Isokinetic strengthening and neuromuscular electrical stimulation protocol impact on physical performances, functional status and quality of life in knee osteoarthritis overweight/obese women.

BACKGROUND: Knee muscle weakness associated with overweight/obesity can lead to impairment of vital daily function in knee osteoarthritis patients. This study investigated the effect of a knee eccentric isokinetic muscle strength (IMS) training program combined with neuromuscular electrical stimulation (NMES) on muscle strength and flexibility, joint ROM, functional status, physical performance, and quality of life in knee osteoarthritis overweight/obese women. METHODS: Thirty-six women were randomized into three groups, two experimental groups (EG) and a control group following a classic rehabilitation program. During 6 weeks of two sessions/week, one of the two EGs performed an IMS program (ISO.G); the other underwent combined IMS and NMES training (ISO + NMES.G). All patients were evaluated with clinical examination, isokinetic test at 60°/s and 240°/s speeds, physical performance tests related to activities of daily living, and Knee injury and Osteoarthritis Outcome Score (KOOS) quality of life questionnaire, before and after the intervention. RESULTS: In the 10-m walk, chair stand, stair climb and monopodal stance tests, muscle flexibility and quality of life scores showed significant improvement for ISO.G (P = 0.000) and ISO + NMES.G (P = 0.000). Concentric strength at 240°/s was improved in ISO + NMES.G (P = 0.000) unlike the muscle strength at 60°/s (quadriceps, P = 0.104; hamstrings, P = 0.171), force asymmetry (P = 0.481) and post-intervention joint ROM (P = 0.309). CONCLUSIONS: The combination of IMS and NMES shows significant superiority over the usual rehabilitation program for the majority of the parameters measured for optimal management of knee osteoarthritis.

Effects of Combined Balance and Strength Training on Measures of Balance and Muscle Strength in Older Women With a History of Falls.

OBJECTIVE: We investigated the effects of combined balance and strength training on measures of balance and muscle strength in older women with a history of falls. METHODS: Twenty-seven older women aged 70.4 ± 4.1 years (age range: 65 to 75 years) were randomly allocated to either an intervention (IG, n = 12) or an active control (CG, n = 15) group. The IG completed 8 weeks combined balance and strength training program with three sessions per week including visual biofeedback using force plates. The CG received physical therapy and gait training at a rehabilitation center. Training volumes were similar between the groups. Pre and post training, tests were applied for the assessment of muscle strength (weight-bearing squat [WBS] by measuring the percentage of body mass borne by each leg at different knee flexions [0°, 30°, 60°, and 90°], sit-to-stand test [STS]), and balance. Balance tests used the modified clinical test of sensory interaction (mCTSIB) with eyes closed (EC) and opened (EO), on stable (firm) and unstable (foam) surfaces as well as spatial parameters of gait such as step width and length (cm) and walking speed (cm/s). RESULTS: Significant group × time interactions were found for different degrees of knee flexion during WBS (0.0001 < p < 0.013, 0.441 < d < 0.762). Post hoc tests revealed significant pre-to-post improvements for both legs and for all degrees of flexion (0.0001 < p < 0.002, 0.697 < d < 1.875) for IG compared to CG. Significant group × time interactions were found for firm EO, foam EO, firm EC, and foam EC (0.006 < p < 0.029; 0.302 < d < 0.518). Post hoc tests showed significant pre-to-post improvements for both legs and for all degrees of oscillations (0.0001 < p < 0.004, 0.753 < d < 2.097) for IG compared to CG. This study indicates that combined balance and strength training improved percentage distribution of body weight between legs at different conditions of knee flexion (0°, 30°, 60°, and 90°) and also decreased the sway oscillation on a firm surface with eyes closed, and on foam surface (with eyes opened or closed) in the IG. CONCLUSION: The higher positive effects of training seen in standing balance tests, compared with dynamic tests, suggests that balance training exercises including lateral, forward, and backward exercises improved static balance to a greater extent in older women.

Differences in Trunk Strength Between Weightlifters and Wrestlers.

