Analyse biomécanique des transferts assis en pivot chez les individus atteints d'une lésion médullaire

Thèse numérisée par la Direction des bibliothèques de l'Université de Montréal

Gait-like vibration training improves gait abilities: a case report of a 62 year old person with a chronic incomplete spinal cord injury

The purpose of this single-subject case study was to quantify the effect of gait-like vibration training on gait abilities after an incomplete spinal cord injury. A 62 year old male with a chronic AIS D spinal cord injury at T11 completed nine sessions of gait-like vibration training in a standing position. Self-selected gait speed and distance covered within 6 minutes were determined before and after training to evaluate the impact of training on gait performance. Associated changes in gait kinematics were assessed with a 3D motion analysis system. Results showed an improvement of gait speed (0.26 m/s vs 0.35 m/s) and distance (23 m vs 37m) after nine gait-like vibration training sessions (+34.6%; +60.9%). In addition, more bilateral hip extension and larger left hip range of motion improved hip-knee cyclograms. Gait-like vibration training improved gait abilities in a person with chronic incomplete spinal cord injury

Development of an automated method to detect sitting pivot transfer phases using biomechanical variables: toward a standardized method

<p>Abstract</p> <p>Background</p> <p>Sitting pivot transfer (SPT) is one of the most important, but at the same time strenuous at the upper extremity, functional task for spinal cord injured individuals. In order to better teach this task to those individuals and to improve performance, a better biomechanical understanding during the different SPT phases is a prerequisite. However, no consensus has yet been reached on how to depict the different phases of the SPT. The definition of the phases of the SPT, along with the events characterizing these phases, will facilitate the interpretation of biomechanical outcome measures related to the performance of SPTs as well as strengthen the evidence generated across studies.</p> <p>Methods</p> <p>Thirty-five individuals with a spinal cord injury performed two SPTs between seats of similar height using their usual SPT technique. Kinematics and kinetics were recorded using an instrumented transfer assessment system. Based on kinetic and kinematic measurements, a relative threshold-based algorithm was developed to identify four distinct phases: pre-lift, upper arm loading, lift-pivot and post-lift phases. To determine the stability of the algorithm between the two SPTs, Student <it>t</it>-tests for dependent samples were performed on the absolute duration of each phase.</p> <p>Results</p> <p>The mean total duration of the SPT was 2.00 ± 0.49 s. The mean duration of the pre-lift, upper arm loading, lift-pivot and post-lift phases were 0.74 ± 0.29 s, 0.28 ± 0.13 s, 0.72 ± 0.24 s, 0.27 ± 0.14 s whereas their relative contributions represented approximately 35%, 15%, 35% and 15% of the overall SPT cycle, respectively. No significant differences were found between the trials (p = 0.480-0.891).</p> <p>Conclusion</p> <p>The relative threshold-based algorithm used to automatically detect the four distinct phases of the SPT, is rapid, accurate and repeatable. A quantitative and thorough description of the precise phases of the SPT is prerequisite to better interpret biomechanical findings and measure task performance. The algorithm could also become clinically useful to refine the assessment and training of SPTs.</p

Somesthetic, Visual, and Auditory Feedback and Their Interactions Applied to Upper Limb Neurorehabilitation Technology: A Narrative Review to Facilitate Contextualization of Knowledge

Reduced hand dexterity is a common component of sensorimotor impairments for individuals after stroke. To improve hand function, innovative rehabilitation interventions are constantly developed and tested. In this context, technology-based interventions for hand rehabilitation have been emerging rapidly. This paper offers an overview of basic knowledge on post lesion plasticity and sensorimotor integration processes in the context of augmented feedback and new rehabilitation technologies, in particular virtual reality and soft robotic gloves. We also discuss some factors to consider related to the incorporation of augmented feedback in the development of technology-based interventions in rehabilitation. This includes factors related to feedback delivery parameter design, task complexity and heterogeneity of sensory deficits in individuals affected by a stroke. In spite of the current limitations in our understanding of the mechanisms involved when using new rehabilitation technologies, the multimodal augmented feedback approach appears promising and may provide meaningful ways to optimize recovery after stroke. Moving forward, we argue that comparative studies allowing stratification of the augmented feedback delivery parameters based upon different biomarkers, lesion characteristics or impairments should be advocated (e.g., injured hemisphere, lesion location, lesion volume, sensorimotor impairments). Ultimately, we envision that treatment design should combine augmented feedback of multiple modalities, carefully adapted to the specific condition of the individuals affected by a stroke and that evolves along with recovery. This would better align with the new trend in stroke rehabilitation which challenges the popular idea of the existence of an ultimate good-for-all intervention

Which trunk inclination directions best predict multidirectional-seated limits of stability among individuals with spinal cord injury?

