2
l’activité et la participation (T-score pondéré). Étaient également calculées les moyennes des scores bruts obtenus à chaque échelle, pondérées ou non selon les mêmes critères. La distribution normale des T-scores et des moyennes était testée par le test de Kolmogorov-Smirnov et leurs corrélations par Rho de Spearman. Re ´sultats.Cent trente-neuf patients-toxine ont été inclus, donnant un total de 541 échelles dont 537 qui ont pu être analysés pour l’étude. Les T-scores (56,77 10,2) et les moyennes de scores bruts (0,49 0,74) étaient très fortement corrélées (p = 0,99). Les T-scores pondérés et les moyennes pondérés suivaient une distribution normale. En revanche, les T-scores et des moyennes NON pondérés ne suivait pas une loi normale (p = 0,013 et 0,011). Discussion.Vu la forte corrélation des T-scores et des moyennes des scores bruts dans notre étude, le calcul de T-score peut raisonnablement être remplacé par le calcul de la moyenne des scores bruts en pratique clinique. Malgré son appellation de « T-score », la formule de Kiresuk ne permet pas forcément une normalisation des scores. Les implications de l’utilisation du T-score dans les études de groupe seront discutées. http://dx.doi.org/10.1016/j.rehab.2012.07.573 CO10-006-f Matelas de correction cervico-ce ´phalique : nouveau traitement du torticolis et de la plagioce ´phalie du nourrisson J. Durigneux a, * , M. Dinomais a , B. Chevalier b , L. Marquois c , G. Payneau c , X. Deries a a CRRRFAngers, rue des Capucins, BP 40329, 49103 Angers cedex 02, France b Kine ´sithe ´rapeute libe ´ral, Angers, France c Entreprise Proteor, Angers, France *Auteur correspondant. Adresse e-mail : [email protected]. Mots cle ´s : Plagioce ´phalie ; Torticolis ; Nourrisson ; Matelas Introduction.Depuis les recommandations de 1992 incitant à faire dormir les nourrissons en décubitus dorsal, l’augmentation de la prévalence de la plagiocéphalie est reconnue [1]. Les traitements actuels reposent essentielle- ment sur le positionnement simple, la kinésithérapie et/ou la médecine manuelle. Dans les formes sévères, une correction crânienne exclusive est proposée depuis quelques années par le port d’une orthèse (casque) avec une tolérance variable. Nous avons mis en place l’utilisation d’un matelas dont l’objectif est non seulement d’agir sur la plagiocéphalie mais également sur l’attitude en torticolis habituellement associée. Me ´thode.Étude prospective concernant 18 nourrissons (âge moyen de cinq mois) présentant une plagiocéphalie positionnelle postérieure asymétrique en lien avec un torticolis. Mesures anthropométriques au temps initial et après traitement : par empreintes crânienne au ruban plombé, calcul du Cranial Vault Asymetry Index (CVAI), classification en cinq degrés de sévérité (cinq étant le plus sévère) de la plagiocéphalie [2] et de l’index céphalique (IC) représentant une évaluation de la brachycéphalie. Re ´sultats.Après traitement on note une réduction significative du CVAI de 8,69 à 5,33 (p < 0,0001, test t pairé), du degré de sévérité qui passe de 3,6 à 2,3 (p < 0,0001, test t pairé), sans modification de l’IC 0,91 versus 0,92 (p = 0,503, test t pairé). De plus l’efficacité est corrélée à l’âge de début de traitement (Spearman r = 0,70, p = 0,008), plus le traitement est commencé jeune plus celui-ci est efficace. Discussion et conclusion.Notre étude montre une efficacité de l’utilisation du matelas quant à la diminution de l’asymétrie crânienne et donc de la plagiocéphalie sans majorer la brachycéphalie (IC). Elle confirme l’intérêt d’une prise en charge précoce. Références [1] Hutchison B, Hutchison L, Thompson J, Mitchell E. Plagiocephaly and brachycephaly in the first two years of life: a prospective cohort study. Pediatrics 2004;114:970. [2] Loveday BP, de Chalain TB. Active counterpositioning or orthotic device to treat positional plagiocephaly? J Craniofac Surg 2001;12(4):308–13. http://dx.doi.org/10.1016/j.rehab.2012.07.574 English version CO10-001-e Update on the treatment of childhood movement disorders: Focus on dystonia A. Roubertie * , B. Echenne Service de neurope ´diatrie, CHU Gui-de-Chauliac, 80, avenue Fliche, 34295 Montpellier, France *Corresponding author. E-mail address: [email protected]. Keywords: Dystonia; Therapy; L-dopa; Anticholinergics; Botulinum toxin; Deep brain stimulation Dystonia represents the most common form of non paroxysmal movement disorders in childhood. Dystonia treatment is often a challenging situation for the physician. Material and methods.Based on a systematic review of the literature and on our personal experience, we propose an update regarding the therapeutic management of childhood dystonia. Attenuation of the abnormal movements, improvement of the functional disabilities and alleviation of painful manifestations are idealistic objectives of the treatment. Therapeutic strategy depends on: the phenomenology of the dystonic movements (hyperkinetic/fixed dystonia); topography, extension and functional disability; mixed motor disorders (especially associated spasticity); etiology of the dystonic symptoms; age of the patient; potential drug-induced adverse events given the clinical status of the patients; associated comorbidities. Sometimes, the abnormal movements are part of a treatable disorder: these situations must be identified and a specific treatment should be initiated rapidly (Wilsons disease, creatine deficiency, organic aciduria). Most of the time, therapies for dystonia are purely symptomatic. Rehabilitation methods (physiotherapy, speech therapy and occupational therapy, psycho-social support) and adapted equipment and procedures (special computer keyboards, pictograms, voice synthesizers) are very important in the management of the patients. Various drugs are available: anticholinergics, dopaminergics, dopamine antagonists, muscle relaxants. Their efficacy is sometimes limited, and their indications will be discussed. Specific pediatric studies are needed to clarify the efficacy, safety and optimal dose of botulinum toxin in childhood dystonia. The progress of functional neurosurgery has open new therapeutic options; functional results of deep brain stimulation are good in primary dystonias, and more heterogeneous in secondary dystonias. Conclusion.A careful physical examination and a comprehensive and multidisciplinary work-up are mandatory for the elaboration of a therapeutic strategy. The therapeutic approach must be individually tailored, and must be discussed with both the patient and the parents. http://dx.doi.org/10.1016/j.rehab.2012.07.575 CO10-002-e Electromyographic analysis of progressive equinus in typically developing children L. Houx * , M. Lempereur, S. Brochard, O. Re ´my-Ne ´ris Service de me ´decine physique et re ´adaptation, CHRU Brest, 2, avenue Foch, 29609 Brest, France *Corresponding author. E-mail address: [email protected]. Keywords: Cerebral palsy; Lower limb; Electromyography; Equinus; Gait Objective.The purpose of this study was to measure the muscular activity of the main muscular groups of the lower limbs of healthy children according to the degree of plantarflexion imposed by an orthosis witch simulate an unilateral progressive equinus. Method.A 3D gait analysis an electromyographic analysis was performed for 10 healthy children with the non-adjusted orthosis (OL), with the orthosis adjusted to 108, 08, 108, 208 of ankle dorsiflexion and maximum plantarflexion (MP). The muscular envelopes were calculated for the soleus Pathologies de l’enfant et de l’adolescent (II) / Revue d’E ´ pide ´miologie et de Sante ´ Publique 55S (2012) e225e229 e227

