Activity monitor placed at the non-paretic ankle is accurate in measuring step counts during community walking in post-stroke individuals : a validation study

Background: Different environmental factors may affect the accuracy of step-count activity monitors (AM). However, the validationconditions for AM accuracy largely differ from ecological environments.Objectives: To assess and compare the accuracy of AM in counting steps among poststroke individuals: during different locomotortasks, with AM placed at the nonparetic ankle or hip, and when walking in a laboratory or inside a mall.Design: Validation study.Settings: Laboratory and community settings.Participants: Twenty persons with chronic hemiparesis, independent walkers.Methods: First session: participants performed level walking (6-minute walk test [6MWT]), ramps, and stairs in the laboratory withAM placed at the nonparetic ankle and hip. Second session: participants walked a mall circuit, including the three tasks, with AMplaced at the nonparetic ankle. The sessions were video recorded.Main Outcome Measurements: Absolute difference between the steps counted by AM and the steps viewed on the video recordings(errors, %); occurrence of errors greater than 10%.Results: Median errors were similar for the 6MWT (0.86 [0.22, 7.70]%), ramps (2.17 [0.89, 9.61]%), and stairs (8.33 [2.65, 19.22]%)with AM at the ankle. Step-count error was lower when AM was placed at the ankle (8.33 [ 2.65, 19.22]%) than at the hip (9.26[3.25, 42.63]%, P = .03). The greatest errors were observed among the slowest participants (≤0.4 m/s) on ramps and stairs, whereassome faster participants (>1 m/s) experienced the greatest error during the 6MWT. Median error was slightly increased in the mallcircuit (2.67 [0.61, 12.54]%) compared with the 6MWT (0.50 [0.24, 6.79]%, P = .04), with more participants showing errors >10% dur-ing the circuit (7 vs 2, P = .05).Conclusions: Step counts are accurately measured with AM placed at the nonparetic ankle in laboratory and community settings.Accuracy can be altered by stairs and ramps among the slowest walkers and by prolonged walking tasks among faster walkers.Level of Evidence: III

Slow and faster post-stroke walkers have a different trunk progression and braking impulse during gait

Background Braking forces absorbed by the leading paretic limb are greater than expected with regard to gait speed and not correlated with propulsive forces generated by the non-paretic limb in individuals with severe hemiparesis. Altered foot placement due to poor sensorimotor capacities may explain excessive braking forces. Research question The main objective of this study was to determine whether paretic foot placement was related to paretic braking forces in post-stroke individuals with various self-selected walking speeds and motor deficits. Methods In this cross-sectional study, 34 chronic hemiparetic post-stroke individuals, divided into slow (< 0.7 m/s, n = 17) and faster (n = 17) subgroups, walked at their self-selected speed. Kinematic and kinetic parameters were measured. Braking impulses, peak braking forces, step characteristics and clinical status were compared between groups and limbs, and their correlations were tested using Pearson (or Spearman) correlation tests. Results On the paretic side, braking impulses and step length were similar between groups despite the slower walking speed in the slow group. Paretic peak braking forces and step length were correlated in both groups (r = 0.5). Paretic braking forces were correlated with walking speed, foot placement ahead of the pelvis, trunk progression (TP) from non-paretic initial contact to paretic initial contact, and better motor function of the paretic limb for the faster walkers (0.6 < r < 0.7), but not for the slow walkers. Among the slow walkers, reduced TP ahead of the paretic foot was correlated with a higher paretic impulse (r =  -0.6). Significance Better motor function likely helped the faster walkers to decelerate their center of mass appropriately relative to their walking speed. In the slow hemiparetic walkers, TP ahead of the paretic foot was perturbed. Clinicians should therefore consider vasti and plantar flexor muscle tone and activity that likely restrict TP ahead of the paretic foot and increase braking forces

A mapping of home-rehabilitation exercises modalities in chronic post-stroke individuals to increase physical activity

Stroke, a leading cause of mortality and disability globally, often leaves survivors inactive, heightening their risk of recurrence. To address this, a study investigates home-based physical therapy's content and efficacy for chronic post-stroke patients. By analyzing therapist involvement, adherence strategies, and stakeholder engagement, the research aims to enhance post-stroke physical activity and overall well-being

Première année de fonctionnement du parcours accès spécifique santé (PASS) de l’Université de Bordeaux : caractérisation et identification des facteurs de réussite pour la validation du PASS et l’entrée dans la filière médecine

Contexte : La réforme de la première année des études de santé définie dans le décret du 4 novembre 2019 a mis fin à la première année commune aux études de santé (PACES) pour introduire un nouveau système ayant pour objectif de diversifier l’accès aux formations de médecine, maïeutique, odontologie, pharmacie et kinésithérapie (MMOP-K) par différents parcours de formation antérieurs. À l’Université de Bordeaux a été mis en place un double système avec un parcours accès spécifique santé (PASS) et des licences accès santé (L.AS). La voie L.AS étant minoritaire en cette première année de mise en place de la réforme, nous avons centré notre analyse sur les étudiant·es en PASS en 2020–2021 et l’accès à la filière médecine. Méthodes : Cette première année de PASS a été évaluée au regard des résultats académiques aux épreuves écrites des deux semestres (nombre d’UE validées, validation/échec du PASS, admissibilité dans la filière médecine) et aux épreuves orales (réussite aux mini entretiens multiples, admission dans la filière médecine). Résultats et conclusion : Nous avons identifié le niveau scolaire à l’entrée à l’Université, mesuré par la mention au bac, comme étant le principal facteur de réussite pour la validation du PASS et la réussite à l’admission dans la filière médecine. Le déterminant social est également associé à la validation du PASS, indépendamment du niveau scolaire. Les résultats montrent également que l’hétérogénéité des résultats en fonction de l’option disciplinaire et du site géographique est essentiellement liée à des disparités de niveaux scolaires à l’entrée en PASS

Gait Posture

Background Using a mobile phone while performing a postural and locomotor tasks is a common, daily situation. Conversing or sending messages (SMS) while walking account for a significant share of accidental injuries. Therefore, understanding the consequences of using a mobile phone on balance and walking is important, all the more so when these postural and locomotor tasks are aggravated by a disease. Research question Our objective was to conduct a scoping review on the influence of a dual-task situation – generated by the use of mobile phone – on users' postural and/or locomotor tasks. Methods The literature search was conducted in English on PubMed/Medline and CINHAL databases, using keywords associated with postural and locomotor tasks and with the use of mobile phone. Study location, population, number of subjects, experimental design, types of phone use, evaluated postural-locomotor tasks and expected effects were then analyzed. Results and significance 46 studies were included in this work, 24 of which came from North America. All studies compared postural and locomotor tasks with and without the use of a smartphone. Ten studies also compared at least 2 groups with different characteristics. Only 4 studies included pathological subjects. Various modalities were tested, and most studies focused on walking. Results show that the use of smartphones slows down movement and induces a systematic imbalance, except when listening to music. The dual task of "using the smartphone during a postural or locomotor tasks" induces systematic disturbances of balance and movement, which must be taken into account in the rehabilitation approach. Future studies will have to extend the knowledge regarding pathological situations