Évaluation de l'équilibre chez la population lésée médullaire: validation de l'échelle de Berg et étude des interrelations avec les données cliniques.

L'évolution des soins médicaux auprès de la population ayant une lésion médullaire (LM) s'est traduite par une amélioration du profil fonctionnel des personnes atteintes. Ainsi une proportion importante retrouve une capacité à se tenir debout et à marcher qu'il convient d'évaluer adéquatement. Si quelques outils spécifiques à la population lésée médullaire existent pour évaluer leur ambulation, aucune évaluation de l'équilibre debout n'a été validée auprès de cette clientèle. L'échelle de Berg est un outil recommandé auprès de diverses populations, entre autres celles possédant des pathologies d'origine neurologique; et le score obtenu semble lié au niveau d'autonomie à la marche ainsi qu'aux aides techniques utilisées. L'objectif de ce projet de recherche était donc d'établir la validité concomitante de l'échelle de Berg auprès de la population LM et d'explorer les liens entre le score Berg et l'aide technique utilisée. Pour ce faire, trente-deux sujets BM ASIA D ont été recrutés parmi la clientèle hospitalisée de l'Institut de réadaptation Gingras-Lindsay de Montréal. L'évaluation de l'équilibre debout a été réalisée à l'aide de l'échelle de Berg ainsi que des tests statiques, dynamiques et des limites de stabilité du Balance Master. Le Walking Index for Spinal Cord Injury (WISCI), le Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), la vitesse de marche sur 10m et le Timed up and go ont été utilisés pour évaluer l'ambulation. Des analyses descriptives et corrélatives ont été effectuées sur les données obtenues. Une corrélation forte (0.714

Evaluation of the 3D symmetry of the knees when walking using na ambulatory inertia system: results 14 months after ACL Plasty.

Purpose of the study: Reconstruction of the anterior cruciate ligament (ACL) controls laxity but does not enable restoration of strictly normal 3D kinematics. The purpose of this study was to compare the kinematics of the pathological knee with that of the healthy knee after ACL plasty. This study applied a new ambulatory system using miniature captors. Material and method: Five patients with an isolated injury of the ACL participated in this study. The patients were assessed after injury (T1), at five months (T2), and at 14 months (T3) after surgery. The assessment included laxity (KT-1000), the IKDC score and the Lysholm score. The 3D angles of the knees were measured when walking 30 m on flat ground using a system composed of to small inertia units (3D accelerometer and 3D gyroscope) and a portable recorder. Functional settings were optimised and validating to ensure easy precise measurement of the 3D angles. Symmetry of the two knees was quantified using a symmetry index (SI) (difference in amplitude normalised in relation to mean amplitude) and the correlation coefficient CC. Results: Clinical indicators improved during the follow-up (IKDC T1: 3C, 2C; T2: 5B; T3: 2A, 3B; subjective IKD: 53-95; Lysholm 67-96). Mean laxity improved from 8.6m to 2.5 mm. The gait analysis showed increased symmetry in terms of amplitude for flexion-extension (SI: −17% at T1, −1% at T2, 1% at T3), and an increase in symmetry in terms of the rotation signature (CC: 0.16 at T1, 0.99 at T2, 0.99 at T3). There was no trend to varus-valgus. Discussion: This study demonstrates the clinical application of the new ambulatory system for measuring 3D angles of the knee joint. Joint symmetry increased after ACL plasty but still showed some perturbation at 14 months. The results observed here are in agreement with the literature. Other patients and other types of gait are being analysed. Conclusion: This portable system allows gait analysis outside the laboratory, before and after ACL injury. It is very useful for follow-up after surgery.

Outcome evaluation of ankle osteoarthritis treatments: plantar pressure analysis during relatively long-distance walking.

