Publications by authors named "Christine Detrembleur"

102 Publications

Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review.

Acta Orthop Belg 2021 Mar;87(1):85-92

Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost.
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March 2021

Effects of prolonged-release fampridine on multiple sclerosis-related gait impairments. A crossover, double-blinded, placebo-controlled study.

Clin Biomech (Bristol, Avon) 2021 Jun 12;86:105382. Epub 2021 May 12.

Cliniques universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Avenue Hippocrate 10, B-1200 Brussels, Belgium; Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium.

Background: People with multiple sclerosis have reduced walking speed and impaired gait pattern. Prolonged release-fampridine is a potassium channel blocker that improves nerve conduction in patients with multiple sclerosis, leading to walking benefits. Whether fampridine alters gait pattern is unknown.

Methods: In this crossover, randomized controlled trial, patients with multiple sclerosis were tested for responder status during a 4-week run-in period. Patients were considered responders if they improved their 25-ft walk test by 10% and improved their perceived walking capacity. Responders were randomized to prolonged release-fampridine (10 mg b.i.d.) or placebo for a 6-week period. After a 2-week wash-out period, they were allocated to the other treatment for 6 weeks. Participants were assessed before and after both conditions. Three-dimensional gait analysis assessed kinematic, kinetic, mechanic and energetic variables while walking on a treadmill at comfortable speed. Six-minute walk test and 25-ft walk test were used to assess walking speed on middle and short-distances, respectively. Patient-reported outcome measures were also used. Repeated measures ANCOVAs were applied to assess the treatment effects.

Findings: Out of 39 included patients, 24 responders (12 women; Expanded Disability Status Scale:4.25[4-5]; age:46 ± 10 years; maximal speed:0.93 ± 0.38 m·s) were identified. Among them, prolonged release-fampridine reduced the external mechanical work (-0.039 J·kg·m;p = 0.02), and improved knee flexion during swing phase (+5.3°; p = 0.02). No differences were found in other walking tests and patient-reported outcomes, at group-level.

Interpretation: Prolonged release-fampridine increases knee flexion during swing phase and lowers mechanical external work. Whether these changes are related to clinically meaningful improvements in walking capacity and other functional variables should be further investigated.
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http://dx.doi.org/10.1016/j.clinbiomech.2021.105382DOI Listing
June 2021

Debridement, antibiotics, irrigation and retention in prosthetic joint infection : predictive tools of failure.

Acta Orthop Belg 2020 Dec;86(4):636-643

Debridement, antibiotic, irrigation and retention of the implant (DAIR) is an attractive treatment for periprosthetic joint infection (PJI). The purpose of this study is to determine predictive factors of failure. We reviewed all DAIR procedures for hip PJI performed between 2002-2017 (n=69). Data recorded included all factors correlated with treatment failure. KLIC score, McPherson adapted score were analyzed. Infection eradication for early PJI (< 4 weeks) was achieved in 68% of patients and was correlated with treatment success (p=0.01). KLIC score (p=0.036), McPherson adapted score (p=0.01), CRP (p=0.025) and late PJI (p=0.031) were significantly predictive of failure treatment. We have established an equation in order to predict failure treatment that has to be validated. DAIR is an effective treatment for early PJI. KLIC score and McPherson adapted score are two ways to predict outcome of a DAIR procedure and should help making the decision in PJI treatment.
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December 2020

A Comparison of Genicular Nerve Blockade With Corticosteroids Using Either Classical Anatomical Targets vs Revised Targets for Pain and Function in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

Pain Med 2021 05;22(5):1116-1126

Neuro-Musculo-Skeletal pole (NMSK) - Experimental and clinical research institute (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgium.

Objective: Compare the effectiveness of genicular nerve blockade (GNB) using classical anatomical targets (CT) versus revised targets (RT) in patients suffering from chronic knee osteoarthritis pain.

Design: Double-blinded randomized controlled trial.

Setting: Pain medicine center of a teaching hospital.

Methods: We randomly assigned 55 patients with chronic knee osteoarthritis pain to receive a GNB (using a fluid mixture of 2 mL: lidocaine 1% + 20 mg triamcinolone) with either classical targets (CT-group, n = 28) or revised targets (RT-group, n = 27). Numeric rating pain scale (NRS), Oxford knee score (OKS), Western Ontario and McMaster Universities osteoarthritis index score (WOMAC), Quantitative analgesic questionnaire (QAQ) and global perceived effects were assessed at baseline, and at 1-hour, 24-hours, 1, 4, and 12 weeks post-intervention.

