- Email: [email protected]
Clinimetric analysis of the visual vertical in stroke patients
Biome´canique (II) / Revue d’E´pide´miologie et de Sante´ Publique 55S (2012) e100–e103 Me´thode.– Étude multicentrique, randomisée, traitement actif versus placebo, en double insu. Critères d’inclusion : hémiplégie séquellaire plus d’un an après un AVC avec hypertonie spastique des muscles de jambe et varus équin. Évaluation clinique et instrumentale quatre à six semaines après l’injection sur des critères d’interrogatoire, d’examen clinique et d’évaluation du contrôle postural. Enregistrement sur des plateformes de force AMTI de la surface d’oscillation du centre de pression pendant 30 secondes dans trois conditions : yeux ouverts, yeux ouverts en situation de double tâche, yeux fermés. La double tâche consistait en une tâche de contrôle postural associée à une tâche arithmétique. Re´sultats.– Quarante patients ont été inclus et randomisés en un groupe traité par toxine botulique (n = 19) et un groupe placebo (n = 21). Les surfaces d’oscillation avant traitement n’étaient pas significativement différentes entre les deux groupes. La surface d’oscillation du centre de pression yeux ouverts a augmenté dans le groupe placebo (+2,48 cm2 ; sd 11,11) et diminué dans le groupe traité ( 1,74 ; sd 8,30) après l’injection mais la différence n’était pas significative (p = 0,735). L’effet principal a été retrouvé en situation de double tâche avec une diminution significative (p = 0,005) de la surface d’oscillation dans le groupe traité ( 3,11 ; sd 6,92) par rapport au groupe placebo (+0,27 ; sd 3,57). Discussion.– Le traitement de la spasticité par injection de toxine botulique dans les muscles de jambe chez le sujet hémiplégique post-AVC a un effet sur le contrôle postural dans cette étude avec une diminution significative de la surface d’oscillation dans le groupe traité par rapport au groupe placebo. L’évaluation du contrôle postural en situation de double tâche pourrait être un test intéressant et sensible à ces effets. http://dx.doi.org/10.1016/j.rehab.2012.07.259
CO25-005-f
Simulation de l’effet de l’inertie de la partie supe´rieure du corps sur la re´cupe´ration de l’e´quilibre chez l’homme Z. Aftab a,*, T. Robert a, P.B. Wieber b a Universite´ de Lyon, IFSTTAR, UMR_T9406, LBMC, universite´ Lyon 1, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France b ´ Equipe Bipop, INRIA Rhoˆne-Alpes, France *Auteur correspondant. Adresse e-mail : [email protected]. Communication de la Société de biomécanique.
e101
Me´thodes.– Des mesures posturographiques de 41 patients hémiparétiques (premier AVC, 16 avec lésion du côté gauche, 25 avec lésion du côté droit) ont été effectuées avec la consigne de rester debout le plus immobile possible. Quarante et un sujets sains appariés en âge et adoptant une répartition de poids similaire ont été aussi testés. Des indices de contribution des mécanismes de hanche et de cheville dans la production des déplacements du CPRes ont été calculés [1]. Re´sultats.– Comparativement aux sujets normaux (0,96 + 0,03 a.u.), les indices de contribution des chevilles étaient moins élevés sur l’axe AP des patients hémiparétiques (0,88 + 0,10 a.u. ; t = 4,52, p < 0,001). Cette diminution était liée à la distance sur l’axe AP entre les deux positions moyennes des CP plantaires. Discussion.– Chez les patients hémiparétiques, le contrôle de l’équilibre de bout sollicite davantage les muscles plus proximaux du bassin et du tronc au détriment des muscles plus distaux des jambes. Mobiliser ces muscles pourrait constituer un objectif intéressant dans la perspective de protocoles de rééducation ciblés. Références [1] Rougier P. Relative contribution of the pressure variations under the feet and body weight distribution over both legs in the control of upright stance. J Biomech 2007;40(11):2477–82. [2] Genthon N, et al. Contribution of each lower limb to upright standing in stroke patients. Stroke 2008;39:1793–9. http://dx.doi.org/10.1016/j.rehab.2012.07.261
CO25-007-f
Postures et gonalgie chronique chez les personnes ^ age´es : contribution du traitement oste´opathique Y. Huard De´partement de la recherche, e´cole supe´rieure d’oste´opathie, cite´ Descartes, 8, rue Alfred-Nobel, 77420 Champs-sur-Marne, France Adresse e-mail : [email protected]. Communication de la Société de biomécanique. http://dx.doi.org/10.1016/j.rehab.2012.07.262
