Le syndrome de Rasmussen (SR) est une maladie inflammatoire chronique d’étiologie inconnue, caractérisée par une épilepsie sévère pharmacorésistante, un déficit neurologique hémicorporel et une ...hémiatrophie cérébrale d’installation progressive.
Mr R. est un patient de 16 ans, qui vient d’être diagnostiqué lorsque nous le rencontrons. Il présente une hémi-hypotrophie corporelle droite, une hémiparésie droite, des troubles du langage et des troubles cognitifs sur les versants mnésiques, attentionnel et exécutif. À l’imagerie il existe une atrophie corticale fronto-pariéto-temporale gauche. L’EEG montre un tracé asymétrique globalement ralenti à gauche. À l’EEG quantifié (EEGq) nous observons un excès d’ondes Delta dans l’hémisphère gauche, compensé par un excès d’ondes Haut Bêta dans l’hémisphère droit. Une prise en charge par entraînement neurofeedback a été proposée. Le neurofeedback EEG est une technique non invasive qui mesure le signal EEG d’un sujet, le traite en temps réel, extrait un paramètre d’intérêt et présente cette information sous forme visuelle ou auditive au sujet. L’objectif est de permettre une modification du comportement du sujet en apprenant à moduler l’activité de son cerveau. Pour Monsieur R., la prise en charge s’est déroulée en trois temps : psychoéducation (ondes cérébrales, neurofeedback) ; inhibition du Haut Bêta dans l’hémisphère droit avec une électrode posée en C4 ; renforcement du SensoriMotor Rythm (SMR) dans l’hémisphère gauche avec une électrode posée en C3.
L’entraînement par neurofeedback s’est déroulé durant quatre semaines, à raison de quatre fois par semaine. L’EEGq réalisé à l’issue de la prise en charge montre une diminution nette des ondes lentes (Delta) dans l’hémisphère gauche, ainsi qu’une compensation moindre de l’hémisphère droit. Le bilan neuropsychologique comparatif objective également une amélioration dans la plupart des domaines. Enfin, de manière plus écologique, en particulier dans la scolarité, des progrès ont été relevés.
L’amélioration des performances cognitives obtenue par l’entraînement neurofeedback auprès de ce jeune patient est prometteuse et incite à proposer ce type de rééducation à d’autres personnes souffrant d’un syndrome de Rasmussen.
Isokinetic shoulder rotational strength was evaluated in four groups of subjects as follows: 12 nonathletes, 12 runners, 15 tennis players, and 12 baseball players for a total of 51 subjects. The ...tests were performed in the seated 45 degrees abducted test position in the scapular plane at 60, 180, and 300 degrees.s-1 for both shoulders. Peak torque and mean power values were gathered, and from these values the internal/external rotation ratios were calculated. Intergroup comparison showed a progression of the ratio related to the sports discipline. The nonathletes and runners had ratios close to those reported for nonathletes (1.3 to 1.5). The tennis players had ratios close to 1.5, whereas the baseball players had ratios from 1.6 to 2.2. The comparison between dominant and nondominant side showed no significant differences in the tennis players and higher values for the dominant side in the nonathletes and runners under certain conditions (180 degrees.s-1 for the nonathletes and 300 degrees.s-1 for the runners). Regarding the baseball players, the ratio was systematically higher for the dominant side. These results raise questions about the influence of sports discipline on the internal/external rotator muscle ratio and indicate the need to establish normative values based on the characteristics of the population under study.
Abstract Background Isokinetic assessment of shoulder internal and external rotators is commonly used by clinicians to assess muscle performance and to guide rehabilitation. The reliability of ...isokinetic assessment is fundamental to track small but clinically relevant changes. Objectives We aimed to analyze the absolute and relative reliability of strength imbalance indices such as peak torque ratios (ERconc/IRconc, ERecc/IRecc, ERecc/IRcon, IRecc/ERcon), bilateral concentric and eccentric strength ratios, and to examine the reliability of external rotator and internal rotator peak torque measured using a Biodex® dynamometer in the seated position. Design Cross-sectional laboratory study. Methods Forty-six healthy participants were tested twice with seven days between sessions, at 60 °/s and 120 °/s concentrically, and 30 °/s eccentrically. Results Low to moderate relative reliability (intraclass correlation coefficient: 0.25–0.81) was found for unilateral and bilateral strength imbalance ratios. High intraclass correlation coefficient values (0.87–0.97) were found for peak torque. Concerning absolute reliability, the standard error of measurement ranged from 9.1 to 25.6% for strength imbalance ratios and from 7.7 to 14.5% for peak torque measurements, and minimal detectable change ranged from 25.2 to 71% for strength imbalance ratios and from 21.3 to 40.2% for peak torque measurements. Conclusions The standard error of measurement and minimal detectable change reported in the present study should be taken into account when evaluating the individual longitudinal changes in clinical practice.