Results: The RT-group showed greater reduction in NRS mean score at 1-hour post-intervention (2.4 ± 2.1 vs 0.4 ± 0.9, 95% confidence interval (CI) [.0-.8] vs [1.6-3.2], P < .001). The proportion of patients achieving more than 50% knee pain reduction was higher in the RT-group at each follow up interval, yet these differences were statistically significant only at 1-hour post intervention (82.1% [95% CI = 63.1-93.9] vs 100% [95% CI = 97.2-100] P = .02). Both protocols resulted in significant pain reduction and joint function improvement up to 12 weeks post-intervention.

Conclusions: The revised technique allowed more pain relief as well as greater proportion of successful responders at 1-hour post intervention. The large volume injected during therapeutic GNB could have compensated the lack of precision of the classical anatomical targets, mitigating differences in outcomes between both techniques.
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http://dx.doi.org/10.1093/pm/pnab014DOI Listing
May 2021

Effects of Mulligan Mobilization with Movement in Subacute Lateral Ankle Sprains: A Pragmatic Randomized Trial.

J Man Manip Ther 2021 Feb 26:1-12. Epub 2021 Feb 26.

Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal lab, Brussels, Belgium.

: In a pragmatic and randomized clinical trial, patients with lateral ankle sprains were assessed, under blinded conditions, for their responsiveness and improvements during Mulligan mobilization-with-movement (MWM) therapy. : Overall, 51 participants with subacute lateral ankle sprains (Grade I-II) were recruited. Following an MWM screening procedure, responders were randomized to either an intervention group (MWM) or a sham group. The MWM group received inferior tibiofibular, talocrural, or cubometatarsal MWM. The treatment or sham was administered upon three sessions, each 4 days apart. Changes from baseline were measured and compared between the sessions for dorsiflexion range of motion, pain, stiffness perception, and the Y-balance test. : In total, 43 participants were considered responders to MWM. Using a two-way repeated-measure ANOVA, a statistical and clinically meaningful improvement in dorsiflexion range of motion was revealed in the MWM group (p = 0.004, 1 = +1.762 cm; 3 = +2.714 cm), whereas no improvement following the first session occurred in the sham group (p = 0.454, 1trial = +1.091 cm; 3trial = +1.409 cm). Pain and stiffness significantly improved, yet below the clinically meaningful level. The MWM group demonstrated a significant improvement after three sessions for the Y-balance test (p = 0.001, +8.857 cm). : More than 80% of participants with subacute lateral ankle sprains responded well to the MWM approach. Three sessions of pragmatically determined MWM provided a significant and clinically meaningful benefit in dorsiflexion range of motion and Y-balance test performance compared to a sham treatment.
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http://dx.doi.org/10.1080/10669817.2021.1889165DOI Listing
February 2021

Frequency and risk factors of complications after surgical treatment of ankle fractures : a retrospective study of 433 patients.

Acta Orthop Belg 2020 Sep;86(3):563-574

Ankle fractures are frequently treated using surgical interventions, and are associated with a high rate of postoperative complications. We wonder if complications can be anticipated and correlated to patient demographics, lifestyle, fracture or surgery related factors. We retrospectively reviewed all medical reports of patients who underwent ankle fracture surgery between 2013 and 2017. We focused our risks factors analysis on 5 common complications : poor wound healing, surgical site infection, malunion, nonunion and chronic pain. Multivariate logistic regression was performed to analyze significant risk factors for these complications. We identified 433 patients. Complications were present in 26% of the cases. The most frequent complication was poor wound healing (10%) associated with deep surgical site infection in 6%. Malunion was found in 7% and nonunion in 3%. Seven percent of patients suffered from chronic pain. More severe fractures happened to be a risk factor for poor wound healing (p = 0,032) and malunion (p < 0,001). Open fractures had respectively 6 to 9 times more mal- (p = 0,012) and nonunion (p = 0,018). Overweight patients with alcohol abuse were doubling their chances of cutaneous (p = 0,030) and infectious (p = 0,040) complications, and tripling their risks of ankle fracture nonunion (p = 0,003). Female and patients operated at night (p = 0,045) seemed to be more at risk to develop chronic pain (p = 0,028). Complications of ankle fracture treatment are frequent and their risks increases with more complex and open fractures. This study brings new evidence concerning the combined effect of overweight and alcohol abuse on poor wound healing, surgical site infection and non-union.
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September 2020

Assessment of Resection Margins in Bone Tumor Surgery.

Sarcoma 2020 10;2020:5289547. Epub 2020 Dec 10.

Service de Chirurgie Orthopédique et Traumatologique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.

