involved in the relation between MHDEE and VO2max for a smaller, but still substantial part: age (6.92%), PAST (exathletes who had considerably reduced or stopped their training) (2.45%), body mass (0.85%), and gender (0.43%). Two variables regarding maximal intensity of activity were not included in the multiple-linear regression analysis. These results suggested that the most important factor in the variation of VO2max is the total quantity of energy expenditure and not only the maximal intensity that could reach the subject.

Heterotopic ossification and rhabdomyolysis.

Heterotopic ossification and rhabdomyolysis are well described entities but, as far as we know, their association has never been described in the literature. We recently treated a patient who presented with this association. After a suicide attempt, this patient developed rhabdomyolysis of the left upper and lower limbs with peripheral neurological impairment. Two months later radiographs showed ectopic ossification around the left hip. Rhabdomyolysis is underdiagnosed, and is due to local disturbance of the calcium-phosphorus metabolism resulting in soft tissue calcifications. Underlying rhabdomyolysis may be a possible aetiology of heterotopic ossification. Recognition of this may help us to understand the pathophysiology and to improve the management of heterotopic ossification.

The relations between physical ability and bone mass in women aged over 65 years.

In this cross-sectional study of 55 women (mean age 73.54 +/- 5.87), the magnitude of the relation between different indices of physical ability and confounding factors to bone density were determined. Physical fitness was assessed by direct measurement of maximal oxygen consumption (VO2 max), isokinetic muscle strength, and quadriceps and psoas muscle surfaces and densities using computed tomography. Anthropometry, chronological and gynecological ages, and dietary calcium intake were also recorded. The bone mineral density (BMD) was evaluated at the axial level (lumbar spine and proximal femur) and at the peripheral level (radius and tibia, cancellous and cortical compartments). Parameters related to physical ability proved to be the best predictors of BMD in radial and tibial cancellous compartments, spine, femoral neck, and trochanter, accounting for 15-27.5% of the total variance. The VO2 max was a major determinant of the femoral mineral density and one of the predictors of radial and tibial cancellous compartments. Psoas parameters were strongly related to spine mineral density and also constituted a predictor of radius (cancellous) and tibia mineral densities. The arm muscle strength could predict, though weakly, the BMD of axial skeleton, whereas thigh muscle strength only predicted the BMD of inferior limbs. No correlation was observed between current dietary calcium intake and BMD. Age-postmenopause and fertile life remained predictive of BMD at mostly cancellous sites, whereas anthropometry exerted important effects on radial and tibial cortices. The study suggests distinct sets of relations between physical ability and the BMD variables. Subjects with greater and denser psoas muscles had greater spine BMD, and those with higher VO2 max had greater proximal femur BMD.

[Epidemiology and psycho-social consequences of urinary incontinence]. / Epidémiologie et conséquences psycho-sociales de l'incontinence urinaire.

Previous studies about urinary incontinence epidemiology are disparate. Incontinence affects about 7% of children between 5 and 14, without predominance of sex. Among adults, prevalence is higher for female. In male patients incontinence percentage varies between 1.4% and 2.9% according to the age, with a low increase in prevalence after the age of 40. In female population, the percentage varies between 4 and 57% according to age after 45, and menopause status. The menopause occurrence is not unanimous admitted as causal factor. Obstetrical traumatism, pelvic surgery, child enuresis, postpartum urinary incontinence increase the risk of urinary incontinence. Overall in France, we estimate that 39% of adult women have micturition disorder: 24% with urgency, 25% with pollakiurie and 21% with incontinence. A lot of studies underline that incontinence exists in young nullipara woman. Over the age of 65, prevalence of urinary incontinence is estimated between 14 and 55% (average 30%). Incontinence rate is higher in institution than at home.

Cross-sectional study of muscle strength and bone mineral density in a population of 106 women between the ages of 44 and 87 years: relationship with age and menopause.

This study examined the correlations between isokinetic muscle strength of knee and elbow flexors and extensors with vertebral and femoral bone mineral density in a population of 106 women between the ages of 44 and 87 years. The absolute value of muscle strength correlated significantly with bone mineral density; muscle strength of the upper limb appeared to be more closely correlated with bone mass, while muscle strength in the lower limb was more specific for femoral mineral bone density. The most important finding that these results demonstrated was a concomitant decline in muscle strength of the upper limb and bone mineral density between the 5th and 6th decades. In contrast, they also showed a decline in muscle strength of the lower limbs after the 6th decade, occurring before the decline in bone mineral density observed between the 7th and 8th decades. From these results it would appear that other studies are required to examine the relationship between the essentially hormonal role in postmenopausal decline in muscle strength and the decline in physical activity during the senile period. These elements are important because they must be taken into account in physical exercise programmes designed to prevent osteoporosis.