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Page 1: Electromyographic analysis of progressive equinus in typically developing children

Pathologies de l’enfant et de l’adolescent (II) / Revue d’Epid

l’activité et la participation (T-score pondéré). Étaient également calculées lesmoyennes des scores bruts obtenus à chaque échelle, pondérées ou non selon lesmêmes critères. La distribution normale des T-scores et des moyennes étaittestée par le test de Kolmogorov-Smirnov et leurs corrélations par Rho deSpearman.Resultats.– Cent trente-neuf patients-toxine ont été inclus, donnant un total de541 échelles dont 537 qui ont pu être analysés pour l’étude. Les T-scores(56,77 � 10,2) et les moyennes de scores bruts (0,49 � 0,74) étaient trèsfortement corrélées (p = 0,99). Les T-scores pondérés et les moyennes pondéréssuivaient une distribution normale. En revanche, les T-scores et des moyennesNON pondérés ne suivait pas une loi normale (p = 0,013 et 0,011).Discussion.– Vu la forte corrélation des T-scores et des moyennes des scoresbruts dans notre étude, le calcul de T-score peut raisonnablement être remplacépar le calcul de la moyenne des scores bruts en pratique clinique. Malgré sonappellation de « T-score », la formule de Kiresuk ne permet pas forcément unenormalisation des scores. Les implications de l’utilisation du T-score dans lesétudes de groupe seront discutées.

http://dx.doi.org/10.1016/j.rehab.2012.07.573

CO10-006-f

Matelas de correction cervico-cephalique : nouveautraitement du torticolis et de la plagiocephalie dunourrissonJ. Durigneux a,*, M. Dinomais a, B. Chevalier b, L. Marquois c, G. Payneau c,

X. Deries a

a CRRRFAngers, rue des Capucins, BP 40329, 49103 Angers cedex 02, Franceb Kinesitherapeute liberal, Angers, Francec Entreprise Proteor, Angers, France

*Auteur correspondant.Adresse e-mail : [email protected].