Limb salvage surgery is now the preferred procedure for bone tumor surgery. To decrease the risk of local recurrence, it is crucial to obtain adequate resection margins. The obtained margins must be evaluated postoperatively because they influence what treatment is given subsequently when margins are not adequate (e.g., surgical revision and radiotherapy). The study aims to evaluate margin assessment of tumor specimen by MRI compared to conventional histology (to establish the viability of using MRI) and assess the accuracy of a patient-specific instrument when narrow margins were aimed. The resection margins in 12 consecutive patients that were operated on for bone tumor resection were prospectively analyzed using three methods: MRI of the resection specimen, macroscopic evaluation of specimen slices, and microscopic pathological evaluation. The assessments were qualitative (R0, R1, and R2) and quantitative (distance in mm). MRI, macroscopic, and microscopic margins generated similar results for both the qualitative (all resections were R0) and quantitative assessments. The median error in safe margins was 2 mm with a surgical guide (PSI) and 5 mm without a surgical guide. Local recurrences were not detected after a mean follow-up period of 3.7 years (range, 2.1-5 years); however, four patients died during the study. In conclusion, MRI is a valuable tool for assessing safe margins. When specimens are not available for pathological assessment (e.g., extracorporeally irradiated autograft or autoclaved autograft), MRI could be used to evaluate margins. In particular, when tumor volume is high, MRI could also help to focus the pathological examination on areas of concern.
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http://dx.doi.org/10.1155/2020/5289547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789471PMC
December 2020

Influence of Autocorrelated Rhythmic Auditory Stimulations on Parkinson's Disease Gait Variability: Comparison With Other Auditory Rhythm Variabilities and Perspectives.

Front Physiol 2020 23;11:601721. Epub 2020 Dec 23.

Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium.

Parkinson's Disease patients suffer from gait impairments such as reduced gait speed, shortened step length, and deterioration of the temporal organization of stride duration variability (i.e., breakdown in Long-Range Autocorrelations). The aim of this study was to compare the effects on Parkinson's Disease patients' gait of three Rhythmic Auditory Stimulations (RAS), each structured with a different rhythm variability (isochronous, random, and autocorrelated). Nine Parkinson's Disease patients performed four walking conditions of 10-15 min each: Control Condition (CC), Isochronous RAS (IRAS), Random RAS (RRAS), and Autocorrelated RAS (ARAS). Accelerometers were used to assess gait speed, cadence, step length, temporal organization (i.e., Long-Range Autocorrelations computation), and magnitude (i.e., coefficient of variation) of stride duration variability on 512 gait cycles. Long-Range Autocorrelations were assessed using the evenly spaced averaged Detrended Fluctuation Analysis (α-DFA exponent). Spatiotemporal gait parameters and coefficient of variation were not modified by the RAS. Long-Range Autocorrelations were present in all patients during CC and ARAS although all RAS conditions altered them. The α-DFA exponents were significantly lower during IRAS and RRAS than during CC, exhibiting anti-correlations during IRAS in seven patients. α-DFA during ARAS was the closest to the α-DFA during CC and within normative data of healthy subjects. In conclusion, Isochronous RAS modify patients' Long-Range Autocorrelations and the use of Autocorrelated RAS allows to maintain an acceptable level of Long-Range Autocorrelations for Parkinson's Disease patients' gait.
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http://dx.doi.org/10.3389/fphys.2020.601721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786048PMC
December 2020

Surgical treatment of lateral ankle instability. Does allograft tendon have a better functional result?

Acta Orthop Belg 2020 Jun;86(2):327-334

Surgical treatment of lateral ankle instability can be performed with or without allograft. We compared these two technical options referring to patients' functional, radiological and ultrasound data. Forty patients were surgically treated for lateral pain- ful instability of the ankle. Twenty patients underwent ligamentoplasty using the Broström-Gould technique and twenty underwent a ligamentoplasty by allograft tendon. Patients were matched in age and gender. The assessment was done at 2.5 years postoperatively by functional scores (Olerud & Molander, and Foot & Ankle Outcome), dynamic x-rays (focused on varus and anterior drawer stress tests) and ultrasound examination (focused on anterior talo-fibular and calcaneo-fibular ligaments). No significant difference was found between the two techniques for all scores. Functional scores were more than 75% and the complication rate was low (<10%). Regarding the surgical technique, the tendon allograft could not prove to be more beneficial.
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June 2020

Can infection be predicted after intramedullary nailing of tibial shaft fractures?

