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Donze C.,Groupe Hospitalier Of Linstitut Catholique Of Lille
Presse Medicale | Year: 2015

Given that mobility impairment is a hallmark of multiple sclerosis, people with this disease are likely to benefit from rehabilitation therapy throughout the course of their illness. The review provides an update on rehabilitation focused on balance and walking impairment. Classical rehabilitation focusing on muscle rehabilitation, neurotherapeutic facilitation is effective and recommended. Other techniques did not prove their superiority: transcutaneal neurostimulation, repetitive magnetic stimulation, electromagnetic therapy, whole body vibration and robot-assisted gait rehabilitation and need more studies to conclude. Cooling therapy, hydrotherapy, orthoses and textured insoles could represent a complementary service to other techniques in specific conditions. Multidisciplinary rehabilitation program provides positive effects and high satisfaction for patients with multiple sclerosis but needs more evaluation. New technologies using serious game and telerehabilitation seem to be an interesting technique to promote physical activity, self-management and quality of life. Rehabilitation like other therapy needs regular clinical evaluation to adapt the program and propose appropriate techniques. Moreover, the objective of rehabilitation needs to be decided with the patient with realistic expectation. © 2015 Elsevier Masson SAS. Source

Wang Z.F.,Engineering School HEI | Peyrodie L.,Engineering School HEI | Cao H.,Engineering School HEI | Agnani O.,Groupe Hospitalier Of Linstitut Catholique Of Lille | And 2 more authors.
Mechanical Systems and Signal Processing | Year: 2015

Walk training research with children having multiple disabilities is presented. Orthosis aid in walking for children with multiple disabilities such as Cerebral Palsy continues to be a clinical and technological challenge. In order to reduce pain and improve treatment strategies, an intermediate structure - humanoid robot NAO - is proposed as an assay platform to study walking training models, to be transferred to future special exoskeletons for children. A suitable and stable walking model is proposed for walk training. It would be simulated and tested on NAO. This comparative study of zero moment point (ZMP) supports polygons and energy consumption validates the model as more stable than the conventional NAO. Accordingly direction variation of the center of mass and the slopes of linear regression knee/ankle angles, the Slow Walk model faithfully emulates the gait pattern of children. © 2015 Elsevier Ltd. Source

Boulvain M.,University of Geneva | Senat M.-V.,University Paris - Sud | Perrotin F.,Pole de Gynecologie obstetrique | Winer N.,Hopital Mere enfant | And 16 more authors.
The Lancet | Year: 2015

Background Macrosomic fetuses are at increased risk of shoulder dystocia. We aimed to compare induction of labour with expectant management for large-for-date fetuses for prevention of shoulder dystocia and other neonatal and maternal morbidity associated with macrosomia. Methods We did this pragmatic, randomised controlled trial between Oct 1, 2002, and Jan 1, 2009, in 19 tertiary-care centres in France, Switzerland, and Belgium. Women with singleton fetuses whose estimated weight exceeded the 95th percentile, were randomly assigned (1:1), via computer-generated permuted-block randomisation (block size of four to eight) to receive induction of labour within 3 days between 37+0 weeks and 38+6 weeks of gestation, or expectant management. Randomisation was stratified by centre. Participants and caregivers were not masked to group assignment. Our primary outcome was a composite of clinically significant shoulder dystocia, fracture of the clavicle, brachial plexus injury, intracranial haemorrhage, or death. We did analyses by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00190320. Findings We randomly assigned 409 women to the induction group and 413 women to the expectant management group, of whom 407 women and 411 women, respectively, were included in the final analysis. Mean birthweight was 3831 g (SD 324) in the induction group and 4118 g (392) in the expectant group. Induction of labour significantly reduced the risk of shoulder dystocia or associated morbidity (n=8) compared with expectant management (n=25; relative risk [RR] 0·32, 95% CI 0·15-0·71; p=0·004). We recorded no brachial plexus injuries, intracranial haemorrhages, or perinatal deaths. The likelihood of spontaneous vaginal delivery was higher in women in the induction group than in those in the expectant management group (RR 1·14, 95% CI 1·01-1·29). Caesarean delivery and neonatal morbidity did not differ significantly between the groups. Interpretation Induction of labour for suspected large-for-date fetuses is associated with a reduced risk of shoulder dystocia and associated morbidity compared with expectant management. Induction of labour does not increase the risk of caesarean delivery and improves the likelihood of spontaneous vaginal delivery. These benefits should be balanced with the effects of early-term induction of labour. Funding Assistance Publique-Hôpitaux de Paris and the University of Geneva. © 2015 Elsevier Ltd. Source

