Effect of the COVID-19 pandemic lockdown on physical activity of individuals with a spinal cord injury in Belgium: observational study.

The letter reports an observational study, which our group has undertaken, to evaluate the effect of the Covid-19 lockdown among individuals with a spinal cord injury in Belgium. The primary focus of the study was the impact of the lockdown on physical activity levels, as the literature shows that individuals with a physical disability, such as spinal cord injury, particularly benefit from physical activity. The report was written in accordance to the STROBE guidelines

Age Effects on Upper Limb Kinematics Assessed by the REAplan Robotin Healthy School-Aged Children

The use of kinematics is recommended to quantitatively evaluate upper limb movements. The aims of this study were to determine the age effects on upper limb kinematics and establish norms in healthy children. Ninetythree healthy children, aged 3–12 years, participated in this study. Twenty-eight kinematic indices were computed from four tasks. Each task was performed with the REAplan, a distal effector robotic device that allows upper limb displacements in the horizontal plane. Twenty-four of the 28 indices showed an improvement during childhood. Indeed, older children showed better upper limb movements. This study was the first to use a robotic device to show the age effects on upper limb kinematics and establish norms in healthy children

Muscular compartment syndrome and in vivo optical spectroscopy monitoring: a new model

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Mécanique et énergétique de la locomotion des patients hémiparétiques et spastiques

This thesis aimed to investigate the heightened energy consumption of walking in hemiparetic stroke patients, and to establish its origin, i.e. either an increased mechanical work, or a decreased muscular efficiency. The effect of a focal spasticity treatment was also studied on these variables. The speed-dependent reference values were obtained in twelve healthy subjects walking at different steady speeds. These data established normal values for kinematics, kinetics, electromyography, mechanics, and energetics for healthy subjects walking on the same treadmill that was used for stroke patients. The energy consumption of stroke patients pedaling with one sole leg (healthy or pathological one) was compared with that of healthy subjects also pedaling with one leg. For an equal amount of mechanical work, the energy consumption was similar in patients (pathological or healthy leg) and in healthy subjects. In other words, the efficiency of work production by muscles was similar for the pathological and healthy legs of stroke patients as compared to the legs of healthy subjects. Thus, alterations in efficiency cannot explain the increase in energy consumption observed in stroke patients during walking. The effects of walking speed on energy cost were then evaluated, as the relationships between energy cost, mechanical work, and muscle work efficiency. Energy cost was increased in stroke patients compared to healthy subjects, and the effect of speed was similar in both groups, giving a typical U-shaped curve. The increase in energy cost observed in stroke patients was mainly determined by the mechanical work done by muscles and, particularly, the mechanical work done by the healthy limb to lift up the center of body mass. The efficiency was globally normal, confirming the results obtained on the cycle ergometer. Finally, this thesis analyzed the effects of Botulinum toxin injection in the rectus femoris muscle on the stiff-knee gait of stroke patients. Our results showed a real improvement of knee kinematics, dynamics, and electromyography. A lowering of the energy cost was observed, but only in patients presenting a knee flexion greater than 10°. These results suggest that a focal treatment as botulinum toxin injection is likely to have a favorable effect on energy expenditure.(SBIM 3) -- UCL, 200

How and why to predict spasticity after stroke?

Although many stroke patients present with spasticity, this impairment re- mains a riddle for physicians. Why, when, and how does a patient develop spas- ticity, whereas another patient with a similar cerebral lesion does not? Moreover, the evolution of spasticity among these chronic patients and its relation to functional activity are not straightforward. Thus, the assessment and treatment of spasticity remain a challenge in neurorehabilitation. Opheim et al.1 identify the early predictors of spasticity among stroke patients: age, sex, and neurologic impairments assessed with the Fugl-Meyer scale. Assessing the patient 10 days and 4 weeks after stroke allows the prediction, respectively, of the presence of spasticity and its severity at 1 year poststroke. Interestingly, stroke severity assessed by the NIH Stroke Scale at admission was not a predictor. This emphasizes the importance of assessing patients regularly and accurately during rehabilitation. Ideally, this assessment should not focus only on neurologic impairments. Following the WHO International Classification of Functioning, Disability, and Health (www.who.int/ classifications/icf), the activities that the patient performs in his or her environment and his or her social participation should also be assessed. This study also underlines the usefulness of the Fugl-Meyer scale. However, whereas the authors used the original ordinal scale, they submitted the results to complex statistical methods. The Fugl-Meyer scale, as many other scales used in neurorehabilitation,2 has been transformed to a linear scale through Rasch anal- ysis. In clinical practice and future research, it would be preferable to use these improved versions to optimize the quality of assessment and to gather continuous data suitable to powerful parametric statistics.3,4 Early identification of patients at risk of developing spasticity should improve the quality of care. They should be regularly assessed and would benefit from early treatment to avoid long-term complications (e.g., contractures), espe- cially for the most impaired patients or those with reduced access to specialists

