Predictive factors of return-to-work trajectory after work-related rotator cuff syndrome: A prospective study of 96 workers.

OBJECTIVE: Sustained return to work after surgery for work-related rotator cuff syndrome (WRRCS) remains quite difficult. The main purpose of the present study was to identify predictive factors of a return-to-work (RTW) trajectory. METHODS: A total of 96 workers with WRRCS were identified by 4 surgeons. They were followed prospectively before and after the surgery, until 1 year after RTW, or for 20 months after surgery when they did not. Participants completed a series of standardized questionnaires related to working conditions, health, and beliefs, and performed functional tests at the inclusion time. During the follow-up period, they were regularly asked about their working conditions (present or not at work), activity (normal or lightened physical duties) and schedules (full- or part-time job). Statistical analysis was based on single- and multiple-factor models of prediction of the workers' trajectory. RESULTS: Three trajectories of RTW were distinguished, considering RTW and absenteeism that occurred during the follow-up: stable, unstable, and non-RTW. The median age of the sample was 49.5 [45.0-54.0], with 67.7% of workers employed in highly physically demanding jobs. In the multiple factor model, three factors were highly predictive of the trajectory: perceived health before surgery, having had a repaired ruptured-rotator-cuff tendinopathy, and the level of physical demand of the job. CONCLUSION: Three easy-to-collect predictive factors of RTW trajectory have been identified. They may be useful for healthcare professionals and care givers to identify vulnerable workers' risk of occupational dropout after arthroscopic surgery for rotator cuff tendinopathy.

Innovative Therapy Combining Neck Muscle Vibration and Transcranial Direct Current Stimulation in Association with Conventional Rehabilitation in Left Unilateral Spatial Neglect Patients: HEMISTIM Protocol for a Randomized Controlled Trial.

Unilateral spatial neglect (USN) rehabilitation requires the development of new methods that can be easily integrated into conventional practice. The aim of the HEMISTIM protocol is to assess immediate and long-term recovery induced by an innovative association of left-side neck-muscle vibration (NMV) and anodal transcranial Direct Current Stimulation (tDCS) on the ipsilesional posterior parietal cortex during occupational therapy sessions in patients with left USN. Participants will be randomly assigned to four groups: control, Left-NMV, Left-NMV + sham-tDCS or Left-NMV + anodal-tDCS. NMV and tDCS will be applied during the first 15 min of occupational therapy sessions, three days a week for three weeks. USN will be assessed at baseline, just at the end of the first experimental session, after the first and third weeks of the protocol and three weeks after its ending. Our primary outcome will be the evolution of the functional Catherine Bergego Scale score. Secondary outcome measures include five tests that investigate different neuropsychological aspects of USN. Left NMV, by activating multisensory integration neuronal networks, might enhance effects obtained by conventional therapy since post-effects were shown when it was combined with upper limb movements. We expect to reinforce lasting intermodal recalibration through LTP-like plasticity induced by anodal tDCS.

Rehabilitation of Postural Control and Gait in Children with Cerebral Palsy: the Beneficial Effects of Trunk-Focused Postural Activities.

PURPOSE: In children with cerebral palsy (CP), with impaired trunk control and toe-walking, trunk-focused rehabilitation (TFR) based on postural activities was hypothesized to improve trunk postural control, early trunk deceleration, and ankle dorsiflexion braking during walking. Methods: Seventeen children with CP (5-12 years) walking autonomously were randomly assigned to TFR and then usual rehabilitation (TFR-UR) or vice versa (UR-TFR). RESULTS: Only after TFR was significant improvements in (i) the Trunk Control Measurement Scale score, postural sway on an unstable sitting device and standing, and (ii) early sternal and sacral decelerations and coupled negative ankle power due to plantar flexors. CONCLUSION: TFR improves trunk dynamics and consequently improves coupled toe-walking.

Comparison of compensatory shoulder movements, functionality and satisfaction in transradial amputees fitted with two prosthetic myoelectric hooks.