Background : This study aimed to use plantar pressure analysis in relatively long-distance walking for objective outcome evaluation of ankle osteoarthritis treatments, i.e., ankle arthrodesis and total ankle replacement.Methods : Forty-seven subjects in four groups: three patient groups and controls, participated in the study. Each subject walked twice in 50-m trials. Plantar pressure under the pathological foot was measured using pressure insoles. Six parameters: initial contact time, terminal contact time, maximum force time, peak pressure time, maximum force and peak pressure were calculated and averaged over trials in ten regions of foot. The parameters in each region were compared between patient groups and controls and their effect size was estimated. Besides, the correlations between pressure parameters and clinical scales were calculated.Findings : We observed based on temporal parameters that patients postpone the heel-off event, when high force in forefoot and high ankle moment happens. Also based on maximum force and peak pressure, the patients apply smoothened maximum forces on the affected foot. In ten regions, some parameters showed improvements after total ankle replacement, some showed alteration of foot function after ankle arthrodesis and some others showed still abnormality after both surgical treatments. These parameters showed also significant correlation with clinical scales in at least two regions of foot.Interpretation : Plantar pressure parameters in relatively long-distance trials showed to be strong tools for outcome evaluation of ankle osteoarthritis treatments. (C) 2010 Elsevier Ltd. All rights reserved.

Outcome evaluation of ankle osteoarthritis treatments using spatio-temporal gait parameters and plantar pressure during unconstrained long distance walking : P25

Introduction: Ankle arthrodesis (AD) and total ankle replacement (TAR) are typical treatments for ankle osteoarthritis (AO). Despite clinical interest, there is a lack of their outcome evaluation using objective criteria. Gait analysis and plantar pressure assessment are appropriate to detect pathologies in orthopaedics but they are mostly used in lab with few gait cycles. In this study, we propose an ambulatory device based on inertial and plantar pressure sensors to compare the gait during long-distance trials between healthy subjects (H) and patients with AO or treated by AD and TAR. Methods: Our study included four groups: 11 patients with AO, 9 treated by TAR, 7 treated by AD and 6 control subjects. An ambulatory system (Physilog®, CH) was used for gait analysis; plantar pressure measurements were done using a portable insole (Pedar®-X, DE). The subjects were asked to walk 50 meters in two trials. Mean value and coefficient of variation of spatio-temporal gait parameters were calculated for each trial. Pressure distribution was analyzed in ten subregions of foot. All parameters were compared among the four groups using multi-level model-based statistical analysis. Results: Significant difference (p <0.05) with control was noticed for AO patients in maximum force in medial hindfoot and forefoot and in central forefoot. These differences were no longer significant in TAR and AD groups. Cadence and speed of all pathologic groups showed significant difference with control. Both treatments showed a significant improvement in double support and stance. TAR decreased variability in speed, stride length and knee ROM. Conclusions: In spite of a small sample size, this study showed that ankle function after AO treatments can be evaluated objectively based on plantar pressure and spatio-temporal gait parameters measured during unconstrained walking outside the lab. The combination of these two ambulatory techniques provides a promising way to evaluate foot function in clinics.

Aerobic fitness evaluation during walking tests identifies the maximal lactate steady state

Objective. The aim of this study was to verify the possibility of lactate minimum (LM) determination during a walking test and the validity of such LM protocol on predicting the maximal lactate steady-state (MLSS) intensity. Design. Eleven healthy subjects (24.2 ± 4.5 yr; 74.3 ± 7.7 kg; 176.9 ± 4.1 cm) performed LM tests on a treadmill, consisting of walking at 5.5 km h -1 and with 20-22% of inclination until voluntary exhaustion to induce metabolic acidosis. After 7 minutes of recovery the participants performed an incremental test starting at 7% incline with increments of 2% at each 3 minutes until exhaustion. A polynomial modeling approach (LMp) and a visual inspection (LMv) were used to identify the LM as the exercise intensity associated to the lowest [bLac] during the test. Participants also underwent to 24 constant intensity tests of 30 minutes to determine the MLSS intensity. Results. There were no differences among LMv (12.6 ± 1.7 %), LMp (13.1 ± 1.5 %), and MLSS (13.6 ± 2.1 %) and the Bland and Altman plots evidenced acceptable agreement between them. Conclusion. It was possible to identify the LM during walking tests with intensity imposed by treadmill inclination, and it seemed to be valid on identifying the exercise intensity associated to the MLSS. Copyright © 2012 Guilherme Morais Puga et al.