English version
http://dx.doi.org/10.1016/j.rehab.2012.07.260 CO25-001-e
Static and dynamic postural analysis in rehabilitation CO25-006-f
Les patients he´mipare´tiques utilisent davantage que les sujets normaux leurs muscles proximaux pour contr^oler leur e´quilibre debout D. Pe´rennou a,*, P. Rougier b a Clinique MPR, hoˆpital sud, CHU Grenoble, 38434 Grenoble, France b Universite´ de Savoie, Savoie, France *Auteur correspondant. Adresse e-mail : [email protected]. Mots cle´s : Posture ; E´quilibre ; Posturographie ; He´mipare´sie ; Asyme´trie ; Hanche ; Cheville ; Centre des pressions Objectifs.– L’équilibre de l’homme debout met en jeu des mécanismes différents et complémentaires. Ainsi, lorsque les pieds se trouvent côte à côte, les déplacements du centre des pressions résultant (CPRes) sur l’axe antéropostérieur (AP) résultent de variations de pressions et mobilisent les chevilles alors que sur l’axe médio-latéral (ML) c’est le transfert des appuis entre les deux membres inférieurs qui intervient principalement [1]. L’analyse posturographique des patients hémiparétiques montre, sur l’axe AP, une avancée des positions moyennes des CP plantaires sous la jambe parétique et un recul sous la jambe non-parétique [2]. Cet écart, propice à l’utilisation d’un mécanisme de charge-décharge pour le contrôle des mouvements AP, pourrait être accru chez les patients hémiparétiques.
F. Prince Universite´ de Montre´al, C.P. 6128, succursale Centre-ville, H3 C 3J7 Montre´al, Canada Adresse e-mail : [email protected]. Unknown abstract. http://dx.doi.org/10.1016/j.rehab.2012.07.263
CO25-002-e
Clinimetric analysis of the visual vertical in stroke patients C. Piscicelli a,*, P. Davoine b, M.B. Sibille b, M. Guerraz c, D. Perennou a a Clinique MPR- CHU et universite´, e´quipe SMP laboratoire TIMC CNRS, avenue de Kimberley, 38434 Grenoble, France b Clinique MPR- CHU et universite´, Grenoble, France c LPNC, universite´ Savoie, France *Corresponding author. E-mail address: [email protected]. Keywords: Visual vertical; Metrological properties; Test-retest reliability The visual vertical (VV) is the most widely used technique to assess verticality perception, especially in neurological and vestibular diseases. The tight link between troubles in verticality perception and postural disorders after stroke
e102
Biome´canique (II) / Revue d’E´pide´miologie et de Sante´ Publique 55S (2012) e100–e103
might generalize VV measurement after stroke, which requires analyzing VV clinimetric properties. Objectives.– To analyze the reproducibility of the VV, and to determine the minimum number of trials required to reach a robust final result, comparatively in stroke patients and control subjects. Materials and methods.– Twenty patients with a first and unique hemispheric stroke (61.9 12 years; 10 left-10 right-sided; 2.6 3 months since stroke), matched to 20 control subjects (54.4 6 years) were recruited from a neurorehabilitation unit. The VV was assessed in a darkened room, subjects being seated, with head and trunk maintained upright Subjects verbally indicated how to reset a luminous line presented on a computer screen to their subjective visual vertical. VV was measured twice, 5 days apart, with 10 trials performed each time. An average (orientation) and a standard deviation (uncertainty) were calculated. The minimum number of trials was the lowest number of consecutive trials leading to a final result similar (not significantly different) to that obtained with 10 trials, both for orientation and uncertainty. Non-parametric statistics were used for analyses. Results.– The mean VV orientations were 3.7 0.88 vs. 0.1 0.88 (P < 0.01), and the mean VV uncertainty were 1.4 0.18 vs. 0.8 0.18 (P < 0.01), in stroke patients and control subjects, respectively. The testretest reliability was high in patients for the orientation (r = 0.79; P = 0.001); acceptable for the uncertainty (r = 0.64; P = 0.002), and modest in control subjects due to very small variations in data (r = 0.45; P = 0.06). The minimum number of trials required to reach a stable and robust final result was 6 in controls as in stroke patients, both for VV orientation and uncertainty. Conclusion.– VV orientation and uncertainty are reliable clinical criteria for assessing the sense of verticality in stroke patients, provided results are averaged on at least six trials. http://dx.doi.org/10.1016/j.rehab.2012.07.264
