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Biomedical subjects

P Calmels

Publications and source records attributed to P Calmels.

At least 19 recordsLinked to original sources
PubMed2006

[Training programs in stroke patients: literature review].

INTRODUCTION: An increased number of physical retraining programs are available for the rehabilitation of stroke patient; generally positive results are observed, but no consensus in methodology exists (program characteristics, intensity, duration, frequency, etc.). OBJECTIVE: To review the literature about training program characteristics for stroke patients and describe their efficacy, limits, and results. METHODS: A search of the Medline database revealed 97 references, including 53 clinical studies examining protocols of physical training and 15 meta-analyses and literature reviews of physical training. RESULTS: Three physical training protocols were found (walking, neuromuscular and 'force' training). Each training had specific effects: cardiovascular, functional, and muscular. DISCUSSION-CONCLUSION: To obtain positive cardiovascular effects and/or walking improvement, classical rehabilitation and physical training programs need to be associated for rehabilitation of the stroke patient.

Electric Stimulation↗
PubMed2006

[Relationship between walking capacity and maximal exercise capacity, strength and motor deficiency in adult hemiplegic stroke patients].

OBJECTIVE: To evaluate the relation between walking capacity and maximal exercise capacity, strength and motor deficiency in hemiplegic stroke patients. DESIGN: Uncontrolled observational study. SETTING: Physical medicine and rehabilitation unit in a teaching hospital. PARTICIPANTS: Twenty hemiplegic stroke patients (17 men and 3 women) aged 18-70 years, whose stroke occurred more than 3 months before the study and who could walk independently with or without walking aids. MAIN OUTCOME MEASURES: Peak oxygen uptake (VO(2peak)), maximal power output walking capacity (6-min walk test) and motor deficiency (Fugl-Meyer scale). RESULTS: Walking capacity was correlated with both VO(2peak) and maximal power output (Pmax) [r=0.609, P<0.003 and r=0.868, P<0.0001, respectively] but also with strength (from r=0.640 to r=0.734; P=0.0018 to P=0.0001) and motor deficiency (r=0.6; P=0.004). CONCLUSIONS: Aerobic capacity and walking capacity are correlated and decreased in hemiplegic stroke patients. These results underscore the need for future studies to confirm the role of fitness in relation to walking capacity and to evaluate the benefit of integrating aerobic training into more traditional rehabilitation programs after stroke.

Adolescent↗
PubMed2006

Fatigue and neuromuscular diseases.

PURPOSE: To identify the role of fatigue, its evaluation and its causes in the pathophysiology context of acquired or hereditary neuromuscular diseases of the spinal anterior horn cell, peripheral nerve, neuromuscular junction and muscle. MATERIAL AND METHODS: A literature review has been done on Medline with the following keywords: neuromuscular disease, peripheral neuropathy, myopathy, fatigue assessment, exercise intolerance, force assessment, fatigue scale and questionnaire, then with the terms: Fatigue Severity Scale, Chalder Fatigue Scale, Fatigue Questionnaire, Piper Fatigue Scale, electromyography and the combination of the word Fatigue with the following terms: Amyotrophic Lateral Sclerosis (ALS), Post-Polio Syndrome (PPS), Guillain-Barre Syndrome, Immune Neuropathy, Charcot-Marie-Tooth Disease, Myasthenia Gravis (MG), Metabolic Myopathy, Mitochondrial Myopathy, Muscular Dystrophy, Facioscapulohumeral Dystrophy, Myotonic Dystrophy. RESULTS: Fatigue is a symptom very frequently reported by patients. Fatigue is mainly evaluated by strength loss after an exercise, by change in electromyographic activity during a given exercise and by questionnaires that takes into account the subjective (psychological) part of fatigue. Due to the large diversity of motor disorders, there are multiple clinical expressions of fatigue that differ in their presentation, consequences and therapeutic approach. CONCLUSION: This review shows that fatigue has to be taken into account in patients with neuromuscular diseases. In this context, pathophysiology of fatigue often implies the motor component but the disease evolution and the physical obligates of daily life also induce an important psychological component.