Acta Orthop Belg 2020 Jun;86(2):313-319

Despite the progress in tibial fracture care, some patients contract infection following intramedullary nailing. We analyzed which risk factors could predict infection in 171 tibial fractures. The independent variables included age, gender, body mass index, and comorbidities, along with external factors of fracture pattern, nailing settings, and treatment processing time. A multiple logistic regression was used to identify infection risk factors. The risk of infection significantly increased according to the open grading, the fractures' classification, time until antibiotic administration, and time until nailing. Gustilo type I fractures presented a higher rate of infection than expected, explained by a longer delay before surgery. The probabilistic equation allows infection prediction with high sensitivity and specificity. In total, we showed that no antibiotics' prescription in emergency service and a transverse fracture pattern were predictors of infection. An infection risk score can be computed, aiding surgeons in decision making. Outcomes could improve keeping these observations in mind. Level of evidence: Retrospective cohort study. Level iii.
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June 2020

Disability and functioning in primary and secondary hip osteoarthritis in Benin.

Afr J Disabil 2020 12;9:675. Epub 2020 Nov 12.

Neuro Musculo Skeletal Lab (NMSK), Faculté des Sciences de la Motricité, Université Catholique de Louvain, Brussels, Belgium.

Background: In Africa, primary hip osteoarthritis seems to be less frequent than in Europe. Sickle cell disease is responsible for aseptic osteonecrosis of the femoral head associated with secondary hip osteoarthritis. Very little evidence is available on the influence of aetiology (primary and secondary) and radiographic status on pain and disability in a Beninese population with hip osteoarthritis.

Objectives: The aim of this study was to compare the impacts of aetiology and radiographic status on pain, disability and quality of life in a Beninese population with hip osteoarthritis.

Method: This was a descriptive cross-sectional study, including participants recruited in the Clinic of Physical Medicine and Rehabilitation at the National Teaching Hospital in Cotonou.Assessment was based on the International Classification of Functioning, Disability and Health model. The main outcomes were severity of osteoarthritis, pain, range of motion, muscle strength, gait speed and quality of life. Statistical comparisons between the aetiologies were performed using a -test or rank sum test. One-way analysis of variance was used to test the effect of radiographic status.

Results: Forty-nine participants (26 women and 23 men; mean age [standard deviation] 40.5 [17.9] years) were recruited. According to the aetiology (59.2% and 40.8% of primary and secondary osteoarthritis, respectively), there were no significant differences for any of the outcomes. Grades I, II, III and IV osteoarthritis were observed in 22.4%, 14.3%, 26.5% and 36.7% of the participants, respectively. Participants with grade IV osteoarthritis were more affected than those with grades I, II and III based on the Kellgren and Lawrence classification.

Conclusion: Aetiology did not influence pain, gait speed or quality of life. Participants with grade IV osteoarthritis had more pain, were more limited in walking and had a more impaired quality of life.
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http://dx.doi.org/10.4102/ajod.v9i0.675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7736690PMC
November 2020

Effect of Age and Body Size on the Wrist's Viscoelasticity in Healthy Participants From 3 to 90 Years Old and Reliability Assessment.

Front Sports Act Living 2020 7;2:23. Epub 2020 Apr 7.

Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, Université catholique de Louvain, Brussels, Belgium.

Excessive or insufficient levels of passive musculoarticular stiffness (PMAS) can lead to joint impairment or instability. Quantifying the PMAS may provide a better understanding of neurological or musculoskeletal disorders. The aims of the present study were multiple: first, to assess the reliability of quantifying PMAS and to collect normative data on the wrist in healthy participants, and second, to assess the effect of age and body size on PMAS. For this purpose, a total of 458 participants from 3 to 90 years old were analyzed with an electromechanical oscillation device (EOD). Passive sinusoidal movements were induced in a flexion/extension pattern in the participants' wrists, enabling an objective measurement of elastic stiffness (EL) and viscous stiffness (VI). Both the dominant and non-dominant wrists were assessed. Two-way repeated-measures ANOVA revealed a sex differentiation from puberty (12-18 years old) and an increase of EL and VI from childhood to adulthood and a decrease of stiffness at old age. EL and VI values were associated with body size characteristics and age. After body size normalization, EL was no longer influenced by the variables measured. On the other hand, VI remained moderately influenced by age and body size. The current study was able to provide normative data of PMAS in the wrist of healthy participants.
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http://dx.doi.org/10.3389/fspor.2020.00023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739808PMC
April 2020

Lower limb kinematics improvement after genicular nerve blockade in patients with knee osteoarthritis: a milestone study using inertial sensors.

BMC Musculoskelet Disord 2020 Dec 7;21(1):822. Epub 2020 Dec 7.

Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200, Brussels, Belgium.

Background: Genicular nerve blockade is a possible treatment for patients with knee osteoarthritis. Pain relief and improvement in functioning is expected. This procedure could be of major interest for patients in low-income countries where total knee arthroplasty is not available for the population. This study aims at assessing the immediate benefits on pain, gait, and stairs kinematics after a genicular nerve blockade in patients suffering from knee osteoarthritis in Cameroun.

