Synthèse du colloque

Les évolutions considérables survenues durant les dernières décennies du XXe siècle, tant dans les domaines économiques que politiques, culturels et scientifiques, sont en passe de révolutionner en profondeur, dans le monde entier, les modes d’organisation, de pensée, de vie. Ces évolutions, parce qu’elles touchent les individus et le monde dans lequel ils vivent, auront, et ont déjà, un impact énorme sur l’éducation d’une manière générale, qu’elle soit formelle ou non formelle, à tous les ni..

La politique européenne d’éducation et de formation

Le 24 mars 2000 prenait fin le Conseil européen spécial de Lisbonne, durant lequel les chefs d’États et de gouvernements s’étaient penchés sur une « Europe de l’innovation et de la connaissance ». Leurs conclusions signaient une nouvelle étape, marquante, dans la construction d’une politique européenne d’éducation et de formation. Les États membres s’engageaient sans tambours ni trompettes dans la voie d’une mise en cohérence des systèmes éducatifs, ou tout du moins vers l’acceptation d’un po..

Banque mondiale : un séminaire en français « Choix stratégiques en matière de réformes éducatives »

Le premier séminaire en français sur le thème des « choix stratégiques en matière de réformes éducatives », organisé par l’Institut de la Banque mondiale et le Bureau de la Banque mondiale Moyen-Orient/Afrique du Nord (MENA), avec le concours du CIEP et de l’Institut international de planification de l’éducation (IIPE), s’est tenu au CIEP du 4 au 15 février 2002. Depuis une quinzaine d’années, la Banque mondiale accompagne le développement du secteur de l’éducation dans les pays pauvres et à ..

Are the medio-lateral joint forces in the lower limbs different between scoliotic and healthy subjects during gait?

INTRODUCTION: The quantification of internal joint efforts could be essential in the development of rehabilitation tools for patients with musculo-skeletal pathologies, such as scoliosis. In this context, the aim of this study was to compare the hips joint mediolateral forces during gait, between healthy subjects and adolescents with left lumbar or thoracolumbar scoliosis (AIS), categorized by their Cobb angle (CA). MATERIAL AND METHODS: Twelve healthy subjects, 12 AIS with CA between 20° and 40° and 16 AIS in pre-operative condition (CA : > 40°) walked at 4 km/h on an instrumented treadmill. The experimental set-up include six infrared cameras allow the computation of the tridimensional (3D) angular displacement and strain gauges located under the motor-driven treadmill allow the computation of ground reaction forces (GRF). The hips joint mediolateral forces were calculated using a 3D inverse dynamic of human body. One-way ANOVA was performed for the maximum, the minimum and the range of medio-lateral forces at each joint of the lower limbs. When appropriate, a Tukey's post hoc was performed to determine the differences. RESULTS: The mediolateral forces were significantly lower at the right hip for AIS with CA between 20° and 40° compared to healthy subject. CONCLUSION: The spinal deformation leads to a reduced medio-lateral force at the right hip, which could gradually change the scheme of postural adjustments for AIS during gait. Further research on the quantification of the joint lower limb efforts should include the knee and ankle joints to evaluate the impact of spinal deformation on the lower limb dynamic behaviour in AIS patients

Planispheric multiplanar reformatted CT: a new method for evaluation of paediatric congenital spine abnormalities.

We describe an original reconstruction method for spine CT performed in four patients with single or multiple congenital spine abnormalities. Conventional radiographic imaging is at the forefront of diagnosis and follow-up of congenital scoliosis, but is frequently difficult to interpret. Three-dimensional CT reconstruction facilitates visualization of complex anatomic structures, but does not give a reliable assessment of failures of segmentation. Mental three-dimensional reconstruction of the information displayed by classical multiplanar reformatted CT remains difficult. Planispheric reformatted imaging allows the visualization of all deformities in a single plane

Intervertebral force computation: a non invasive computation method

INTRODUCTION : Spine surgery planning involves many decisions for which the surgeon has not enough information, and for which a dynamic model can be helpful. Research studies show a high variability in decision making in the planning of scoliosis surgery by experienced surgeons (Robitaille et al. 2007). That variability is problematic because this lack of information may cause complications for the patient, such as revision surgery or an increased limitation in spine mobility. Therefore, a biomechanical model for spine surgery planning can be useful in providing the surgeon with the information needed to propose the best treatment. In this context, intervertebral efforts represent an essential input in assisting diagnosis and subsequently guiding the surgical planning of scoliosis. [...

