Intérêts d’un pédalage unilatéral après une ligamentoplastie du genou chez des footballeurs amateurs

Objective

To examine cardiorespiratory fitness changes in subjects having undergone knee surgery and to assess the benefits of one-leg cycling aerobic training program during the rehabilitation period.

Method

Two groups of 12 patients took part in this study. The control group profited from a five-week conventional rehabilitation in day hospital without cardiorespiratory training. The second group profited in supplement from a one-leg cycling aerobic training program with the valid leg. The subjects were trained for 21 minutes, by alternating three minutes at 70% and three minutes at 85% of VO_2peak. They totaled 15 sessions spread over five weeks. The initial evaluation (T1) is carried out the first day of rehabilitation and the final evaluation (T2) at a distance within 35 days. The evaluation consisted in realizing a maximal graded tests starting from the valid leg.

Results

After five weeks of conventional rehabilitation, we recorded a reduction of peak power output (W_peak), peak oxygen uptake (VO_2peak) and peak minute ventilation (VE_peak), respectively of 11, 12 and 13% for the control group. On the other hand, in T2, the training group has on average identical maximum values and some of them increased (W_peak = +14%; VE_peak = + 15%). The first and second ventilatory thresholds appear with higher intensities of exercises.

Conclusion

After knee surgery, conventional rehabilitation does not limit cardiorespiratory deconditioning. One leg cycling appears to be an adapted method to stop the effects of hypoactivity.     

Plaidoyer pour une mobilisation précoce dans les ruptures du tendon calcanéen opérées

This work puts forward a quick program of rehabilitation for operated Achilles’ tendons. From a review of the literature, we call back the following in the rehabilitation of tendinous ruptures over a period of 25 years. We insist on the interest of such a method in order to improve the overall care of the patients. There are many theoretical benefits such as a better scar on biomechanical aspects, quicker articular amplitudes, less complication due to immobilization, less physical therapy sessions, a quick return to physical and professional activities. To train such mobilizations, different devices are used either articulated splints close to the instep, or anterior/posterior plastered splints of the leg. Whatever device has been chosen, it allows gentle mobilizations of the ankle while protecting the surgical act by locking the dorsal flexion of the foot. This kind of therapy must be appropriate to the patient and be especially supervised by PMR doctors in order to avoid a repeated rupture which is the main complication.     

Instabilité d’épaule et isocinétisme : apport de l’isocinétisme dans une situation clinique complexe

Introduction

The treatment of shoulder instability is codified. In case of a resistant instability to a well-conducted rehabilitation, the surgery can be proposed with good results. Sometimes, the situation can be more complex, and the case report presents the interest of isokinetics as an alternative therapeutic.

Case report

A man of 36 years, operated of Latarjet for recurrent anterior dislocation of the shoulder, presented in postoperation an infectious osteoarthritis. After recovery of the infectious episode, in a painful and stiffness shoulder, shoulder instability repeated with a clinical examination agreeing and an evocative context: failure of the surgical treatment, osseous postinfectious rehandlings. The surgery having been excluded and traditional rehabilitation having shown its limits. A rehabilitation oriented by the research of a muscular imbalance in isokinetic evaluation permitted a functional improvement with disappearance of the instability feeling.

Discussion

In complex clinical situations, isokinetic evaluation showed an interest to adapt and to optimize rehabilitation. A practical application of isokinetics is in the pathologies of articular instability and in particular the shoulder instability. The positions of evaluation will be adapted to the patients. That opens new prospects in rehabilitation.

Conclusion

This case report illustrates isokinetic interest for an objective and rigorous assessment of muscular strength and so an adaptation and optimization of the rehabilitation.     