Methods: A prospective study was carried out on 26 subjects in Cameroun. A genicular nerve blockade was performed on 14 women with painful knee osteoarthritis grade 2-4. Lower limb joint angles were recorded with inertial sensors before and 1 h after injection. Patient-reported outcomes of pain and perceived difficulty were collected, as well as 10 m and 6 min walking tests. A reliability analysis of inertial sensors was performed on a sample of 12 healthy subjects by calculating the intraclass correlation coefficient and the standard error of measurement.

Results: Pain and perceived difficulty decreased significantly (p < 0.001). Cadence increased significantly in stairs climbing (upstairs: + 7.7 steps/min; downstairs: + 7.6 steps/min). There was an improvement for hip sagittal range of motion during gait (+ 9.3°) and pelvis transverse range of motion in walking upstairs (- 3.3°). Angular speed range of the knee in the sagittal plane and of the hip in the frontal plane increased significantly in stairs descent (+ 53.7°/s, + 94.5°/s).

Conclusions: This study quantified improvement of gait and stair climbing immediately after a genicular nerve blockade in patients suffering from knee OA in Cameroon. This is the first study objectifying this effect, through wearable sensors.

Trial Registration: Pan African Clinical Trial Registry, PACTR202004822698484 . Registered 28 March 2020 - Retrospectively registered.
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http://dx.doi.org/10.1186/s12891-020-03836-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722305PMC
December 2020

Validation of a new protocol for ultrasound-guided genicular nerve radiofrequency ablation with accurate anatomical targets: cadaveric study.

Reg Anesth Pain Med 2021 03 3;46(3):210-216. Epub 2020 Dec 3.

Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite Catholique de Louvain, Brussels, Belgium.

Introduction: Ultrasound (US)-guided radiofrequency ablation (RFA) of genicular nerves (GNs) is increasingly performed to manage chronic knee pain. The anatomical foundations supporting the choice of original targets for US-guided GN-RFA have been thoroughly improved by recent anatomical studies. Therefore, this study aimed to provide a new protocol with revised anatomical targets for US-guided GN-RFA and to assess their accuracy in a cadaveric model.

Materials And Methods: Fourteen fresh-frozen cadaveric knees were used. After a pilot study with 4 knees, five consistent nerves were targeted in the other 10 knees with revised anatomical landmarks: superior medial genicular nerve (SMGN), superior lateral genicular nerve (SLGN), inferior medial genicular nerve (IMGN), recurrent fibular nerve (RFN) and the infrapatellar branch of the saphenous nerve (IPBSN). For each nerve, the lumen of radiofrequency (RF) cannula was prefilled with non-diffusible black paint, and then the cannula was inserted at the target site under US guidance. After US verification of correct placement, the stylet was introduced in the cannula to create a limited black mark on the tissues at the top of the active tip. Anatomical dissection was performed to assess for accuracy.

Results: The proportion of nerves directly found in contact with the black mark was 7/10, 8/10, 10/10 and 9/10 for the SMGN, SLGN, IMGN and RFN, respectively. The proportions of nerve captured by the theoretical largest monopolar RF lesions were 100% for the SMGN, IMGN and RFN, and IPBSN and 95% for SLGN. The mean distances from the center of the black mark to the targeted nerve were 2.1±2.2 mm, 1.0±1.4 mm, 0.75±1.1 mm and 2.4±4.5 mm for the SMGN, SLGN, IMGN and RFN, respectively.

Conclusion: US-guided GN-RFA with revised anatomical targets resulted in accurate capture of the five targeted nerves. This protocol provides precise sensory denervation of a larger panel of nerves, targeting those whose constancy regarding anatomical location has been clearly demonstrated. It is expected to improve the clinical outcomes.
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http://dx.doi.org/10.1136/rapm-2020-101936DOI Listing
March 2021

Immersive Virtual Reality to Restore Natural Long-Range Autocorrelations in Parkinson's Disease Patients' Gait During Treadmill Walking.

Front Physiol 2020 23;11:572063. Epub 2020 Sep 23.

Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium.