Fatigue↗
PubMed2005

[Is very old age a prognostic factor for outcome after a first stroke?].

AIM: To determine whether very old age, older than 80 years, after a stroke is a significant predictor of mortality, orientation to a specific care pathway after the acute phase and functional status at 6 months after the stroke. PATIENTS: A sample of 112 consecutive patients admitted to the emergency department because of a first stroke, with hemiplegia and/or aphasia over 6 months, who satisfied strict inclusion/exclusion criteria. Forty-seven patients were older than 80. METHOD: After initial diagnosis and enrolment in the study, follow-up assessments were conducted at 48 hours, 15 days and 6 months. Demographic, medical, and radiographic data were collected, and patients were evaluated on the NIHSS, MMSE, Barthel Index, FIM(TM) and FAM scales. Descriptive statistics were generated, as were uni- and multivariate between group comparisons. RESULTS: Our study shows that after a first stroke, old age is significantly associated with a high rate of death, a low rate of orientation to a physical medicine and rehabilitation unit and return to home but not poorer functional outcome. CONCLUSION: Old age is therefore a determinant of post stroke management. Further studies are needed to evaluate whether in patient rehabilitation would result in significant functional benefit, considering the high cost of care, high risk of recurrent stroke, and high rate of death.

Age Factors↗
PubMed2005

[Low back pain disability assessment tools].

OBJECTIVES: To identify and compare low back pain functional assessment tools and to determine their characteristics and the selection criteria for their use. MATERIALS AND METHOD: We systematically searched Medline with the key words: low back pain, scale validity, questionnaire, assessment, outcome, and functional evaluation and with some data from the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation", which allowed us to complete the search on specific tools including the Roland Disability Questionnaire, Dallas Pain Questionnaire, Quebec Back Pain Questionnaire, and Oswestry Back Pain Questionnaire. We restricted our analysis to studies about the psychometric properties of functional tools. RESULTS: We identified 19 scales or questionnaires, 9 specifically for low back pain and with a concept of functional incapacity. Four tools are recognised as having good psychometric properties and are widely used with linguistic adaptations in different countries. We also identified 10 generic tools proposed to assess outcome in low back pain, which are more conceptually linked to perceived health status, quality of life, and pain assessment. CONCLUSION: A "gold standard" to evaluate disability in low back pain does not exist, but only 4 tools (the Dallas Pain Questionnaire, Roland Disability Questionnaire, Quebec Back Pain Disability Scale and Oswestry Low Back Pain Disability Questionnaire) demonstrated strong qualities (content and construct validity, feasibility, linguistic adaptation and international use).

Disability Evaluation↗
PubMed2005

[Training programs in spinal cord injury].

INTRODUCTION: Individualised exercise training programs in spinal cord injury (SCI) individuals are considered highly effective for improving and maintaining capacity for physical activity, as well as for reducing cardiovascular risk. However, no consensus exists on the type, intensity, and frequency of the training programs for SCI. OBJECTIVE: To review the literature about training program characteristics for SCI and describe their efficacy, limits, and results, with the aim of proposing specific recommendations. METHODS: Query using Medline and Embase databases. Ninety-nine references were found, including the following: Clinical studies examining physical endurance capacity of individuals with SCI, physiological responses to maximal exercise, or cardiovascular differences between sedentary and wheelchair-trained subjects; Articles? investigating the effects of training programmes for SCI. RESULTS: Various combinations of training intensity, duration, frequency, type, and ergometers have been proposed for SCI. Whatever the characteristics of the training program, a review of 25 cardiorespiratory training studies involving SCI subjects revealed an average improvement of 9% to 99% in VO2max, 19% to 118% in power output, and a decrease in submaximal values after 4 to 36 weeks of training. DISCUSSION - CONCLUSION: Wheelchair ergometers seems to be interesting for SCI because it mimics closely the daily motor tasks of wheelchair users and allows for adjustment of the wheelchair. Both continuous and interval training programmes are appropriate, but intermittent exercise intensities may be more beneficial since they mimic the intermittent nature of daily activity patterns. Furthermore, on the basis of the results of these studies, we recommend that training at or above 70% of maximum heart rate, for 30 minutes of rhythmic exercise, three days per week during eight weeks, will provide a sound of basis for design of an endurance exercise programme for people with SCI.