Fascial therapy,strength exercises and taping in soccer players with recurrent ankle sprains: A randomized controlled trial

IntroductionRecurrent ankle sprains are common in soccer players, characterized by restricted range of motion, pain, and decreased proprioception, strength, and postural control. The objective was to evaluate the effectiveness of a fascial therapy and strength training program, combined with kinesiotaping, in improving ankle range of motion, pain, strength and stability in footballers with recurrent sprains.MethodA simple blind randomized clinical trial was conducted on soccer players. Thirty-six federated footballers were recruited and randomized to the two study groups. The experimental group received an intervention using myofascial techniques applied to the subastragaline joint, eccentric training with an isoinertial device and neuromuscular taping. The control group was administered an intervention using myofascial techniques on the subastragaline joint and eccentric training with an isoinertial device. The results were recorded for all players at baseline, after 4 weeks of intervention, and at the end of the 4-week follow-up period.ResultsSubsequent to intervention and follow-up, we found statistically significant improvements in the experimental group in ankle mobility, strength and stability. The control group exhibited improvements in all study variables. No differences in the improvement of variables were found based on the allocation of athletes to one group or another.ConclusionThe combination of fascial therapy and eccentric strength training with an isoinertial device improves ankle mobility, strength and stability in footballers with recurrent ankle sprains. The use of taping techniques failed to provide a greater improvement of the study variables when combined with manual therapy and strength techniques.     

Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study

de Araújo RC, Junior FL, Rocha DN, Sono TS, Pinotti M. Effects of intensive arm training with an electromechanical orthosis in chronic stroke patients: a preliminary study.

Objectives

To evaluate the use of an electromechanical device, comprising an exoskeleton, a static orthosis, and a glove, for functional rehabilitation of the elbow and hand in patients with hemiparesis, and to compare it with physical therapy rehabilitation.

Design

Pretest-posttest design.

Setting

Rehabilitation laboratory.

Participants

Volunteer sample of persons (N=12) with persistent hemiparesis from a single, unilateral stroke within the past 3 to 36 months.

Interventions

The volunteers were randomly divided into 2 groups. One group was treated with a conventional program of physiotherapy, and another group participated in a training program in which an electromechanical orthosis was used. All volunteers received 24 sessions, held 3 times a week for 8 weeks.

Main Outcome Measures

Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), and electromyogram (EMG) amplitude.

Results

No statistical difference was found in the initial and final values of the MAS. Both groups showed a significant increase for the total scores of the FMA. However, only the group treated with the orthosis showed an increase in FMA scores related to the wrist and hand joint. The EMG analysis showed increased EMG amplitudes for all muscles in the group treated with the orthosis, whereas the group treated with physiotherapy showed gains in electromyographic activity only in the extensor digitorum communis. Intergroup comparison showed that the initial FMA scores of the wrist/hand were higher in the group treated with physiotherapy. However, after training, the scores in the group that used the orthosis were equivalent to those of the physiotherapy group.

Conclusions

The results suggest that this device can be an auxiliary tool to help the conventional rehabilitation program of motor function of the affected upper extremity.     

综合康复疗法治疗汶川地震伤员周围神经损伤24例临床疗效观察

目的报告综合康复治疗方法对汶川地震伤员周围神经损伤的治疗效果。方法对四川大学华西医院地震伤员医疗康复中心符合纳入标准的24例周围神经损伤患者，进行包括运动疗法、针刺疗法、功能性电刺激及作业治疗（感觉训练、矫形器的佩戴为主）等综合康复治疗。治疗30次后，采用英国医学研究会BMRC周围神经损伤后的运动功能恢复等级及周围神经损伤后感觉功能恢复等级评定、上肢功能活动的评定及电诊断检查评价疗效，同时记录合并损伤情况。结果治疗后24例BMRC周围神经损伤患者的运动功能恢复等级及感觉功能恢复等级评价的疗效优良率为41．66％；简易上肢机能检查治疗前后评分差值差异有统计学意义（P〈0．01）；肌电图、神经传导速度检测评定治疗前后疗效有效率87．50％。合并损伤越多，恢复越差。结论综合康复治疗可明显改善汶川地震伤员周围神经损伤的运动和感觉功能障碍。     

Coalitions du tarse ou « fausses entorses » de l’enfant et de l’adolescent. À propos d’un cas

Tarsal coalitions, also called synostoses, are a cause of pain and gait disturbance in children and adolescents. They are often diagnosed as tarsal sprains, leading to an inappropriate functional prognosis. This is the case of an 8-year-old child with talo-calcaneum synostosis, presenting pain, hind-foot stiffness and marked disability in daily life activities and sports.     

