Visualisation to enhance biomechanical tuning of ankle-foot orthoses (AFOs) in stroke: study protocol for a randomised controlled trial

There are a number of gaps in the evidence base for the use of ankle-foot orthoses for stroke patients. Three dimensional motion analysis offers an ideal method for objectively obtaining biomechanical gait data from stroke patients, however there are a number of major barriers to its use in routine clinical practice. One significant problem is the way in which the biomechanical data generated by these systems is presented. Through the careful design of bespoke biomechanical visualisation software it may be possible to present such data in novel ways to improve clinical decision making, track progress and increase patient understanding in the context of ankle-foot orthosis tuning

Walking Stroop carpet: an innovative dual-task concept for detecting cognitive impairment

A Perrochon,1,2,5 G Kemoun,1,2 E Watelain,3,4 A Berthoz51ISIS, Research Institute on Handicap and Aging, Paris; 2Université de Poitiers, Laboratoire Mobilité, Vieillissement et Exercice (MOVE), EA 6314, 3Université de Valenciennes, LAMIH, UMR CNRS 8201, 4Université Sud Toulon Var, HandiBio, EA 4322, La Garde, 5LPPA, UMR CNRS 7152, Collège de France, Paris, FranceBackground: Several studies have reported the potential value of the dual-task concept during locomotion in clinical evaluation because cognitive decline is strongly associated with gait abnormalities. However, current dual-task tests appear to be insufficient for early diagnosis of cognitive impairment.Methods: Forty-nine subjects (young, old, with or without mild cognitive impairment) underwent cognitive evaluation (Mini-Mental State Examination, Frontal Assessment Battery, five-word test, Stroop, clock-drawing) and single-task locomotor evaluation on an electronic walkway. They were then dual-task-tested on the Walking Stroop carpet, which is an adaptation of the Stroop color–word task for locomotion. A cluster analysis, followed by an analysis of variance, was performed to assess gait parameters.Results: Cluster analysis of gait parameters on the Walking Stroop carpet revealed an interaction between cognitive and functional abilities because it made it possible to distinguish dysexecutive cognitive fragility or decline with a sensitivity of 89% and a specificity of 94%. Locomotor abilities differed according to the group and dual-task conditions. Healthy subjects performed less well on dual-tasking under reading conditions than when they were asked to distinguish colors, whereas dysexecutive subjects had worse motor performances when they were required to dual task.Conclusion: The Walking Stroop carpet is a dual-task test that enables early detection of cognitive fragility that has not been revealed by traditional neuropsychological tests or single-task walking analysis.Keywords: stroop, dual-task, walking, mild cognitive impairmen

Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions

International audienceObjective: We compared falling and non-falling healthy elderly subjects to identify balance disorders associated with falling. Gait parameters were determined when carrying out single and dual tasks. Design: Case comparison study. Setting: Subjects were studied in the gait laboratory at Hopital Roger Salengro, Lille, France. Subjects: A group of 40 healthy elderly women were assigned to one of two groups according to their falling history: 21 fallers aged 70.4±6.4 years and 19 non-fallers aged 67.0±4.8 years. All subjects performed first a single leg balance test with two conditions (eyes open/closed). Then, gait parameters were analysed under single-task and dual motor-task conditions (walking with a glass of water in the hand). Main measures: Falls, number of times suspended foot touched the floor during the single leg balance test, cadence, speed, stride time, step time, single-support time, stride length and step length during walking under single- and dual-task conditions. Results: During the single leg balance test, fallers placed their feet on the floor three times more often than non-fallers under eyes open conditions (P < 0.05) and twice as often under eyes closed conditions (P < 0.05). In the single-task condition, no significant difference in gait parameters was reported between fallers and non fallers. There was a significant difference (P < 0.05) in the gait parameters (cadence, speed, stride and step time, single-support time) between fallers and non-fallers under dual-task conditions. Conclusions: Dual tasks perturb walking in fallers, who exhibit deteriorated static balance. Consequently, walking under dual-task conditions plus a single leg balance test could be helpful in detecting walking disorders and planning physiotherapy to prevent falls

Walking Stroop carpet: an innovative dual-task concept for detecting cognitive impairment

International audienceBackground: Several studies have reported the potential value of the dual-task concept dur- ing locomotion in clinical evaluation because cognitive decline is strongly associated with gait abnormalities. However, current dual-task tests appear to be insufficient for early diagnosis of cognitive impairment.Methods: Forty-nine subjects (young, old, with or without mild cognitive impairment) underwent cognitive evaluation (Mini-Mental State Examination, Frontal Assessment Battery, five-word test, Stroop, clock-drawing) and single-task locomotor evaluation on an electronic walkway. They were then dual-task-tested on the Walking Stroop carpet, which is an adaptation of the Stroop color–word task for locomotion. A cluster analysis, followed by an analysis of variance, was performed to assess gait parameters.Results: Cluster analysis of gait parameters on the Walking Stroop carpet revealed an inter- action between cognitive and functional abilities because it made it possible to distinguish dysexecutive cognitive fragility or decline with a sensitivity of 89% and a specificity of 94%. Locomotor abilities differed according to the group and dual-task conditions. Healthy subjects performed less well on dual-tasking under reading conditions than when they were asked to distinguish colors, whereas dysexecutive subjects had worse motor performances when they were required to dual task.Conclusion: The Walking Stroop carpet is a dual-task test that enables early detection of cognitive fragility that has not been revealed by traditional neuropsychological tests or single- task walking analysis

