APSIC: Training and fitting amputees during situations of daily living

Today, the prevalence of major amputation in France can be estimated between 90,000 and 100,000 and the incidence is about 8300 new amputations per year (according to French National Authority for Health estimation). This prevalence is expected to increase in the next decade due to the ageing of the population. Even if prosthetic fitting allows amputee people recovering the walking ability, their autonomy remains limited when crossing obstacles such as slopes, stairs or cross-slopes frequently encountered during outdoors displacements. The aim of the project APSIC was to complete scientific knowledge about adaptation strategies to situations of daily living compared to level walking through an extensive motion analysis study of transtibial and transfemoral amputee compared to non-amputee people. APSIC succeeded in identifying physiologic joint functions and current prosthetic joint limitations in the studied situations, which notably resulted in the design of a prototype of ankle-knee prosthesis adapted to multimodal locomotion of transfemoral amputee. Perspectives of the clinical use of motion analysis within the rehabilitation process were explored and proved to be relevant for personalized approach of motor learning

Neurologic findings in children with ear malformations

Cephalic neural crest cells contribute to the formation of the external and middle ears, the supporting cells of the statoacoustic ganglion, other cranial nerve components, and the face. The anlage of otic sensory structures receive inductive stimuli from adjacent rhombencephalic tissue. The complex series of interactions that guide organogenesis of the outer, middle, and inner ear structures may explain why neurologic dysfunction is likely to be associated with malformations of the ear. We reviewed the records of 100 patients with complex ear anomalies with or without hearing loss. Mean age was 4.2 years (range 1 day–27 years). Malformations, either bilateral (70) or unilateral (30), involved the external ear (94), middle ear (16), and/or inner ear (12). Eighty-five patients had neurologic dysfunction. Cranial nerve dysfunction was found in 56 patients and involved nerves VIII (39 auditory and/or vestibular), VII (22), II (11), VI (8), V (4), III (3), X (3), XII (1), and IX (1). Sixty-four patients had evidence of central nervous system dysfunction such as mental deficiency/developmental delay (44), non-paretic gait disorders (17), hypotonia (16), microcephaly (13), seizures (8), motor deficits (8), autistic features (7), and radiographically confirmed intracranial abnormalities (5). Eleven of 19 children with hypoactive vestibules had delayed motor development or poor balance. Seventy-four patients had anomalies in other organ systems: 56 craniofacial, 28 osseous, 19 cardiac, 16 genito-urinary, 14 ocular, 11 gastrointestinal, and 7 cutaneous. Sixty-one patients had syndromic conditions, 32 of them branchial arch syndromes. The level of cognitive competence was not related to severity of craniofacial ear, or cranial nerve abnormality Children with ear malformation ederve neurologic and peddiatric evaluations in addition toan otologic work-up