Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 27
Filter
1.
Dig Liver Dis ; 2024 Sep 02.
Article in English | MEDLINE | ID: mdl-39227293

ABSTRACT

BACKGROUND: Gastrointestinal (GI) bleeding is a leading cause of intensive care unit (ICU) admission in pancreatic cancer patients. AIMS: To analyze causes, ICU mortality and hemostatic treatment success rates of GI bleeding in pancreatic cancer patients requiring ICU admission. METHODS: Retrospective multicenter cohort study between 2009 and 2021. Patients with a recent pancreatic resection surgery were excluded. RESULTS: Ninety-five patients were included (62 % males, 67 years-old). Fifty-one percent presented hemorrhagic shock, 41 % required mechanical ventilation. Main GI bleeding causes were gastroduodenal tumor invasion (32 %), gastroesophageal varices (21 %) and arterial aneurysm (12 %). Arterial aneurysms were more frequent in patients with previous pancreatic resection (36 % vs 2 %, p < 0.001). Hemostatic procedures included gastroduodenal endoscopy in 81 % patients and arterial embolization in 28 % patients. ICU mortality was 19 %. Multivariate analysis identified four variables associated with mortality: performance status >2 (OR 9.34, p = 0.026), mechanical ventilation (OR 14.14, p = 0.003), treatment success (OR 0.09, p = 0.010), hemorrhagic shock (OR 11.24, p = 0.010). Treatment success was 46 % and was associated with aneurysmal bleeding (OR 29.89, p = 0.005), ongoing chemotherapy (OR 0.22, p = 0.016), and prothrombin time ratio (OR 1.05, p = 0.001). CONCLUSION: In pancreatic cancer patients with severe GI bleeding, early identification of aneurysmal bleeding (particularly in case of previous resection surgery) and coagulopathy management may increase the treatment success and reduce mortality.

2.
Dig Liver Dis ; 56(3): 514-521, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37718226

ABSTRACT

BACKGROUND: We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. PATIENTS AND METHODS: Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). RESULTS: 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3-4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3-4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. CONCLUSION: Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission.


Subject(s)
Pancreatic Neoplasms , Shock, Septic , Humans , Retrospective Studies , Hospital Mortality , Intensive Care Units , Hospitalization , Pancreatic Neoplasms/therapy
3.
Neurophysiol Clin ; 45(3): 181-90, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25911975

ABSTRACT

AIMS OF THE STUDY: To evaluate a dual-task named the "Stroop Walking Task", which is similar to the task of making a decision of whether to cross a street based on a pedestrian traffic light. PATIENTS AND METHODS: Fifty-one subjects (15 young adults, 21 subjectively healthy old subjects and 15 old subjects with mild cognitive impairment) had to respond to a visual signal (pictogram) with an appropriate motor response (walk or stop). We used an electronic walkway system to record the gait parameters and performed a cluster analysis on the obtained data. RESULTS: This dual-task enables the early detection of executive function impairment with 89% sensitivity and 87% specificity. CONCLUSION: The use of a dual-task that is inspired by an everyday event as an evaluation tool seems to facilitate the detection of ageing subjects' cognitive impairment, which is not detectable with traditional psychometric tests.


Subject(s)
Cognitive Dysfunction/diagnosis , Executive Function , Stroop Test , Walking/psychology , Adult , Aged , Aged, 80 and over , Cognitive Dysfunction/psychology , Female , Gait , Gait Disorders, Neurologic/physiopathology , Humans , Male , Middle Aged , Neuropsychological Tests , Photic Stimulation , Psychomotor Performance , Reproducibility of Results , Young Adult
5.
J Nutr Health Aging ; 18(3): 303-6, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24626759

ABSTRACT

BACKGROUND: The psychological burden suffered by elderly subjects after a fall adds to rehabilitation difficulties. We hypothesised that Post Traumatic Stress Disorder (PTSD) may be at the root of these psychological post-fall problems. The immediate psychological state was examined after 2 months post-fall in order to determine the prevalence of anxiety and PTSD and their possible correlates. METHOD: A single centre prospective survey including elderly subjects referred to an emergency department (ED) after a fall with a 2-month follow-up. RESULTS: 30.5% of patients showed a significant level of anxiety after their fall and (26%) showed evidence supporting the presence of PTSD at 2-months. Immediate anxiety, ability to re-establish upright posture and a history of repeated falls were significant predictors of PTSD at 2-months. CONCLUSION: persistent psychological problems post fall may be related to PTSD which is significantly correlated to immediate anxiety. This study can be seen as a first step in patient characterisation, and predicts who may benefit from which of the various approaches of rehabilitation.