Les accidents des muscles ischiojambiers. Un comportement très excentrique

Acute hamstring muscle strains are common in sports and are often causing extended absence from training and competition. Hamstring strains occur in slow speed stretching exercises and primarily during activities with excentric contraction of hamstring. Rehabilitation can be divided into restoration of muscle structure, function, activity and comeback to sports training. We propose a rather strict progressive protocol for field retraining to minimize the risk of recurrence.     

The role of tilt training in preventing recurrent syncope in patients with vasovagal syncope: a prospective and randomized study

Background: Recurrent vasovagal syncope (VVS) can be a severely disabling disorder that may lead to an important deterioration of quality of life because of the severity and recurrence of episodes. This study sought to investigate the effectiveness of repeated orthostatic self-training in preventing syncope in patients with recurrent VVS.
Methods: Eighty-two consecutive patients (mean age 41 ± 4 years, 37 males) with recurrent VVS episodes and positive head-up tilt testing (HUT) were enrolled in this study. The patients were then randomized (1:1) to conventional therapy or conventional therapy plus additional tilt training sessions. The patients were followed for spontaneous syncope for one year. Primary end-points were the recurrence of syncope, the number of episodes, and the interval of time to the first recurrence.
Results: There were no significant differences of baseline clinical characteristics and parameters of HUT between the tilt training and control groups. The patients had 4 ± 2/year syncopal episodes prior to the HUT. The mean follow-up after randomization was 12 ± 2 months. Spontaneous syncope recurrence during follow-up was 56% (23 patients) versus 37% (15 patients) in the control and tilt training groups, respectively (P = 0.1). Time to first recurrence was also similar in both groups (70 ± 20 days vs 50 ± 15 days, P = 0.09). The frequency of recurrent syncopes was similar in all types of VVSs while the rate of episodes was significantly higher in control group in patients with vasodepressor type during follow-up period (32% vs 10%, P = 0.04). The mean number of recurrent syncope episodes was also similar in both groups (3 ± 1 vs 2 ± 1, P = 0.4).
Conclusions: Tilt training was unable to influence the spontaneous syncope recurrence for recurrent VVS except for vasodepressor type.     

电脑肺功能康复治疗机的研制和临床应用

目的：研制一种具有呼吸训练和电流排痰功能的呼吸康复治疗仪器,并观察其应用效果。方法：仪器以单片计算机处理系统作为主机并存储两类程序。它既可输出两组不同的声、光和电信号,创立一种新的呼吸训练方法（呼吸电刺激训练）,又可输出干扰电流用于排痰治疗。５８例慢性阻塞性肺病（ＣＯＰＤ）患者进行呼吸电刺激训练,５５例排痰困难患者进行干扰电治疗。结果：ＣＯＰＤ患者呼吸电刺激训练的总有效率为９６％,干扰电流排痰治疗的总有效率为８７％。结论：该治疗仪有明显的肺功能康复作用和排痰治疗作用,值得在临床推广应用。     

Sport injury prevention in individuals with chronic ankle instability: Fascial Manipulation® versus control group: A randomized controlled trial

Chronic ankle instability (CAI) is one of the most common syndromes that occurs following an initial ankle sprain. Sprains are often correlated with recurrent sprains, loss of range of motion (ROM) and deficits in proprioception and postural control. The objectives were to evaluate the effectiveness of Fascial Manipulation^® (FM) as a preventative measure in semi-professional athletes with CAI, and to monitor the symptomatology, equilibrium and ROM of the injured ankle.A single-blinded randomized controlled trial was conducted in the rehabilitation department of a medical centre. Twenty-nine semi-professional male footballers were recruited. Nine subjects with no previous symptomatology, were assigned to a baseline group, twenty symptomatic subjects were randomized into either the study or the control group. All three groups followed a specific training program. The control group followed normal training protocols and received standard medical care. The study group received an additional three FM treatment sessions.Symptomatology and ROM outcomes were recorded for all players at baseline, before each treatment for the treatment group, and at 1-, 3-, and 6-month follow-ups. At one year, an additional follow-up on was performed via phone.Four severe ankle traumas and one mild ankle trauma were reported in the control group during the trial period. The 6-month outcomes in the study group showed statistically significant improvements. The 1-year follow-up reported the absence of any reported trauma in the study group.FM was effective in improving ROM and symptomatology in footballers with CAI. FM intervention was effective in preventing injury in the study sample.     