Commentary: Dedication of Additional Resources to Evaluation and Low-Income Schools is Critical to Increasing Levels of Safe Walking and Bicycling to School

A commentary on Mendoza et al.'s article entitled, "Ethnic Minority Children’s Active Commuting to School and Association with Physical Activity and Pedestrian Safety Behaviors."

Perceived environmental aesthetics and convenience and company are associated with walking for exercise among Australian adults

Background. This study aimed to investigate relationships between environmental aesthetics, convenience, and walking companions and walking for exercise or recreation and to investigate differences in these relationships by sex and by reported physical and mental health. Methods. Analyses of cross-sectional self-report data from a statewide population survey of 3,392 Australian adults were used. Results. Men and women reporting a less aesthetically pleasing or less convenient environment were less likely to report walking for exercise or recreation in the past 2 weeks. Those respondents, particularly women, reporting no company or pet to walk with were also less likely to walk for exercise or recreation. Associations with environmental and social influences were observed for men and women reporting both good and poor physical and mental health. Conclusions. Perceived environmental aesthetics and convenience and walking companions are important correlates of walking for exercise among urban Australians. Acknowledging the cross-sectional nature of these data, findings support a case for evaluation of environmental policies to promote physical activity. (C) 2001 American Health Foundation and Academic Press.

An evaluation of a suburban railway pedestrian crossing safety programme

This study evaluated a programme of educational and environmental (access prevention) interventions designed to reduce the incidence of illegal and unsafe crossing of the rail corridor at a suburban station in Auckland, New Zealand. Immediately after the programme of interventions, the proportion of those crossing the rail corridor by walking across the tracks directly rather than using the nearby overbridge had decreased substantially. Three months later, the decrease was even greater. However, the educational and environmental interventions were introduced simultaneously so that the effects of each could not be separated, nor could other unmeasured factors be ruled out. Anonymous surveys administered immediately before and 3 months after the interventions indicated that while awareness of the illegality of walking across the tracks had increased slightly, perception of risk had not changed. This suggests that the educational interventions may have had less effect than the access prevention measures. (C) 2001 Elsevier Science Ltd. All rights reserved.

Validation of a Brazilian Portuguese Version of the Walking Estimated-Limitation Calculated by History (WELCH)

Abstract Background: The Walking Estimated-Limitation Calculated by History (WELCH) questionnaire has been proposed to evaluate walking impairment in patients with intermittent claudication (IC), presenting satisfactory psychometric properties. However, a Brazilian Portuguese version of the questionnaire is unavailable, limiting its application in Brazilian patients. Objective: To analyze the psychometric properties of a translated Brazilian Portuguese version of the WELCH in Brazilian patients with IC. Methods: Eighty-four patients with IC participated in the study. After translation and back-translation, carried out by two independent translators, the concurrent validity of the WELCH was analyzed by correlating the questionnaire scores with the walking capacity assessed with the Gardner treadmill test. To determine the reliability of the WELCH, internal consistency and test–retest reliability with a seven-day interval between the two questionnaire applications were calculated. Results: There were significant correlations between the WELCH score and the claudication onset distance (r = 0.64, p = 0.01) and total walking distance (r = 0.61, p = 0.01). The internal consistency was 0.84 and the intraclass correlation coefficient between questionnaire evaluations was 0.84. There were no differences in WELCH scores between the two questionnaire applications. Conclusion: The Brazilian Portuguese version of the WELCH presents adequate validity and reliability indicators, which support its application to Brazilian patients with IC.

Evaluation of a mixed approach combining stationary and wearable systems to monitor gait over long distance.

Thanks to decades of research, gait analysis has become an efficient tool. However, mainly due to the price of the motion capture systems, standard gait laboratories have the capability to measure only a few consecutive steps of ground walking. Recently, wearable systems were proposed to measure human motion without volume limitation. Although accurate, these systems are incompatible with most of existing calibration procedures and several years of research will be necessary for their validation. A new approach consisting of using a stationary system with a small capture volume for the calibration procedure and then to measure gait using a wearable system could be very advantageous. It could benefit from the knowledge related to stationary systems, allow long distance monitoring and provide new descriptive parameters. The aim of this study was to demonstrate the potential of this approach. Thus, a combined system was proposed to measure the 3D lower body joints angles and segmental angular velocities. It was then assessed in terms of reliability towards the calibration procedure, repeatability and concurrent validity. The dispersion of the joint angles across calibrations was comparable to those of stationary systems and good reliability was obtained for the angular velocities. The repeatability results confirmed that mean cycle kinematics of long distance walks could be used for subjects' comparison and pointed out an interest for the variability between cycles. Finally, kinematics differences were observed between participants with different ankle conditions. In conclusion, this study demonstrated the potential of a mixed approach for human movement analysis.