The functionalities of myoelectric hooks, such as whether they allow wrist movements, as well as the volume and design of the devices, may impact how fitted transradial amputees use their upper limbs. The aim of the current study was to compare two prosthetic myoelectric hooks in terms of compensatory shoulder movements, functionality and user satisfaction. This monocentric, randomized, controlled, cross-over trial evaluated eight transradial amputees fitted with two prosthetic myoelectric hooks, the Greifer and the Axon-Hook, during two consecutive periods. At the end of each period, shoulder abduction (mean and percentage of time with shoulder abduction > 60°) and manual dexterity were assessed using the Box and Blocks Test (BBT) on both sides, and satisfaction was assessed with the Evaluation of Satisfaction with Assistive Technology questionnaire. For each patient, data obtained with the BBT on the amputated side were compared with those obtained on the non-amputated side. Shoulder abduction was significantly higher with the Greifer (60.9°± 20.3°, p = 0.03) than with the Axon-Hook (39.8°± 16.9°) and also than with the NA side (37.6 ± 19.4°, p = 0.02). Shoulder abduction on the NA side (37.6 ± 19.4°) was close to that of the Axon-Hook (39.8°± 16.9°). The percentage of time spent with shoulder abduction > 60° during the BBT was higher with the Greifer than with the Axon-Hook or with the NA side (53.3 ± 34.4%, 17.6 ± 27.0% and 18.4 ± 34.9%, respectively), but the differences were not significant (p = 0.15). A significant strong negative correlation was found between shoulder abduction and wrist position with the Axon-Hook (r = -0.86; p < 0.01), but not with the Greifer. Manual dexterity and satisfaction did not differ significantly between the two devices. These results revealed compensatory movements, such as shoulder abduction in transradial amputees equipped with hooks, themselves influenced by the prosthetic device settings.

Effects of a microprocessor-controlled ankle-foot unit on energy expenditure, quality of life, and postural stability in persons with transtibial amputation: An unblinded, randomized, controlled, cross-over study.

BACKGROUND: Microprocessor-controlled prostheses are designed to improve mobility and quality of life through better balance and energy restoration in persons with transtibial amputation. Quasi-active microprocessor-controlled ankles (MPA) adapt to variable terrain by ankle angle adjustment. OBJECTIVES: To compare energy expenditure, balance, quality of life, and satisfaction of Proprio-foot® (a quasi-active MPA model) with standard prescribed ankle prosthesis (prescribed ankle-foot units [PA]) (standard energy storage and return prosthesis). STUDY DESIGN: Multicenter, unblinded, randomized, controlled, cross-over study. METHODS: Energy expenditure (primary outcome) was assessed by oxygen uptake (VO2) measured at the maximum level reached with the 2 prostheses during treadmill walking at progressively increasing incline and speed. Balance was assessed by stabilometry in different static positions. Quality of life and satisfaction were assessed by "Short Form 36" questionnaire (0-100) and by Evaluation de la Satisfaction envers une Aide Technique (0-5) questionnaires after wearing each of the 2 prostheses for 34 days. RESULTS: Forty-five patients tested the 2 prostheses. No statistical difference in VO2 was observed. Significant improvement of balance was observed both during standing on an incline or decline with MPA and PA (p < 0.01). Short Form 36 questionnaire physical scores and Short Form 36 questionnaire mental scores were 68.5 ± 19.5 vs. 62.1 ± 19.6 (p < 0.01) and 72.0 ± 20.8 vs. 66.2 ± 20.9 (p < 0.01) in MPA and PA, respectively. Evaluation de la Satisfaction envers une Aide Technique score on the device was not statistically significant between the 2 groups (MPA 4.4 ± 0.5 vs. PA 4.3 ± 0.5, p = 0.360). CONCLUSION: Proprio-foot® improved balance, quality of life, and patient satisfaction despite no reduction or increase in energy expenditure in comparison with standard energy storage and return prosthesis.

Phantom Sensations Influenced by Global and Local Modifications of the Prosthetic Socket as a Potential Solution for Natural Somatosensory Feedback During Walking: A Preliminary Study of a Single Case.

