EMC - Kinesiterapia - Medicina Física, Oct 1, 2020
Resumen La implementacion de programas de readaptacion al esfuerzo, y mas especificamente el entr... more Resumen La implementacion de programas de readaptacion al esfuerzo, y mas especificamente el entrenamiento de resistencia, es un elemento clave en el tratamiento rehabilitador de los pacientes con esclerosis multiple. Se efectua una prueba de esfuerzo para determinar la capacidad cardiorrespiratoria del paciente con el fin de personalizar el programa de readaptacion al esfuerzo. Los programas de readaptacion al esfuerzo continuos estan programados al 50-70% de la potencia maxima aerobica durante 30 minutos. A falta de una prueba de esfuerzo, se proponen basandose en una frecuencia cardiaca objetivo calculada a partir de la frecuencia cardiaca maxima teorica o en la escala de percepcion subjetiva del esfuerzo de Borg. Ademas de los programas continuos, estan surgiendo programas intermitentes y combinados sin recomendaciones actuales. Las modalidades de readaptacion al esfuerzo son personalizadas, adaptadas a las capacidades fisicas del paciente. Los beneficios de la readaptacion al esfuerzo son multiples: mejora de la capacidad cardiorrespiratoria, de la fuerza, de la marcha, reduccion de la fatiga y mejora de la calidad de vida. En este articulo se especifican los efectos de la readaptacion al esfuerzo y se definen las modalidades de estos programas, para que puedan utilizarse en la rehabilitacion y readaptacion de pacientes con esclerosis multiple, en centros de rehabilitacion o en consultorios privados.
Évaluation de la fatigabilité chez les patients post-Covid-19
Kinésithérapie, la Revue, Mar 1, 2023
Sclerosi multipla e riallenamento allo sforzo
EMC - Medicina Riabilitativa, Nov 1, 2020
Impact of a combined rehabilitation program on fatigue and fatigability in patients with multiple sclerosis
Annals of physical and rehabilitation medicine, Jul 1, 2018
Introduction/Background Fatigue and fatigability are common problems in patients with multiple sc... more Introduction/Background Fatigue and fatigability are common problems in patients with multiple sclerosis (MS). The aim of this study was to explore the impact of a combined rehabilitation program on fatigue and on fatigability of knee extensor muscles in patients with MS. Material and method Twenty-three patients with MS were included in this study. Knee extensor muscles strength and fatigability were assessed using an isokinetic ergometer and perceived fatigue was assessed with a self-reported fatigue scale (Modified Fatigue Impact scale) before and after the rehabilitation program. The combined rehabilitation program included sessions on balance and gait training; sessions of endurance and resistance training. Results After rehabilitation, fatigue decreased significantly, on the other hand, torque fatigability index increased. Strength at the beginning of the fatigability protocol increased but strength at the end of the fatigability protocol did not change. Conclusion Combined rehabilitation program increased strength and decreased fatigue. However, torque fatigability index increased because the program enhanced strength at the beginning of the fatigability protocol but not at the end of the fatigability protocol.
Lesioni midollari acquisite dell’adulto: rieducazione delle paraplegie incomplete: AIS C e D
EMC - Medicina Riabilitativa, Sep 1, 2015
La rieducazione delle paraplegie incomplete presenta un certo numero di punti in comune con quell... more La rieducazione delle paraplegie incomplete presenta un certo numero di punti in comune con quella dei pazienti completi (cfr. articolo 26-460-A-15 dell’EMC). Tuttavia, essa integra altri parametri, come la gestione della spasticita, la rieducazione motoria e sensitiva sottolesionale e il lavoro della rieducazione in piedi e della deambulazione con o senza aiuto tecnico. L’oggetto di questo articolo e di affrontare le particolarita di questa gestione e di proporre degli esercizi rieducativi per questi pazienti, tenendo conto della variabilita delle loro possibilita neuromotorie e dei quadri clinici. Sono affrontate anche la problematica dell’invecchiamento e del reinserimento socioprofessionale e le prospettive future.