CO25-003-e
Determination of force platform parameters during sit to stand movement in elderly: A preliminary study F. Chorin *, C. Cornu, B. Beaune, A. Rahmani Laboratoire Motricite´, interactions, performance (EA4334) Le Mans-Nantes, 25 bis, boulevard Guy-Mollet, BP 72206, 44322 Nantes cedex 3, France *Corresponding author. E-mail address: [email protected]. Keywords: Ageing; Force platform Communication of Socie´te´ de biome´canique. http://dx.doi.org/10.1016/j.rehab.2012.07.265
CO25-004-e
Effect on postural control of spastic equinovarus foot treatment with botulinum toxin in stroke patients: Randomized, controlled, multicenter trial L. Bensoussan a,*, G. Lotito a, J.-M. Viton a, F. Pellas b, J. Pelissier b, P. Calmels c, V. Gautheron c, A. Delarque a a CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France b CHU Caremeau, Nıˆmes, France c CHU Bellevue, Saint-E´tienne, France *Corresponding author. E-mail address: [email protected]. Keywords: Botulinum toxin; Spasticity; Posural control; Dual task Objective.– To study the effects on postural control of the treatment with botulinum toxin in lower limb muscles in stroke patients. Method.– Multicenter, randomized, active treatment versus placebo, doubleblind study. Inclusion criteria: Hemiplegia over a year after a stroke with spasticity of leg muscles and equinovarus. Clinical evaluation and instrumental at 4 to 6 weeks after injection on clinical examination and evaluation of postural
control. Assessment on an AMTI force plate of the center of pressure sway area for 30 seconds in three conditions: eyes open, eyes open in a dual task condition, eyes closed. The dual task consisted of a postural control task combined with an arithmetic task. Results.– Forty patients were enrolled and randomized into two groups, one treated with botulinum toxin (n = 19) and the other with placebo (n = 21). The sway area before treatment was not significantly different between the two groups. The sway area of the center of pressure eyes open increased in placebo group (+2.48 cm2; sd 11.11) and decreased in the treated group ( 1.74, SD 8.30) after injection but the difference was not significant (P = 0 735). The main effect was found in dual task with a significant decrease (P = 0.005) of the sway area in the treated group ( 3.11; sd 6.92) compared with the placebo group (+0.27, sd 3.57). Discussion.– Treatment of spasticity by botulinum toxin injection in the lower limb muscles in hemiplegic stroke patient changes postural control in this study with a significant decrease of the sway area in the treated group compared with the placebo group. The assessment of postural control in dual task seems to be an interesting test and sensitive to these effects. http://dx.doi.org/10.1016/j.rehab.2012.07.266
CO25-005-e
Simulating the effect of upper-body inertia on human balance recovery Z. Aftab a,*, T. Robert a, P.B. Wieber b a Universite´ de Lyon, IFSTTAR, UMR_T9406, LBMC, universite´ Lyon 1, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France b ´ Equipe Bipop, INRIA Rhoˆne-Alpes, France *Corresponding author. E-mail address: [email protected]. Keywords: Balance; Fall Simulation Communication by Socie´te´ de biome´canique. http://dx.doi.org/10.1016/j.rehab.2012.07.267
CO25-006-e
Hemiparetics use more their proximal muscles for controlling the upright stance than healthy subjects do D. Pe´rennou a,*, P. Rougier b a Clinique MPR, hoˆpital sud, CHU Grenoble, 38434 Grenoble, France b Universite´ de Savoie, Savoie, France *Corresponding author. E-mail address: [email protected]. Keywords: Posture; Balance; Posturography; Hemiparesis; Asymmetry; Hip; Ankle; Center of pressure Objectives.– Upright stance maintenance in humans is achieved by complementary and different mechanisms. For instance, when feet are positioned side by side, the resultant center of pressure (CPRes) are displaced along the antero-posterior (AP) axis are achieved through pressure variations mechanisms occurring around the ankle joints whereas, along the medio-lateral (ML) axis, the main mechanisms is the body-weigh distribution which mainly involves the hip joint [1]. The posturographic analysis of hemiparetic patients shows, along the AP axis, a forward shift of the mean plantar CP positions under the paretic leg and a backward shift under the non-paretic leg [2]. This gap, which favors the use of a loading-unloading for controlling the AP CPRes displacements, could be enhanced in hemiparetic patients. Methods.– Posturographic measurements of 41 hemiparetic patients (first CVA, 16 and 25 with stroke on the left and right sides, respectively) were recorded with the instruction to stand still upright. Forty-one healthy