Following lower limb amputation, amputees are trained to walk with a prosthesis. The loss of a lower limb deprives them of essential somatosensory information, which is one of the causes of the difficulties of walking with a prosthesis. We here explored whether a solution to this lack of somatosensory feedback could come from natural sensations of the phantom limb, present in most amputees, instead of from substitutive technologies. Indeed, it is known that phantom sensations can be modulated by (i) global mechanical characteristics of the prosthesis socket, and (ii) locally applying a stimulus on an area of the residual limb. The purpose of this pilot study was to verify the feasibility of influencing phantom sensations via such socket modifications in a participant with transfemoral amputation. Four prosthetic interface conditions were studied: a rigid and a semi-rigid socket, each one with and without a focal pressure increase on a specific area of the residual limb. The results show that phantom sensations during walking were different according to the 4 interface conditions. The participant had more vivid phantom sensations in his foot and calf of which some varied as a function of the gait phases. Preliminary gait analysis with wearable sensors shows that these modifications were accompanied by changes in some gait spatiotemporal parameters. This preliminary study of single case demonstrates that phantom sensations can be modulated by the prosthetic interface and can provide natural somatosensory information dynamically varying with gait phases. Although this needs to be confirmed for a larger population of lower limb amputees, it already encourages non-painful phantom sensations to be considered early during the rehabilitation of lower limb amputees.

Real intensity of physical activity capacity of patients with chronic disease: a cross-sectional study.

The aim of this study was to evaluate the real intensity level of exercise in a sample of patients with chronic disease from obesity, rheumatology, hematology and other departments involved in a hospital-based program of adapted physical activity (APA). For this cross-sectional study, we studied seventy-five patients with chronic disease and no beta-blocker treatment. They systematically performed a cardiopulmonary exercise test before participating in a supervised APA practice using a telemetry wireless system to monitor heart rate (HR) during the first session. Based upon the results of the functional evaluation of exercise performance, we studied two groups of patients: (1) No limitation in exercise performance (maximal oxygen uptake greater than or equal to 80% of the theoretical reference) and (2) limited exercise performance (maximal oxygen uptake less than 80% of the theoretical value). Fifty-two patients (69.3%) were women, mean age was 42.6 (± 13.8), and mean BMI was 36.7 (± 10.6). Most patients had been referred for obesity (57.3%). We found 39 patients with normal exercise capacities and 36 patients with limited exercise performance. There were no significant differences in demographic and clinical characteristics between the two groups. For all populations, the mean and median real intensity levels of exercise in a sample of patients were moderate (55-70% HR max) and were the same for both groups. During the most intensive 15-min bout of the APA session, the HR for patients in both groups was greater than 70% of the actual maximum HR. This study observed a moderate level of APA exercise intensity in patients suffering from various chronic diseases. We found no significant difference in intensity level of exercise between patients' capacities, i.e., with and without limitation of their maximal performance.

Simultaneous Control of 2DOF Upper-Limb Prosthesis With Body Compensations-Based Control: A Multiple Cases Study.

Controlling several joints simultaneously is a common feature of natural arm movements. Robotic prostheses shall offer this possibility to their wearer. Yet, existing approaches to control a robotic upper-limb prosthesis from myoelectric interfaces do not satisfactorily respond to this need: standard methods provide sequential joint-by-joint motion control only; advanced pattern recognition-based approaches allow the control of a limited subset of synchronized multi-joint movements and remain complex to set up. In this paper, we exploit a control method of an upper-limb prosthesis based on body motion measurement called Compensations Cancellation Control (CCC). It offers a straightforward simultaneous control of the intermediate joints, namely the wrist and the elbow. Four transhumeral amputated participants performed the Refined Rolyan Clothespin Test with an experimental prosthesis alternatively running CCC and conventional joint-by-joint myoelectric control. Task performance, joint motions, body compensations and cognitive load were assessed. This experiment shows that CCC restores simultaneity between prosthetic joints while maintaining the level of performance of conventional myoelectric control (used on a daily basis by three participants), without increasing compensatory motions nor cognitive load.

Physical Activity Capacity Assessment of Patients with Chronic Disease and the Six-Minute Walk Test: A Cross-Sectional Study.

Background: This study aimed to evaluate the efficacy of the Six-Minute Walk Test (6MWT) to determine the physical activity capacities of patients with chronic disease. Methods: For this cross-sectional study, we investigated 156 patients with chronic disease and no beta-blocker treatment. They systematically performed a maximal cardiopulmonary exercise test to determine their heart rate peak (HRPeak) and maximal oxygen uptake (V'O2max). We considered two groups of patients based upon the results of the functional evaluation of exercise performance: (1) No limitation in exercise performance (V'O2max greater or equal to 80% of the theoretical reference) and (2) limited exercise performance (V'O2max less than 80% of the theoretical value). All patients also received a 6MWT on the same day as the exercise test. Results: We found 68 (43.6%) patients with normal exercise capacities and 88 (56.4%) patients with limited exercise performance. In this sample, 6MWT mean distances were 510 (87) and 506 (86) m, respectively. There were no significant differences between the two groups for distance and end-test heart rate. The correlation between matrix V'O2max measured during the maximal incremental exercise test and the 6MWT distance displayed a positive slope (r = 0.549 CI95 [0.431−0.656]­p < 0.001). Conclusion: Our results showed a moderate relationship between 6MWT and physical activity capacity for patients with chronic disease.