Subject(s)
Accidental Falls , Anxiety/etiology , Stress Disorders, Post-Traumatic/etiology , Stress, Psychological/etiology , Aged , Aged, 80 and over , Anxiety/psychology , Emergency Service, Hospital , Female , Follow-Up Studies , Humans , Male , Pilot Projects , Posture , Prospective Studies , Rehabilitation , Risk , Stress Disorders, Post-Traumatic/psychology , Stress, Psychological/psychology , Time Factors
6.
Neurophysiol Clin ; 43(4): 229-36, 2013 Oct.
Article in English | MEDLINE | ID: mdl-24094908

ABSTRACT

AIM OF THE STUDY: The objective of this preliminary study was to evaluate the effectiveness, in terms of fall reduction, of an in-home strategy that we have developed for elderly fallers. We also aimed at finding links between the expected changes in the data obtained in static posturography and in clinical balance tests through our program. PATIENTS AND METHODS: Twelve elderly patients living at home who were diagnosed as fallers (5 males and 7 females; 77.9±4.1 years) participated in the study. Our multimodal intervention lasted 6 months. Before this period, and one year later, an evaluation was conducted using cognitive (MMSE), clinical balance tests (i.e. Berg Balance Scale, Balance One leg, Timed Up and Go, and Functional Reach tests) and static posturography (where the area of body sway, velocity and medio-lateral and antero-posterior amplitudes were recorded twice, first with eyes open and then with eyes closed). RESULTS: Among the 12 patients who were diagnosed as fallers, eight became non-fallers. When comparing data obtained after the intervention with those obtained beforehand, we found significant changes in all of the clinical balance tests and in the posturographic-derived variables indicating improvements in the balance control in our group of subjects. We also found significant correlations between the changes in the Berg Balance Scale scores and the changes in the area of body sway data, in antero-posterior amplitude both with eyes open and with eyes closed, and also in the medio-lateral amplitude in the eyes closed condition. CONCLUSIONS: We prospectively demonstrated the relevance of our anti-falling intervention at home and of the use of posturography for clinical follow-up.


Subject(s)
Accidental Falls/prevention & control , Postural Balance/physiology , Aged , Female , Humans , Male , Prospective Studies
7.
Clin Interv Aging ; 8: 317-28, 2013.
Article in English | MEDLINE | ID: mdl-23682211

ABSTRACT

BACKGROUND: Several studies have reported the potential value of the dual-task concept during locomotion in clinical evaluation because cognitive decline is strongly associated with gait abnormalities. However, current dual-task tests appear to be insufficient for early diagnosis of cognitive impairment. METHODS: Forty-nine subjects (young, old, with or without mild cognitive impairment) underwent cognitive evaluation (Mini-Mental State Examination, Frontal Assessment Battery, five-word test, Stroop, clock-drawing) and single-task locomotor evaluation on an electronic walkway. They were then dual-task-tested on the Walking Stroop carpet, which is an adaptation of the Stroop color-word task for locomotion. A cluster analysis, followed by an analysis of variance, was performed to assess gait parameters. RESULTS: Cluster analysis of gait parameters on the Walking Stroop carpet revealed an interaction between cognitive and functional abilities because it made it possible to distinguish dysexecutive cognitive fragility or decline with a sensitivity of 89% and a specificity of 94%. Locomotor abilities differed according to the group and dual-task conditions. Healthy subjects performed less well on dual-tasking under reading conditions than when they were asked to distinguish colors, whereas dysexecutive subjects had worse motor performances when they were required to dual task. CONCLUSION: The Walking Stroop carpet is a dual-task test that enables early detection of cognitive fragility that has not been revealed by traditional neuropsychological tests or single-task walking analysis.


Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/physiopathology , Gait Disorders, Neurologic/physiopathology , Psychomotor Performance , Adult , Aged , Aged, 80 and over , Analysis of Variance , Cluster Analysis , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Sensitivity and Specificity
8.
Neurophysiol Clin ; 42(3): 133-7, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22500703

ABSTRACT

INTRODUCTION: Posturographic measurements are often performed in hospital in the context of assessing fall risks in elderly subjects. These hospital visits may generate different kinds of stimuli that could influence test outcomes. STUDY AIM: The aim was to investigate whether posturographic measurements performed both at home and in hospital in a randomized order provide similar data. METHODS: Thirty-five healthy elderly subjects (average age 72.5 ± 3.7 years) were assigned to two postural evaluations performed in a random order: one at home and one at the hospital. Before the first evaluation, subject's levels of anxiety, depression and stress were assessed. Then, the area of body sway, velocity and medial-lateral and antero-posterior amplitudes were recorded twice, first with the subject's eyes opened and then with eyes closed. RESULTS AND DISCUSSION: The posturographic data obtained in hospital and at home were quite similar. However, when the group that was first evaluated in hospital was compared with the group first evaluated at home, the medio-lateral amplitude was observed to significantly decrease in the second evaluation compared with the data obtained in the first trial (P<0.05), and this decrease was significantly higher in the first group (P<0.05). For the eyes-opened condition, we found significant correlations between anxiety and the area of body sway, stress and the area of body sway, and anxiety and the medial-lateral amplitude. CONCLUSIONS: Psychological factors may influence some posturographic data, and carrying out posturographic evaluations at home for elderly subjects could be a reasonable strategy.


Subject(s)
Postural Balance/physiology , Aged , Anxiety/physiopathology , Anxiety/psychology , Female , Hospitals , Humans , Male , Photic Stimulation , Social Environment
9.
Clinics (Sao Paulo) ; 65(9): 895-903, 2010.
Article in English | MEDLINE | ID: mdl-21049218

ABSTRACT

CONTEXT: The multifactorial nature of falls among elderly people is well-known. Identifying the social-demographic characteristics of elderly people who fall would enable us to define the typical profile of the elderly who are at risk of falling. OBJECTIVE: We aimed to isolate studies in which the social-demographic risk factors for falls among the elderly have been evaluated and to carry out a meta-analysis by combining the results of all of these selected studies. METHOD: We did a systematic literature review using the key words "accidental fall / numerical data" and "risk factors." Inclusion criteria entailed the selection of articles with the following characteristics: population of subjects aged 60 years or over, falls that took place in everyday life, and social-demographic risk factors for falls. RESULTS: 3,747 indexed articles published between 1981 and 2007 were identified, and 177 studies with available data were included, of which 129 had data on social-demographic risk factors for falls. Difficulties in activities of daily living (ADL) or in instrumental activities of daily living (IADL) double the risk of falling: The OR and 95% Cl were 2.26 (2.09, 2.45) for disturbance ADL and 2.10 (1.68, 2.64) for IADL. The OR and 95% Cl for Caucasians were 1.68 (0.98 - 2.88) and 0.64 (0.51 - 0.80) for Hispanics. In the subgroup of patients older than eighty, being married protected people from falling with an OR and 95% Cl =0.68 (0.53 - 0.87). CONCLUSION: Defining factors that create a risk of falling and protect elderly people from falls using social-demographic characteristics lets us focus on an "at risk" population for which a specific program could be developed.


Subject(s)
Accidental Falls/statistics & numerical data , Aged , Female , Humans , Male , Risk Factors , Socioeconomic Factors
11.
Clinics ; 65(9): 895-903, 2010. ilus, graf, tab
Article in English | LILACS | ID: lil-562831

ABSTRACT

CONTEXT: The multifactorial nature of falls among elderly people is well-known. Identifying the social-demographic characteristics of elderly people who fall would enable us to define the typical profile of the elderly who are at risk of falling. OBJECTIVE: We aimed to isolate studies in which the social-demographic risk factors for falls among the elderly have been evaluated and to carry out a meta-analysis by combining the results of all of these selected studies. METHOD: We did a systematic literature review using the key words "accidental fall / numerical data" and "risk factors." Inclusion criteria entailed the selection of articles with the following characteristics: population of subjects aged 60 years or over, falls that took place in everyday life, and social-demographic risk factors for falls. RESULTS: 3,747 indexed articles published between 1981 and 2007 were identified, and 177 studies with available data were included, of which 129 had data on social-demographic risk factors for falls. Difficulties in activities of daily living (ADL) or in instrumental activities of daily living (IADL) double the risk of falling: The OR and 95 percent Cl were 2.26 (2.09, 2.45) for disturbance ADL and 2.10 (1.68, 2.64) for IADL. The OR and 95 percent Cl for Caucasians were 1.68 (0.98 - 2.88) and 0.64 (0.51 - 0.80) for Hispanics. In the subgroup of patients older than eighty, being married protected people from falling with an OR and 95 percent Cl =0.68 (0.53 - 0.87). CONCLUSION: Defining factors that create a risk of falling and protect elderly people from falls using social-demographic characteristics lets us focus on an "at risk" population for which a specific program could be developed.