CO25-005-f
Simulation de l’effet de l’inertie de la partie supe´rieure du corps sur la re´cupe´ration de l’e´quilibre chez l’homme Z. Aftab a,*, T. Robert a, P.B. Wieber b a Universite´ de Lyon, IFSTTAR, UMR_T9406, LBMC, universite´ Lyon 1, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France b ´ Equipe Bipop, INRIA Rhoˆne-Alpes, France *Auteur correspondant. Adresse e-mail : [email protected]. Communication de la Société de biomécanique.
e101
Me´thodes.– Des mesures posturographiques de 41 patients hémiparétiques (premier AVC, 16 avec lésion du côté gauche, 25 avec lésion du côté droit) ont été effectuées avec la consigne de rester debout le plus immobile possible. Quarante et un sujets sains appariés en âge et adoptant une répartition de poids similaire ont été aussi testés. Des indices de contribution des mécanismes de hanche et de cheville dans la production des déplacements du CPRes ont été calculés [1]. Re´sultats.– Comparativement aux sujets normaux (0,96 + 0,03 a.u.), les indices de contribution des chevilles étaient moins élevés sur l’axe AP des patients hémiparétiques (0,88 + 0,10 a.u. ; t = 4,52, p < 0,001). Cette diminution était liée à la distance sur l’axe AP entre les deux positions moyennes des CP plantaires. Discussion.– Chez les patients hémiparétiques, le contrôle de l’équilibre de bout sollicite davantage les muscles plus proximaux du bassin et du tronc au détriment des muscles plus distaux des jambes. Mobiliser ces muscles pourrait constituer un objectif intéressant dans la perspective de protocoles de rééducation ciblés. Références [1] Rougier P. Relative contribution of the pressure variations under the feet and body weight distribution over both legs in the control of upright stance. J Biomech 2007;40(11):2477–82. [2] Genthon N, et al. Contribution of each lower limb to upright standing in stroke patients. Stroke 2008;39:1793–9. http://dx.doi.org/10.1016/j.rehab.2012.07.261
CO25-007-f
Postures et gonalgie chronique chez les personnes ^ age´es : contribution du traitement oste´opathique Y. Huard De´partement de la recherche, e´cole supe´rieure d’oste´opathie, cite´ Descartes, 8, rue Alfred-Nobel, 77420 Champs-sur-Marne, France Adresse e-mail : [email protected]. Communication de la Société de biomécanique. http://dx.doi.org/10.1016/j.rehab.2012.07.262
English version
http://dx.doi.org/10.1016/j.rehab.2012.07.260 CO25-001-e
Static and dynamic postural analysis in rehabilitation CO25-006-f
Les patients he´mipare´tiques utilisent davantage que les sujets normaux leurs muscles proximaux pour contr^oler leur e´quilibre debout D. Pe´rennou a,*, P. Rougier b a Clinique MPR, hoˆpital sud, CHU Grenoble, 38434 Grenoble, France b Universite´ de Savoie, Savoie, France *Auteur correspondant. Adresse e-mail : [email protected]. Mots cle´s : Posture ; E´quilibre ; Posturographie ; He´mipare´sie ; Asyme´trie ; Hanche ; Cheville ; Centre des pressions Objectifs.– L’équilibre de l’homme debout met en jeu des mécanismes différents et complémentaires. Ainsi, lorsque les pieds se trouvent côte à côte, les déplacements du centre des pressions résultant (CPRes) sur l’axe antéropostérieur (AP) résultent de variations de pressions et mobilisent les chevilles alors que sur l’axe médio-latéral (ML) c’est le transfert des appuis entre les deux membres inférieurs qui intervient principalement [1]. L’analyse posturographique des patients hémiparétiques montre, sur l’axe AP, une avancée des positions moyennes des CP plantaires sous la jambe parétique et un recul sous la jambe non-parétique [2]. Cet écart, propice à l’utilisation d’un mécanisme de charge-décharge pour le contrôle des mouvements AP, pourrait être accru chez les patients hémiparétiques.