Exercise Therapy↗
PubMed2005

[Hemiplegia and a hiking tour of Mont Blanc: from hope to reality].

INTRODUCTION: At the end of an endurance training program for stroke patients with hemiplegia, we offered a hiking tour around the Mont Blanc Pedestrian Tour. We found no publication describing a similar experience and no scientific data in the literature to determine the physiological characteristics required for this performance, particularly regarding cardiac and vascular capacities, level of impairment, and functional abilities. OBJECTIVE: To complete a part of the Mont Blanc Pedestrian Tour over six days, with a group of adults with hemiparesis and aphasia due to stroke. POPULATION: Seven of 20 subjects with right hemiparesis and aphasia were selected on the basis of results of physiological tests, after an endurance training program and two tests hikes at medium altitude. Mean age was 51.71 +/- 7.13 years, mean VO(2max) 19.76 +/- 3.46 ml.g(-1).mm(-1), mean P(max) 90 +/- 22.68 and mean walking speed 3.60 +/- 1.30 km/hour. ORGANIZATION: Organization involved setting up the itinerary, recruiting accompanying personnel (9 people), and arranging security. No specific adaptations for accessibility were available, and no specific equipment was used, except for standard walking sticks. RESULTS: During this pedestrian tour, the subjects demonstrated strong motivation, as well as exceptional physical and functional performance, despite significant changes in elevation (up to 1500 m per day) and long walking times (from 5 to 9 hours per day). DISCUSSION: This experience has enriched our reflection about the medical, functional, and psychological conditions required for this type of physical effort, both from patients and accompanying personnel. In the absence of reports on similar experiences with this patient population, we thought it interesting, six months after this challenge, to present our observations as well as the patients' point of view. This may encourage other rehabilitation teams to offer intensive walking activities for stroke patients.

Aphasia↗
PubMed2004

[Use of isokinetic techniques vs standard physiotherapy in patients with chronic low back pain. Preliminary results].

OBJECTIVE: To determine if the use of an isokinetic device for trunk exercise is more effective than standard physiotherapy in promoting motor disinhibition for patients with chronic low back pain. POPULATION: chronic low back pain outpatients who are treated in a Rheumatology or PM & R unit within an academic hospital. METHODOLOGY: This is a prospective, controlled, randomized study, with two groups of treatment: one treated with isokinetic techniques and the other with standard physiotherapy, six sessions for each treatment during 2 weeks. Outcome measures include pain (VSA), trunk mobility (Schöber index, distance from fingers to floor), muscle extensibility and muscle strength (Biering-Sorensen and Shirado-Ito test), and functional capacity (Quebec scale). RESULTS: Seventeen subjects were enrolled. The results suggest that both isokinetic exercise and physiotherapy result in improved range of motion, extensibility, muscle strength, and pain, without any significant superiority of one technique over the other. However, each technique has specific advantage. DISCUSSION: Despite methodologic limitations, this study shows that isokinetic exercise is not better than physiotherapy in reversing motor inhibition in chronic low back pain. Our results are consistent with those of other studies in the literature, with regard to the absence of established overall superiority of one exercise technique or program over the other in this population, and with regard to partial benefits of specific exercise techniques. CONCLUSION: The non-specific benefit of one technique indicates that further studies are needed to evaluate the benefit of combining exercise techniques in chronic low back pain, in order to address the multiple factors involved in this pathology.