Effects of tiludronate on bone loss in paraplegic patients.

Immobilization secondary to spinal cord injury is associated with a marked and rapid atrophy of trabecular bone (disuse osteoporosis). This is due to an early increase of osteoclastic bone resorption associated with a pronounced decreased osteoblastic bone formation. Bisphosphonates are antiosteoclastic compounds and they have been effective in preventing disuse osteoporosis. However, some of them also depress osteoblastic activity and may impair the mineralization process. Tiludronate was shown effective in reducing bone resorption in several metabolic bone diseases without inducing mineralization defects. Twenty paraplegic patients (6 females and 14 males) were randomly assigned to three groups: 6 patients entered the placebo group; 7 patients received tiludronate 200 mg/day; and 7 received 400 mg/day. Histomorphometric analysis was performed on transiliac bone biopsies before and after 3 months treatment. An insignificant decrease of bone volume was observed in the placebo group and the 200 mg group. In patients receiving 400 mg/day, a slight increase was noted. Osteoid parameters changed nonsignificantly in three groups although the 400 mg group exhibited a slight tendency to decrease osteoid volume and thickness. Eroded surfaces increased in all groups. The number of osteoclasts (identified histochemically by TRAP staining) increased in the placebo group but decreased in groups receiving tiludronate. Tiludronate appears effective in reducing bone resorption without impairing bone formation in a manner that preserved bone mass and bone cell coupling.

[Functional ability and quality of life in rheumatoid arthritis: use of the Functional Independence Measure and the Reintegration to Normal Living Index]. / Capacité fonctionnelle et qualité de vie dans la polyarthrite rhumatoïde: utilisation de la mesure de l'indépendance fonctionnelle (MIF) et de l'index de réintégration a la vie normale (RNLI).

Functional disability and quality of life were evaluated using the Functional Independence Measure and the Reintegration to Normal Living Index, respectively, in 57 subjects (15 men and 42 women) with a mean disease duration of 15 years. Scores on both these nonspecific scales correlated with those obtained using instruments specifically designed for rheumatoid arthritis (ARA index, Lee index) and with a number of clinical parameters including patient age, disease duration and number of affected joints. Functional ability was correlated with quality of life in this study and in others performed using other evaluation tools. Nonspecific assessment scales are useful for comparing function and quality of life in various diseases.

Medical activity during an international sporting competition for the physically disabled: Saint-Etienne World Handicapped Sport Championships.

This paper describes the medical activity performed during the 1990 World Games for the Disabled, in Saint-Etienne, France. These Games were attended by 1200 athletes, 229 consultations were performed, and 175 treatments were administered by the medical team. This activity represents a rather high frequency of medical problems, linked either to the disabling disease or to sports injuries. There is a need for specific equipment, for better training of disabled athletes and for improved preparation.

A new tool for evaluating energy expenditure: the "QAPSE" development and validation.

The objective of this study was to design and validate a working tool for the objective evaluation of daily energy expenditure (DEE) by means of a simple, noninvasive method: the QAPSE (Saint-Etienne Physical Activity Questionnaire), a questionnaire about physical activity (PA) over a period of 7 d (168 h). This eight-page questionnaire is designed to provide a complete picture of the subject's habitual PA without any restriction concerning the activities investigated, nor any specialization in relation to health components. It investigates the five areas of PA during daily life: work or way of keeping occupied, leisure activity (sports and nonsports activities), housework, basic everyday activity, moving about from place to place. Assessment of physical activity was conducted in 115 healthy volunteer subjects of both sexes aged 20-88. The values of mean habitual daily energy expenditure (MHDEE) obtained varied between 6,510 and 24,331 kJ.d-1. The MHDEE were in agreement with the data reported in the literature for various groups differing in respect to level of activity, sex, and age. The study demonstrated the reproducibility of the QAPSE (r = 0.997; N = 20; P < 0.0001). Its validity was tested in a comparative study between MHDEE and caloric intake (r = 0.576; N = 20; P < 0.01).

A comparative study of the muscle strength and mass of the arm flexors and extensors in paraplegic and in non paraplegic basketball players.