F. Prince Universite´ de Montre´al, C.P. 6128, succursale Centre-ville, H3 C 3J7 Montre´al, Canada Adresse e-mail : [email protected]. Unknown abstract. http://dx.doi.org/10.1016/j.rehab.2012.07.263
CO25-002-e
Clinimetric analysis of the visual vertical in stroke patients C. Piscicelli a,*, P. Davoine b, M.B. Sibille b, M. Guerraz c, D. Perennou a a Clinique MPR- CHU et universite´, e´quipe SMP laboratoire TIMC CNRS, avenue de Kimberley, 38434 Grenoble, France b Clinique MPR- CHU et universite´, Grenoble, France c LPNC, universite´ Savoie, France *Corresponding author. E-mail address: [email protected]. Keywords: Visual vertical; Metrological properties; Test-retest reliability The visual vertical (VV) is the most widely used technique to assess verticality perception, especially in neurological and vestibular diseases. The tight link between troubles in verticality perception and postural disorders after stroke
e102
Biome´canique (II) / Revue d’E´pide´miologie et de Sante´ Publique 55S (2012) e100–e103
might generalize VV measurement after stroke, which requires analyzing VV clinimetric properties. Objectives.– To analyze the reproducibility of the VV, and to determine the minimum number of trials required to reach a robust final result, comparatively in stroke patients and control subjects. Materials and methods.– Twenty patients with a first and unique hemispheric stroke (61.9 12 years; 10 left-10 right-sided; 2.6 3 months since stroke), matched to 20 control subjects (54.4 6 years) were recruited from a neurorehabilitation unit. The VV was assessed in a darkened room, subjects being seated, with head and trunk maintained upright Subjects verbally indicated how to reset a luminous line presented on a computer screen to their subjective visual vertical. VV was measured twice, 5 days apart, with 10 trials performed each time. An average (orientation) and a standard deviation (uncertainty) were calculated. The minimum number of trials was the lowest number of consecutive trials leading to a final result similar (not significantly different) to that obtained with 10 trials, both for orientation and uncertainty. Non-parametric statistics were used for analyses. Results.– The mean VV orientations were 3.7 0.88 vs. 0.1 0.88 (P < 0.01), and the mean VV uncertainty were 1.4 0.18 vs. 0.8 0.18 (P < 0.01), in stroke patients and control subjects, respectively. The testretest reliability was high in patients for the orientation (r = 0.79; P = 0.001); acceptable for the uncertainty (r = 0.64; P = 0.002), and modest in control subjects due to very small variations in data (r = 0.45; P = 0.06). The minimum number of trials required to reach a stable and robust final result was 6 in controls as in stroke patients, both for VV orientation and uncertainty. Conclusion.– VV orientation and uncertainty are reliable clinical criteria for assessing the sense of verticality in stroke patients, provided results are averaged on at least six trials. http://dx.doi.org/10.1016/j.rehab.2012.07.264
CO25-003-e
Determination of force platform parameters during sit to stand movement in elderly: A preliminary study F. Chorin *, C. Cornu, B. Beaune, A. Rahmani Laboratoire Motricite´, interactions, performance (EA4334) Le Mans-Nantes, 25 bis, boulevard Guy-Mollet, BP 72206, 44322 Nantes cedex 3, France *Corresponding author. E-mail address: [email protected]. Keywords: Ageing; Force platform Communication of Socie´te´ de biome´canique. http://dx.doi.org/10.1016/j.rehab.2012.07.265
CO25-004-e