Physical Activity Capacity Assessment of Patients With Chronic Disease and the 1-Minute Sit to Stand Test: Is There an Interest?

Objective: This study aimed to evaluate the efficacy of the 1-minute Sit to Stand test (1MSTS) to determine physical activity capacities for patients with chronic disease. Methods: For this cross-sectional study, we studied fifty patients with chronic disease and no beta-blocker treatment. They systematically performed a cardiopulmonary exercise test to determine maximal oxygen uptake (V'O2max). We considered two groups of patients based on the results of the functional evaluation of exercise performance: (1) No limitation in exercise performance (V'O2max greater or equal to 80% of the theoretical reference) and (2) limited exercise performance (V'O2max <80% of the theoretical value). All patients also received an 1MSTS on the same day. Results: We found 22 (44.0%) patients with normal exercise capacity and 28 (56.0%) patients with limited exercise performance. In this sample, mean 1MSTS repetitions were 27.1 (7.1) and 25.2 (8.7), respectively. There were no significant differences between the two groups for repetition and Borg Scale end test. The correlation between V'O2max measured during the exercise test and 1MSTS repetitions displayed a positive slope [r = 0.401 (95% CI 0.114-625)]. Conclusion: This study demonstrated a moderate relationship between 1MSTS and V'O2max for patients with chronic disease. 1MSTS did not permit the precise determination of physical activity capacities in this sample.

Predictive factors for the duration until return to work after surgery for work-related rotator cuff syndrome: A prospective study of 92 workers.

BACKGROUND: Return to work (RTW) after surgery for a work-related rotator cuff disorder (WRRCD) is often difficult. The study's purpose was to identify preoperative factors predicting RTW. METHODS: Ninety-two workers with a WRRCD were identified by four surgeons. Before surgery, the workers completed a series of standardized questionnaires related to working conditions, health, and health beliefs. They were followed up prospectively for 20 months. Statistical analysis was based on single and multiple-factor Cox models of the duration of absence from the time of surgery until RTW. RESULTS: The median age at inclusion was 49 years (27-62), with 52 women included (57%). Sixty-one subjects (66%) were employed in highly physically demanding jobs. Forty-two (46%) stayed at work until their surgery, whereas preoperative sick leave exceeded 100 days in 20 subjects (21%). Twenty months after surgery, 14 were still not back at work. For the other participants, the mean duration until RTW was 225 days (SD 156). In the fully adjusted model, variables that were significantly predictive of the duration until RTW were: work physical demand levels, preoperative sick leave, the number of body parts causing pain or discomfort in the last 12 months, self-assessed 2-year workability, and the Readiness for RTW (RRTW) Scale. CONCLUSIONS: Several physical, psychological, and work-related factors, easily recorded, can be identified preoperatively. They may be predictive of delayed return, loss of employment, or employability as a result of shoulder surgery.

Impaired postural control of axial segments in children with cerebral palsy.

BACKGROUND: Sensorimotor control of axial segments, which develops during childhood and is not mature until adolescence, is essential for the development of balance control during motor activities. Children with cerebral palsy (CP) have deficits in postural control when standing or walking, including less stabilization of the head and trunk which could affect postural control. RESEARCH QUESTION: Is dynamic stabilization of axial segments during an unstable sitting task deficient in children with CP compared to typically developing children? Is this deficit correlated with the deficit of postural control during standing? METHOD: Seventeen children with CP (GMFCS I-II) and 17 typically-developing children from 6 to 12 years old were rated on the Trunk Control Measurement Scale (TCMS). In addition, posturography was evaluated in participants while they maintained their balance in stable sitting, unstable sitting, and quiet standing, under "eyes open" and "eyes closed" conditions. In sitting tasks, the participants had to remain stable while being prevented from using the lower and upper limbs (i.e. to ensure the involvement of axial segments alone). RESULTS: Children with CP compared to TD children had significantly larger surface area, mean velocity and RMS values of CoP displacements measured during the unstable sitting task and the standing task, under both "eyes open" and "eyes closed" conditions. No significant group effects were observed during the stable sitting task. The TCMS total score was significantly lower, indicating trunk postural deficit, in the CP group than in the TD group and was significantly correlated with postural variables in the sitting and standing tasks. SIGNIFICANCE: Children with CP indeed have a specific impairment in the postural control of axial segments. Since the postural control of axial segments is important for standing and walking, its impairment should be taken into account in rehabilitation programs for children with CP.