Mots cles : Plagiocephalie ; Torticolis ; Nourrisson ; Matelas

Introduction.– Depuis les recommandations de 1992 incitant à faire dormir lesnourrissons en décubitus dorsal, l’augmentation de la prévalence de laplagiocéphalie est reconnue [1]. Les traitements actuels reposent essentielle-ment sur le positionnement simple, la kinésithérapie et/ou la médecinemanuelle. Dans les formes sévères, une correction crânienne exclusive estproposée depuis quelques années par le port d’une orthèse (casque) avec unetolérance variable. Nous avons mis en place l’utilisation d’un matelas dontl’objectif est non seulement d’agir sur la plagiocéphalie mais également surl’attitude en torticolis habituellement associée.Methode.– Étude prospective concernant 18 nourrissons (âge moyen de cinqmois) présentant une plagiocéphalie positionnelle postérieure asymétrique enlien avec un torticolis. Mesures anthropométriques au temps initial et aprèstraitement : par empreintes crânienne au ruban plombé, calcul du Cranial VaultAsymetry Index (CVAI), classification en cinq degrés de sévérité (cinq étant leplus sévère) de la plagiocéphalie [2] et de l’index céphalique (IC) représentantune évaluation de la brachycéphalie.Resultats.–Après traitement on note une réduction significative du CVAI de8,69 à 5,33 (p < 0,0001, test t pairé), du degré de sévérité qui passe de 3,6 à 2,3(p < 0,0001, test t pairé), sans modification de l’IC 0,91 versus 0,92 (p = 0,503,test t pairé). De plus l’efficacité est corrélée à l’âge de début de traitement(Spearman r = 0,70, p = 0,008), plus le traitement est commencé jeune pluscelui-ci est efficace.Discussion et conclusion.–Notre étude montre une efficacité de l’utilisation dumatelas quant à la diminution de l’asymétrie crânienne et donc de laplagiocéphalie sans majorer la brachycéphalie (IC). Elle confirme l’intérêtd’une prise en charge précoce.

Références[1] Hutchison B, Hutchison L, Thompson J, Mitchell E. Plagiocephaly and

brachycephaly in the first two years of life: a prospective cohort study.

Pediatrics 2004;114:970.

[2] Loveday BP, de Chalain TB. Active counterpositioning or orthotic device to

treat positional plagiocephaly? J Craniofac Surg 2001;12(4):308–13.

http://dx.doi.org/10.1016/j.rehab.2012.07.574

English version

CO10-001-e

Update on the treatment of childhood movementdisorders: Focus on dystoniaA. Roubertie *, B. Echenne

Service de neuropediatrie, CHU Gui-de-Chauliac, 80, avenue Fliche,

34295 Montpellier, France

*Corresponding author.E-mail address: [email protected].

Keywords: Dystonia; Therapy; L-dopa; Anticholinergics; Botulinum toxin;

Deep brain stimulation

Dystonia represents the most common form of non paroxysmal movementdisorders in childhood. Dystonia treatment is often a challenging situation forthe physician.Material and methods.– Based on a systematic review of the literature and onour personal experience, we propose an update regarding the therapeuticmanagement of childhood dystonia.Attenuation of the abnormal movements, improvement of the functionaldisabilities and alleviation of painful manifestations are idealistic objectives ofthe treatment. Therapeutic strategy depends on:– the phenomenology of the dystonic movements (hyperkinetic/fixed dystonia);– topography, extension and functional disability;– mixed motor disorders (especially associated spasticity);– etiology of the dystonic symptoms;– age of the patient;– potential drug-induced adverse events given the clinical status of the patients;– associated comorbidities.Sometimes, the abnormal movements are part of a treatable disorder: thesesituations must be identified and a specific treatment should be initiated rapidly(Wilsons disease, creatine deficiency, organic aciduria).Most of the time, therapies for dystonia are purely symptomatic. Rehabilitationmethods (physiotherapy, speech therapy and occupational therapy, psycho-socialsupport) and adapted equipment and procedures (special computer keyboards,pictograms, voice synthesizers) are very important in the management of thepatients. Various drugs are available: anticholinergics, dopaminergics, dopamineantagonists, muscle relaxants. Their efficacy is sometimes limited, and theirindications will be discussed. Specific pediatric studies are needed to clarify theefficacy, safety and optimal dose of botulinum toxin in childhood dystonia.The progress of functional neurosurgery has open new therapeutic options;functional results of deep brain stimulation are good in primary dystonias, andmore heterogeneous in secondary dystonias.Conclusion.– A careful physical examination and a comprehensive andmultidisciplinary work-up are mandatory for the elaboration of a therapeuticstrategy. The therapeutic approach must be individually tailored, and must bediscussed with both the patient and the parents.