Subject(s)
Humans , Male , Female , Aged , Accidental Falls/statistics & numerical data , Risk Factors , Socioeconomic Factors
12.
Neurophysiol Clin ; 38(2): 99-104, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18423330

ABSTRACT

CONTEXT: To show that emotional and cognitive information acts upon the postural balance system in a way comparable to that of the other known inputs (vision, vestibular, proprioception). METHOD: Controlled case study on 90 subjects. One group was composed of 45 subjects suffering from obsessive-compulsive disorder (OCD) in accordance with the Yale-Brown scale, while the other was the control group. All of the subjects underwent recording of their orthostatic posture on a force platform with eyes open and eyes closed. RESULTS: As regards to the postural findings, the two groups appear to be quite different. The OCD patients present a considerably reduced area and velocity of sway regardless of whether their eyes are open or closed. CONCLUSION: These results are coherent with regard to those of other studies establishing the link between postural balance and psychological status. Recent morphological studies likewise tend to confirm the existence of neuronal networks common to postural regulation and cognitive and emotional functioning. When interpreting symptoms, these interactions should be taken into account.


Subject(s)
Cognition/physiology , Obsessive-Compulsive Disorder/psychology , Postural Balance/physiology , Posture/physiology , Adult , Anthropometry , Emotions , Female , Humans , Male , Middle Aged , Photic Stimulation , Proprioception/physiology , Psychiatric Status Rating Scales , Vestibule, Labyrinth/physiology , Visual Perception/physiology
13.
Rev Med Interne ; 29(5): 421-3, 2008 May.
Article in French | MEDLINE | ID: mdl-18262687

ABSTRACT

The Dandy-Walker syndrome is a rare malformation usually diagnosed during pregnancy or early in the course of life. We report a case in an elderly hospitalised for gait disorders and recurrent falls. Cerebral MRI revealed hydrocephalus and posterior fossa cyst. The patient improved after ventriculocisternostomia.


Subject(s)
Dandy-Walker Syndrome/diagnosis , Gait Disorders, Neurologic/etiology , Aged , Brain/pathology , Dandy-Walker Syndrome/pathology , Female , Gait Disorders, Neurologic/pathology , Humans , Hydrocephalus/pathology , Magnetic Resonance Imaging
14.
Ann Readapt Med Phys ; 50(5): 280-6, 2007 Jun.
Article in French | MEDLINE | ID: mdl-17337312

ABSTRACT

OBJECTIVE: We aimed to assess the isokinetic profile of the flexor and extensor muscles of the knee within a population of rugby players. METHODS AND POPULATION: This was a descriptive study. The rugby players underwent bilateral isokinetic assessment of knee flexion and extension on a CON-TREX MJ isokinetic dynamometer functioning at four angular frequencies - 90, 120, 180 and 240 degrees/s - in a concentric manner. The isokinetic parameters were peak torque, mean power, and mean work in relation to weight and femoral bicep: quadriceps ratio. The population included 16 "Federal 1" (semi-professional) rugby players with mean age 25 years (range 20-33 years). The players were divided into two groups: "forward" players (props, hookers, second line, third line) and "back" players (scrum, inside, center, wing, tail). RESULTS: The values of the isokinetic parameters did not reveal use of a preferred limb. Consequently, peak torque and mean power were higher in forward players than back players, whereas back players showed a higher relative power throughout the isokinetic test. CONCLUSION: Among rugby players, forward and back players showed differences in several isokinetic parameters. Accurate knowledge of the equilibrium between the knee's effector muscles is important for stability of the joint, to not only minimize articular accidents but also pinpoint force imbalances, thereby preventing muscular lesions during the sports season.