Annals of physical and rehabilitation medicine, Oct 1, 2012
visual analog scale satisfaction in post-therapeutic. Results.-Among the 52 patients treated 64% ... more visual analog scale satisfaction in post-therapeutic. Results.-Among the 52 patients treated 64% were male, 37% are children aged 5 to 15 years. Hemiplegia and cerebral palsy represent 73% of diseases treated. The equine foot was treated in 54% of cases where a percentage of 64% muscle toxins represented by the triceps surae (42% of gastrocnemius, soleus 21%). Before treatment, the mean VAS pain was 6.85, the average Ashworth was 3.1, the mean range of motion (dorsiflexion of the ankle) was À78. After treatment, the mean VAS pain increased to 4.02 that of Ashworth 2, and the mean joint amplitudes increased to 1.58. Discussion.-The results obtained after injection of botulinum toxin in these 52 patients were satisfactory standard analgesic, hypertonic and joint mobility, by a regression of pain intensity estimated at three points on average, a regression point of the spasticity and a gain of passive joint movement of 8.58 on average. These results have led to an improvement in the lives of patients at the functional level with an average of 53.63% EVA satisfaction. Conclusion.-Focal spasticity is causing functional impairment of a major source of pain and muscle-tendon and articular use of botulinum toxin has dramatically improved the lives of these 52 patients, hence the interest to generalize this method therapeutic.
Iconography : Les outils de mesure pour l’évaluation fonctionnelle du blessé médullaire
Évaluation de la fatigabilité chez les patients post-Covid-19
Kinésithérapie, la Revue
Les facteurs déterminants de la montée et descente d’escaliers chez les sujets atteints de sclérose en plaques
Kinésithérapie, la Revue
Lesioni midollari acquisite dell’adulto: rieducazione delle paraplegie incomplete: AIS C e D
EMC - Medicina Riabilitativa, 2015
La rieducazione delle paraplegie incomplete presenta un certo numero di punti in comune con quell... more La rieducazione delle paraplegie incomplete presenta un certo numero di punti in comune con quella dei pazienti completi (cfr. articolo 26-460-A-15 dell’EMC). Tuttavia, essa integra altri parametri, come la gestione della spasticita, la rieducazione motoria e sensitiva sottolesionale e il lavoro della rieducazione in piedi e della deambulazione con o senza aiuto tecnico. L’oggetto di questo articolo e di affrontare le particolarita di questa gestione e di proporre degli esercizi rieducativi per questi pazienti, tenendo conto della variabilita delle loro possibilita neuromotorie e dei quadri clinici. Sono affrontate anche la problematica dell’invecchiamento e del reinserimento socioprofessionale e le prospettive future.
Lesiones medulares adquiridas del adulto: rehabilitación de las paraplejías completas
EMC - Kinesiterapia - Medicina Física, 2015
La paraplejia adquirida del adulto provoca deficiencias primarias motoras, sensitivas, vesicoesfi... more La paraplejia adquirida del adulto provoca deficiencias primarias motoras, sensitivas, vesicoesfinterianas y genitosexuales, que a su vez pueden ser el origen de deficiencias secundarias cutaneas, troficas, vasculares, ortopedicas y respiratorias, ademas de dolores. Estas deficiencias varian en funcion del nivel lesional de la paraplejia y perturban la autonomia funcional del paciente. Tras una resena fisiopatologica y medica de la patologia, se describiran la rehabilitacion de las paraplejias completas del adulto y los medios que deben aplicarse para prevenir y manejar las complicaciones, escoger y adaptar las ayudas tecnicas y proporcionar al paciente la posibilidad de alcanzar un nivel de autonomia y de rendimiento funcional en relacion con los signos clinicos, el nivel lesional, los factores de riesgo, la edad y el entorno.
Is spasticity exarcerbated with acute neuromuscular fatigue in stroke patients ?