Impact of C-LEG on mobility, satisfaction and quality of life in a multicenter cohort of femoral amputees.

BACKGROUND: In some countries, the microprocessor-controlled C-LEG knee joint is reimbursed by the national health insurance for transfemoral amputees under certain conditions. However, whether users really benefit from such a technology in their daily life is unknown. OBJECTIVE: To observe the performance of active C-LEG users in terms of locomotor ability and activities, satisfaction and quality of life after 6 months of wearing the prosthesis in real-life conditions. METHODS: This multicenter observational study investigated locomotor ability [Locomotor Capability Index 5 (LCI-5)], satisfaction [Quebec User Evaluation of Satisfaction with Assistive Device 2.0 (QUEST 2.0)] and quality of life [Medical Outcomes Study Short Form 36 (SF-36)] at the beginning (T0) and end (T1) of the C-LEG test period and at 6 months (T2) after the confirmed prescription of the C-LEG. Information was also collected on the use of walking aids, daily wear of the prosthesis, falls and adverse events. RESULTS: We enrolled 102 participants; 81 were assessed at T1 (62 had a previous prosthesis) and 56 were followed up after 6 months (45 had a previous prosthesis). For participants who had previously been fitted with a prosthetic knee, which was mechanical in almost all cases, as compared with baseline, the use of C-LEG significantly improved locomotor ability (LCI-5 52.6 vs. 46.7, P<0.001), satisfaction (QUEST score 4.6 vs. 3.7, P<0.001) and physical quality of life (SF-36 physical component summary score 51.1 vs. 45.3, P<0.001). In addition, daily use of the prosthesis was higher and use of walking aids and frequency of falls were lower as compared with the previous period. CONCLUSIONS: Active transfemoral amputees with prescription of the C-LEG knee joint showed improved function, satisfaction and physical quality of life after 6 months of wear as compared with their previous prosthesis.

Guiding the Training of Users With a Pattern Similarity Biofeedback to Improve the Performance of Myoelectric Pattern Recognition.

Next generation prosthetics will rely massively on myoelectric "Pattern Recognition" (PR) based control approaches, to improve their users' dexterity. One major identified factor of successful functioning of these approaches lies in the training of amputees and in their understanding of how those prosthetics works. We thus propose here an intuitive pattern similarity biofeedback which can be easily used to train amputees and allow them to optimize their muscular contractions to improve their control performance. Experiments were conducted on twenty able-bodied participants and one transradial amputee. Their performance in controlling an interface through a myoelectric PR algorithm was evaluated; before and after a short automatic user training session consisting in using the proposed visual biofeedback for ten participants, and using a generic PR algorithm output feedback for the others ten. Participants who were trained with the proposed biofeedback increased their classification score for the retrained gesture (by 39.4%), without affecting the overall classification performance (which progressed by 10.2%) through over-training and increase of False Positive rate as observed in the control group. Additional analysis indicates a clear change in contraction strategy only in the group who used the proposed biofeedback. These preliminary results highlight the potential of this method which does not focus so much on over-optimizing the pattern recognition algorithm or on physically training the users, but on providing them simple and intuitive information to adapt or change their motor strategies to solve some misclassification issues.

Spa therapy with physical rehabilitation is an alternative to usual spa therapy protocol in symptomatic knee osteoarthritis.