Effect on postural control of spastic equinovarus foot treatment with botulinum toxin in stroke patients: Randomized, controlled, multicenter trial L. Bensoussan a,*, G. Lotito a, J.-M. Viton a, F. Pellas b, J. Pelissier b, P. Calmels c, V. Gautheron c, A. Delarque a a CHU Timone, 264, rue Saint-Pierre, 13005 Marseille, France b CHU Caremeau, Nıˆmes, France c CHU Bellevue, Saint-E´tienne, France *Corresponding author. E-mail address: [email protected]. Keywords: Botulinum toxin; Spasticity; Posural control; Dual task Objective.– To study the effects on postural control of the treatment with botulinum toxin in lower limb muscles in stroke patients. Method.– Multicenter, randomized, active treatment versus placebo, doubleblind study. Inclusion criteria: Hemiplegia over a year after a stroke with spasticity of leg muscles and equinovarus. Clinical evaluation and instrumental at 4 to 6 weeks after injection on clinical examination and evaluation of postural
control. Assessment on an AMTI force plate of the center of pressure sway area for 30 seconds in three conditions: eyes open, eyes open in a dual task condition, eyes closed. The dual task consisted of a postural control task combined with an arithmetic task. Results.– Forty patients were enrolled and randomized into two groups, one treated with botulinum toxin (n = 19) and the other with placebo (n = 21). The sway area before treatment was not significantly different between the two groups. The sway area of the center of pressure eyes open increased in placebo group (+2.48 cm2; sd 11.11) and decreased in the treated group ( 1.74, SD 8.30) after injection but the difference was not significant (P = 0 735). The main effect was found in dual task with a significant decrease (P = 0.005) of the sway area in the treated group ( 3.11; sd 6.92) compared with the placebo group (+0.27, sd 3.57). Discussion.– Treatment of spasticity by botulinum toxin injection in the lower limb muscles in hemiplegic stroke patient changes postural control in this study with a significant decrease of the sway area in the treated group compared with the placebo group. The assessment of postural control in dual task seems to be an interesting test and sensitive to these effects. http://dx.doi.org/10.1016/j.rehab.2012.07.266
CO25-005-e
Simulating the effect of upper-body inertia on human balance recovery Z. Aftab a,*, T. Robert a, P.B. Wieber b a Universite´ de Lyon, IFSTTAR, UMR_T9406, LBMC, universite´ Lyon 1, 43, boulevard du 11 novembre 1918, 69100 Villeurbanne, France b ´ Equipe Bipop, INRIA Rhoˆne-Alpes, France *Corresponding author. E-mail address: [email protected]. Keywords: Balance; Fall Simulation Communication by Socie´te´ de biome´canique. http://dx.doi.org/10.1016/j.rehab.2012.07.267
CO25-006-e
Hemiparetics use more their proximal muscles for controlling the upright stance than healthy subjects do D. Pe´rennou a,*, P. Rougier b a Clinique MPR, hoˆpital sud, CHU Grenoble, 38434 Grenoble, France b Universite´ de Savoie, Savoie, France *Corresponding author. E-mail address: [email protected]. Keywords: Posture; Balance; Posturography; Hemiparesis; Asymmetry; Hip; Ankle; Center of pressure Objectives.– Upright stance maintenance in humans is achieved by complementary and different mechanisms. For instance, when feet are positioned side by side, the resultant center of pressure (CPRes) are displaced along the antero-posterior (AP) axis are achieved through pressure variations mechanisms occurring around the ankle joints whereas, along the medio-lateral (ML) axis, the main mechanisms is the body-weigh distribution which mainly involves the hip joint [1]. The posturographic analysis of hemiparetic patients shows, along the AP axis, a forward shift of the mean plantar CP positions under the paretic leg and a backward shift under the non-paretic leg [2]. This gap, which favors the use of a loading-unloading for controlling the AP CPRes displacements, could be enhanced in hemiparetic patients. Methods.– Posturographic measurements of 41 hemiparetic patients (first CVA, 16 and 25 with stroke on the left and right sides, respectively) were recorded with the instruction to stand still upright. Forty-one healthy