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Biomedical subjects

P Thoumie

Publications and source records attributed to P Thoumie.

At least 19 recordsLinked to original sources
PubMed2006

Muscular compensation and lesion of the anterior cruciate ligament: contribution of the soleus muscle during recovery from a forward fall.

BACKGROUND: Knee stability following an anterior cruciate ligament lesion has been widely studied. Only recent studies focused on the contribution of the soleus muscle. Our purpose was to characterize the dynamic and muscular activity of balance recovery in healthy subjects and patients with an anterior cruciate ligament rupture. The role of the soleus was investigated in the ipsilateral compensation developed to stabilize the knee and in the contralateral compensation to recover balance. METHODS: Twelve anterior cruciate ligament deficient patients, ten anterior cruciate ligament repaired patients and 14 control subjects were recorded during a forward fall involving stepping to recover balance. FINDINGS: The dynamic of the centre of gravity remained normal when compared to the control group regardless of the treatment, suggesting an adapted compensation to knee instability in this situation. A bilateral increase in soleus activity was related to an increased duration in the balance recovery process in all patients. Patients used one of two strategies to recover balance regardless of the treatment: reducing the step length, involving an early recruitment of the soleus before heel contact, or anticipating braking with a similar step length requiring a predominant activity of the hamstrings. INTERPRETATIONS: These results suggest that bilateral activity of the soleus is involved to compensate for instability and highlight the contribution of the soleus to rehabilitation after an anterior cruciate ligament lesion, not only as a compensatory muscle acting at the knee level but also at a higher level in the bilateral control of stance.

Accidental Falls↗
PubMed2006

Perineal neuromuscular fatigue.

AIM: The physiology of urinary continence during stress is complex and the role of passive and active mechanisms remains unclear. Coughing leads to a contraction of urethral rhabdomyosphincter and pelvic floor muscles leading to a positive urethro-vesical gradient and continence. Neuromuscular fatigue can involve all striated muscles, including rhabdomyosphincter, peri-urethral and pelvic floor muscles. This article reviews results of studies assessing perineal muscular fatigue in urinary incontinence. MATERIALS AND METHODS: A systematic review of the literature (Medline, Pascal and Embase) with use of the MESH keywords fatigue, stress, urinary incontinence, pelvic floor, urethra, urethral pressure, and muscle. RESULTS: Animal models have shown that the pelvic muscles (iliococcygeus and pubococcygeous) exhibit more neuromuscular fatigue than classical skeletal striated muscles (i.e. soleus muscle). Although the human external urethral sphincter is considered to be a highly fatigue-resistant muscle with its high proportion of slow muscle fibers, repeated coughing seems to lead to decreased urethral pressure in numerous women affected with stress urinary incontinence. In this case, "urethral fatigue" might be a possibility. CONCLUSIONS: Although few studies have focused on perineal muscular fatigue, such increased fatigue in pelvic floor muscles may play a role in the pathophysiologic features of stress urinary incontinence in women.

Electromyography↗
PubMed2006

[Strength, postural and gait changes following rehabilitation in multiple sclerosis: a preliminary study].

OBJECTIVE: To evaluate the impact of rehabilitation on balance, gait and strength in inpatients with multiple sclerosis (MS). METHODS: Twenty-one in patients with MS benefited from a program of rehabilitation with evaluation before and after rehabilitation. Balance was assessed by stabilometry, walking speed with use of a locometer device and maximal peak torque of knee extensor and flexor with use of an isokinetic dynamometer at 60 degrees /s speed. The functional independence measure (FIM) was also applied before and after rehabilitation. RESULTS: After rehabilitation, patients showed significant improvement in balance with opened and closed eyes, velocity gait, strength of the lower quadriceps and the higher hamstrings and FIM values. Absolute values of gait speed and strength parameters were related as were improvement in velocity speed and the higher hamstrings. CONCLUSION: The results are encouraging and confirm the interest and tolerance of a program of rehabilitation among patients with MS.

Adult↗
PubMed2005

Motor determinants of gait in 100 ambulatory patients with multiple sclerosis.