Effect of speed on kinematic, kinetic, electromyographic and energetic reference values during treadmill walking. [La marche sur tapis roulant : données cinématiques, cinétiques, électromyographiques et énergétiques normales spécifiques à la vitesse de marche]

OBJECTIVE: Evaluation of normal and pathological gait on the level ground has drawbacks that could be overcome by walking on a treadmill. The present work was designed to assess the feasibility of extended gait analysis on a treadmill allowing multiple steps recording at a constant speed in young healthy subjects. It also aimed to provide speed-specific kinematic, kinetic, electromyographic and energetic reference values. METHOD: Twelve healthy volunteers (23+/-two years) walked on a force measuring treadmill at six speeds (1-6kmh(-1)). Kinematics and kinetics were analysed at the hip, knee and ankle. Electromyographic muscle activity timing of quadriceps femoris, biceps femoris, tibialis anterior and lateral gastrocnemius was recorded. The energy cost was computed from oxygen consumption measurement. RESULTS: All variables were speed-dependent. Kinematics and kinetics peaks amplitude increased and occurred earlier during the walking cycle with increasing walking speed. Muscle activity timing also changed with speed, although the number of bursts remained constant. The energetic cost presented a U-shaped curve, with minimal values around 4kmh(-1). Data were compared to overground walking data obtained by several authors: all results, except kinetic ones, were similar, turning down the thought that biomechanics of treadmill and overground walking could be different. CONCLUSION: This study provides reference values for normal and pathological walking on treadmill and allows speed-dependent comparison between subjects

Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions

The recovery of walking capacity is one of the main aims in stroke rehabilitation. Being able to predict if and when a patient is going to walk after stroke is of major interest in terms of management of the patients and their family’s expectations and in terms of discharge destination and timing previsions. This article reviews the recent literature regarding the predictive factors for gait recovery and the best recommendations in terms of gait rehabilitation in stroke patients. Trunk control and lower limb motor control (e.g. hip extensor muscle force) seem to be the best predictors of gait recovery as shown by the TWIST algorithm, which is a simple tool that can be applied in clinical practice at 1 week post-stroke. In terms of walking performance, the 6-min walking test is the best predictor of community ambulation. Various techniques are available for gait rehabilitation, including treadmill training with or without body weight support, robotic-assisted therapy, virtual reality, circuit class training and self-rehabilitation programmes. These techniques should be applied at specific timing during post-stroke rehabilitation, according to patient’s functional status

The reasons why stroke patients expend so much energy to walk slowly

BACKGROUND: The energy consumed per covered distance (C) is increased in hemiparetic stroke adults during walking. OBJECTIVE: To ascertain if increased C in stroke patients is a result of increased mechanical work, of decreased efficiency of work production by muscles or of slow walking speed. METHODS: C and mechanical work were computed in 20 patients walking on a force measuring treadmill at speeds ranging from 1 km h(-1) to their own maximum speed (WS(MAX)). Works done by healthy and pathological limbs were computed separately. RESULTS: For hemiparetic patients, C was around 1.7 times greater than normal. When these patients had a slower WS(MAX), they had greater C and mechanical work (r=-0.44 and -0.57, respectively). The increased C was related to the external work performed to lift the center of body mass when the healthy limb was supporting the body weight (r=0.77). CONCLUSIONS: The increase of C in stroke patients is more pronounced when WS(MAX) is slow. Moreover, this increase is related to increased mechanical work done by muscles and is not related to slow walking speed or decreased efficiency. As in healthy subjects, C and external work presented optimum speeds, indicating a preserved pendular mechanism of walkin