Adult↗
PubMed2004

[Influence of speed variation and age on the intrasubject variability of ground reaction forces and spatiotemporal parameters of children's normal gait].

OBJECTIVE: To assess the effect of age and speed on the variability of ground reaction forces (GRF) and stride parameters of gait in normal children. MATERIAL AND METHOD: Forty-seven children aged 4-10 years were split into three age groups. Each child walked at three constant speeds on a treadmill. Thirty consecutive steps of each leg were recorded. For each child, the mean parameters of the 30 steps were calculated. The mean parameter of each child was taken to calculate the mean parameters of the group. The variability was evaluated by the coefficient of variation (CV). The influence of both age and speed on the variability was examined with a to-way analysis of variance. RESULTS: The cross effect of age and speed on the variability was not significant. The variability of the parameters decreased significantly with age between 4 and 8 years. The variability of vertical forces increased significantly with speed (between 2.7 and 4.5 km/h), while the variability of antero-posterior forces, the stride and the stance decreased between 2.7 and 3.6 km/h. However, the variability of double stance was not influenced by walking speed between 2.7 and 4.5 km/h. Except the time of production of the vertical force of propulsion (Tz3), the variability of temporal vertical parameters decreased significantly with speed between 2.7 and 4.5 km/h and the variability of temporal antero-posterior parameters decreased significantly between 2.7 and 3.6 km/h. DISCUSSION-CONCLUSION: The variability of the GRF and spatio-temporal parameters in children was influenced by age between 4 and 8 years old and by speed between 2.7 and 3.6 km/h. Moreover, the effect of age on the GRF persists up to 8 years. The variabilities of the time of production of the antero-posterior force of propulsion (Ty2) and stance duration were lower than the variabilities of the others parameters. These two variables could be the most reliable parameters when assessing gait in children aged 4-10 years, walking at speeds between 2.7 and 4.5 km/h.

Age Factors↗
PubMed2004

[Isokinetic assessment of muscular strength in subjects with acute inflammatory demyelinating polyradiculoneuropathy].

OBJECTIVE: To evaluate the feasibility and the interest of isokinetic measures tests in subjects with inflammatory demyelinating polyradiculoneuropathy or Guillain-Barré syndromes (GBS). METHODS: Nine patients with GBS are tested at the beginning and after 6 months of recovery stage. They benefit from (1) isokinetic assessment of muscular strength of knee, elbow, ankle: flexion/extension and shoulder abduction/adduction ranging 30 per s at 180 per s angular velocity; (2) isometric assessment of the same muscular groups; (3) manual muscle testing; (4) functional independence measure. RESULTS: Isokinetic tests were tolerated at 60 and 120 per s. Fatigability appears since the third second of isometric test. The relationships between isokinetic, manual tests and isometric tests are variables (0.29 < r < 0.97). The evaluation after 6 months of recovery showed a good sensibility of isokinetic test. CONCLUSION: The continuation of this motor isokinetic evaluation, in a large population, will permit to establish longitudinal and evolutive profile of each patient and will facilitate to chose the rehabilitation program.

Adolescent↗
PubMed2004

Dantrolene and pleural effusion: case report and review of literature.

STUDY DESIGN: Single-subject case (a quadriplegic female, 56 years). OBJECTIVES: To describe a new case of eosinophilic pleural effusion induced by dantrolene chronic administration. SETTING: Physical medicine and rehabilitation unit in a teaching hospital, France. METHODS: Diagnosis of an eosinophilic pleural effusion induced by dantrolene without any respiratory symptoms, except a decrease of breath sounds on the right lung base. RESULTS: Chest radiograph revealed a right-sided pleural effusion, and blood cell count a significant peripheral eosinophilia. Thoracenthesis contained 85% of eosinophils. The other explorations eliminated other causes of pleural effusion. The diagnosis of drug-induced effusion was almost sure and led us to discontinue the dantrolene. After 3 months, she had completely recovered. These characteristics, similar to the eight other cases described in the literature, are essential for the diagnosis of pleural effusion induced by dantrolene. CONCLUSION: Dantrolene, a long-acting skeletal muscle relaxant, is well known to induce liver side effects but it can also induce pleural pericarditis. The pathogenesis is still not clearly identified, but similarities of chemical structures of dantrolene and nitrofurantoine make us think that it could be the same mechanism. The association between dantrolene and nitrofurantoine may have contributed to the expression of the pleural effusion.