The International Universities Walking Project: Development of a Framework for Workplace Intervention Using the Delphi Technique

Background: This paper aimed to use the Delphi technique to develop a consensus framework for a multinational, workplace walking intervention. Methods: Ideas were gathered and ranked from eight recognized and emerging experts in the fields of physical activity and health, from universities in Australia, Canada, England, the Netherlands, Northern Ireland, and Spain. Members of the panel were asked to consider the key characteristics of a successful campus walking intervention. Consensus was reached by an inductive, content analytic approach, conducted through an anonymous, three-round, e-mail process. Results: The resulting framework consisted of three interlinking themes defined as “design, implementation, and evaluation.” Top-ranked subitems in these themes included the need to generate research capacity (design), to respond to group needs through different walking approaches (implementation), and to undertake physical activity assessment (evaluation). Themes were set within an underpinning domain, referred to as the “institution” and sites are currently engaging with subitems in this domain, to provide sustainable interventions that reflect the practicalities of local contexts and needs. Conclusions: Findings provide a unique framework for designing, implementing, and evaluating walking projects in universities and highlight the value of adopting the Delphi technique for planning international, multisite health initiatives.

A new ambulatory system for comparative evaluation of the three-dimensional knee kinematics, applied to anterior cruciate ligament injuries

The aim of this study was to develop an ambulatory system for the three-dimensional (3D) knee kinematics evaluation, which can be used outside a laboratory during long-term monitoring. In order to show the efficacy of this ambulatory system, knee function was analysed using this system, after an anterior cruciate ligament (ACL) lesion, and after reconstructive surgery. The proposed system was composed of two 3D gyroscopes, fixed on the shank and on the thigh, and a portable data logger for signal recording. The measured parameters were the 3D mean range of motion (ROM) and the healthy knee was used as control. The precision of this system was first assessed using an ultrasound reference system. The repeatability was also estimated. A clinical study was then performed on five unilateral ACL-deficient men (range: 19-36 years) prior to, and a year after the surgery. The patients were evaluated with the IKDC score and the kinematics measurements were carried out on a 30 m walking trial. The precision in comparison with the reference system was 4.4 degrees , 2.7 degrees and 4.2 degrees for flexion-extension, internal-external rotation, and abduction-adduction, respectively. The repeatability of the results for the three directions was 0.8 degrees , 0.7 degrees and 1.8 degrees . The averaged ROM of the five patients' healthy knee were 70.1 degrees (standard deviation (SD) 5.8 degrees), 24.0 degrees (SD 3.0 degrees) and 12.0 degrees (SD 6.3 degrees for flexion-extension, internal-external rotation and abduction-adduction before surgery, and 76.5 degrees (SD 4.1 degrees), 21.7 degrees (SD 4.9 degrees) and 10.2 degrees (SD 4.6 degrees) 1 year following the reconstruction. The results for the pathologic knee were 64.5 degrees (SD 6.9 degrees), 20.6 degrees (SD 4.0 degrees) and 19.7 degrees (8.2 degrees) during the first evaluation, and 72.3 degrees (SD 2.4 degrees), 25.8 degrees (SD 6.4 degrees) and 12.4 degrees (SD 2.3 degrees) during the second one. The performance of the system enabled us to detect knee function modifications in the sagittal and transverse plane. Prior to the reconstruction, the ROM of the injured knee was lower in flexion-extension and internal-external rotation in comparison with the controlateral knee. One year after the surgery, four patients were classified normal (A) and one almost normal (B), according to the IKDC score, and changes in the kinematics of the five patients remained: lower flexion-extension ROM and higher internal-external rotation ROM in comparison with the controlateral knee. The 3D kinematics was changed after an ACL lesion and remained altered one year after the surgery