Quantify osteoarthritis gait at the doctor’s office: a simple pelvis accelerometer based method independent from footwear and aging

The gold standard to evaluate the severity of steoarthritis in the doctor’s office remains clinical scores (Bellamy 2002). The Western Ontario and McMaster Universities (WOMAC) oste- oarthritis index is the most largely used score in rheumatology for lower limb osteoarthritis. It is based on clinical observation and it assesses pain, stiffness, and physical function in patients with hip and knee osteoarthritis. It is valid, reliable, and sen- sitive to evaluate osteoarthritis and adapted to doctor’s office (Bellamy 2002). However, clinical scores are inherently subjective and they depend from the patient’s impression and from the clinician’s interpretation. Gait analysis in modern gait laboratories with force plates and photogrammetry is a good tool to have an objec- tive, quantified, and precise insight in osteoarthritis (Astephen et al. 2008). For practical reasons, skin-mounted inertial sensors are well suited for investigating gait kinematics (Auvinet et al. 2002). In accelerometer-based gait analysis, aging is also known to affect gait parameters (Oberg et al. 1993). To have a clinical measure of osteoarthritis, it is essential to find a technique that is independ- ent from aging. Footwear can also affect walking parameters (Chambon et al. 2014). Since it is too time consuming to ask the patient to take off his shoe for the measurement, it is essential to find a method independent from the shoe type. Walking ten meters go and ten meters back on a level sur- face at comfortable walking speed is a well-suited protocol for clinical situations. This study proposes to test a 3D pelvis accelerometer-based measurement method on a group of 47 patients suffering from lower limb osteoarthritis and 12 asymptomatic subjects. The aim was to see whether the ccelerometer-based method is correlated with the clinical severity of the lower limb osteoarthritis evalu- ated with the WOMAC index. In addition, this study valuates whether the accelerometer-based method is independent of aging on 75 asymptomatic subjects and whether the acceler- ometer-based method is independent from footwear on one asymptomatic subject

Brief Communication External globus pallidus stimulation modulates brain connectivity in Huntington's disease

Positron emission tomography with O-15-labeled water was used to study at rest the neurophysiological effects of bilateral external globus pallidus (GPe) deep brain stimulation in patients with Huntington's disease (HD). Five patients were compared with a control group in the on and off states of the stimulator. External globus pallidus stimulation decreased neuronal activity and modulated cerebral connectivity within the basal ganglia-thalamocortical circuitry, the sensorimotor, and the default-mode networks. These data indicate that GPe stimulation modulates functional integration in HD patients in accordance with the basal ganglia-thalamocortical circuit model

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Evaluation de la coopération entre médecins généralistes et médecins de médecine physique et de réadaptation via l'étude d'une patientèle porteuse de séquelles de poliomyélite

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Construct validity of the Functional Independence Measure (FIM) : Questioning the unidimensionality of the scale and the "value" of FIM scores.

International audienc

Construct validity of the Functional Independence Measure (FIM) : Questioning the unidimensionality of the scale and the "value" of FIM scores.

International audienc

Spasticity: To treat or not to treat?

International audienc

A century of research on spasticity: Editors’ opinion

International audienc

Sensory reweighting in controls and stroke patients

International audienceOBJECTIVE:To test sensitivity to proprioceptive, vestibular and visual stimulations of stroke patients with regard to balance.METHOD:The postural control of 20 hemiparetic patients after a single hemispheric stroke that had occurred at least 6 months before the study along with 20 controls was probed with vibration, optokinetic, and vestibular galvanic stimulations. Balance was assessed using a force platform (PF) with two miniature inertial sensors placed on the head (C1) and the trunk (C2) under each sensory condition and measured by three composite scores as the mean displacement of the body (PF, C1, C2) during the stimulation. A subject with a composite score greater than the 75th percentile of the composite scores found in the control subjects was arbitrarily considered to be sensitive to that stimulation.RESULTS:Both control and stroke patients showed large inter-individual variations in response to the three types of sensory stimulation. Among the hemiparetic patients, nearly 65% were sensitive to the optokinetic stimulation, 60% to the galvanic stimulation and 65% to the vibration stimulation. In contrast to the control group, all the hemiparetic subjects were sensitive to at least one type of stimulation.CONCLUSION:Stroke patients are highly dependent on visual, proprioceptive and vestibular information in order to control their standing posture and individually differ in their relative sensitivity to each type of sensory stimulation.SIGNIFICANCE:Contrarily to what one might suppose, the increased visual dependence manifested by stroke patients does not necessarily entail any neglect of proprioceptive and vestibular information

Validity of Functional Ambulation Performance Score for the Evaluation of Spatiotemporal Parameters of Children's Gait

International audienceGait characteristics of a healthy adult population have been used to develop the Functional Ambulation Profile (FAP) score to evaluate gait in patients with neuromuscular or musculoskeletal involvement (A. J. Nelson, 1974). Further technological progress allowed a more precise recording of walk parameters and propitiated the development of the Functional Ambulation Performance Score (FAPS). The authors aimed to explore the evolution of the FAPS in healthy children to determine what the lower limit of age would be to ensure reliability of this score. Participants were 32 children with normal development. A GAITRite® walkway was used to log the spatiotemporal parameters. Compared with values obtained in adults, the average FAPS was significantly lower for children under 12 years old. The interparticipant variability was particularly high for the younger children and decreased with age. Similar trends were observed regarding the intraparticipant variability. In conclusion, the authors observed that the FAPS is not suitable to compare the gait of different children younger than 12 years old. At least, the adult standards used to calculate FAPS would need to be modified if the score has to be applied to a pediatric population