A prospective analysis of gait and strength parameters was performed in 100 patients diagnosed with MS and pyramidal involvement admitted in a rehabilitation unit The patients were divided into two groups based on their ability to walk in daily life (nonassisted or cane-assisted gait) and into four clinical subgroups depending on associated involvements such as sensory loss or cerebellar ataxia. Twenty healthy subjects were studied as a control group. Gait parameters were evaluated with a Locometre and muscle strength with an isokinetic dynamometer. The results showed that the average velocity and strength of the hamstring and quadriceps were strongly correlated and reduced in the MS group in comparison with the control, and in the cane-assisted group compared with the nonassisted group. Gait velocity tended to be more correlated to hamstring strength in the nonassisted group with a determination coefficient (r2) reaching a value of 0.44 in the sensory subgroup. These findings provide evidence that a correlation between strength reduction and gait impairment is obvious whatever the clinical form in patients with MS. This correlation is higher with hamstrings but may change depending on the disability level and the clinical form. This could be taken into account in the individual assessment of further rehabilitation programmes.

Activities of Daily Living↗
PubMed2004

[Evaluation of physiological properties of ankle braces based on a review of the literature].

INTRODUCTION: The objective of this work was to proceed to a review of the literature to assess the physiological basis of the ankle brace use. METHOD: An analysis of the international literature relating to the years 1980-2002 was carried out by questioning the Medline data bank. RESULTS: Three hundred and twenty-two articles were collected and 25 physiological studies were retained. Various changes can occur during brace use, first of all stability parameters and proprioceptive sense. Main changes affect position sense, stiffness, mobility and stability of ankle when standing. DISCUSSION: This review of the literature allows to specify the mechanisms involved by brace use in ankle stability. Some studies allow to compare the principal devices used to stabilize the ankle (taping, semi rigid braces) but, no physiological study was able to discriminate between different orthosis models. CONCLUSION: Many studies have been conducted in the field of the physiological evaluation of ankle orthosis. When these devices are widely used in current medical practice, physiological studies do not allow to characterize a better device with a specific test. These data point out the methodological difficulties in ankle brace evaluation.

Ankle Joint↗
PubMed2003

[Relationship between gait speed and strength parameters in multiple sclerosis].

INTRODUCTION: Recent studies have focused on correlation between strength and gait parameters in hemiplegia, suggesting the interest for strength training in patients with central nervous system lesions. The aim of this study was to evaluate this correlation in multiple sclerosis (MS) patients with special regard to the different clinical forms including proprioceptive loss or cerebellar ataxia. PATIENTS AND METHOD: Gait speed and muscular function were performed in 27 patients with moderate affected gait (EDDS < 6). Gait speed was evaluated with Locometre and peak-torques of quadriceps and hamstrings were evaluated with isokinetic dynamometer. Patients were separated in three groups related to their deficiency: spastic group (8 patients), spastic with proprioceptive loss (12 patients) and spastic with cerebellar ataxia (7 patients). Gait parameters were evaluated in 10 healthy subjects as control group. RESULTS: Gait speeds (spontaneous and maximal) and peak torques of quadriceps and hamstring were similar in the three groups. In the whole patients group, gait speed was reduced and related to hamstring peak torque (r = 0.56 at spontaneous speed and 0.51 at high speed) but not with quadriceps peak torque. Patients with proprioceptive loss exhibited not only a higher correlation between gait speed and hamstring torque (r = 0.76 and 0.65 respectively) than other patients but also with quadriceps torque (r = 0.66 and 0.59 respectively) when patients in other groups did not. CONCLUSION: As it was previously pointed out in hemiplegic patients, MS patients exhibit some correlation between gait speed and muscle strength, mainly with hamstrings. These correlations can change in special sensory conditions suggesting that patients with sensory loss use different muscular strategies to maintain gait speed. Strength training may therefore be discussed in MS including specific modalities as a function of clinical parameters.

Biomechanical Phenomena↗
PubMed2003

[Multiple sclerosis and botulinum toxin].