The objective of the study was to demonstrate the non-inferiority of low-frequency spa therapy combined with rehabilitation (Spa-rehab) versus standard spa therapy at 6 months for symptomatic knee osteoarthritis (KOA). A prospective, randomized, monocenter, non-inferiority trial with recruitment of community-based symptomatic KOA patients was performed. Standard spa therapy comprised standardized spa treatment, 6 days a week for 3 weeks, and Spa-rehab therapy comprised spa sessions, 3 days a week for 3 weeks, followed by a dedicated rehabilitation program, 3 days a week for 3 weeks. The primary endpoint was achieving at 6 months a minimal clinically important improvement (MCII) for pain on a visual analog scale and/or an MCII for function on the WOMAC index and no knee surgery (composite MCII). Secondary endpoints were composite MCII at 3 months and achieving a Patient Acceptable Symptom State (PASS) for pain and function at 3 and 6 months. Among 283 patients included, 145 were allocated to standard spa therapy and 138 to Spa-rehab therapy. We could not demonstrate the non-inferiority of Spa-rehab therapy for the primary endpoint: difference for responders - 0.08 [90% CI (- 0.18 to 0.02), p = 0.14]. However, the difference test between the groups was not significant (p = 0.18). Spa-rehab therapy was not inferior to standard spa therapy for the composite MCII at 3 months or the PASS at 3 and 6 months. Spa-rehab therapy can reasonably be proposed to patients with symptomatic KOA. This protocol may be more cost-effective than standard spa therapy and avoid absenteeism from work and accommodation costs for patients who live close to a centre.

Prospective multicentre validation study of a new standardised version of the 400-point hand assessment.

BACKGROUND: Hand rehabilitation needs valid evaluation tools; the 400-point Hand Assessment (HA) is an exhaustive but not standardised tool. The aim of this study was to validate a standardised version of this test. METHODS: A modified version and a standardised prototype was made for this prospective validation study (four centres, three countries). Psychometric properties studied: reliability (intra-rater and inter-rater, standard error of measurement [SEM], minimum detectable change [MDC],internal consistency); content validity, construct validity with Jebsen Taylor hand function test, QuickDASH, MOS-SF 36 and pain; responsiveness, using an anchor-based approach (ROC curve with area under curve, mean response change) with calculation of MCID. For SEM, MDC and responsiveness, QuickDASH was used for comparison. RESULTS: One hundred and seventy-six patients with hand/wrist injuries were included between May 2013 and February 2015. One hundred and seventy were available for final analysis: 67% men; mean age 43.4 ± 13.2 years; both manual and office workers (46, 5% of each); 37% had a hand or wrist fracture. Reliability: ICC intra-rater = 0.967 [0.938-0.982]; inter-rater = 0.868 [0.754-0.932]. Distribution-based approach: for 400-point HA/QuickDASH: SEM = 3.48/4.52, MDC = 9.065/12.53, internal consistency of 400-point HA: Cronbach α = 0.886. VALIDITY: Content validity was good according to COSMIN guidelines. Construct validity: correlation coefficient: Jebsen-Taylor hand function test = - 0.573 [- 0.666-0.464], QuickDASH = - 0.432 at T0 [- 0.545-0.303], - 0.551 at T3 [- 0.648-0.436]; MOS-SF 36 physical component = 0.395 [0.263-0.513]; no correlation with MOS-SF 36 mental component = 0.142 [- 0.009 + 0.286] and pain = - 0.166 [- 0.306 + 0.018]. Responsiveness: Anchor-based approach: AUC Δ400-point HA = 0.666 [0.583-0.749], AUC ΔQuickDASH = 0.556 [0.466-0.646]. MCID (optimal ROC curve cut-off): 6.07 for 400-point HA, - 2.27 for QuickDASH. MCID with mean response change + 12.034 ± 9.067 for 400-point HA and - 8.03 ± -9.7 for QuickDASH. The patient's global impression of change was only correlated with the Δ400-point HA. CONCLUSIONS: The 400-point HA standardised version has good psychometric properties. For responsiveness, we propose an MCID of at least 12.3/100. However, these results must be confirmed in other populations and pathologies. TRIAL REGISTRATION: This study was retrospectively registered into ISCTRN registry (Number ISRCTN25874481) the 07/02/2019.

How do children aged 6 to 11 stabilize themselves on an unstable sitting device? The progressive development of axial segment control.