http://dx.doi.org/10.1016/j.rehab.2012.07.575

CO10-002-e

Electromyographic analysis of progressive equinus intypically developing childrenL. Houx *, M. Lempereur, S. Brochard, O. Remy-Neris

Service de medecine physique et readaptation, CHRU Brest, 2, avenue Foch,

29609 Brest, France

*Corresponding author.E-mail address: [email protected].

Keywords: Cerebral palsy; Lower limb; Electromyography; Equinus; Gait

Objective.– The purpose of this study was to measure the muscular activity ofthe main muscular groups of the lower limbs of healthy children according tothe degree of plantarflexion imposed by an orthosis witch simulate an unilateralprogressive equinus.Method.– A 3D gait analysis an electromyographic analysis was performed for10 healthy children with the non-adjusted orthosis (OL), with the orthosisadjusted to 108, 08, �108, �208 of ankle dorsiflexion and maximumplantarflexion (MP). The muscular envelopes were calculated for the soleus

emiologie et de Sante Publique 55S (2012) e225–e229 e227

Page 2: Electromyographic analysis of progressive equinus in typically developing children

Pathologies de l’enfant et de l’adolescent (II) / Revue d’Epidemiologie et de Sante Publique 55S (2012) e225–e229e228

(SOL), tibialis anterior (TA), vastus lateralis (VL), rectus femoris (RF) andhamstrings (HA) and were compared between lower limbs according to thedegree of induce equinus. The data were divided into nine intervals in relation tothe phases of the motion as described by Perry.Results.– On the lower limb with the orthosis, the activation of the SOL wasearlier from 73–100% and 0–50% of the cycle (coactivation SOL-TA) and theamplitude increase from �108 of dorsiflexion (P < 0.01). From 0 to 10% ofcycle, the TA amplitude decreases from �208 (P < 0.01). From �108 ofdorsiflexion, the HA activation significantly increase from 0 to 10% of the cycle.The DA activation decrease from 0–10% cycle (P < 0.05) and like the VL, amuscular activation appear in the middle of stance phase �208 (VL 20–30%:P < 0.05). The contralateral limb, SOL activated earlier from 87–100% and 0–

10% at MP (P < 0.01).Discussion.– Equinus gait secondary to the orthosis induced changes in muscleactivation both in terms of timing and in terms of signal amplitude. Thepremature activity of SOL, the TA-SOL coactivation and the reduce TAamplitude are frequently observed during cerebral palsy gait. These findings inhealthy children show that a foot deformation without neurological disturbanceinduce primary changes in muscle activation, which must be taken into accountduring interpretation in motion analysis.

Further readingPerry J. Gait analysis normal and pathological function. Thorofare N.J 1992.Houx and al, Simulation of using unilateral equinus year adjustable orthosis inchildren: design, Feasibility years biomechanical effects. Prosthetics andOrthotics International 2011.

http://dx.doi.org/10.1016/j.rehab.2012.07.576

CO10-003-e

Peroneus longus and the midfoot in children: EMGnormative dataC. Boulay *, V. Pomero, M. Jacquemier, G. Authier, E. Castanier, Y. Glard, G.

Bollini, B. Chabrol, J.-L. Jouve, E. Viehweger

Plate forme d’analyse de la motricite, pole medico-chirurgical pediatrique,

CHU Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille, France

*Corresponding author.E-mail address: [email protected].