Budzik J.-F.,Groupe Hospitalier Of Linstitut Catholique Of Lille | Budzik J.-F.,Lille Catholic University | Budzik J.-F.,University of Lille Nord de France | Balbi V.,Groupe Hospitalier Of Linstitut Catholique Of Lille | And 8 more authors.
Radiographics | Year: 2014

Diffusion tensor (DT) imaging is an emerging magnetic resonance (MR) imaging technique for evaluating the microstructure of wellorganized biologic tissues such as muscles and nerves. DT imaging provides information about tissue microstructure by producing three-dimensional maps of water molecule movements. The two main parameters of measurement at DT imaging, fractional anisotropy and the apparent diffusion coefficient, allow quantitation of architectural changes occurring in tissue. These parameters are modified in the presence of cervical spondylotic myelopathy, cervical spine trauma, carpal tunnel syndrome, lumbar nerve compression, peripheral nerve tumors, and muscle ischemia. Their alteration may be observed at DT imaging even when no abnormality is seen at conventional MR imaging, a fact that suggests that DT imaging allows the detection of abnormalities at an earlier stage of injury. Experimental studies in animals have shown that DT imaging consistently allows identification of pathophysiologic alterations in tissue that correlate with histologic findings. Tractographic images accurately depict both normal and abnormal diffusion in anatomic structures such as the thigh and pelvic muscles, cervical spine, and lumbar nerves. Patients with chronic diseases also may benefit from follow-up evaluation with DT imaging, although DT imaging sequences must be further adapted to improve the evaluation of specific anatomic regions by reducing artifacts, optimizing spatial resolution, and minimizing acquisition time. Given its proven potential for use in identifying abnormalities that are otherwise identifiable only with electrophysiologic and histopathologic studies, and with future technical improvements, DT imaging could soon become a standard method for early diagnosis, management, and follow-up of disease in the spine, muscles, and peripheral nerves. © RSNA, 2014. Source

Budzik J.-F.,Groupe Hospitalier Of Linstitut Catholique Of Lille | Budzik J.-F.,Lille Catholic University | Budzik J.-F.,University of Lille Nord de France | Lefebvre G.,University of Lille Nord de France | And 9 more authors.
European Radiology | Year: 2014

Methods: The right hips of 21 adult patients under 50 years of age were studied. Spatial resolution was 1.8 × 1.8 × 1.8 mm3, and temporal resolution was 13.5 seconds. Two musculoskeletal radiologists independently processed DCE images and measured semi-quantitative and pharmacokinetic parameters in areas of YBM and RBM. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Intra- and inter-observer reproducibility was assessed.Objective: The objective of this study was to compare measurements of semi-quantitative and pharmacokinetic parameters in areas of red (RBM) and yellow bone marrow (YBM) of the hip, using an in-house high-resolution DCE T1 sequence, and to assess intra- and inter-observer reproducibility of these measurements.Results: Area under the curve (AUC) and initial slope (IS) were significantly greater for RBM than for YBM (p < 0.05). Ktrans and kep were also significantly greater for RBM (p < 0.05). There was no significant difference in time to peak between the regions (p < 0.05). SNR, CNR, and intra- and inter-observer reproducibility were all good.Conclusions: DCE study of the whole hip is feasible with high spatial resolution using a 3D T1 sequence. Measures were possible even in low vascularized areas of the femoral head. Ktrans, kep, AUC, and IS values were significantly different between red and yellow marrow, whereas TTP values were not.Key Points: • High-spatial-resolution dynamic contrast-enhanced MRI of hip structures is feasible.• Intra- and inter-observer reproducibility is good.• Red and yellow bone marrow have different perfusion patterns. © 2014, European Society of Radiology. Source

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