Do French medical schools provide appropriate training on gait and gait disorders?

AbstractAimEvaluate the need for integrated teaching on normal and pathological gait at medical school.MethodA questionnaire filled out by 91 French general practitioners (GPs, 130 of whom were contacted) with an average of 19 years of practice and 56 sixth-year medical students. Assessment of the students’ knowledge of normal and pathological gait.ResultsSeventy-two percent of the GPs and 82% of the students considered gait to be a frequent reason for consultation. Eighty-nine percent of the GPs and 98% of the students stated that they had difficulty analysing a gait disorder. Eighty percent of the GPs and 50% of the students considered that the teaching on gait and gait disorders at medical school was insufficient. The responses notably highlighted the poor coordination between teachers from the various disciplines involved. The students’ knowledge of gait was poor (only 20% of their answers were correct). This was especially true for semiological questions, which were correctly answered by less than one student in 10.ConclusionThe results of the present study demonstrate that French medical schools need to provide better teaching on gait. We, therefore, propose the implementation of an integrated teaching programme with a sufficient focus on functional and semiological approaches

Do Gravity-Related Sensory Information Enable the Enhancement of Cortical Proprioceptive Inputs When Planning a Step in Microgravity?

International audienceWe recently found that the cortical response to proprioceptive stimulation was greater when participants were planning a step than when they stood still, and that this sensory facilitation was suppressed in microgravity. The aim of the present study was to test whether the absence of gravity-related sensory afferents during movement planning in microgravity prevented the proprioceptive cortical processing to be enhanced. We reestablished a reference frame in microgravity by providing and translating a horizontal support on which the participants were standing and verified whether this procedure restored the proprioceptive facilitation. The slight translation of the base of support (lateral direction), which occurred prior to step initiation, stimulated at least cutaneous and vestibular receptors. The sensitivity to proprioceptive stimulation was assessed by measuring the amplitude of the cortical somatosensory-evoked potential (SEP, over the Cz electrode) following the vibration of the leg muscle. The vibration lasted 1 s and the participants were asked to either initiate a step at the vibration offset or to remain still. We found that the early SEP (90–160 ms) was smaller when the platform was translated than when it remained stationary, revealing the existence of an interference phenomenon (i.e., when proprioceptive stimulation is preceded by the stimulation of different sensory modalities evoked by the platform translation). By contrast, the late SEP (550 ms post proprioceptive stimulation onset) was greater when the translation preceded the vibration compared to a condition without pre-stimulation (i.e., no translation). This suggests that restoring a body reference system which is impaired in microgravity allowed a greater proprioceptive cortical processing. Importantly, however, the late SEP was similarly increased when participants either produced a step or remained still. We propose that the absence of step-induced facilitation of proprioceptive cortical processing results from a decreased weight of proprioception in the absence of balance constraints in microgravity

[Towards a better understanding and quantitative assessment of pushing, a postural behaviour caused by some strokes].

International audienceINTRODUCTION: Postural control aims to build up and align the body orientation (posture) and stabilize body segments. The existence of two separate mechanisms, one for the control of body orientation with respect to gravity and one for its stabilisation, is an emerging concept that allows a better understanding of postural disorders, including pushing, after stroke. Objectives. - Literature review concerning pushing, one of the most puzzling postural behaviours after stroke. METHODS: Critical review of papers indexed in Medline and book chapters dealing with pushing. RESULTS: There is no agreement about the definition of pushing: some authors consider that pushers push himself toward the paretic side using the healthy arm or leg; others consider that pushers lean (list) toward the side opposite the lesion and resist any attempt to become more upright. Surprisingly, the push itself has never been measured. Some ordinal scales have been recently proposed, but their psychometric properties have not been analysed. These methodological insufficiencies explain in part the disagreements about frequency (from 5% to 50% of patients with stroke) and cause(s) of pushing. CONCLUSION: Pushing may be the most dramatic clinical manifestations of an extreme bias in the construction of the biological vertical. We argue for a better assessment of vertical perception/representation after stroke involving the three modalities of the biological (subjective) vertical: the visual vertical, the haptic or tactile vertical, and especially the postural vertical