OBJECTIVES: to study the changes in the strength of the elbow flexors and extensors in paraplegic subjects, and the agonist/antagonist mass and strength ratio in paraplegic wheelchair users. METHOD: 10 paraplegic wheelchair basketball players were compared with 10 healthy basketball players. The 20 subjects underwent a clinical and dynamometric isokinetic assessment, and a CT scan measurement of the muscle cross-sectional surface area of the flexor and extensor muscles of the elbows. RESULTS: there was an increase in muscle strength in paraplegic subjects. There was no significant difference in the agonist/antagonist ratio between the dominant and non dominant upper limb in paraplegics whereas such a difference was found in healthy subjects. The muscle mass was increased in the paraplegics, but a correlation between muscle mass and strength was only found in the healthy subjects.

[The prevalence of female urinary incontinence in general practice]. / La prévalence de l'incontinence urinaire féminine en médecine générale.

To determine the prevalence of urinary incontinence, a questionnaire was administered to 2,911 women by 60 general practitioners, in April and May 1989. The first 50 women seen by the physician in his practice were included in the study. 1,075 women out of 2,911 (37%) declared the presence of episodes of incontinence. Among these 1,075 women, 77% had genuine stress incontinence, 60% urge incontinence, 35% spontaneous leakage. One out of five had these three conditions together. 12% of women with incontinence were less than 31 years of age, 36% were between 31 and 51 years, 20% between 51 and 70 years, and 31% above 70 years. Incontinent women were more frequently post-menopausal; 83% had children (74% for those without incontinence), but the parity was comparable in the two groups. Perineal tears, use of forceps for delivery, high-birth-weight children (above 3,500 g) were more frequently found in incontinent women; but not episiotomy. Incontinent women had more urinary infections, were more often obese, were slightly older at their first childbirth. Post-partum incontinence was found more frequently in incontinent women. A positive association is found with the presence of diabetes, neurological diseases, and chronic bronchitis and cough. Incontinent women more frequently underwent a gynecological surgical procedure, particularly hysterectomies. Incontinence had been present for more than 5 years in 34% of cases, one year in 77% of cases. Only 47 women out of 2,911 (1.6%) consulted specifically for their incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Disease, illness and health: theoretical models of the disablement process.

Handicap is the result of a process of disablement whose origin is a pathological condition (disease). According to some definitions of health (e.g., a state of complete physical, mental and social well-being), the classical biomedical concept is too restrictive to cover all the consequences of disease. New models have been proposed: the impairment-disability-handicap model presented by WHO, the situational handicap model, and the quality-of-life model. A unifying schema of the disablement process includes these concepts and provides a useful way of analysing the consequences of disease. Factors that modify the disablement process can be identified by their respective impacts, and provide operational guidelines for public health interventions.

Cortical osteoclasts are less sensitive to etidronate than trabecular osteoclasts.

Acute osteoporosis after spinal cord injury is related to an early increase in osteoclastic resorption. Healthy subjects subjected to bed rest similarly increase their osteoclast number in trabecular bone. Bisphosphonates possess a highly antiosteoclastic activity. The effects of a 120 day bed rest period, with or without etidronate therapy on cortical bone were measured in 15 subjects. Cortical thickness and cortical porosity were measured on transiliac bone biopsies taken before and after the bed rest period. Osteoclasts were detected histochemically and were counted with a semiautomatic image analyzer. Cortical thickness, cortical porosity, and cortical osteoclast number were not significantly modified in subjects submitted to bed rest alone. In the etidronate-treated patients, cortical bone mass parameters were also found to be unaffected, but the most striking feature was that the osteoclast number was unchanged. Trabecular osteoclasts, on the contrary, were increased in the untreated subjects (+95.2%) but decreased in the treated subjects (-78%). Bone cells may have heterogeneous responses according to their trabecular or cortical location. Cortical osteoclasts seem to be unaffected by etidronate therapy.

Posturographic evaluation of the proprioceptive effect of ankle orthoses in healthy volunteers.

This study analyses the proprioceptive effect of wearing a unilateral and then bilateral ankle orthosis on 34 healthy volunteer subjects by posturography. An elastic orthosis with a ligamentous support band was used, and evaluation was performed by a posturographic statokinesimetric platform. Three tests, one without an orthosis, one with one orthosis, and one with two orthoses, were recorded for each volunteer. The results and statistical analyses demonstrated a significant difference in the antero-posterior measurement between the test without ankle orthosis and the tests with one and with two orthoses. This study provides information about the prophylactic effect of wearing a flexible support; it appears that there are important inter-individual variations in postural equilibrium, and the wearing of prophylactic ankle orthoses should be reserved for subjects after a posturographic examination.