Comparison of Trunk Activity during Gait Initiation and Walking in Humans

To understand the role of trunk muscles in maintenance of dynamic postural equilibrium we investigate trunk movements during gait initiation and walking, performing trunk kinematics analysis, Erector spinae muscle (ES) recordings and dynamic analysis. ES muscle expressed a metachronal descending pattern of activity during walking and gait initiation. In the frontal and horizontal planes, lateroflexion and rotation occur before in the upper trunk and after in the lower trunk. Comparison of ES muscle EMGs and trunk kinematics showed that trunk muscle activity precedes corresponding kinematics activity, indicating that the ES drive trunk movement during locomotion and thereby allowing a better pelvis mobilization. EMG data showed that ES activity anticipates propulsive phases in walking with a repetitive pattern, suggesting a programmed control by a central pattern generator. Our findings also suggest that the programs for gait initiation and walking overlap with the latter beginning before the first has ended

a retrospective multicenter study

Funding This study was supported in part by a grant from the French government through the « Programme Investissement d’Avenir» (I-SITE ULNE) managed by the Agence Nationale de la Recherche (coVAPid project). Prof. Ignacio Martin-Loeches has been supported by SFI (Science Foundation Ireland), Grant number 20/COV/0038. The funders of the study had no role in the study design, data collection, analysis or interpretation, writing of the report or deci sion to submit for publication.BACKGROUND: Ventilator-associated pneumonia (VAP) is common in patients with severe SARS-CoV-2 pneumonia. The aim of this ancillary analysis of the coVAPid multicenter observational retrospective study is to assess the relationship between adjuvant corticosteroid use and the incidence of VAP. METHODS: Planned ancillary analysis of a multicenter retrospective European cohort in 36 ICUs. Adult patients receiving invasive mechanical ventilation for more than 48 h for SARS-CoV-2 pneumonia were consecutively included between February and May 2020. VAP diagnosis required strict definition with clinical, radiological and quantitative microbiological confirmation. We assessed the association of VAP with corticosteroid treatment using univariate and multivariate cause-specific Cox's proportional hazard models with adjustment on pre-specified confounders. RESULTS: Among the 545 included patients, 191 (35%) received corticosteroids. The proportional hazard assumption for the effect of corticosteroids on the incidence of VAP could not be accepted, indicating that this effect varied during ICU stay. We found a non-significant lower risk of VAP for corticosteroid-treated patients during the first days in the ICU and an increased risk for longer ICU stay. By modeling the effect of corticosteroids with time-dependent coefficients, the association between corticosteroids and the incidence of VAP was not significant (overall effect p = 0.082), with time-dependent hazard ratios (95% confidence interval) of 0.47 (0.17-1.31) at day 2, 0.95 (0.63-1.42) at day 7, 1.48 (1.01-2.16) at day 14 and 1.94 (1.09-3.46) at day 21. CONCLUSIONS: No significant association was found between adjuvant corticosteroid treatment and the incidence of VAP, although a time-varying effect of corticosteroids was identified along the 28-day follow-up.publishersversionpublishe

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Le tronc, de la locomotion à la commande

The topic of this thesis is the analysis of trunk implication during locomotion. The firs part describe the measurement in kinematics and eletromyography of the trunk during locomotion. The second describe a model of trunk CPG and its functionning.Le but de ce travail de thèse a été d'analyser l'implication du tronc dans la locomotion, notamment sa commande rythmique, afin d'en comprendre les mécanismes de contrôle et les différentes activités segmentaires qui amènent ses mouvements. Ces m´ecanismes peuvent alors être modélisés pour reproduire les différentes synchronisations observées au niveau des activités de chaque segment vertébral considéré. Enfin, cette modélisation permet de spécifier les activités du tronc à observer pour suivre en continu le cycle de marche d'un individu se déplacant. Dans un premier temps nous rappellerons les données de la littérature sur la locomotion, et notamment l'activité du tronc, qui nous ont permis de définir les axes principaux dans lesquels nous allons orienter notre travail. Cet état de l'art nous a notamment amenés à étudier les structures de type ”générateurs de rythme centraux” (Central pattern generator, CPG, en anglais). Dans un second temps nous avons réalisé une série de mesures expérimentales pour analyser de facon systématique et précise l'activité musculaire et cinématique du tronc lors de diverses situations locomotrices (marche, course, bond, pédalage). Ces mesures nous ont permis de mieux comprendre la manière dont le tronc se mettait en mouvement et comment ses activités musculaires et cinématiques, notamment les synchronisations intersegmentaires, évoluaient afin de tirer le meilleur parti des mouvements du haut du corps lors de la locomotion proprement dite. Dans un troisième temps, les résultats obtenus par les mesures d'activités du tronc ayant mis en évidence l'utilité du tronc et les mécanismes de contrôle dans une locomotion efficace, nous avons exploré la modélisation de l'activité du tronc au moyen d'un réseau d'oscillateurs mimant un CPG. Le choix d'un modèle de CPG pour représenter l'activité du tronc fait suite à des considérations phylogénétiques qui semblent indiquer qu'une telle structure pourrait exister chez l'homme. Une des propriétés de ce type de réseaux est leur capacité à exprimer différentes synchronisations sans changer de structure, c'est ce que nous avons appliqué aux observations faites lors de la marche, la course... Une autre propriété de ces réseaux est leur aptitude à se synchroniser avec un signal externe, nous avons donc explor´e diff´erents moyens de commander ce réseau d'oscillateur en phase avec la locomotion, encore une fois à partir de l'activité du tronc, de son accélération pour être plus précis

Le tronc, de la locomotion à la commande

MONTPELLIER-BU Sciences (341722106) / SudocSudocFranceF

Using the trunk acceleration to detect gait initiation

International audienc

Le rôle du tronc dans la locomotion, de l'initiation à la marche

National audienc