Approche comparée de l’apprentissage synchrone vs asynchrone de la propulsion en fauteuil roulant manuel

International audiencePurpose: This study aims to analyze learning differences between synchronous and asynchronous propulsion mode in manual wheelchairs.Materials and methods: Twenty novice and abled-bodied subjects (19.9 ± 1.3 years, 65.4 ± 8.8 kg, 173.6 ± 6.5 cm) participated in this study. Two sprints, in synchronous and asynchronous conditions, before and after twelve hours of sport practice including the learning of these two modes of propulsion, were realized. The rate of increase of the total force when entering the handrail, cadence, total and tangential force, speed and power were measured.Results: Significant differences before and after the twelve hours of practice are highlighted for speed (P < 0.0001), power (P = 0.006), rate of increase in total force (P = 0.02) and the tangential force (P = 0.005). The ANOVA performed also shows significant differences for the total force (P = 0.01), the velocity (P = 0.0002), the power (P = 0.002) and the tangential force (P = 0.005) between asynchronous and synchronous. Statistical analysis shows no significant interaction. The measured parameters tend to increase more significantly for the asynchronous vs. synchronous mode.Conclusion: The learning of the two modes of propulsion had significant effects on the main parameter of propulsive performance, speed. However, two of the biomechanical parameters related to the risk of injury, the rate of increase of the total force and the total force, increase significantly for the two modes of propulsion. It would be interesting to propose adapted muscle strengthening sessions during the learning phase. In addition, evolution percentages tend to be higher in asynchronous vs. synchronous propulsion. These results suggest that asynchronous instruction should be favored early on in the learning of manual wheelchair basketball.Objectifs: Cette étude vise à analyser les différences d’apprentissage existantes entre le mode de propulsion synchrone et asynchrone en fauteuil roulant manuel.Matériels et méthode: Vingt sujets valides novices (19,9 ± 1,3 ans ; 65,4 ± 8,8 kg ; 173,6 ± 6,5 cm) ont pris part à cette étude. Deux sprints, en conditions synchrone et asynchrone, avant et après douze heures de pratique sportive incluant l’apprentissage de ces deux modes de propulsion, ont été réalisés. Le taux d’augmentation de la force totale lors de la saisie de la main courante, la cadence, la force totale et tangentielle, la vitesse et la puissance ont été mesurés.Résultats: Des différences significatives avant et après les douze heures de pratique sont mises en évidence pour la vitesse (p < 0,0001), la puissance (p = 0,006), le taux d’augmentation de la force totale (p = 0,02) et la force tangentielle (p = 0,005). L’Anova réalisée montre également des différences significatives pour la force totale (p = 0,01), la vitesse (p = 0,0002), la puissance (p = 0,002) et la force tangentielle (p = 0,005) entre asynchrone et synchrone. L’analyse statistique ne montre pas d’interaction significative. Les paramètres mesurés tendent à augmenter de manière plus importante pour le mode asynchrone vs synchrone.Conclusion: L’apprentissage des deux modes de propulsion a eu des effets significatifs sur le principal paramètre de performance propulsive, la vitesse. Or, deux des paramètres biomécaniques liés aux risques de blessures, le taux d’augmentation de la force totale et la force totale, augmentent significativement pour les deux modes de propulsion. Il serait alors intéressant de proposer des séances de renforcement musculaire adaptées durant la phase d’apprentissage. De plus, les pourcentages d’évolution tendent à être plus importants en propulsion asynchrone vs synchrone. Ces résultats amènent à penser qu’il faudrait privilégier l’enseignement asynchrone de manière précoce durant l’apprentissage du basket en fauteuil roulant manuel

Physiological responses in handcycling. Preliminary study.

INTRODUCTION: In the field of sports for the disabled, this last decade has been marked by the development of handcycling. Although assessment of maximal capacity during arm exercises in cases of spinal cord injury (SCI) has been widely investigated, investigations of maximal capacity in handcyclists remain less frequent. OBJECTIVE: The aim of this study was to investigate the physiological parameters of an incomplete quadriplegic athlete (cervical lesion C5-C6; ASIA-D) during an adapted incremental handcycling test and to judge the appropriateness of the test. Using such a test, it will then be possible to determine the individualized training program intensity needed to improve the athlete's aerobic capacity. METHODS: The athlete completed an incremental hand cycling test (i.e., an adapted Léger-Boucher test), with the handbike mounted on an ergotrainer. The athlete's physiological parameters were recorded during the test, and the pedalling rate and the perceived exertion rate were estimated. Given the athlete's pathology, ergonomic adaptations were necessary in order to improve comfort and propulsion quality. RESULTS: The maximum values recorded ( [Formula: see text] = 1.16l/min; [La]=7.7mmol/l; heart rate peak=133beats/min; maximum respiratory frequency=85cycles/min and averaged pedaling rate=95tours/min) indicate that the incremental test, adapted for handcycling, is maximal, and consequently, it should be possible to individualize the training intensity. CONCLUSION: This test is innovative and potentially applicable in a booming discipline garnering more and more interest. However, first it is necessary to extend this test to a larger population and to test the extended application in field