Effects of treadmill walking on Parkinson's disease (PD) patients' spatiotemporal gait parameters and stride duration variability, in terms of magnitude [coefficient of variation (CV)] and temporal organization [long range autocorrelations (LRA)], are known. Conversely, effects on PD gait of adding an optic flow during treadmill walking using a virtual reality headset, to get closer to an ecological walk, is unknown. This pilot study aimed to compare PD gait during three conditions: Overground Walking (OW), Treadmill Walking (TW), and immersive Virtual Reality on Treadmill Walking (iVRTW). Ten PD patients completed the three conditions at a comfortable speed. iVRTW consisted in walking at the same speed as TW while wearing a virtual reality headset reproducing an optic flow. Gait parameters assessed were: speed, step length, cadence, magnitude (CV) and temporal organization (evenly spaced averaged Detrended Fluctuation Analysis, α exponent) of stride duration variability. Motion sickness was assessed after TW and iVRTW using the Simulator Sickness Questionnaire (SSQ). Step length was greater ( = 0.008) and cadence lower ( = 0.009) during iVRTW compared to TW while CV was similar ( = 0.177). α exponent was similar during OW (0.77 ± 0.07) and iVRTW (0.76 ± 0.09) ( = 0.553). During TW, α exponent (0.85 ± 0.07) was higher than during OW ( = 0.039) and iVRTW ( = 0.016). SSQ was similar between TW and iVRTW ( = 0.809). iVRTW is tolerable, could optimize TW effects on spatiotemporal parameters while not increasing CV in PD. Furthermore, iVRTW could help to capture the natural LRA of PD gait in laboratory settings and could potentially be a challenging second step in PD gait rehabilitation.
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http://dx.doi.org/10.3389/fphys.2020.572063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538859PMC
September 2020

Anatomical study of the descending genicular artery and implications for image-guided interventions for knee pain.

Clin Anat 2021 May 21;34(4):634-643. Epub 2020 Sep 21.

Neuro-Musculo-Skeletal Department (NMSK)-IREC, UCLouvain, Brussels, Belgium.

Introduction: The descending genicular artery (DGA) has recently been mentioned as accompanying some nerves in the medial aspect of the knee joint. This could be clinically relevant as the arteries could serve as landmarks for accurate nerve capture during ultrasound-guided nerve blockade or ablation. The aim of this cadaveric study was to investigate the anatomical distribution of the DGA, assess the nerves running alongside its branches, and discuss the implications for regional anesthesia and knee pain interventions.

Methods: We dissected the femoral artery (FA) all along its course to identify the origin of the DGA, from which we carefully dissected all branches, in 27 fresh-frozen human specimens. Simultaneously, we systematically dissected the nerves supplying the medial aspect of the knee from proximally to distally and identified those running alongside the branches of the DGA. The surrounding anatomical landmarks were identified and measurements were recorded.

Results: The DGA was found in all specimens, arising from the FA 130.5 ± 17.5 mm (mean ± SD) proximally to the knee joint line. Seven distribution patterns of the DGA were observed. We found three consistent branches from the DGA running alongside their corresponding nerves at the level of the medial aspect of the knee: the artery of the superior-medial genicular nerve, the artery of the infrapatellar branch of the saphenous nerve, and the saphenous branch of the DGA.

Conclusion: The consistent arteries and surrounding landmarks found in this study could help to improve the capture of the targeted nerves during ultrasound-guided interventions.
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http://dx.doi.org/10.1002/ca.23680DOI Listing
May 2021

Inferior tibiofibular joint mobilization with movement and taping does not improve chronic ankle dorsiflexion stiffness: a randomized placebo-controlled trial.

J Man Manip Ther 2021 Apr 18;29(2):73-82. Epub 2020 Aug 18.

Faculté des Sciences de La Motricité, Université Catholique de Louvain, Louvain-La-Neuve, Belgium.

Objective: This study compared the modification of musculoarticular stiffness (MAS) and clinical outcomes after mobilization with movement (MWM) on the inferior tibiofibular joint and a placebo MWM. Moreover, injured and non-injured ankle MAS were compared after MWM therapy.

Methods: A single-blinded randomized trial was conducted on 75 participants (mean age: 22.3 ± 2.17 years) with chronic self-reported asymmetric perception of ankle dorsiflexion stiffness. Participants were allocated to one of three groups: inferior tibiofibular MWM (ITFMWM), placebo and non-injured. Sinusoidal oscillation methods were used for experimental quantification of the MAS and clinical outcomes were assessed using the weight-bearing lunge test (WBLT), pain and stiffness perception. Three assessments were made: one pre-treatment (T0), one after the manual technique (T1) and one after taping (T2).

Results: Two-way ANOVA showed no significant differences between the groups and no interaction effect for the outcome measures. However, a significant difference for the time effect (T0-T1-T2) was found in the three groups for WBLT dorsiflexion range of motion (p < 0.001, Cohen's d = 0.21) and stiffness perception (p < 0.001, Cohen's d = 0.54) but the minimal clinically important differences were not reached for either value.