La rééducation d'emblée des ischiojambiers après chirurgie du DIDT

Introduction

Following knee ligamentoplasty, the task of muscle restoration principally focuses on the hamstrings, which are the only active structure which can protect the graft and prevent detachment. However, specialists generally advise against work on these muscles for a period of 3–6 weeks following semi-tendinosus and gracilis surgery. The hamstrings are thus left resting during this period, which encourages their wasting and tightening.

Objective

Our team, guided by the principles of rehabilitation for muscular problems, has for more than 2 years been strengthening the hamstrings immediately following ligamentoplasty surgery, making use of the semi-tendinous and gracilis. The objective is not only muscle performance and the protection of the graft, but above all encouraging the healing of the semi-tendinous and gracilis in order to align the collagen fibres and improve their mechanical resistance.

Content

It is a single-focus study, continually rolled forward. This protocol was practised on 56 patients, two patients having to withdraw from the programme because of strain problems.

Methodology

During the hospitalisation of the patient, concentric contraction of the knee flexors was engendered using weak resistance operated manually. Later in our rehabilitation centre, our patients exercised in a hamstring « chair », in the eccentric mode below maximum charge, with an increasing load progression. This was done daily up to the sixth week.

Results

Our results, at the 3rd and 6th week post-surgery, showed a favourable change in articular amplitude and pain suffered, with a low rate of complications. Evidence of pain was found in 12.5% of cases (7/56). Of these 7 patients, 2 (3.5%) had incidents involving muscular strain, rendering the interruption of the physiotherapy necessary for more than 3 consecutive days. Isokinetic results carried out at 4.6 ± 0.7 months showed excellent muscular recuperation of the hamstrings with a deficit of 9.6 ± 14% at slow speed and of 6.8 ± 13.1% at fast speed compared with the heterolateral side.

Discussion

The number of painful occurrences in our study, at 12.5%, is lower than the 20% ad higher frequently found in other documented cases. However the definition of these painful occurrences is imprecise. The performance deficit of hamstrings measured by isokinetic tests after 6 months varied between 15 and 20% depending upon the published study. In our study the results at 4.6 months were better (< 10%).

Conclusion

There can no longer be any doubt about the benefits of strengthening the hamstrings in pathologies of an anterior cruciate ligament. Our work has shown that the early strengthening of these muscles is not disadvantageous. On the contrary we believe that our policy promotes the patient's muscular and functional recovery.     

截瘫步行器的仿生效果

背景：截瘫步行器的临床应用,使截瘫患者重建步行功能成为可能,但截瘫步行器只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远。目的：对目前几种截瘫步行器的结构特点、作用机制及仿生效果进行归纳、分析。方法：应用计算机检索1990-01/2008-12PubMed数据库及万方数据库有关截瘫步行器的特点、仿生效果及临床应用方面的相关文献,英文检索词＂reciprocation gait orthosis,walkabout,bionice＂,中文检索词＂截瘫步行器,仿生＂。检索文献量总计32篇。结果与结论：目前无动力截瘫步行器运用较广泛,但对截瘫患者来说,通常只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远。运用最广的往复式截瘫步行器和互动截瘫步行器这两种截瘫步行器仿生效果较差,步态严重失真,体能消耗大,而由外部能源补充能耗的步行器则可以克服无动力步行器的不足,随着人工智能技术在机器人和许多工业领域得到了广泛应用,它的发展可为患者提供性能优良,安全可靠,更具有仿生性的截瘫步行器产品。     

Transforming Magnetic Resonance Imaging Education through Simulation-Based Training