Subject(s)
Football/physiology , Knee Joint/physiology , Muscle Contraction/physiology , Muscle, Skeletal/physiology , Adult , Humans , Male , Muscle Strength/physiology , Muscle Strength Dynamometer
16.
Ann Readapt Med Phys ; 48(9): 668-74, 2005 Dec.
Article in French | MEDLINE | ID: mdl-16023756

ABSTRACT

OBJECTIVES: To determine factors predicting falls by patients with vascular hemiplegia to establish a program aimed at preventing falls in this population. METHODS: A comparative prospective study performed over 19 months with 44 patients older than 16 years who had had a cerebral vascular accident (CVA, stroke) and were consequently admitted to the Centre Richelie. The exclusion criteria were represented by CVA history, evidence of another form of encephalic lesion, and subsequent admission to hospital after hemiplegia or for follow-up. Assessment consisted of taking note of the mechanism of the fall, possible lesions, and number of falls and analyzing follow-up after the return home. Also included for all patients was information on 20 variables that could be risk factors for fall. RESULTS: The patients' average age was 60.43+/-13.43 years and 20 had had at least one fall (mean 2.2), which allowed us to determine a "falling" group and a control group. Statistical analysis revealed the following factors considered to predict falls: large amount of time prior to hospitalization and lengthy hospitalization, low functional independence measure for entering and leaving, the existence of sensitivity disorders, spatial neglect, failed seated and standing equilibrium, and sedative treatment. In most cases, whatever their nature, falls occurred during transfers (68% of cases). Most often, the post-fall lesions were minor. However, in one case, a femur neck fracture necessitated osteosynthesis. One-third of the patients had a fall at home (as opposed to 5% of the control group). CONCLUSION: Our results confirm those in the literature. The predictive factors for falls in patients with hemiplegia are therefore well established and essentially correlate with the CVA. This consideration must lead to implementation of a prevention program including material-based as well as human measures.


Subject(s)
Accidental Falls/statistics & numerical data , Hemiplegia/complications , Adult , Aged , Aged, 80 and over , Female , Forecasting , Health Facilities , Hemiplegia/etiology , Humans , Male , Middle Aged , Prospective Studies , Risk Factors , Stroke/complications
17.
Ann Readapt Med Phys ; 48(4): 165-71, 2005 May.
Article in French | MEDLINE | ID: mdl-15848258

ABSTRACT

OBJECTIVES: To determine the main clinical and posturographic factors correlated with falls in elderly individuals and to specify the role of static posturography in this appraisal. MATERIALS AND METHODS: The study involved 38 people living in an residential center who were autonomously ambulatory and had a Mini Mental Test score> or =24. Fallers (N = 15) had fallen within 1 month, and nonfallers (N = 23) had not fallen for at least a year. Assessment consisted of a series of questions, a complete clinical appraisal, specific independently validated tests, and static posturographic analysis different parameters of the stabilogram with the eyes first open and then closed, all carried out in the center. RESULTS: From the clinical standpoint, spinal pathologic features and the scores on the Functional Reach Test were significantly different between the fallers and nonfallers. In static posturography, fallers' equilibrium was more precarious than that of nonfallers with eyes are closed: significant differences were observed in surface, X length and overall fast Fourier transform score. The comparison between results with open and closed eyes showed that the fallers had a pronounced tendency to retropulsion in the absence of visual participation: a significant difference as regards overall length, Y length, minimum Y and FFT Y (0.5-2 Hz). CONCLUSIONS: To complement a satisfactorily conducted clinical examination, static posturography allows for rapid assessment of equilibrium and posture in elderly patients who fall? Performed at the place where an individual resides, this appraisal constitutes an original and pragmatic element. As an evaluation strategy, it can reveal nonnegligible information within the framework of an appraisal of such, and thereby allows for adjustment of the rehabilitation or compensatory strategy.


Subject(s)
Accidental Falls/statistics & numerical data , Postural Balance/physiology , Posture/physiology , Aged , Aged, 80 and over , Female , Geriatric Assessment , Humans , Male , Proprioception/physiology
18.
Ann Readapt Med Phys ; 47(3): 93-7, 2004 Apr.
Article in French | MEDLINE | ID: mdl-15059671

ABSTRACT

OBJECTIVE: To assess the impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain. METHODS: Open prospective study in eight spine centers. Seventy patients enrolled in several restoration programs were evaluated before and at the end of the program. Variables recorded were pain (VAS), disability (Quebec back pain disability scale), handicap (VAS), anxiety and depression (HAD scale), and fears, avoidance and beliefs (FABQ). RESULTS: All variables recorded significantly improved at the end of the programs except for fears about professional activities (FABQ1) and lumbar mobility. Fears about physical activities (FABQ2) significantly decreased after these programs. Variations in FABQ1 and FABQ2 scores were not correlated with variations in scores of outcome measures assessing impairment, disability, and handicap. CONCLUSION: Functional restoration programs in their current form in France do not decrease fears and beliefs about professional activities in chronic low back pain patients. Adding psychosocial intervention at the work place to the functional restoration programs may lead to a better impact on fears about work thus reducing work loss.