Discussion: The results could not support that a single session of ITFMWM modifies MAS or the clinical outcomes compared to placebo treatment. Furthermore, injured MAS does not differ from non-injured MAS in chronic ankle dorsiflexion stiffness. Further studies should assess subjects' responsiveness concerning the Mulligan concept and focus on a medium- to long-term follow-up.
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http://dx.doi.org/10.1080/10669817.2020.1805690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023605PMC
April 2021

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones.

J Orthop Surg Res 2020 Jul 6;15(1):247. Epub 2020 Jul 6.

Experimental and Clinical Research Institute (IREC), Neuro-Musculo-Skeletal Pole (NMSK), Université Catholique de Louvain, Tour Pasteur +4 - 53 Avenue Emmanuel Mounier, 1200, Brussels, Belgium.

Background: External fixation improves open fracture management in emerging countries. However, sophisticated models are often expensive and unavailable. We assessed the biomechanical properties of a low-cost external fixation system in comparison with the Hoffmann® 3 system, as a reference.

Methods: Transversal, oblique, and comminuted fractures were created in the diaphysis of tibia sawbones. Six external fixators were tested in three modes of loading-axial compression, medio-lateral (ML) bending, and torsion-in order to determine construction stiffness. The fixator construct implies two uniplanar (UUEF1, UUEF2) depending the pin-rods fixation system and two biplanar (UBEF1, UBEF2) designs based on different bar to bar connections. The designed low-cost fixators were compared to a Hoffmann® 3 fixator single rod (H3-SR) and double rod (H3-DR). Twenty-seven constructs were stabilized with UUEF1, UUEF2, and H3-SR (nine constructs each). Nine constructs were stabilized with UBEF1, UBEF2, and H3-DR (three constructs each).

Results: UUEF2 was significantly stiffer than H3-SR (p < 0.001) in axial compression for oblique fractures and UUEF1 was significantly stiffer than H3-SR (p = 0.009) in ML bending for transversal fractures. Both UUEFs were significantly stiffer than H3-SR in axial compression and torsion (p < 0.05), and inferior to H3-SR in ML bending, for comminuted fractures. In the same fracture pattern, UBEFs were significantly stiffer than H3-DR (p = 0.001) in axial compression and torsion, while only UBEF1 was significantly stiffer than H3-DR in ML bending (p = 0.013).

Conclusions: The results demonstrated that the stiffness of the UUEF and UBEF device compares to the reference fixator and may be helpful in maintaining fracture reduction. Fatigue testing and clinical assessment must be conducted to ensure that the objective of bone healing is achievable with such low-cost devices.
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http://dx.doi.org/10.1186/s13018-020-01777-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339426PMC
July 2020

Effectiveness of a self-rehabilitation program to improve upper-extremity function after stroke in developing countries: A randomized controlled trial.

Ann Phys Rehabil Med 2021 Jan 15;64(1):101413. Epub 2020 Oct 15.

NMSK lab, Institut de recherche expérimentale et clinique (IREC), UCLouvain, Brussels, Belgium; Physical medicine and rehabilitation department, cliniques universitaires Saint-Luc, Brussels, Belgium; Louvain Bionics, UCLouvain, Louvain-La-Neuve, Belgium. Electronic address:

Background: About two-thirds of stroke patients present long-term upper-limb impairment and limitations of activity, which constitutes a challenge in rehabilitation. This situation is particularly true in developing countries, where there is a need for inexpensive rehabilitation solutions.

Objective: This study assessed the effectiveness of a self-rehabilitation program including uni- or bi-manual functional exercises for improving upper-limb function after stroke with respect to the context in Benin, West Africa.

Methods: In this single-blind randomized controlled trial, chronic stroke individuals (>6 months post-stroke) performed a supervised home-based self-rehabilitation program for 8 weeks (intervention group); the control group did not receive any treatment. Participants were assessed before treatment (T0), at the end of treatment (T1) and 8 weeks after the end of treatment (T2). The primary outcome was the manual ability of the upper limb, assessed with ABILHAND-Stroke Benin. Secondary outcomes were grip force, motor impairment (Fugl-Meyer Assessment - Upper Extremity), gross manual ability (Box and Block test, Wolf Motor Function test) and quality of life (WHOQOL-26).

Results: We included 28 individuals in the intervention group and 31 in the control group. Adherence to the program was 83%. After 8 weeks of self-rehabilitation, individuals in the intervention group showed significantly improved manual ability and grip force as compared with the control group (P<0.001), with effect size 0.75 and 0.24, respectively. In the intervention group, the difference in average scores was 10% between T0 and T1 and between T0 and T2. Subscores of physical and psychological quality of life were also significantly improved in the intervention group. The other variables remained unchanged.