Dantrolene↗
PubMed2003

[Evaluation of the handicap and the quality of life in spinal cord injuries: study in a population of 58 patients living at home].

GOAL: The main purpose of this study was to identify objective factors (social and economic status, impairments, functional limitations) contributing to the subjective quality of life of subjects presenting with residual neurological deficits from a traumatic spinal cord injury (SCI) and living at home. SUBJECTS AND METHOD: This is a cross-sectional descriptive study of a sample of SCI patients followed at a Physical Medicine and Rehabilitation facility. After informed consent was obtained, a clinical and functional examination was conducted and questionnaires were filled out by the subjects. The following parameters were assessed: impairments (sensory and motor ASIA scores), disability (Barthel Index and Functional Independence Measure), and quality of life (Reintegration to Normal Living Index and Nottingham Health Profile). RESULTS: Fifty-eight subjects completed the study (mean age 41.38 +/-13.55 years and mean delay from onset 6.24 +/- 6.06 years). There was a strong significant correlation between the level of quality of life and the current age, the age at the time of the accident and the disability level, particularly for the dimensions of physical independence, social integration and mobility. CONCLUSION: Our results are consistent with published data, which identify age as a determining factor of quality of life after SCI. Our review of the literature indicated that time from onset influences quality of life. Longitudinal studies, taking into account the levels of social participation, are needed to better understand the impact of time on quality of life after SCI.

Activities of Daily Living↗
PubMed2002

[Relationship between burden of care at home and functional independence level after stroke].

OBJECTIVE: To determine the relationship between functional disability assessed with the Functional Independence Measure (FIM) and burden of care in hemiplegic stroke patients living at home. METHOD: The population is constituted of stroke survivors, initially treated in an academic inpatient Physical Medicine and Rehabilitation unit. Assessments included an evaluation of impairments (aphasia, negligence, cognitive impairment, motor impairment : Fugl-Meyer (FM) scale), disability (Functional Independence Measure (FIM) ), and burden of care (physical assistance and supervision). RESULTS: Forty-five subjects and their caregiver completed the assessments. Time spent on physical assistance and supervision were significantly correlated with FM and FIM scores. Cognitive deficits correlated with supervision time but not with physical assistance time. DISCUSSION-CONCLUSION: These results confirm the predictive value of functional independence measure relative to burden of care in a population of stroke patients with hemiplegia living at home. These results show that cognitive impairments are more specifically correlated with supervision time. This must be confirmed by studies taking into account functional and cognitive conditions of the patient, functional and psychological conditions of life of caregiver and also economical and environmental conditions of life.

Activities of Daily Living↗
PubMed2002

[Prevention of thromboembolic risk in spinal cord injury: results of a questionnaire concerning short- and long-term treatment].