Annals of Physical and Rehabilitation Medicine, 2012
visual analog scale satisfaction in post-therapeutic. Results.-Among the 52 patients treated 64% ... more visual analog scale satisfaction in post-therapeutic. Results.-Among the 52 patients treated 64% were male, 37% are children aged 5 to 15 years. Hemiplegia and cerebral palsy represent 73% of diseases treated. The equine foot was treated in 54% of cases where a percentage of 64% muscle toxins represented by the triceps surae (42% of gastrocnemius, soleus 21%). Before treatment, the mean VAS pain was 6.85, the average Ashworth was 3.1, the mean range of motion (dorsiflexion of the ankle) was À78. After treatment, the mean VAS pain increased to 4.02 that of Ashworth 2, and the mean joint amplitudes increased to 1.58. Discussion.-The results obtained after injection of botulinum toxin in these 52 patients were satisfactory standard analgesic, hypertonic and joint mobility, by a regression of pain intensity estimated at three points on average, a regression point of the spasticity and a gain of passive joint movement of 8.58 on average. These results have led to an improvement in the lives of patients at the functional level with an average of 53.63% EVA satisfaction. Conclusion.-Focal spasticity is causing functional impairment of a major source of pain and muscle-tendon and articular use of botulinum toxin has dramatically improved the lives of these 52 patients, hence the interest to generalize this method therapeutic.
Characterization of knee extensor muscles fatigability during isokinetic concentric contractions in patients with multiple sclerosis
Annals of physical and rehabilitation medicine, Jul 1, 2018
Introduction/Background Increased muscle fatigability has been reported in patients with multiple... more Introduction/Background Increased muscle fatigability has been reported in patients with multiple sclerosis (MS) assessed during sustained isometric contractions however rehabilitation programs and daily life activities often involve concentric contractions. The aim of this study was to characterize knee extensor muscles fatigability in patients with MS during concentric contractions. Material and method Thirty-eight patients with MS and 14 healthy persons were included in this study. An isokinetic assessment of knee extensor muscles fatigability was carried out during a fatiguing task of 50 concentric contractions, associated with an electromyographic activity analysis of the rectus femoris, vastus lateralis, biceps femoris and semitendinosus muscles. Results Patients with MS experienced lower knee extensor muscles fatigability than healthy subjects. When torque was normalized to maximal isometric peak torque, patients with MS and healthy persons had the same level of relative strength at the end of the fatigue protocol (50% of the maximal isometric peak torque). During the fatiguing task neuromuscular efficiency decreased but coactivations of knee flexor muscles remained unchanged. Conclusion Fatigability is a common complaint in patients with MS but they experienced lower muscle fatigability than healthy persons during maximal concentric contractions, nevertheless they finished fatigue protocol at the same level of relative strength.
Les patients atteints de sclérose en plaques présentent une majoration de la fatigue perçue et de... more Les patients atteints de sclérose en plaques présentent une majoration de la fatigue perçue et de la fatigabilité. Mais à l’heure actuelle, la fatigabilité chez les patients atteints de sclérose en plaques a été peu étudiée ; son rôle comme facteur limitant des capacités fonctionnelles, ses spécificités par rapport aux sujets sains ou encore sa réponse à des programmes de rééducation restent des questions en suspens. De plus, la fatigabilité a été principalement étudiée lors de contractions isométriques maintenues qui sont peu représentatives des activités de la vie quotidienne des patients, au cours desquelles une part importante des contractions des extenseurs du genou est réalisée en dynamique, en particulier, durant la locomotion.L’objectif de ce travail était de caractériser la fatigue et la fatigabilité des patients atteints de SEP au cours de contractions maximales volontaires isocinétiques concentriques, de connaitre les liens avec les performances locomotrices et d’explorer...