Investigations of trunk strength with high-level athletes are limited. The purpose of this study was to compare maximal concentric isokinetic trunk extension and flexion torque, power, and strength ratios between high-level weightlifters (n = 20), wrestlers (n = 20) and a control (n = 25) population. Isokinetic dynamometry was used to evaluate peak torque, power and strength ratios during seated trunk extension/flexion actions at 60°/s and 180°/s. There were no significant anthropometric differences between groups. Overall, trunk isokinetic force variables as a function of the increase in angular velocity, showed a decrease in peak torque, but an increase in power (athletes and controls). Compared to the control group, athletes demonstrated significantly higher trunk extension torque (+67.05 N·m, ES = 0.81) and power (+49.28 N·m, ES = 0.82) at 60°/s and 180°/s, respectively. Athletes produced significantly greater trunk flexion-extension ratios at 60°/s and 180°/s (ES = 0.80-0.47) than controls. Weightlifters and wrestlers exhibited significantly higher extensor than flexor torque at all angular velocities. Weightlifters demonstrated greater torque (ES = 0.79) than wrestlers at 60°/s. The wrestlers' average power was significantly higher (ES = 0.43) than weightlifters at 180°/s. There were no significant ratio differences between wrestlers (66.23%) and weightlifters (72.06%). Weightlifters had stronger extensor muscles at 60°/s, whereas wrestlers had higher power at 180°/s for extensor muscles. It was postulated that the extensor muscles were stronger than the flexors to ensure trunk stabilisation, and for prevention of injuries. These differences seem to be associated to the movements that occur in each sport in terms of both muscle actions and contractile forces.

Comparison of isokinetic trunk flexion and extension torques and powers between athletes and nonathletes.

This study is aimed to perform and compare maximal concentric isokinetic trunk extension and flexion torques and powers between high-level athletes and a control population. In addition, the ratio of isokinetic trunk extension and flexion torques was measured, and compared between groups. Eighteen high-level male athletes and 15 male nonathletes without low back pain were recruited. Subjects performed isokinetic trunk extension and flexion at 60°/sec, 90°/sec, and 120°/sec through a maximal range of motion in a dynamometer. Trunk extension torque of athletes was significantly higher than in nonathletes at 60°/sec and 90°/sec but not at 120°/sec. Trunk extension power of athletes was significantly higher than the control group at 90°/sec and 120°/sec but not at 60°/sec. There was no difference between the athlete and nonathlete groups in respect of trunk flexion torque or power at any angular velocity. Consequently, the ratio of trunk flexion to extension strength was greater in nonathletes than in athletes. Trunk extension and flexion torques tended to decrease, and trunk extension and flexion powers tended to increase, with increasing angular velocity. High-level athletes seem to display preferentially greater trunk extension strength and power in comparison with trunk flexion strength, compared to nonathletes. This could be caused by the use of strength training exercises such as squats and deadlifts, or it may be associated with greater athletic performance.

[The contribution of the new scale for assessing disability]. / Apport de la nouvelle grille d'évaluation du handicap.

PROBLEM: The assessment of disability and its management is complex and problematic. With a view to ensuring equality of opportunity between disabled people and others, a new law adopted in August 2005 proposed a new method for assessing disability is applicable on a wider scale by GPs. AIM: Assessing the contribution of the new scale for assessing disability in patients suffering from debilitating diseases, to verify compliance in Tunisia. METHODS: Cross-sectional study on 60 hemiplegic, paraplegic and post traumatic head injuries. The patients underwent clinical evaluation and a functional assessment. The assessment tools used were: the classification of the American Spinal Injury Association, the Barthel Index, Glasgow Outcome Scale, Functional Independence Measure, the Health Assessement Questionnaire and the Social Function-36. Patients were also evaluated with the new scale of disability. RESULTS: concerning paraplegic patients, limitation of activity concerned mobility, maintenance staff, domestic life, social relationships, community life and major areas of life. On the hemiplegic, areas related to communication, mobility, maintenance staff, domestic life, social relationships, community life and major areas of life have been affected. We have noted a correlation between the new scale and the Barthel Index. Regarding traumatic brain injury, the areas most affected were those related to mobility, maintenance staff, domestic life and the major areas of life. A correlation was found between the new scale and the Functional Independence Measure in three populations, as well as the quality of life that has been correlated with disability. Disability was observed in 90% of paraplegics, 80% and 50% of hemiplegic patients with severe brain injury. The handicap was the heaviest seen in traumatic brain injury patients with a frequency of 20%. CONCLUSION: The new scale for assessing disability has reproduced disability and special needs of paraplegic patients, stroke patients and traumatic brain injury.