INTRODUCTION: The use of medications to prevent thromboembolic risk is recommended in spinal cord injury patients during the early phase, but there is no consensus on treatment duration and modalities. Differences in practice include choice of medication (heparin, low molecular weight heparin, inhibitors of platelet aggregation), treatment duration (three to six months or more), and criteria for discontinuation of treatment. GOALS: To determine usual practice modalities for prophylaxis of deep vein thrombosis in spinal cord injury patients, and to identify determinant criteria. METHODS: Postal survey of physiatrists taking care of spinal cord injury patients. The questionnaire asks the physician about his usual practice modalities (choice of treatments, paraclinical tests, use of compressive stockings, during and after the first six months and criteria for discontinuation of treatments). RESULTS: Forty-two questionnaires were suitable for analysis. Results show that usual practice modalities combine venous doppler testing only in the setting of suggestive clinical signs, treatment with low molecular weight heparin during three to six months, and combination with compressive stockings. DISCUSSION: Despite the absence of consensus on this question, our results are consistent with data from the literature, which identify acute spinal cord lesions as a factor of high risk for deep vein thrombosis. The risk decreases during the chronic phase. Adjuvant techniques include mobilisation, elastic compression, and standing. A study of long-term treatment modalities after deep vein thrombosis would be needed.

Bandages↗
PubMed2001

[Quality of life of lumbago patients cared for in a pain center].

OBJECTIVE: To evaluate the quality of life of patients treated in a pain center. METHOD: Sixty eight patients were assessed during their first consultation, then 6, 12 and 18 months later, using a quality of life questionnaire "SQVP or Subjective Quality of Life Profile" validated in French populations and a panel of questionnaires for the monitoring of chronic pain, recommended by the ANAES (French Agency for Health Assessment). RESULTS: Results showed that: the patients' quality of life was clearly deteriorated (lowest quality in the data base--14,000 patients--with regard to the SQVP); the profile obtained (severe handicap) suggests that the lumbagos are part of a psychiatric context; the patients' quality of life clearly improves after 6 months' treatment, but the pain only stabilizes later.

Adult↗
PubMed2001

Validation of a new ergometer adapted to all types of manual wheelchair.

Research concerning the physiological and biomechanical parameters of wheelchair propulsion requires the use of an accurate and reproducible protocol. Although some research comparing different ergometers has been conducted, it is not easy to fulfil the requirements of the realistic simulation of propulsion together with the careful analysis of metabolic and biomechanical parameters of performance. The VP100H ergometer has been validated for this purpose by comparing the values of power output (W) and force exerted to accelerate the wheels (F) with the same measures obtained using a two-dimensional force transducer (platform). The reproducibility of the power was verified during a test re-test procedure. Ten sportsmen performed an incremental exercise. Maximal aerobic power (Waer,max), maximum oxygen uptake (VO2max), maximum heart rate (fcmax), % Waer,max/%VO2max relationship (aV) and %Waer,max/%fcmax relationship (aH) were calculated. Results indicated no significant differences (P > 0.05) in VP100H versus platform measurements for F and W. Errors of measured Fand W ranged from 0.89% to 7.56% and from 0.41% to 6.74%, respectively, depending upon the trunk muscles that participate in the propulsion. This corresponded to a maximum error of 4.9 W for W. No significant differences (P > 0.05) were observed during the test re-test procedure for Waer,max, VO2max, fcmax, aH and aV. The coefficient of variation of these values ranged from 1.4 to 9.5, and the correlation coefficient from 0.68 to 0.98. We conclude that the VP100H is valid for measuring W, and F, and that these values are reproducible (when tested 10 days later).

Adult↗
PubMed2001

[Functional assessment scales and lower limb amputation].

INTRODUCTION: This paper is a review of the literature on assessment tools in lower limb amputees. MATERIAL AND METHODS: The authors have research on Medline(R) data base the different tools with keys words "lower limb amputee or amputation, functional evaluation or outcome assessment tools, activity of daily living", and have completed the research with the references of papers. RESULTS: A comprehensive approach of the consequences of an amputation and of the outcome of prosthetic care should include an evaluation of gait, use of the prosthesis in activities of daily life, acceptability and satisfaction with the device. DISCUSSION: Functional assessment tools that are validated are recent, and most of them were developed in English. They take into account the use and the acceptance of the device, but there is no study using them for an important sample population. CONCLUSION: It is now necessary to translate the recent tools into French, and to confirm their validity and sensitivity to change.

Activities of Daily Living↗