Rôle des contractures lors de la marche des enfants atteints de dystrophie musculaire de Duchenne

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

Effect of Conservative Interventions for Musculoskeletal Disorders in Preprofessional and Professional Dancers: A Systematic Review

# Background Preprofessional and professional dancers are among the athletes who sustain the most musculoskeletal disorders. In recent years, conservative treatment and preventive measures have been investigated in this population. However, no systematic review regarding their effectiveness has been conducted. # Hypothesis/Purpose The aim of this systematic review was to locate, appraise and synthesize the available information on conservative interventions currently used for treating and preventing MSK disorders and their effect on pain and function in preprofessional and professional dancers. # Study design Systematic review. # Methods A systematic literature search was conducted using PubMed, CINHAL, ERIC, SportDiscus and Psychology and behavioral science collection. Prospective and retrospective cohort studies, as well as randomized and non-randomized controlled trials investigating conservative interventions for musculoskeletal disorders in preprofessional and professional dancers were included in this study. The main outcome measures included pain intensity, function, and performance. All included studies were evaluated for risk of bias using the Downs and Black checklist. # Results Eight studies were included in the review. These studies included ballet and contemporary dancers, as well as professional and preprofessional dancers. In total, the studies included 312 dancers, 108 male and 204 female. Studies had a risk of bias that ranged from poor (8/28) to good (21/28) on the Downs and Black checklist. The conservative interventions used included customized toe caps, dry-needling, motor imagery, and strength and conditioning programs. The use of customized toe caps, motor imagery and strength and conditioning programs had promising results regarding pain and function in dancers. # Conclusion In order to reach a solid conclusion, more quality studies are needed. The addition of control groups to studies, as well as multimodal interventions should be considered. # Level of Evidence

Does the Movement Competency Screen Correlate with Deep Abdominals Activation and Hip Strength for Professional and Pre-professional Dancers?

# Background Dancers are a unique category of athletes who are frequently injured and experience pain. The primary cause of dance injuries is overuse, which could potentially be prevented. However, literature is scarce regarding validated methods of evaluating the risk of injury in dancers. The Movement Competency Screen (MCS) could potentially fill this gap. # Hypothesis/Purpose To investigate the validity of the Movement Competency Screen (MCS) for dancers by 1) examining the correlation between scores on this functional test and the activation of deep abdominals and hip strength; 2) investigating the correlation between MCS scores and those of the Functional Movement Screen (FMS™). # Study Design Cross-sectional study. # Methods A total of 77 pre-professional and professional dancers from ballet and contemporary backgrounds were evaluated. The activation of deep abdominals was evaluated using ultrasound imaging and the hip strength was evaluated using a handheld dynamometer. The FMS™, another tool evaluating fundamental movement competency, was also administered. # Results The dancers’ MCS score was correlated with the activation of the transversus abdominis (r=0.239, p=0.036) and the strength of hip abductors (r=0.293, p=0.010), adductors (r=0.267, p=0.019) and external rotators (r=0.249, p=0.029). The MCS score was also correlated with the FMS™ score (r=0.489, p<0.001). # Conclusion This study shows that the MCS score is correlated with deep abdominal activation and hip strength in dancers, as well as with the FMS™ score. These findings provide evidence toward the validation of the MCS in dancers. # Levels of Evidence Level 2B

Assessment of the paraspinal muscles of subjects presenting an idiopathic scoliosis: an EMG pilot study