IntroductionClinical instructors are facing the challenge of limited clinical training sites as the opportunities to train on actual patients become less available. In addition, work regulations, productivity requirements, and patients’ awareness of trainees “practicing” on them has led to a decline in training opportunities. These factors reduced training experience into fewer direct patient encounters, and fewer opportunities to perform procedures. This study assesses the perception of students on the MRI simulation training for undergraduate medical imaging students.MethodsThis action research study used a triangulation method to integrate quantitative and qualitative data. After participation in six simulated MRI training sessions, students completed a questionnaire and focus group discussion to assess their perceptions. Percentage distributions were calculated for the questionnare and qualitative comments were summarized using thematic content analysis to identify recurrent themes.ResultsThe MRI simulation program was well received by students. Simulation proved to be an effective educational method, providing a comfortable learning environment for learning.The study confirmed the constructive role of simulation in MRI education and preparation for clinical practice as 69% endorsed using the learned skills during simulation in clinical practice. Simulation training also helped to identify areas for improvement in practice and learning from mistakes (60%).ConclusionsThe results of this study support the use of simulation in MRI education and demonstrate that MRI-simulated training sessions were well received by radiography students. Students perceived both educational and clinical benefits from this simulation training session.     

Hernie discale,microchirurgie et sport. De la rééducation au retour sur le terrain

Background

Microdiscectomy of lumbar disc herniation changed rehabilitation after lumbar disc surgery of athletes.

Hypothesis

Returning to a high activity level after microdiscectomy for athletes versus possible with a well-conducted rehabilitation and athlete training.

Methods

Thirty-three athletes (29 males and four females with a mean age of 30.8 years, range: 20–49 years) were identified in Centre européen de rééducation du sportif (CERS) during 2007–2008 after lumbar disc microdiscectomy. By phone, 31 answered a Oswestry's low back pain disability questionnaire, a Prolo's questionnaire, gave the delays of training's resumption, of competition return and the importance of residual pain with numeric verbal scale (0 to 10).

Results

At the time of the inquiry, the average post-surgery delay was 768 days (from 405 at 1642 days). The mean Oswestry's disability questionnaire was 6.5 (range: 0–32) and the median sum of Prolo's scales was 8.9 (range: 3–10). Forty-three percent of athletes have pain estimated at 4. On a scale from 0 to 10, mean score of functional abilities was 8.6. Seventy-seven percent of athletes returned jogging 4.9 months (range: 1.5–10 months), 81% returned training 6.5 months and 52% athletes came back competition at 8.2 months with 33% returned to sport on previous level.

Discussion and conclusion

The authors discuss the literature's data and conclude that the rehabilitation must be early, heavy, long until return on the field.     

Effect of a virtual reality-enhanced exercise protocol after coronary artery bypass grafting

BACKGROUND AND PURPOSE: Virtual reality (VR) technology has gained importance in many areas of medicine. Knowledge concerning the application and the influence of VR-enhanced exercise programs is limited for patients receiving coronary artery bypass grafting. The purpose of this study was to evaluate the effect of a virtual "country walk" on the number of sessions necessary to reach cardiac rehabilitation goals in patients undergoing coronary artery bypass grafting. SUBJECTS: Twenty subjects who were seen for cardiac rehabilitation between January and June 2004 comprised the study sample. METHODS: The protocol for this study included an initial maximum graded exercise tolerance test, given to determine the subsequent training goals for the subject, followed by biweekly submaximal endurance training sessions. All subjects were assigned by lot to 1 of 2 submaximal endurance training programs, one (group 2) with and the other (group 1) without the added VR environment. In all other respects, the 2 programs were identical. Each training session lasted for 30 minutes and was carried out twice per week for about 3 months. The primary outcome measures were maximum load during the work sessions, target oxygen consumption, target heart rate (beats per minute), and number of training sessions required to reach rehabilitation goals. RESULTS: By the end of 20 training sessions, only 4 of the 10 control subjects had reached the heart rate target goal of 85% their maximum heart rate. In contrast, 9 of the 10 subjects in the VR program had attained this goal by 9 or fewer training sessions. When target metabolic cost (75% peak oxygen consumption) was used as the training goal, all 10 subjects in the VR program had reached this target after 2 training sessions (or, in some cases, 1 training session), but not until training session 15 did a cumulative number of 9 control subjects reach this goal. DISCUSSION AND CONCLUSION: These study outcomes clearly support the notion that incorporating a VR environment into cardiac rehabilitation programs will accelerate maximum recovery of patients' cardiovascular function.