EquiMoG : proposition d’un outil pour l’évaluation de la fonction d’équilibration en rééducation gériatrique
En pratique clinique de reeducation geriatrique, l’evaluation de la fonction d’equilibration est souvent longue et difficile, mais tres precieuse pour orienter les priorites de traitement ou objectiver l’effet d’une prise en charge. La principale difficulte reside dans le choix des tests qui s’averent souvent mal adaptes a une population fatigable. Il est donc prioritaire de rationaliser les choix afin de mieux adapter l’evaluation aux capacites du patient. Pour ce faire, nous avons procede a la lecture de nombreux resumes et articles references sur PubMed dans le domaine de l’evaluation de l’equilibre en geriatrie. Apres avoir analyse ces differents articles, nous proposons dans ce travail…
Kinésithérapie gériatrique à domicile : effets sur les capacités motrices et cognitives chez des patients présentant une maladie d’Alzheimer
Resume Objectif Evaluer l’effet d’une prise en charge de kinesitherapie a domicile sur les capacites motrices et cognitives de patients âges souffrant d’une maladie d’Alzheimer (MA) de stade leger a modere. Methode Les sujets etaient inclus et divises en deux groupes, l’un sans kinesitherapie (SK) et l’autre avec kinesitherapie (AK). Pour le groupe AK, la prise en charge en kinesitherapie etait proposee entre l’evaluation initiale (T0) et l’evaluation finale (T1). A T0 comme a T1, il a ete enregistre les donnees suivantes : duree d’intervention (DI), Mini-Mental State Examination (MMSE), test de Tinetti (TT), test moteur minimum (TMM), Timed Up and Go (TUG) et vitesse de marche (VM), ainsi …
Parcours de soins de la personne âgée, du diagnostic kinésithérapique aux nouvelles technologies, vous saurez tout. Préférences sensorielles, vieillissement et fragilité
La fonction d’equilibration repose sur l’integration de donnees sensorielles autorisant une regulation sensori-motrice des activites musculaires [1] , [2] , [3] . Les donnees relatives a l’evolution de notre corps dans l’environnement, utiles pour coordonner la posture et le mouvement, proviennent principalement de l’appareil visuel, de l’oreille interne et des capteurs de la somesthesie [4] , [5] . Cependant, la ponderation de ces entrees peut varier d’un individu a un autre, et en fonction des contraintes de l’environnement : ces variations constituent des preferences sensorielles [6] , [7] . Des situations particulieres, telles que la privation d’une de ces entrees suite a un accident, p…
The Early Indicators of Functional Decrease in Mild Cognitive Impairment
OBJECTIVES: Motor deficiency is associated with cognitive frailty in patients with Mild Cognitive Impairments (MCI). In this study we aimed to test the integrity of the muscle synergy involved in an arm-pointing movement in MCI patients, non-impaired functionally. Thus, we were able to test the hypothesis that early motor indicators exist in this population at a preclinical level. METHODS: The electromyographic signals were collected for 11 muscles in 3 groups: Young Adults (YA), Aged Adults (AA), and MCI patients. The AA and MCI groups presented the same functional status. Each subject performed twenty arm-pointing movements from a standing position. RESULTS: The main differences were (1) …
EquiMog : équilibre et motricité en gériatrie
Introduction L’evaluation geriatrique de la motricite, et notamment de la fonction d’equilibration, est habituellement de type fonctionnel et regroupe differents tests valides [1] , [2] , [3] , [4] , [5] , [6] , [7] . Cependant, ces tests ne permettent pas d’orienter le reeducateur dans son bilan diagnostique kinesitherapique. Le raisonnement systemique a ete developpe en reponse a cette volonte d’analyse fine des troubles de l’equilibre. Le « Balance Evaluation Systems Test » (BESTest) [8] evalue le fonctionnement de six sous-unites systemiques du controle de l’equilibre. Le raisonnement EquiMoG, equilibre et motricite en geriatrie [9] , a ete developpe dans la meme logique, mais en tenant…
Sensory reweighting in frail aged adults: Are the balance deficiencies mainly compensated by visual or podal dependences?