INTRODUCTION: The aim of this work was to collect litterature datas to have an indication of botulinum toxin in multiple sclerosis disease. METHOD: The international literature relating the years 1982-2002 was carried out with the Medline data bank. The article presenting of the controlled studies were mainly retained. RESULTS: Thirty-seven articles were indexed, 6 were retained according to our criteria. The selected articles show mainly a use of botulinum toxin in the spasticity. The principal criteria of evaluation were the muscular tone, the spasms, the pain, the or passive amplitude of joint. Two articles report the effectiveness of toxin injection in acquired nystagmus and the paralysis of a vocal fold. DISCUSSION: This review shows that the principal indication of toxin in multiple sclerosis is spasticity with a good effectiveness of the treatment. However controlled-placebo studies among these patients are still very few. The side effects are rare but sometimes appearance of muscular weakness always making discuss the existence of a push. It is necessary to take account of these effects and their consequences before proposing the treatment. CONCLUSION: Botulinum toxin has an indication in the treatment of spasticity of patients with multiple sclerosis. However more studies are necessary with more sits of injection to fix the good indications.

Anti-Dyskinesia Agents↗
PubMed2002

[Knee orthosis. Evaluation of clinical efficiency with a review of the literature].

INTRODUCTION: The aim of this work was to collect literature data to assess the knee orthosis use with controlled clinical trials. METHOD: The international literature relating to the years 1980-2000 was carried out with the Medline data bank. RESULTS: Five hundred and twelve articles were collected and 35 were retained, 32 related to clinical studies and three related to toxicity. The evaluations were performed with either functional tests or clinical studies. The open-non controlled clinical trials are far higher than prospective comparative clinical trials that were developed only during last years. Main criteria of judgement are articular stability, functional pain and clinical index. Most of studies focused the anterior cruciate ligament lesions, patellar pains and osteoarthritis. DISCUSSION: This review of the literature may help to determine the interest and the limits of orthosis use as well as side effect occurrence. Both these clinical and experimental data point out the methodological difficulties facing the investigatory clinician in knee orthosis evaluation. CONCLUSION: Many studies contributed to the clinical evaluation of the knee orthosis. This work highlights various clinical indications for the same orthosis and variable results for the same indication. These methodological difficulties may not prevent a further evaluation of these devices to improve their use in current practice.

Anterior Cruciate Ligament↗
PubMed2002

Relation between walking speed and muscle strength is affected by somatosensory loss in multiple sclerosis.

OBJECTIVE: To evaluate the correlation between gait speed and strength in multiple sclerosis (MS) with particular regard to patients presenting with proprioceptive loss. METHODS: Gait evaluation and isokinetic testing of muscular function were performed in 20 patients with unaided gait (expanded disability status scale < 6). Patients were separated into two groups in relation to the occurrence of somatosensory involvement: pyramidal group (8 patients) and sensory-pyramidal group (12 patients). Ten healthy subjects of similar age, sex, and height constituted a control group to evaluate gait parameters. RESULTS: In the whole patient group, gait speed was reduced and strongly related to hamstring peak torque but not with quadriceps peak torque. The gait speed and peak torques of quadriceps and hamstrings were similar in both groups of patients. However, in the patients with proprioceptive loss there was both a strong correlation between gait speed and hamstring torque and a significant correlation with quadriceps torque. In the pyramidal group there was poor or no correlation. CONCLUSION: In patients with undifferentiated MS there is some correlation between gait speed and muscle strength. In the case of sensory loss, a higher contribution of both flexor and extensors of the lower limbs was observed, suggesting that muscular compensation occurred in this situation to maintain gait speed. These results are relevant to assess rehabilitation modalities in MS.

Adult↗
PubMed2001

[Knee orthosis. First part : evaluation of physiological properties based on a review of the literature].

INTRODUCTION: The aim of this work was to proceed to a literature review to determine the physiological justifications underlying knee orthosis use in medical practice. METHOD: An analysis of the international literature relating to the years 1980-2000 was carried out with the Medline data bank. We added extra articles focusing on the validity of the protocols used in the different evaluations. RESULTS: Five hundred and twelve articles were selected and 46 articles of experimental validation were retained. The experimental protocols are divided into in vitro studies and clinical studies carried out in both healthy subject and patients. Only the in vitro experimental data allowed to reach strain values simulating traumatisms of the articular structures. They allowed to define the interest and limits of the orthosis according to articular physiology. Measurements carried out in vivo were effective to characterize the parameters of stability and proprioception and to discriminate between the orthosis. These studies correspond to experimental situations with related constraints that remain far below lesional constraints, focusing on their clinical validity. CONCLUSION: This work point out many studies focusing on the physiological characterization of the knee orthosis. This evaluation of the orthosis through a single methodology remains difficult and justifies confrontation with clinical trials data.