Although 40 assessment tools are described in the literature, very few of them have been correctly validated. The Standardized Index of Shoulder Function (FI2S) encompasses pain, mobility, strength ...and function. The aim of this work is to describe the FI2S and to study its construct validity, reliability and responsiveness to change.
Fifty-nine patients with non-surgical (rotator cuff lesions, frozen shoulders, osteoarthritis) or post-surgical (acromioplasty, repairs of rotator cuff tears, arthroplasty) shoulder disorders were included.
The FI2S was compared with the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), with the Constant-Murley Score (CMS), and with a visual analogue scale for pain.
Inter-test reliability and inter-rater reliability are excellent, with intra-class correlation coefficient of 0.93 (0.88-0.96) and 0.94 (0.90-0.96), respectively. Under a convergent hypothesis, the Spearman's correlation coefficients with the CMS and DASH score are 0.91 (p < 0.0001) and -0.64 (p < 0.0001), respectively. Correlations between the FI2S and the CMS are excellent for mobility and strength, but moderate for pain and functional capacities. Under a divergent hypothesis, no correlation is observed between the FI2S total score and age. Responsiveness to change is excellent.
The FI2S appears to be a proper assessment tool for pain, mobility, strength and function in shoulder disorders, easy to administer and of good metric value.
To assess the influence of wheelchair propulsion and neurological level on isokinetic shoulder rotational strength.
University of Montpellier, France
Data were evaluated in three groups of subjects ...as follows: 12 nonathletes, 15 tennis players and 21 wheelchair athletes. We then compared 12 high paraplegic athletes (HPA) and nine low paraplegic athletes (LPA) within the group of 21 wheelchair athletes: The isokinetic tests were performed in the seated 45 degrees abducted test position in the scapular plane at 60, 180 and 300 degrees s(-1) for both shoulders. Peak torque and mean power values were gathered and, from these values, the internal/external rotation ratios were calculated.
Intergroup comparison showed an influence of lesion and sport on peak torque at 180 and 300 degrees s(-1) for the internal rotators and significantly higher values of the internal/external ratios in the wheelchair athlete group. For mean power, we observed significant differences under all test conditions and significant differences for ratio only on the dominant side at 180 degrees s(-1) and on the dominant side at 300 degrees s(-1). Comparison of the two groups of paraplegic athletes showed significantly higher values of peak torque and mean power of the external rotators in the LPA for all test conditions.
Neurological level of lesion does not systematically influence the development of internal rotator muscles; in contrast, the participation of the external rotators appears strongly correlated to neurological level. The comparison of the two sides in the two paraplegic groups showed that in two-thirds of the cases the values of the external rotators were significantly higher than those of the internal rotators on the nondominant side for peak torque and mean power. Ratios on the dominant side were systematically higher than on the nondominant side, with significant differences also noted in two-thirds of the cases. These results raise questions about the influence of neurological level and wheelchair propulsion on the muscular adaptations of the shoulder in wheelchair athletes.
Background: Although peak torque has shown acceptable reproducibility, this may not be the case with two other often used parameters: time to peak torque (TPT) and the angle of peak torque (APT). ...Those two parameters should be used for the characterization of muscular adaptations in athletesMethods: The isokinetic performance of the knee extensors and flexors in both limbs was measured in 29 male athletes. The experimental protocol consisted of 3 consecutive identical paradigms separated by 45 min breaks. Each test consisted of 4 maximal concentric efforts performed at 60 and 180°/s. Reproducibility was quantified by the standart error measurement (SEM), the coefficient of variation (CV) and by means of intra-class correlation coefficients (ICCs) with the calculation of 6 forms of ICCs.Results: Using ICC as the indicator of reproducibility, the correlations for TPT of both limbs showed a range of 0.51-0.65 in extension and 0.50-0.63 in flexion. For APT, the values were 0.46-0.60 and 0.51-0.81, respectively. In addition, the calculated standard error of measurement (SEM) and CV scores confirmed the low level of absolute reproducibility. Conclusions: Due to their low reproducibility, neither TPT nor APT can serve as independent isokinetic parameters of knee flexor and extensor performance. So, given its reproducibility level, TPT and APT should not be used for the characterization of muscular adaptations in athletes.