[Necessity of physical activities restriction after lumbar diskectomy]. / Intérêt d'une approche active dans la prise en charge rééducative a la suite d'une première chirurgie rachidienne pour hernie discale.

BACKGROUND: Necessity of physical activities restriction after lumbar discectomy have been described in the literature. AIM: The aim of this study was to determine if early rehabilitation could favorably influence the prognosis of military patients who had undergone lumbar disk surgery. METHODS: We performed a retrospective study involving patients who have had lumbar disk surgery, and had undergone physical rehabilitation program. A clinical evaluation, an assessment of pain and a functional assessment by the Arabic version amended self-questionnaire Oswestry have been made for these patients before and after a rehabilitation program started since the 40th postoperative day. RESULTS: We have collected 50 cases: 40 men and 10 women of average age 30 years. All these patients have been improved after surgery with no radiculalgies, but with persistence lumbar pain syndrome. After rehabilitation program, we noted a reduction of 42.85% of pain and functional improvement with a reduction in the average score of Oswestry index of 61.18%. The average work incapacity was 4 months. A workstation adaptation was indicated for all patients. CONCLUSION: Intensive rehabilitation program started early after lumbar disk surgery can improve the functionality of patients operated, and allows early return to professional activities with reduction of the healthcare cost.

[Neurogenic bladder in diabetes mellitus]. / Les neurovessies du diabete.

BACKGROUND: Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. AIM: characterize the bladder dysfunction in patients with diabetes mellitus. METHODS: The clinical and urodynamic records of patients with diabetes mellitus were reviewed. RESULTS: 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients (31.25%) had decreased flow rates. 12 patients (37.5%) had diminished bladder sensation and/or impaired detrusor contractility. 10 patients (25%) had detrusor hyperreflexia and 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients (5%). CONCLUSION: This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy.

[Neurogenic urinary bladder in patients with spinal cord injury. Protocol of surveillance and management]. / La vessie neurologique du blessé médullaire: protocole de surveillance et de prise en charge.

BACKGROUND: Bladder dysfunction is constant in patients with spinal cord injury and this whatever is the injury level. They are characterized by a variable profile and changing in the course of the years. They constitute not only, an important cause of morbidity in this population but also mortality. AIM: The aim of this work is to emphasize the importance of the diagnosis and to study the bladder behaviour while clarifying the evolution of this type of bladder and to present a protocol of management of a neurogenic bladder. METHODS: retrospective study. 2 assessments in 6 months of interval were realized. The bladder evaluation consisted in a biological assessment, a urinary ultrasound, a cystography and urodynamic investigations. The management is initially realized there to hospital. RESULTS: Our study contains 62 persons with spinal cord injury of average age of 32, 4 years with post traumatic period average is of 41, 47 months. The various evaluations allowed us to conclude that there is a significant change of the neurological status as well as the urinary biological values with significant deterioration of the various ultrasound, cystography and urodynamic data. CONCLUSION: The diagnosis and the management of the neurological bladders of persons with spinal cord injury have to be besides the other deficiencies that these patients as well as neurological, orthopaedic, and cutaneous devices, because this is going to allow to improve their quality as well as their life expectation. Our results underline the importance and the necessity to establish a protocol of neurogenic bladder control rigorous and codified which remains to adapt according to every patient. This protocol is sometimes difficult to apply given the fact of the misunderstanding of this type of deficiency.

[Functional impairment in patients with rheumatoid spondylitis of the pelvis]. / Evaluation du retentissement fonctionnel de la pelvispondylite rhumatismale a propos de 30 cas.