Biomechanical Phenomena↗
PubMed1998

Clinical and functional evaluation of a gaze controlled system for the severely handicapped.

This preliminary study evaluates the suitability of a gaze controlled communication system for severely handicapped patients. The system drives a computer by movements of the patient's pupils. The capacity to communicate by producing text on a screen was assessed in 30 patients, 22 traumatic tetraplegics and 8 patients whose handicaps were due to other causes. The rate at which they learned to use the system, and the speed of their word processing were measured. Those tetraplegics who had used other communication systems found the gaze controlled system tiring, and its lack of other peripherals limiting. But its true application seems to be as the sole available interface for the most severely handicapped who can neither move nor speak. Peripherals and improved calibration systems are presently being developed.

Activities of Daily Living↗
PubMed1997

[A propos of an unusual case of lumbar-pelvic dislocation in a suicidal jumper].

PURPOSE OF THE STUDY: We report a particular case of lombo-pelvic dislocation in a suicidal jumper, characterized by a distal sacral fracture associated with bilateral fractures of both iliac wings. To our knowledge, it has yet not been described. MATERIAL AND METHODS: The patient was a 27 years old individual. On admission, he sustained the following injuries: hemodynamic shock with intraperitoneal bleeding due to disruption of the triangular ligament of the liver, which resolved with blood transfusions and did not require surgical treatment pelvic fractures initially identified as transverse fractures of both iliac wings, with bilateral avulsions of sciatic spines a compression fracture of the first lumbar vertebra without neurologic complication. In the intensive care unit, evolution was favorable. However, an incomplete cauda equina syndrome was noticed: the anal sphincter was flacid but perianal sensation to pinprick was conserved. An electromyogram showed that the latence of perineal reflexes was increased. The fracture and its displacement were recognized secondarily. A pelvic C.T. exhibited an increases in the antero-posterior dimension of the pelvic ring, due to a distal-displaced transverse sacral fracture. The proximal fragment of the sacrum remained attached to the iliac wing since sacro-iliac joints were intact, iliac wings had tilted forward, and the distal tip of the proximal sacral fragment was driven backward and inferiorly. RESULTS: The patient was maintained in the supine position during 3 months. He then rapidly recovered normal function of his lower limbs. He had normal gait patterns and pelvic static. He did not complain of any pain. Finally, the neurological deficit disappeared and he regained full sexual function and complete control of micturition. DISCUSSION: We think that this fracture should be considered as a variety of suicidal jumper's fracture described by Roy Camille et al. It has the same displacement as type 2 fracture in Roy Camille classification. In the emergency room, diagnosis is difficult, based on usual AP pelvic roentgenograms. A bilateral fracture of iliac wings in a suicidal jumper, especially if associated with bilateral sciatic spine avulsions, is an indication to a pelvic C.T.. A neurological perineal deficit should be ruled out. In our case, the perineal deficit can be attributed to the stretching of sacral roots resulting from a posterior displacement of the sacrum. The favorable evolution suggests that surgery may be not required, and there is no evidence in the literature that it would help neurological recovery. In distal fractures, the sacral canal is not narrowed, and a sacral laminectomy appears therefore not indicated. CONCLUSION: We have described a particular type of transverse fracture of the pelvis, which, in our mind, should be put in the same category as type 2 transverse fractures of the sacrum described by Roy Camille and al, in the suicidal jumper. Since there is no compression of sacral roots into the sacral canal, prolonged bedrest is likely to be the better treatment.

Adult↗
PubMed1996

Changes in motor activity and biomechanics during balance recovery following cutaneous and muscular deafferentation.