Les patients atteints de sclerose en plaques presentent une majoration de la fatigue percue et de... more Les patients atteints de sclerose en plaques presentent une majoration de la fatigue percue et de la fatigabilite. Mais a l’heure actuelle, la fatigabilite chez les patients atteints de sclerose en plaques a ete peu etudiee ; son role comme facteur limitant des capacites fonctionnelles, ses specificites par rapport aux sujets sains ou encore sa reponse a des programmes de reeducation restent des questions en suspens. De plus, la fatigabilite a ete principalement etudiee lors de contractions isometriques maintenues qui sont peu representatives des activites de la vie quotidienne des patients, au cours desquelles une part importante des contractions des extenseurs du genou est realisee en dynamique, en particulier, durant la locomotion.L’objectif de ce travail etait de caracteriser la fatigue et la fatigabilite des patients atteints de SEP au cours de contractions maximales volontaires isocinetiques concentriques, de connaitre les liens avec les performances locomotrices et d’explorer...
Fatigue and fatigability are common problems in patients with multiple sclerosis, which might be ... more Fatigue and fatigability are common problems in patients with multiple sclerosis, which might be improved by rehabilitation. The aim of this pilot study was to assess changes in the fatigue and fatigability of knee extensors in patients with multiple sclerosis after a short intensive, combined rehabilitation programme (including physiotherapy primarily focused on gait and balance, endurance and resistance training). Twenty-three patients with multiple sclerosis (10 men, 13 women) underwent isokinetic evaluations of fatigability of the knee extensor muscles during concentric contractions and rated a self-reported fatigue scale (Modified Fatigue Impact Scale; MFIS) before and after a rehabilitation programme. Patients performed rehabilitation for 150 min, 4 days per week for 4 weeks, with physiotherapy focused primarily on gait and balance, endurance training and resistance training. After rehabilitation, perception of fatigue decreased significantly (median MFIS scores [1st; 3rd quar...
Archives of physical medicine and rehabilitation, Jul 24, 2017
To compare quadriceps fatigability during maximal concentric contractions in persons with MS and ... more To compare quadriceps fatigability during maximal concentric contractions in persons with MS and healthy subjects (HS). Observational study. Hospital rehabilitation department PARTICIPANTS: Thirty eight persons with MS and fourteen HS were included. Torque of the knee flexor and extensor muscles and fatigability of the knee extensor muscles were evaluated using an isokinetic device. Surface electromyographic activity of rectus femoris, vastus lateralis, biceps femoris, and semi tendinosus was recorded. None. Muscle fatigability (torque fatigue index) RESULTS: The torque fatigue index was lower in persons with MS than in HS, but when the torque is normalized to maximal isometric peak torque, persons with MS and HS finished the fatigue protocol at exactly the same level of relative strength (50% of maximal isometric peak torque). Moreover, the reduction in torque was primarily due to a reduction in neuromuscular efficiency with no changes of coactivation of antagonist muscles. Althoug...
La spasticite et les spasmes constituent une deficience chez la plupart des patients blesses medu... more La spasticite et les spasmes constituent une deficience chez la plupart des patients blesses medullaires complets ou incomplets. Les consequences sont multiples: alteration de l'etat cutane, attitudes vicieuses, impotences fonctionnelles. Ainsi, 5 ans apres le traumatisme initial, plus de 25 % des patients considerent cette spasticite comme genante [1]. Cependant, la spasticite n'est pas uniquement responsable d'effets nefastes. Elle peut egalement potentialiser une motricite deficiente et faciliter l'autonomie du patient: transfert, passage en position debout, marche. Souvent source de complications, parfois utile, la spasticite est un element fondamental a prendre en compte lors de la prise en charge des patients blesses medullaires.
Background Coactivation of agonist and antagonist lower limb muscles during gait stiffens joints ... more Background Coactivation of agonist and antagonist lower limb muscles during gait stiffens joints and ensures stability. In patients with multiple sclerosis, coactivation of lower limb muscles might be a compensatory mechanism to cope with impairments of balance and gait. Objective The aim of this study was to assess coactivation of agonist and antagonist muscles at the knee and ankle joints during gait in patients with multiple sclerosis, and to evaluate the relationship between muscle coactivation and disability, gait performance, dynamic ankle strength measured during gait, and postural stability.
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