L'enfant digitigrade ("toe-walker") (intérêt diagnostique de l'analyse quantifiée de la marche)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Résultat de l'utilisation d'une monothérapie probabiliste dans les infections ostéo-articulaires de l'enfant

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Impact of spinal fusion on severity health status in scoliotic adolescents with polyhandicap.

BackgroundScoliosis constitutes a prevalent comorbidity in adolescents with polyhandicap and frequently leads to other severe impairments, impacting abilities and requiring complex caregiving strategies. Therefore, spinal fusion surgeries are commonly performed to alleviate pain and provide more comfort. However, spine stabilization has not previously been proven to improve the severity health status of adolescents with polyhandicap according to specific clinical scales.ObjectiveThis study describes and compares the severity health status of adolescents with polyhandicap before and after they underwent spinal fusion.MethodsA monocentric retrospective observational study was conducted in the university hospital centre of Saint-Etienne, France. We included between 2009 to 2020, 30 scoliotic adolescents with polyhandicap who underwent spinal fusion performed with the same surgical technique and the same surgeon. The main outcome was the variation in the Polyhandicap Severity Scale (PSS) score after surgery. Secondary outcomes were variations in PSS subscores, quality of life scores, fronto-sagittal X-ray parameters, and measures of surgical complication rates and lengths of stay.ResultsAmong 30 adolescents, 27 PSS analyses were performed. We found a significant improvement between pre- and postoperative PSS scores, mainly for pain and respiratory, digestive, and skin disabilities. These improvements were accompanied by significant reductions in pelvic obliquity, in frontal and sagittal curves. The mean hospital length of stay was 45 days. During postoperative period, patients received a personalized postoperative rehabilitation procedure with spasticity and pain treatments, physiotherapy, and verticalization (wheelchair sitting and positioning devices such as contoured seat intended to increase postural stability). The mortality rate was estimated at 7%. At least 1 complication per patient occurred.ConclusionsWe show that spinal fusion surgeries confer a significant improvement in the severity health status in scoliotic adolescents with polyhandicap

Effet du chaussage sur la marche du jeune enfant avec l’augmentation de la vitesse de déplacement

Contexte. La présente étude tente d’apporter une première réponse aux effets du chaussage de l’enfant selon différentes vitesses de déplacement. Méthodes. Les paramètres cinématiques et dynamiques de la marche de vingt et un enfants ont été déterminés, pieds nus et pieds chaussés. Les essais de marche sont répartis suivant trois groupes de vitesses. Résultats. Le genou et la cheville sont affectés par le chaussage, mais aussi la hanche jusqu’alors considérée comme non-influencée par la chaussure dans la littérature. De plus, l’augmentation de la vitesse de déplacement entraîne des variations entre les deux conditions de marche. Conclusions. L’âge, mais aussi la vitesse de déplacement, doivent donc être considérés pour l’étude de la marche chaussée chez l’enfant et la conception de chaussure. Mots clés : Enfant / chaussure / marche / vitesse de déplacement / cinématique / dynamique

Investigation of biomechanical strategies increasing walking speed in young children aged 1 to 7 years

For young children, biomechanical joint maturation is achieved at 4 years old for the ankle, at about 6-7 years for the knee, at 6 for the hip. These differences may involve different propulsion strategies with respect to age and particularly to increase walking speed. One hundred and six children are included in the study. Mechanical work during the stance phase was computed and an involvement ratio for each joint was deduced (work of one joint divided by the sum of the works of the three joints). Whatever the age, the biomechanical strategy to increase speed is similar for the positive work: increase of the ankle involvement and decrease of the hip involvement. The negative work is mainly produced by the knee whatever age.Chez le jeune enfant, la maturation articulaire est atteinte à des âges différents pour la cheville (4 ans), le genou (6-7 ans) et la hanche (6 ans). Ces différences peuvent entraîner différentes stratégies de propulsion, en particulier, pour augmenter la vitesse de marche. Cent six enfants sont inclus dans l'étude. Le travail mécanique au cours de la phase d'appui est calculé et le ratio d'implication de chaque articulation est déduit (travail d'une articulation divisé par la somme des travaux des trois articulations). Quel que soit l'âge, la stratégie d'augmentation de vitesse est similaire pour le travail positif : augmentation de l'implication de la cheville, diminution de celle de la hanche. Le travail négatif est principalement fourni par le genou, pour tous les âges

Ostéosclérose intramédullaire du tibia chez l’enfant

International audienc

Foot mechanics during the first six years of independent walking

Recognition of the changes during gait that occur normally as a part of growth is essential to prevent mislabeling those changes from adult gait as evidence of gait pathology. Currently, in the literature, the definition of a mature age for ankle joint dynamics is controversial (i.e., between 5 and 10 years). Moreover, the mature age of the metatarsophalangeal (MP) joint, which is essential for the functioning of the foot, has not been defined in the literature. Thus, the objective of the present study explored foot mechanics (ankle and MP joints) in young children to define a mature age of foot function. Forty-two healthy children between 1 and 6 years of age and eight adults were measured during gait. The ground reaction force (GRF), the MP and ankle joint angles, moments, powers, and 3D angles between the joint moment and the joint angular velocity vectors (3D angle aM.o) were processed and compared between four age groups (2, 3.5, 5 and adults). Based on statistical analysis, the MP joint biomechanical parameters were similar between children (older than 2 years) and adults, hinting at a quick maturation of this joint mechanics. The ankle joint parameters and the GRFs (except for the frontal plane) showed an adult-like pattern in 5-year-old children. Some ankle joint parameters, such as the joint power and the 3D angle aM.o still evolved significantly until 3.5 years. Based on these results, it would appear that foot maturation during gait is fully achieved at 5 years

Biomechanical maturation of joint dynamics during early childhood: Updated conclusions

Dynamic parameters have been commonly explored to characterize the biomechanical maturation of children's gaits, i.e., age-revealing joint moment and power patterns similar to adult patterns. However, the literature revealed a large disparity of conclusions about maturation depending on the study, which was most likely due to an inappropriate scaling strategy and uncontrolled walking speed. With the first years of independent walking, a large growth in height and a large variability of dimensionless walking speed are observed. Moreover, the dynamic parameters were not well studied during early childhood. In the present study, seventy-five healthy children between 1 and 6 years of age were assessed during gait trials at a self-selected speed. Four hundred and sixty-two gait trials constituting five age groups with comparable dimensionless walking speeds were selected. 3D joint moments and the power of the lower limbs were computed and expressed using a dimensionless scaling strategy (according to body weight, leg length and the acceleration of gravity). Statistical analysis was performed to examine intergroup differences. Based on the current results, we concluded the biomechanical maturation of joint dynamics occurred around an age of 4 years for the ankle and between 6 and 7 years for the knee and the hip. Moreover, age group comparisons seemed more appropriate in young children using both the dimensionless strategy and a similar walking speed. Future investigations will be conducted on an older population (i.e., adding children older than 6 years) to clearly define the status of knee and hip biomechanical maturation