Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique最新文献

Ten years after the therapeutic revolution that emerged from the discovery of l-dopa, some pioneer teams led the rebirth of a new nonablative stereotaxical surgical treatment, which came from the interest of high frequency stimulation. Three targets were retained as the main location of a reversible functional inhibition: Vim, GPI and STN. The unilateral or bilateral stimulation, adjustable and possibly reversible, led to an exceptional medicosurgical collaboration, within expert dedicated places, based on the control of the Parkinson's disease's (PD) triad. The stimulation was initially applied to the most advanced forms of PD, after the medical control period of the motor performance, when the pejorative effects of the evolution settled and/or when side effects of the treatment appeared. Subsequently, the research of selection criterions and the strict control of the stereotaxical procedure during the per- and postoperatory period, with the collaboration of the patient and his family, progressively brought different teams to an earlier indication of this new treatment option, up to now reserved for fully medicosurgical concerted cases. Apparition of cognitive and postural decline as well as the known resistance stage to l-dopa tend to become a real contra-indication. Despite the initial relative weakness of controlled studies with limited number of patients, the multiplication of follow-up studies among high quality multicentric cohorts enabled the validation of practices respecting the differences related to the initial background of each different team. In Europe first, the prevalence of the subthalamic target is now to be generally admitted. A new objective is now imposing itself: trying to maintain the patient's quality of life, beyond the only motor benefit. The social adaptation of a young patient is now also taken into account. If this exemplary clinical research approach, efficient for a few highly selected patients, has not transformed the long-term prognostic of the PD, it will continue to improve the comprehension of this degenerative pathology and its extension. It still remains hopeful for the future in the actual constant technological progress, and that probably beyond the only PD.

A literature survey of 106 articles shows that standard electrostimulation is an effective treatment of urinary incontinence and urinary disorders with bladder instability. Bladder inhibition is obtained by applying an alternating current at a frequency of between 5 and 25 Hz and with a pulse width of between 0.2 and 0.5 ms. In 19 articles (including three randomized, placebo-controlled studies), good results were achieved in 60 to 90% of cases, depending on the exact method (i.e. chronic or acute stimulation). Standard electrostimulation is also efficient in stress urinary incontinence. Urethral closure is obtained by applying a 50 Hz alternating current with, again, a pulse width of between 0.2 and 0.5 ms. In 21 articles (including two randomized, placebo-controlled studies), good results were achieved in 47.5 to 77% of cases. Treatments combining perineal rehabilitation (behavioural education, muscle improvement and biofeed-back) and electrostimulation are reported by 10 authors, with good results in 70 to 80% of cases after 10 to 12 sessions. According to 14 studies, neuromodulation is also an efficient treatment for complex urinary disorders, urgency, pollakiuria and dysuria. The recommended stimulation parameters are a frequency of 10 to 15 Hz and a pulse width of 210 ms. Good results were found in 34 to 94% of cases (with between 60 and 75% in an international, multicenter study). The overall results different from one study to another because of the need to harmonize stimulation parameters, choice of the study population and treatment follow-up with self-training programs and therapeutic education.

Objectives

To identify the effects of application methods and indications of direct muscle electrostimulation on strength gain.

Methods

Literature review and analysis of articles from Medline database with the following entries: muscular or neuromuscular, electromyostimulation, electrical stimulation, strengthening, strength training, immobilization, muscle dystrophy, bed-rest, bed-bound, knee or hip surgery, postoperative phase, cachexia, sarcopenia, and their French equivalent.

Results

Because of its specific muscle recruitment order, different from that of voluntary contraction, direct muscle electrostimulation is theoretically a complementary tool for muscle strengthening. It can be used in healthy subjects and in several affections associated with muscle function loss. Its interest seems well-established for post-traumatic or postsurgery lower-limb immobilizations but too few controlled studies have clearly shown the overall benefits of its application in other indications. Whatever the indication, superimposed or combined electrostimulation techniques are generally more efficient than electrostimulation alone.