BACKGROUND: It is known that the back muscles of scoliotic subjects present abnormalities in their fiber type composition. Some researchers have hypothesized that abnormal fiber composition can lead to paraspinal muscle dysfunction such as poor neuromuscular efficiency and muscle fatigue. EMG parameters were used to evaluate these impairments. The purpose of the present study was to examine the clinical potential of different EMG parameters such as amplitude (RMS) and median frequency (MF) of the power spectrum in order to assess the back muscles of patients presenting idiopathic scoliosis in terms of their neuromuscular efficiency and their muscular fatigue. METHODS: L5/S1 moments during isometric efforts in extension were measured in six subjects with idiopathic scoliosis and ten healthy controls. The subjects performed three 7 s ramp contractions ranging from 0 to 100% maximum voluntary contraction (MVC) and one 30 s sustained contraction at 75% MVC. Surface EMG activity was recorded bilaterally from the paraspinal muscles at L5, L3, L1 and T10. The slope of the EMG RMS/force (neuromuscular efficiency) and MF/force (muscle composition) relationships were computed during the ramp contractions while the slope of the EMG RMS/time and MF/time relationships (muscle fatigue) were computed during the sustained contraction. Comparisons were performed between the two groups and between the left and right sides for the EMG parameters. RESULTS: No significant group or side differences between the slopes of the different measures used were found at the level of the apex (around T10) of the major curve of the spine. However, a significant side difference was seen at a lower level (L3, p = 0.01) for the MF/time parameter. CONCLUSION: The EMG parameters used in this study could not discriminate between the back muscles of scoliotic subjects and those of control subject regarding fiber type composition, neuromuscular efficiency and muscle fatigue at the level of the apex. The results of this pilot study indicate that compensatory strategies are potentially seen at lower level of the spine with these EMG parameters

Cardiorespiratory fitness among adults with fibromyalgia

This review presents and addresses the conflicting results on cardiorespiratory fitness among adults with fibromyalgia. The heterogeneity in study designs, symptom severity and the assessment protocols might partly explain these conflicting results. It also presents the possible relationship between cardiorespiratory fitness and exercise prescription, attrition from exercise/rehabilitation programmes and independence with activities of daily living. Cardiorespiratory fitness might impact aerobic exercise and independence in daily activities of patients with fibromyalgia, which is often concomitantly diagnosed in patients with sleep disordered breathing, including patients with obstructive sleep apnoea. Therefore, cardiorespiratory fitness evaluation should be considered by general and respiratory physicians as well as physiotherapists who treat patients diagnosed with fibromyalgia for more accurate diagnosis, exercise prescription and monitoring of patients’ status. Key points Adults with fibromyalgia often present with reduced cardiorespiratory fitness. Reduced cardiorespiratory fitness might have an important impact on functional capacity and quality of life. Adults with fibromyalgia who have a secondary condition affecting their ventilatory anaerobic threshold and/or V′O2peak, for example chronic obstructive pulmonary disease, might present with a greater reduction of their cardiorespiratory fitness which may not be entirely related to their lung disease. Educational aims To better understand the cardiorespiratory fitness results among adults with fibromyalgia in general, and when taking into account differences in assessment protocol (maximal versus submaximal testing protocol; cycle ergometer versus treadmill testing protocol) and symptom severity (fibromyalgia severity level). To better understand how cardiorespiratory fitness among adults with fibromyalgia could: 1) assist in exercise prescription; 2) minimise dropout rates from exercise/rehabilitation programmes; and 3) promote independence with activities of daily living. To learn why fibromyalgia might be important to consider in adults who have concurrent fibromyalgia and lung disease

Physiological data validation of the hexoskin smart textile

Keywords: Concordance Correlation Coefficient, Intraclass Correlation Coefficient, Bland-Altman, Agreement Analysis, Cardiorespiratory. Abstract: The aim of this study is to validate cardiorespiratory function measurement of a healthy population provided by a wearable textile during a progressive maximal exercise test. The following measurements were collected using embedded sensors to assess three variables: heart rate (HR), breathing rate (BR) and ventilation (Ve). These variables were recorded simultaneously by the wearable textile and using as a reference system for a comparison purpose. The validation was performed based on the two systems agreement estimation by calculating the intraclass correlation coefficient (ICC), the concordance correlation coefficient (CCC) and the Bland-Altman plot for each variable. Twenty-eight healthy volunteers participated in this study. Analysis of each participant under exercise condition by the two measurement systems revealed high CCC values (rc between 0.91 and 0.99), no deviation from the 45� line (Cb between 0.96 and 0.99) and significant ICC values (r between 0.91 and 0.99, p < 0.05) for HR and BR. The Bland Altman plot for HR and BR indicated no deviation of the mean difference from zero and a small variability with tight agreement limits. However, the analysis of the estimated ventilation Ve of each participant revealed doubtful values for the CCC (rc between 0.2 and 0.99) and ICC (r between 0.11 and 0.99). In summary, the Hexoskin presented good agreement for HR and BR. However, for ventilation, it is difficult to conclude from the results due to variabilit