Postural control continues to develop during middle childhood as shown by the decrease in body sway in stance between the ages of 5 and 11. Although head and trunk control is crucial for balance control during both static and dynamic activities, evaluating its specific development and its contribution to overall postural control is methodologically challenging. Here, we used an unstable sitting device adapted to ensure that only the axial segments could control the balance of the device and thus the balance of the upper body. This study aimed to assess the development of the postural stabilization of axial body segments during middle childhood. Thirty-six children (in three age groups: 6-7yo, 8-9yo, and 10-11yo) and 11 adults sat on the unstable sitting device and had to stabilize their axial segments under several conditions: a moderate vs. high level of balance challenge, and eyes open vs. eyes closed. Upper-body postural sway (area, mean velocity and root mean square (RMS) of the center of pressure (CoP) displacement) decreased progressively with age (6-7yo > 8-9yo > 10-11yo > adults), and this effect was accentuated when the balance challenge was high (for CoP area) or in the "eyes closed" condition (for CoP area and RMS). The stabilization strategies were assessed by anchoring indexes computed from three-dimensional kinematics. A progressive shift was showed, from an "en bloc" pattern at 6-7 years of age toward a more articulated (i.e. adult-like) pattern at 10-11. A head-on-space stabilization strategy first emerged at the age of 8-9. Middle childhood is an important period for the development of axial segment stabilization, which continues to mature until adulthood. This development might be related to the introduction and progressive mastery of feedforward sensorimotor processes and might contribute strongly to the development of overall postural control.

Cross-cultural adaptation and measurement properties of the French version of the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R).

BACKGROUND: The Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) is a self-administered questionnaire to measure multidimensional adjustment to a prosthetic limb. Our aim was to assess the validity and reliability of the French version of the TAPES-R (TAPES-R-F). MATERIALS AND METHODS: The cross-cultural adaptation was performed according to the recommendations. Factor analysis and Rasch analysis were also performed to allow comparison with the original English version. Construct validity was assessed by measuring the correlations between TAPES-R-F subscores and quality of life, pain, body image satisfaction, anxiety and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability. RESULTS: No major difficulties were encountered throughout the trans-cultural adaptation process. The final version of the TAPES-R-F was well accepted and understood by the patients. According to the factor analysis, the satisfaction scale should be treated as a one-dimensional construct when used by French-speaking people and should not be separated into two separate subscales, functional and aesthetic, as is the case in the original English version. Our study confirmed that there is a strong relationship between biopsychosocial factors and adjustment to amputation. Cronbach's α > 0.8 for all the subscales. Reliability was good to excellent for all the subscales (ICCs between 0.61 and 0.89). The smallest detectable changes were 0.7, 0.8, 1.3, 0.4, and 1.8 (general adjustment, social adjustment, adjustment to limitation, activity restriction, and global satisfaction with the prosthesis). CONCLUSIONS: The TAPES-R-F is a valid and reliable instrument to assess multidimensional adjustment of French-speaking lower limb amputees. This questionnaire can be used for both clinical assessment and research purposes.

Cross-cultural adaptation and validation of the ABIS questionnaire for French speaking amputees.

Background: The Amputee Body Image Scale (ABIS) and its shortened version (ABIS-R) are self-administered questionnaires to measure body image perception of amputee. Our aim was to assess the validity and reliability of the French ABIS (ABIS-F and ABIS-R-F).Methods: Ninety-nine patients were included. The cross-cultural adaptation was performed according to the recommendations. Construct validity was assessed by measuring the correlation between ABIS-F or ABIS-R-F scores and quality of life, pain, anxiety, and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability.Results: A highest body image disturbance was associated with lowest quality of life, higher pain, and higher anxiety, and depression. Cronbach's α was 0.91/0.89 (ABIS-F/ABIS-R-F). The standard error of measurement was 5.35/2.28 (ABIS-F/ABIS-R-F). The smallest detectable change was 14.82/6.31 (ABIS-F/ABIS-R-F). The mean difference in ABIS-F score was -3.90 with limits of agreement from -18.71 to 10.92. For ABIS-R-F, the mean difference was -2.12 with limits of agreement from -8.43 to 4.19. Intraclass correlation was 0.87/0.82 (ABIS-F/ABIS-R-F).Conclusions: The French versions ABIS-F and ABIS-R-F share similar psychometric properties, both are as reliable, but ABIS-R-F has a better response structure and is more feasible.Implications for rehabilitationThe quality of life of amputees is impacted by their satisfaction with body imageThe Amputee Body Image Scale questionnaire measures this perception and is available for French-speaking amputeesThe Standard Errors of Measurement proposed could be useful for clinical and research purposesBoth ABIS and ABIS-R showed satisfactory construct validity, internal consistency, and reliabilityThe shortened version has a better response structure and is more readily feasible.