Objective: To determine which trunk inclination directions most accurately predict multidirectional-seated limits of stability among individuals with spinal cord injury (SCI). Design: Predictive study using cross-sectional data. Setting: Pathokinesiology Laboratory. Participants: Twenty-one individuals with complete or incomplete sensorimotor SCI affecting various vertebral levels participated in this study. Interventions: Participants were instructed to lean their trunk as far as possible in eight directions, separated by 45°intervals, while seated on an instrumented chair with their feet positioned on force plates. Outcomes measures: Eight direction-specific stability indices (DSIs) were used to define an overall stability index (OSI) (limits of stability). Results: All DSIs significantly correlated with the OSI (r = 0.816-0.925). A protocol that only tests the anterior, left postero-lateral, and right lateral trunk inclinations accurately predicts multidirectional-seated postural stability (R 2 = 0.98; P &lt; 0.001). Conclusion: Multidirectional-seated postural stability can be predicted almost perfectly by evaluating trunk inclinations performed toward the anterior, left postero-lateral, and right lateral directions

Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study

BACKGROUND: Timely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI) on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program. METHODS: A total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed) were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120) were formed according to the three OAI subgroups: short (less than 20 days), moderate (between 20 and 40 days) or long (over 40 days; maximum of 70 days) OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM), absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores) were evaluated to test for differences between the three OAI subgroups. RESULTS: Analysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972) and discharge (P = 0.083–0.367) FIM scores, absolute (P = 0.533–0.647) and relative (P = 0.496–0.812) FIM gain scores, rehabilitation length of stay (P = 0.096), and efficiency scores (P = 0.103–0.674). CONCLUSION: OAI does not seem to affect significantly inpatient stroke rehabilitation outcomes of patients referred from acute care facilities where rehabilitation services are rapidly initiated after the onset of the stroke and offered throughout their stay. However, other studies considering factors such as the type and intensity of the rehabilitation are required to support those results

Quotation of upper limb risk musculoskeletal disorders by fuzzy logic: Particular case of manual wheelchair propulsion and curb ascent

Introduction. For manual wheel chair users, the capacity to ascend a curb is essential for autonomy, however may contribute to the development or exacerbation of musculoskeletal disorders (MD). The objective of this study was to use fuzzy logic to quantify the risk of MD during curb ascent. Materials and Methods. Seventeen patients with SCI (> 6 months) were included. Kinematics and kinetics were recorded using a motion capture system and instrumented wheels on the manual wheelchair. Three trials were recorded for each subject. Results. The risk of MD was 15% greater during curb ascent than propulsion, mainly because of increases in kinetic risk. The kinetic risk was greatest at the wrist during curb ascent (50%). Discussion and conclusion. Quantification of the risk of MD using fuzzy logic is useful to highlight at-risk situations and to identify the parameters responsible

Quotation of upper limb risk musculoskeletal disorders by fuzzy logic: Particular case of manual wheelchair propulsion and curb ascent

Introduction. For manual wheel chair users, the capacity to ascend a curb is essential for autonomy, however may contribute to the development or exacerbation of musculoskeletal disorders (MD). The objective of this study was to use fuzzy logic to quantify the risk of MD during curb ascent. Materials and Methods. Seventeen patients with SCI (> 6 months) were included. Kinematics and kinetics were recorded using a motion capture system and instrumented wheels on the manual wheelchair. Three trials were recorded for each subject. Results. The risk of MD was 15% greater during curb ascent than propulsion, mainly because of increases in kinetic risk. The kinetic risk was greatest at the wrist during curb ascent (50%). Discussion and conclusion. Quantification of the risk of MD using fuzzy logic is useful to highlight at-risk situations and to identify the parameters responsible