Subject(s)
Low Back Pain/psychology , Low Back Pain/rehabilitation , Rehabilitation, Vocational , Adult , Culture , Data Interpretation, Statistical , Exercise , Fear , Female , France , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Pain Measurement , Prospective Studies , Rehabilitation, Vocational/psychology
19.
Ann Readapt Med Phys ; 46(3): 138-43, 2003 Apr.
Article in French | MEDLINE | ID: mdl-12763644

ABSTRACT

OBJECTIVES: The aim of this paper was to present the first results of a study about lower limbs' soft tissues (fat and muscle) evolution using magnetic resonance images. MATERIALS AND METHODS: Magnetic resonance images method (MRI) was chosen instead of X-ray scanner for its non-invasive and non-radiating properties. Three hemiplegics volunteers were followed during the first 6 months of their therapy. Lower limbs' MRI captures were made at the beginning and in the end of this period. Computerized processing of the data allows automatic recognition of the main lower limb's tissues. Volumes were determined from images and classified in 4 categories (i.e. muscle, fat, spongy bone, cortical bone). RESULTS: Data analysing showed a different evolution of soft tissues in healthy lower limb compared to pathological lower limb. DISCUSSION-CONCLUSION: This results should lead us to a better understanding of therapeutic efficiency.


Subject(s)
Adipose Tissue/pathology , Hemiplegia/pathology , Leg/pathology , Magnetic Resonance Imaging , Stroke/pathology , Aged , Body Composition , Bone Density , Humans , Male , Middle Aged , Muscle, Skeletal/pathology
20.
Rev Neurol (Paris) ; 159(11): 1028-37, 2003 Nov.
Article in French | MEDLINE | ID: mdl-14710023

ABSTRACT

Falls are a dramatic consequence of the age-related gait disorders. There are few prospective studies on falls predictive of the biomechanical features of gait. According to the literature, there are similarities between the gait observed in older people and in parkinsonian subjects. The objective of this study was to apply multiparametric gait analysis to demonstrate changes of the neuromotor gait pattern connected with falls. This prospective study included two groups of 16 subjects aged more than 60 years, who had not fallen during the previous year. One group included 16 minimally disabled parkinsonian patients off drugs, and the other group 16 healthy people. Gait recordings were obtained with a three-dimensional optoelectronic movement analysis system coupled with 2 force platforms in all persons who were followed for 1 year to collect data on all new events, particularly falls. Data analysis concerned spatiotemporal stride and three-dimensional power peaks developed in each lower limb joint. Cluster analysis of the 32 persons was used to determine various infraclinic neuromotor gait patterns. A post hoc analysis of variance was then applied to identify discriminating parameters. Three groups of subjects were identified with 3 different neuromotor gait patterns, independently of the presence of Parkinson disease. There were no fallers in first group (n=18). The second group (n=8) had 20 p.cent fallers and the third group (n=4) 100 p.cent fallers. The groups differed by 4 spatiotemporal parameters and 3 joint power peaks in the sagittal plane. Functional capacity was good in the first group with no falls recorded. This group of subjects had characteristics reported in the literature corresponding to a category of persons who compensate well for the phenomena of aging. Functional capacity was intermediary in the second group (20 p. cent were fallers). The kinematic pattern appeared to be less successful, revealing a tendency for stiff posture. The third group (100 p. cent fallers) exhibited inferior functional capacity. In this group, the kinematic pattern appeared to be disrupted. The subjects were unable to adapt satisfactorily to situations other than by stereotypical neuromotor reactions. In conclusion this study demonstrated a close determinism between physiological neuromotor aging and Parkinson's disease. The prospective follow-up demonstrated that falls that occurred were related to changes in neuromotor gait patterns. Three phases of gait pattern were also identified from minimal to major risk of falls.


Subject(s)
Aging/physiology , Brain/physiopathology , Gait/physiology , Movement Disorders/physiopathology , Parkinson Disease/physiopathology , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prospective Studies , Severity of Illness Index
SELECTION OF CITATIONS
SEARCH DETAIL