Keywords: Mid foot; Children; Peroneus longus; Dynamic EMG; Gait

Introduction.– The EMG overactivity of peroneus longus (PL) is described [1]as the major deforming force in spastic midfoot break in adult after stroke. Beforeto test this hypothesis in children with cerebral palsy (CP), it was necessary toprovide the normal EMG activity of PL in children without neuromusculardisorders. These data are not studied in literature. It was necessary to provide thenormal EMG activity of PL [2] in children without neuromuscular disordersbefore to study its overactivity in CP especially in the midfoot break.Materials and methods.– One thousand one hundred and four strides of 21children (age 6.5yrs � 1) without neuromuscular disorders were examinedusing surface EMG during walking. The PL activity was normalized as apercentage during strides. A software selected the more repeatable strides. Theonset, offset activity of rectified raw EMG signal was detected by a manualselection: the threshold was 20 mV [3].Results.– Resulting in 1104 normal strides: the mean toe off was at 62.8%, thePL onset activity was at 26.8% in midstance and the offset at 52.2% duringterminal stance. There was never activity during swing phase.Discussion.– These data confirmed the PL activation as a locking effect onmidfoot, in midstance during the ankle rocker for progression and without motoraction on the ankle [4]: PL supports the longitudinal and transversal arches. Interminal stance during forefoot rocker for progression, PL has a locking effect onthe first ray: the forefoot is stabilising during the heel rise. It prevents excessiveinversion thus maintaining the first metatarsal down on the ground. PL maintainsthe stabilisation of the first and second ray by a pronation to counteract the lifteffect of the supination muscles. The PL contraction should be rather isometric.Conclusion.– PL EMG activation provides, during mid stance, a locking effecton the midfoot and in terminal stance a stabilising effect on the forefoot afterheel rise [2]. Thus the relation between PL overactivity and midfoot break has tobe assessed in CP children.

References[1] Young. Foot Ankle 1990;10(6):317–24.

[2] Johnson. Foot Ankle Surg 1999;38(5):313–21.

[3] Santili. Am J Sports Med 2005;33(8):1183–7.

[4] Perry. J Bone Joint Surg 1974;56-A(3):511–20.

http://dx.doi.org/10.1016/j.rehab.2012.07.577

CO10-004-e

Impairment profile of shoulder muscle strength in childrenwith brachial plexus palsy at birthS. Brochard *, L. Curatalo, F. Sheehan, K. Alter, D. Damiano

Functional and Applied Biomechanics Section, Rehabilitation Medicine

Department, Clinical Center, National Institutes of Health, 10 Center drive,

20892 Bethesda, United States

*Corresponding author.E-mail address: [email protected].

Keywords: Brachial plexus palsy; Shoulder; Strength; Children

Introduction.– Brachial plexus palsy (BPP) at birth can lead to severe functionallimitations of the whole upper-limb. Although shoulder muscle strength loss andimbalance are central to the loss of upper-limb function associated with BPP,biomechanical and clinical assessments of muscle strength are rarely reported forthis population. Thus, the aim of this study was to quantitatively evaluate themuscle strength impairment profile in a group of children with unilateral BPP. Inaddition, the validity and reliability of the current methodologies was tested.Methods.– Ten children with unilateral BPP (mean age = 12.31, SD = 3.28)underwent the following assessments in both shoulders: (1) three trials ofmaximal isometric contractions in flexion/extension, internal/external rotation,and abd/adduction using a hand held dynamometer, (2) maximal isometriccontractions of flexion/extension using a Biodex1. The maximal values of theinvolved shoulder were compared to the non-involved one.Results.– The concurrent validity between the hand held dynamometer andBiodex1 measures was excellent (r2 = 0.81). The inter-trial reliability was alsoexcellent (ICC between 0.94 and 0.98), regardless of the direction and side. Thecomparison between sides showed significant differences in all directions (P-values ranged from 0.036–0.0009), except for flexion. External rotation andextension were the most impaired directions, with average strength impaired/non impaired shoulder ratios of 30% and 40%.Discussion.– This study provides the first comprehensive quantitativemeasurement of shoulder muscle strength using a hand held and motorizeddynamometer in children with BPP. Future work will relate specific patterns ofweakness to resultant bony and muscle deformity and functional limitations.

http://dx.doi.org/10.1016/j.rehab.2012.07.578

CO10-005-e

T-score computer-calculation in Goal Attainment Scalesdoes not provide further information than hand-calculationof simple mean scores: Analysis of 537 GAS scalesA. Krasny-Pacini a,*, J. Hiebel a,b, S. Godon a, F. Pauly a,c

a CHU de Strasbourg, 1, rue de l’Eglise, 67600 Ebersheim, Franceb CRF Clemenceau, Strasbourg, Francec CHU Luxembourg, Luxembourg, France

*Corresponding author.E-mail address: [email protected].

Keywords: GAS; Personal goals; Scale; Botulinum toxin

Goal Attainment Scaling (GAS) is a method of measuring progress towardsindividual goals. GAS is originally a 5-points scale, that represent baseline anddifferent levels of goal attainment. It is possible to calculate by an Excelcalculation sheet a T-score that gives the overall result of the different scales ofone patient using Kiresuk’s forumulae. The aim of this study was to compare T-scores and simple means of GAS raw scores.For 2 years all patients, aged 2–20 presenting a motor handicap that neededbotulinum toxin treatment were included. One to seven GAS scales were writtenper patients and results were assessed 8 weeks after treatment. T-scores were