The effects of lower limb deafferentation were examined during execution of a balance recovery step following a forward fall induced by release of an initial inclined posture. The subjects were healthy control subjects and patients with a unilateral loss of the Achilles tendon reflex following S1 radiculitis. Deafferentation of healthy subjects was obtained by unilateral leg ischemia (four subjects) and by foot anesthesia (five subjects). The balance recovery step was characterized by the surface electromyographic (EMG) activity of right and left soleus and tibialis anterior muscles and the kinetics of the center of gravity and center of foot pressure. Experimentally induced and pathological deafferentation decreased the EMG activity of the ipsilateral soleus and lowered the vertical ground reaction force. The lower limb motor activity was more affected by loss of muscle proprioceptive afferents than by loss of plantar cutaneous afferents. Patients showed early and bilateral changes in soleus and tibialis activities, whichever side was affected. The step length of patients was also shorter than that of controls, but it remained similar before and after deafferentation in the healthy subjects. The results are discussed in terms of ipsilateral and crossed pathway connections and functional adaptive strategies.

Achilles Tendon↗
PubMed1996

Energy consumption of paraplegic locomotion using reciprocating gait orthosis.

The energy cost of walking using a reciprocating gait orthosis (RGOII) with functional electrical stimulation (FES) was assessed in 14 patients with spastic complete paraplegia from six rehabilitation centres. Before and after training asing RGOII with FES, the subjects performed a progressive maximal test on an arm-crank ergometer to obtain their laboratory peak oxygen uptake (LVO2peak), heart rate (HR) and blood lactate concentration changes. At the end of the training session, oxygen uptake (VO2) was measured during a walking test with orthosis at different speeds (6 min steady state at 0.1 m.s-1, followed by 2-min stages at progressively increasing speeds up to exhaustion). Of the subjects 4 repeated this test using orthosis without FES. At a speed of 0.1 m.s-1, VO2 represented 47 (SD 23)% of LVO2peak, mean HR was 137 (SD 21) beats.min-1 and mean blood lactate concentration 2.4. (SD 1.4) mmol.l-1. Maximal speed ranged from 0.23 to 0.5 m.s-1. At maximal speed, VO2 was 91 (SD 18)% of LVO2peak, mean HR reached 96 (SD 7)% and mean blood lactate concentration only 52 (SD 19)% of the maximal values measured during the laboratory test. Walking without electrical stimulation induced an increase in HR but there was no difference in VO2 and blood lactate compared to walking with stimulation. The training period did not result in any improvement in maximal physiological data. We concluded that the free cadence walking speed with orthosis remains much lower than that of able-bodied people or wheelchair users. The metabolic cost at a given speed is much higher even if, using a stimulation device, the cardiovascular stress is reduced.

Adult↗
PubMed1995

[Pain in paraplegic and tetraplegic patients].

Pain is a common complain in patients with spinal cord injury. Deafferentation, nociceptive stimuli and psychological component may both contribute in pain generating. Main importance of clinical evaluation may be pointed out since level of injury and complete or incomplete lesion may affect the expression of symptomatic pain and projection of neurological pain. Closed to symptomatic approach, pain treatment in spinal cord injured people consist in medical and rehabilitation. Chronic neurological pain remains still difficult and may take in account psychological factors.

Humans↗
PubMed1995

Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicentre controlled study. I. Clinical evaluation.

By means of a multicentric study in six rehabilitation centres, we assessed the RGO-II orthosis to restore functional gait in patients with spinal cord injuries. The 26 subjects participating in the study had spastic complete paraplegia. Twenty one had progressed to the training programme and 19 were able to stand up alone. The trained subject's walking distance ranged from 200 to 1400 m, while their walking speed ranged from 0.15 to 0.45 ms-1. A 2-month follow-up study revealed that, out of 15 patients using the hybrid orthosis, 11 were home users. Modalities and adverse effects of training are reported. The place of gait restoration with a hybrid orthosis in a rehabilitation programme is discussed.

Adult↗
PubMed1995

Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation.

We have investigated physiological changes in 21 patients with a spinal cord injury who were fitted with the RGO-II hybrid orthosis. All parameters were measured before and after a training programme in order to evaluate the benefit of gait rehabilitation, cardiovascular adaptation, constipation, spasticity and osteoporosis. A tendency for the improvement in cardiovascular function was noticed, and a segmental decrease in right colonic transit time was observed. However there was no reproducible change in spasticity, and no gain in bone mineral density. These data suggest that the physiological benefits which occur when patients walk with the aid of a hybrid orthosis only correct the effects of immobility. In addition, we did not find any physiological improvement regarding the neurological lesion (spasticity or osteoporosis).

Adult↗