Abstract Background Postural control is based on the integration of different sensory inputs. The process of scaling the relative importance of these sensory cues (visual, vestibular and proprioceptive) depends on individuals and creates sensory preferences, leading to sensory dependences when one particular source is preponderant. In this context, the literature showed a frequent visual dependence (visual inputs weighting) in aged adults. However, the somaesthetic inputs can also be prioritised in a podal-dependent profile. In the frail aged adults, none study has shown the distribution of these two dependences. Research question Which sensory orientation profile is preferentially adopted …
Test–retest reliability and responsiveness of centre of pressure measurements in patients with hip osteoarthritis
International audience; Objective: The aim of this study was to determine a set of measures for the evaluation of balance in patients suffering from hip osteoarthritis (OA) that were both reliable and responsive to change.Design: Three groups of subjects; Healthy, hip OA patients without surgery, and hip OA with surgery (pre and post-surgery) were included in this study. Subjects had to perform balance tests in two positions: standard and narrowed stance. CoP-based measures test-retest reliability was assessed in hip OA without surgery group, responsiveness were assessed between all groups and between pre and postsurgery.Results: Intraclass Correlation Coefficient (ICC) values from hip OA w…
Imagerie motrice en rééducation gériatrique
Introduction La reeducation geriatrique s’adresse a des patients âges fragiles sur le plan posturo-moteur. L’imagerie motrice (IM) est une technique de physiotherapie interessante [1] notamment en reeducation neurologique [2] [3] ou musculo-squelettique [4] . Son utilisation en reeducation geriatrique est encore peu developpee. Le protocole experimental suivant vise a tester l’efficacite de l’IM pour l’amelioration de la commande motrice du membre superieur, essentielle dans le maintien de l’independance fonctionnelle des personnes âgees. Methode Seize personnes âgees (m = 86,3 ans ± 5,9) ont participe, divisees en 2 groupes de 8 (groupe temoin : GT et groupe entraine GE). La tâche de prehe…
Impact of ambulatory physiotherapy on motor abilities of elderly subjects with Alzheimer's disease
AimWe investigated the impact of ambulatory physiotherapy (AP) on motor abilities in elderly subjects with Alzheimer's disease (AD). MethodsSubjects with mild to moderate AD were included and divided into physiotherapy group (PG) and no physiotherapy group (NPG) according to whether or not they received AP between inclusion (T0) and the second time of assessment, between 15 and 36months after inclusion (T1). The follow-up duration, Mini-Mental State Examination, Tinetti and mini motor test (MMT) scores, Timed Up & Go test (TUG), gait speed (GS), one-leg balance (OLB), history of falls within the last 6months (HF), ability to rise from the floor (RFF) and the use of a walking aid (UWA) were …
L’évaluation systémique au service du diagnostic physiothérapique en gériatrie
L’evaluation geriatrique de la fonction d’equilibration est habituellement realisee sous une visee fonctionnelle autorisee par de nombreux tests valides [1] , [2] , [3] , [4] , [5] , [6] . Cependant, ces differents tests ne permettent pas de determiner l’etiologie precise des troubles de l’equilibre et par consequent n’orientent pas le reeducateur dans son bilan diagnostic kinesitherapique. Une approche systemique a ete concue en reponse a cette problematique. Le « Balance Evaluation Systems Test » (BESTest), [7] propose par l’equipe de Fay Horak en 2010, evalue six sous-systemes essentiels dans le controle de l’equilibre. Dans une logique similaire, le raisonnement EquiMoG (Equilibre et Mo…
Delayed postural control during self-generated perturbations in the frail older adults
Alexandre Kubicki1–3, François Bonnetblanc1,2, Geoffroy Petrement3, Yves Ballay1,2, France Mourey2,4¹UFR STAPS, Université de Bourgogne, Dijon, France; ²Motricité et Plasticité, Institut National de la Santé et de la Recherche Médicale (INSERM), Dijon, France; ³SARL Fovea Interactive, Campus Industriel – Espace Entreprises, Chalon sur Saône, France; 4UFR Médecine, Université de Bourgogne, Dijon, FrancePurpose: The aim of this study was to investigate the coordination between posture and movement in pathological aging (frailty) in comparison with no…
Temporal features of imagined locomotion in normal aging.
Motor imagery is the ability to mentally simulate a movement without executing it. Previous investigations have reported a deterioration of this ability during complex arm movements in aged adults. In the present study, we aimed to extend these findings by investigating the temporal features of imagined precision gait in healthy elderly adults. Locomotion is a unique example of imagined movement because it involves simulated full-body movement and the concurrent updating of environmental spatial information. Nine young and nine older adults actually or mentally walked (walking distance: 5m) along three paths having different widths (15cm, 25cm, and 50cm). The narrowest path required balance…
Relever du sol et maladie d’Alzheimer
Introduction Chez les personnes âgees fragiles, l’incapacite a se relever du sol provient regulierement d’une fragilisation des automatismes moteurs [1] . La presence d’un trouble cognitif doit etre consideree comme un facteur aggravant cette fragilite motrice [2] . Le protocole experimental suivant vise a tester l’efficacite de l’entrainement au relever du sol et de son impact sur les capacites posturo-motrices des sujets âges fragiles presentant un trouble cognitif. Materiel, population et methode Seize personnes âgees (m = 85,5 ans ± 2,5) atteintes d’une maladie d’Alzheimer ont participe. L’organisation du protocole est representee sur la Figure 1 . Resultats Apres verification de ses co…
Et si l’important n’était pas la chute mais de réussir à se relever du sol ?