AIM: To assess functional impairment in patients with rheumatoid pelvispondylite. METHODS: cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index (BASFI), and likert scale assessing social, economic and physical disability. RESULTS: 30 patients (22 men), the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50% are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100; the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social, economic and physical disability was felt among 67% of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. CONCLUSION: The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index, This impact on the quality of life is increased by the low level of education and poor professional integration.

[The contribution of home based exercise programme in case of osteoarthritis of the knee]. / Interet d'un programme d'auto reeducation a domicile dans la prise en charge de la gonarthrose.

BACKGROUND: Knee Osteoarthritis is the most frequent articular disease. It may cause disability and handicap. AIM OF THE STUDY: to assess the effect of a home based exercice programme in a Tunisian population having knee osteoarthritis, associated with medical treatment and education. METHODS: Prospective study during three months, including 34 Tunisian patients with knee osteoarthritis. A clinical and functional assessment of the patients was made using respectively the visual analogic scale for the pain, the Lequesne index, the Functional Independence Measure and the womac function score for the function, the HAQ and SF 36 for the assessment of the quality of life. RESULTS: Visual analogic scores for pain were reduced in the exercise group. Lequesne index scores reduced significantly in the exercise group and were unchanged in the controls. Quality of life was greater in the exercise group compared with the controls. CONCLUSION: Home based exercise programme contributes to relieving pain, maintaining function and to ameliorate the quality of life of people having knee osteoarthritis.

[Place of orthotic devices in the neuromuscular diseases]. / Place de l'appareillage orthopédique dans les maladies neuromusculaires.

UNLABELLED: INTRODUCTION-AIM: If neuromuscular diseases differ by the age of the beginning, the mechanism, the topography and the evolution, they have in common to pull a deficit of the muscular force which establishes the main consequence of these diseases. The orthopedic devices is an essential constituent of the coverage. The purpose is to warn or to correct orthopaedic deformations, to protect, to facilitate or to supply a function, to assure a better comfort and to get for the patient the best quality of life. The purpose of this study is to emphasize the place of the orthopedic devices in the therapeutic protocol, the modalities of attributions but also the frequent difficulties. MATERIAL AND METHODS: retrospective inquiry with patients affected by neuromuscular diseases justifying an orthopedic devices assessed at the monthly multidisciplinary consultation of the service of physical and rehabilitation medicine of the National Institute of Orthopaedics M. Kassab from November, 2002 till April, 2003, the patients listed in the National Institute of Neurology and the patients seen at home. RESULTS: 30 cases of average age 16.7 years with extremes of 6 years and of 54 years. All the subjects of our study use an orthopaedic device which is either an orthosis, or a technical device. The most prescribed orthosis are those of the trunk. the posterior thigh-leg-foot thermo-formable night splints come at the head of list of the orthosis of lower limbs. The lack of satisfaction is reported especially for the orthosis of the trunk. Delivery periods are on average of five months. CONCLUSION: the orthopedic device plays a fundamental role in the physiotherapy strategy. It is always prescribed in multidisciplinary way by taking into account deficits, environment and demand of the patient allowing so the purchase of an adapted and comfortable equipment. "Reproaches" and demands of the users are a delivery periods often long and an insufficient coverage notably for technical and organization of residence. We propose according to a review updated by the literature, the recommendations allowing a better prescription of an performing equipment.

[Medical prevention of handicap in Tunisia]. / La prevention medicale du handicap en Tunisie.

The handicap, phenomenon too often badly discerned, constitute a problem of public health of part his frequency, his gravity and his cost. Interventions aiming to warn the handicap are located to three levels: primary, secondary and tertiary. The measures as the vaccination, the education about health, the hygiene of the setting, the prenatal surveillance, aiming to reduce and even eradicate the transferable illnesses, is applied and integrates in the setting of the different national programs since years 80. The most important are the national program of vaccination and the national program of perinatality. The precocious tracking of deficiencies and their hold in charge is related to centers of cares of basis health, to the regional units of rehabilitation and the school and academic medicine. The sanitary measures of tertiary prevention of the handicap summarize themselves in two types of measures: the rehabilitation and the equipment. The handicap, multi-dimensional phenomenon, require a concerted multidisciplinary action between professionals of health, social business, jurists and community.