Conclusion

Even though widely used, the level of evidence for the efficiency of electromyostimulation is still low. For strength gains, it yielded no higher benefits than traditional strengthening methods. Its interest should be tested in medical affections leading to major muscle deconditioning or in sarcopenia.

In antiquity, the electrical properties of torpedo fishes were used for therapeutic purposes (in headache and gout). In the 18th century, some practitioners used Leyde jars (Musschenbroek, 1746) and electrostatic devices to treat (notably) neuralgia, contractures and paralysis. L. Galvani's (1737–1798) description of “animal electricity” and A. Volta's (1745–1827) discovery of bimetallic electricity and invention of the voltaic battery prompted renewed interest in the therapeutic effects of galvanism. In the mid-19th century, Duchenne de Boulogne (1806–1875) improved electrotherapy procedures with volta and magnetofaradaic apparatuses. During the first half of the 20th century, research in electrophysiology (chronaxia and rheobasis) progressed in parallel with the work of electroradiologists such as A. d’Arsonval (1851–1940) and his high-frequency currents. From the 1960s onwards, the combination of progress in electronics with data processing and the miniaturization of medical devices opened up the way to today's electrostimulation techniques and their implementations in physical medicine and rehabilitation.

Low-frequency electromyostimulation (EMS) acts on the skeletal muscle abnormalities that aggravate intolerance to effort in patients with chronic heart failure (CHF). It improves the oxidative capacity of muscles and thus enhances aerobic performance and physical capacity to almost the same degree, as does conventional physical training. No local or hemodynamic intolerance has been reported, even in cases of severe CHF. However, the presence of a pacemaker is one of the relative contra-indications (prior evaluation of tolerance is required), while that of an implanted defibrillator is one of the absolute contra-indications. EMS is an alternative to physical effort training when the latter is impossible due to a high degree of deconditioning or because there is a contra-indication, which may be temporary, due to the risk of acute decompensation and/or rhythm troubles. EMS can also be used in patients waiting for a heart transplant or in CHF patients who are unwilling to engage in physical activities. As EMS is not expensive and easy to set up, its use is likely to develop in the future.

For nearly half a century, functional electrical stimulation (FES) has been used to restore walking for people with paralysis and muscle weakness due to stroke and spinal cord injury. The first applications of the technology were intended to permanently replace lost neuromuscular function. Later, FES-assisted walking was found to have therapeutic benefits that include increased muscle strength, cardiovascular fitness and improved gait function that could be maintained after use of FES was terminated. In this review, we examine some of the major FES-assisted walking systems that have been developed for experimental and commercial purposes over the last four and a half decades, including foot drop stimulators, multichannel stimulators and hybrid orthotic systems.

Aim

The aim of this study was to interpret and validate a French version of the Oswestry disability index (ODI), using a cross-cultural validation method. The validity and reliability of the questionnaire was assessed in order to ensure the psychometric characteristics.

Method

The cross-cultural validation was carried out according to Beaton's methodology. The study was conducted with 41 patients suffering from low back pain. The correlation between the ODI and the Roland-Morris disability questionnaire (RMDQ), the medical outcome survey short form-36 (MOS SF-36) and a pain visual analogical scale (VAS) was assessed.

Results

The validity of the Oswestry questionnaire was studied using the Cronbach Alpha coefficient calculation: 0.87 (n = 36). The significant correlation between the ODI and RMDQ was 0.8 (P < 0.001, n = 41) and 0.71 (P < 0.001, n = 36) for the pain VAS. The correlation between the ODI and certain subscales (physical functioning 0.7 (P < 0.001, n = 41), physical role 0.49 et bodily pain 0.73 (P < 0.001, n = 41)) of the MOS SF-36 were equally significant. The reproducibility of the ODI was calculated using the Wilcoxon matched pairs test: there was no significant difference for eight out of ten sections or for the final score.

Conclusion

This French translation of the ODI should be considered as valid and reliable. It should be used for any future clinical studies carried out using French language patients. Complimentary studies must be completed in order to assess its sensitivity to change in the event of any modifications in the patients functional capacity.