The purpose of this study was to determine whether imbalance of the internal and external rotator musculature of the shoulder were etiological factors implicated in impingement syndrome. Shoulder ...torque measurements were obtained from 15 asymptomatic volunteers and 30 patients with chronic impingement syndrome, 15 of whom were evaluated after arthroscopic anterior acromioplasty. Isokinetic strength was assessed using the Biodex system in a modified position (in the plane of the scapula and in 45 degrees abduction) with test speeds of 60 degrees and 180 degrees per second. Internal and external rotator strength values and ratios were calculated for both peak torque and average power. Shoulder rotational strength values and the internal rotator/external rotator ratio were significantly higher in the dominant and nondominant control group shoulders than in the involved and uninvolved impingement shoulders for operated on and nonoperated on patients. These data demonstrate that primary change in the normal internal rotator/external rotator ratio of the shoulder is an etiological factor implicated in impingement syndrome not modified by anterior acromioplasty.
Objectifs. –
Préciser, à partir d'une revue de la littérature, l'apport de l'isocinétisme dans l'évaluation et la rééducation de l'épaule.
Méthode. –
La revue de la littérature a porté sur les ...publications en langues anglaise et française, recueillies à partir de la banque de données Medline, des références des articles ainsi colligés ce qui a permis l'analyse de publications non indexées. Quatre-vingt-sept articles présentant un intérêt direct pour cette étude ont été retenus.
Résultat. –
La validité de l'évaluation isocinétique de l'épaule est bonne. La reproductibilité, bien qu'inférieure à celle du genou, est satisfaisante sous réserve d'une méthodologie de test rigoureuse. Les valeurs normales, pour les rotateurs, les abducteurs–adducteurs et extenseurs–fléchisseurs sont dépendantes de divers paramètres tels que l'âge, le sexe, la corpulence, l'activité physique pratiquée. Le calcul des ratios agonistes–antagonistes est surtout intéressant en pathologie. Dans le conflit sous-acromial et l'instabilité de l'épaule est constamment observée une modification du ratio des rotateurs, qui apparaît plus comme un agent causal que comme une conséquence de l'affection. Cette modification perdure habituellement après traitement chirurgical de ces atteintes et la normalisation des ratios doit constituer un des éléments de la rééducation postopératoire.
Conclusion. –
L’isocinétisme constitue une méthode de référence en matière d'évaluation de la force musculaire, permettant de détecter les déficits portant sur certains groupes et plus encore les perturbations de la balance agonistes–antagonistes constatées lors de certaines pathologies d'épaule. Il constitue une aide précieuse à la rééducation en orientant la prise en charge préférentiellement sur les groupes déficitaires, en complétant les techniques de renforcement classiques et en permettant un suivi précis des progrès accomplis.
Objective. –
To evaluate the contribution of isokinetic methods of shoulder strength measurement and training.
Method. –
A Medline search of English and French publications, including referenced articles, allowed us to analyse non-indexed publications. Eighty-seven articles were retained for analysis.
Results. –
The isokinetic evaluation of the shoulder is valid. Although reproducibility of shoulder evaluation is inferior to that of the knee, it is nevertheless satisfactory when a rigorous test method is used. Normal values for the rotators, abductors–adductors, and extensors–flexors depend on diverse parameters such as age, gender, fat mass, and the type and intensity of physical activity. The agonist to antagonist ratio is particularly informative in pathological conditions. The ratio is modified in cases of impingement syndrome and shoulder instability, and this modification appears to be a cause rather than a consequence of pathologic features. The ratio generally remains modified post-surgery, and normalization must be a major focus of post-surgery rehabilitation.
Conclusion. –
Isokinetic measurement, particularly disturbances in the agonist–antagonist balance, is a reference method for evaluating shoulder muscle strength and detecting deficits in specific muscle groups seen in certain shoulder abnormalities. Such measurement is a valuable tool for orienting rehabilitation towards the deficient muscle groups, complements classical techniques of muscle strengthening, and is an accurate means for following the rehabilitation progress.
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