L’incidence des chutes lors du vieillissement reflete l’importance de ne pas banaliser cet evenement. De plus, la station prolongee au sol est source de complications graves chez le sujet âge [1] . En effet, la moitie des personnes restant au sol plus d’une heure decede dans les 6 mois apres la chute [2] . Notre sensibilite de kinesitherapeute est attiree par une autre donnee statistique : la moitie des personnes âgees qui ont chute sont incapables de se relever seule malgre l’absence de blessure grave [3] . L’incapacite de se relever du sol constitue un facteur predictif de chute [4] . Cette impossibilite peut etre mise en lien avec deux causes principales : la presence de contraintes biom…
Coordination posture et mouvement chez les sujets âgés fragiles
Optimisation du contrôle postural anticipé lors d’un entraînement spécifique chez des patients âgés fragiles
Immediate effects of shoes inducing ankle-destabilization around Henke's axis during challenging walking gaits: Gait kinematics and peroneal muscles activities
International audience; Due to its high frequency of occurrence, as well as possible residual symptoms, proper treatment of lateral ankle sprains (LAS) is important. From a physiological point of view, increasing the quantity of electromyographic (EMG) activity in the peroneal muscles will mechanically improve the functional stability of the ankle joint. The present study investigated the immediate effects of an ankle destabilization device (ADD) specifically designed to induce imbalances along the Henke’s axis during 3 challenging walking tasks. As the effects of such a device have to be tested on healthy participants before being implemented in rehabilitation programs, 12 healthy particip…
Advanced 3D movement analysis algorithms for robust functional capacity assessment.
SummaryObjectives: We developed a novel system for in home functional capacities assessment in frail older adults by analyzing the Timed Up and Go movements. This system aims to follow the older people evolution, potentially allowing a forward detection of motor decompensation in order to trigger the implementation of rehabilitation. However, the pre-experimentations conducted on the ground, in different environments, revealed some problems which were related to KinectTM operation. Hence, the aim of this actual study is to develop methods to resolve these problems.Methods: Using the KinectTM sensor, we analyze the Timed Up and Go test movements by measuring nine spatio-temporal parameters, …
Enhancement of Anticipatory Postural Adjustments by Virtual Reality in Older Adults with Cognitive and Motor Deficits: A Randomised Trial.
Background: Postural activities involved in balance control integrate the anticipatory postural adjustments (APA) that stabilize balance and posture, facilitating arm movements and walking initiation and allowing an optimal coordination between posture and movement. Several studies reported the significant benefits of virtual reality (VR) exercises in frail older adults to decrease the anxiety of falling and to induce improvements in behavioural and cognitive abilities in rehabilitation processes. The aim of this study was thus to test the efficiency of a VR system on the enhancement of the APA period, compared to the use of a Nintendo Wii system. Methods: Frail older adults (n = 37) were i…
Kinematic analysis of motor strategies in frail aged adults during the Timed Up and Go: how to spot the motor frailty?
Asma Hassani,1 Alexandre Kubicki,2,3 Vincent Brost,1 France Mourey,2,4 Fan Yang1 1Laboratoire LE2I CNRS 6306, Université de Bourgogne, Dijon, France; 2Institut National de la Santé et de la Recherche Médicale (INSERM), Cognition Action et Plasticité Sensori-Motrice, Campus Universitaire, Université de Bourgogne, Dijon, France; 3Centre Hospitalier Universitaire de Dijon, Hôpital de Champmaillot, Dijon, France; 4Faculté de Médecine, Université de Bourgogne, Dijon, France Objective: The purpose of this work was to analyze and compare the movement kinematics of sit-to-stand (STS) and back-to-sit (B…
Postural Adjustments and Kinematic Index Finger Features in Frail Older Adults under Different Equilibrium Constraints
Background: Anticipatory postural adjustments (APAs) are significantly affected by age and may represent restrictions on functional independence. Previous studies in young adults have already highlighted that changing postural stability (i.e., seated vs. upright posture) affects the motor planning and APAs. In frail older adults (FOAs), the effect of these different conditions of postural stability have not yet been established, and the present study aimed to disentangle this issue. Methods: Participants executed an arm-pointing task to reach a diode immediately after it turned on, under different conditions of stability (seated with and without foot support and in an upright posture). A ki…
Balance control in aging: improvements in anticipatory postural adjustments and updating of internal models
International audience; Postural stability of older subjects can be estimated during orthostatic equilibrium. However, dynamic equilibrium is also important to investigate risks of fall. It implies different interpretations of measures given by force plates. Same dependant variables (e.g. center of pressure displacement) cannot be interpreted the same ways depending of the type of equilibrium that is investigated. In particular, sways increases during dynamic equilibrium and before movement execution may reflect an improvement of feedforward control.