Effect of long-term orthotic treatment on gait biomechanics in adolescent idiopathic scoliosis

Abstract Background context A previous study showed subtle biomechanical changes in the gait of unbraced adolescent idiopathic scoliosis (AIS) patients such as a reduction of pelvic, hip, knee, and ankle displacements. However, lumbopelvic muscles' timing activity was bilaterally increased during gait and correlated to excessive oxygen consumption as compared with healthy subjects. Usually, a brace, when indicated, is worn strictly for 22 hours every day in skeletally immature idiopathic scoliotic girls. To our knowledge, no study has assessed the long-term brace effect (6 months) on functional activities such as level walking. Purpose To assess the stiffening effects of 6 months' brace wearing on instrumented gait analysis in girls with thoracolumbar/lumbar adolescent idiopathic scoliosis. Study design/setting Clinical prospective study. Patient sample Thirteen girls diagnosed as progressive adolescent idiopathic scoliosis with left thoracolumbar/lumbar curves (curves ranging 25°–40°). Outcome measures All patients underwent a radiographic and instrumented gait analysis, including assessment of kinematics, mechanics, electromyography (EMG), and energetics of walking. Methods The scoliotic girls were prospectively studied at S1 (before bracing) and 6 months later at S2 (out-brace: treatment effect). The gait parameters were compared with those of 13 matched healthy girls. A t paired test was conducted to evaluate the effect of the 6-month orthotic treatment in AIS girls. Student t test was performed to compare the scoliotic group at S2 and the healthy subjects to identify if the observed changes in gait parameters meant improvement or worsening of gait. Results After 6 months of orthotic treatment in AIS, thoracolumbar/lumbar curves and apical rotation remained reduced by 25% and 61%, respectively. During gait, frontal pelvis and hip motions were significantly increased. Muscular mechanical work increased becoming closer but still different as compared with healthy subjects. Bilateral lumbopelvic muscles were almost 40% more active in AIS at S1 compared with healthy subjects and did not change at S2 except for the erector spinae muscles EMG activity, which decreased significantly. Energy cost exceeded by 30% in AIS at S1 compared with healthy subjects and did not change at 6 months' follow-up. Conclusions After 6 months of orthotic treatment, in an out-brace situation, the main structural thoracolumbar/lumbar curve remained partly corrected. Frontal pelvis and hip motion increased, contributing to an improvement of muscular mechanical work during walking. EMG activity duration of lumbopelvic muscles did not change except for the erector spinae muscles, which was decreased but without any beneficial change in the energy cost of walking. In summary, brace treatment, after 6 months, did not significantly influence the gait variables in AIS girls deleteriously, but did not reduce the excessive energy cost, which was 30% above the values of normal adolescents

Gait in patients with Adolescent Idiopathic Scoliosis. Effect of surgery at 10 years of follow-up

PURPOSE To assess radiological and gait biomechanical changes before, at one and 10 years after surgery in AIS patients. METHODS This clinical prospective study included fifteen adult women (mean[SD] age: 26 Goldberg et al. (2008) [1] years) diagnosed with thoraco-lumbar/lumbar AIS and operated 10 years ago. Clinical, radiological and gait variables, including kinematics, electromyography (EMG), mechanics and energetics were compared between presurgery (S0), 1 year (S1) and 10 years (S2) postsurgery period using a one way repeated measure ANOVA. RESULTS The Cobb angle of the scoliosis curve was reduced by 55% at 1 year postsugery but only by 37% at 10 years postsurgery suggesting a loss of 32% over time. Frontal plumb line C7-S1 distance was significantly improved by surgery (−44%) and remained stable at 10 years postsurgery. Lower limb kinematics was not affected by the surgery at long term. Excessive bilateral activation of lombo-pelvic muscles, observed before surgery, decreased significantly at S1 and S2 period. Mechanical energy increased significantly between S0, S1 and S2 session, without any change for the energetic variables. CONCLUSIONS Between 1 and 10 years post-surgery, thoraco-lumbar/lumbar AIS women showed a few decompensation of the curve without any change of the improved frontal body balance. Lower limbs and pelvic motion, during gait, was not affected by the surgery. But presurgical excessive EMG activity of the lumbo-pelvic muscle and reduced mechanical energy produced to walk get similar normal patterns. Only the oxygen consumption remained excessive probably due to physical deconditioning or postural instability