Conclusions: A self-rehabilitation program was effective in improving manual ability, grip force and quality of life in individuals with stroke in Benin. More studies are needed to confirm these results in different contexts.
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http://dx.doi.org/10.1016/j.rehab.2020.03.017DOI Listing
January 2021

Current versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model.

Reg Anesth Pain Med 2020 08 18;45(8):603-609. Epub 2020 Jun 18.

Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite catholique de Louvain, Brussels, Belgium.

Introduction: Recent studies have proposed revised anatomical targets to improve accuracy of genicular nerve (GN) radiofrequency ablation (RFA). This study aims to compare the accuracy of classical and revised techniques for fluoroscopic-guided GN-RFA in cadaveric models.

Materials And Methods: Fourteen knees from seven fresh frozen human cadavers were included in this study. For each cadaver, RF cannulas were placed to capture the GN according to the current targets in one knee, and the revised targets in the other knee, randomly. The stylet was removed from the cannula, plunged into non-diffusible black paint, and reintroduced entirely in the cannula, to create a limited black spot on the tissues at the top of the active tip. Anatomical dissection was performed, and the accuracy of both techniques was compared.

Results: The mean distance from the top of the active tip to the nerve was significantly lower with revised than current targets for the superior-medial GN (0.7 mm vs 17.8 mm, p=0.01) and the descending branch of the superior-lateral GN (3.7 mm vs 24.4 mm, p=0.02). In both superior-medial GN and superior-lateral GN, the accuracy rate was higher with revised than current targets: 100% vs 0% and 64% vs 35%, respectively. In addition, the accuracy of revised targets for the recurrent fibular nerve and the infrapatellar branch of saphenous nerve was 100%.

Conclusion: This study demonstrates that the revised targets are more accurate than the current targets for GN-RFA.
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http://dx.doi.org/10.1136/rapm-2020-101370DOI Listing
August 2020

RELIABILITY AND VALIDITY OF THE HIP ABDUCTOR ISOMETRIC ENDURANCE TEST: A NEW METHOD TO ASSESS THE ENDURANCE OF THE HIP ABDUCTORS.

Int J Sports Phys Ther 2020 Apr;15(2):238-245

Laboratory of Functional Anatomy, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, Belgium.

Background: Substantial deficits in the performance of the hip abductor muscles are reported in females with common lower extremity conditions. In this context, the hip abductor isometric test (HAIE) test has been developed to assess the endurance of the hip abductors.

Purposes: The aims of the study were: 1) to assess the test-retest reliability of the HAIE test and 2) to determine if the HAIE test is valid for the measuring hip abductor muscle fatigue.

Design: Diagnostic accuracy of clinical tests; test retest reliability and validity.

Methods: Fifty-two healthy females, aged 18-30 years, were recruited. In two identical sessions, spaced by seven days, the participants performed the HAIE test and the test-retest reliability (ICC, SEM and MDC) was calculated. In ten subjects, surface EMG was used during the test in order to observe the change in the median frequency of EMG output of the gluteus medius and to determine if decrease of the median frequency is correlated with performance on the test, in order to discern validity.

Results: The HAIE test demonstrated good test-retest reliability (ICC = 0.84, SEM = 11.5 seconds and MDC = 32.8 seconds). Significant differences were noted between the average median frequency of participants for the last four fifteen second intervals (p = 0.02). Moderate correlation between MFslope and endurance time (r = 0.56, p = 0.008) and strong correlation between MFslope75s and endurance time (r = 0.71, p = 0.001) were found.

Conclusion: The results from this study support that the HAIE test is a reliable test for evaluating the endurance of the hip abductors. Further investigations should continue to explore the validity of the test, especially to determine which muscles limit the endurance time in healthy and unhealthy subjects.

Level Of Evidence: 2b.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7134344PMC
April 2020

Alpha Defensin: A Diagnostic Accuracy Depending on the Infection Definition Used.

J Arthroplasty 2020 05 18;35(5):1355-1360. Epub 2019 Dec 18.

Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium; Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, UCL, Brussels, Belgium.

Background: The purpose of this study was to evaluate the alpha defensin qualitative detection (ADLF) sensitivity and specificity as compared with 3 standard classifications in the diagnostic management of chronic prosthetic joint infections.

Materials And Methods: A multicenter cohort of 136 patients with a painful arthroplasty was classified into either infected or noninfected according to the Musculoskeletal Infection Society (MSIS) score, Infectious Diseases Society of America (IDSA) score, European Bone and Joint Infection Society (EBJIS) score. The sensitivity and specificity of the ADLF test were calculated for each score. Spearman's correlations between all scores were then analyzed, and multiple logistic regression was applied to identify independent variables strongly connected to the prosthetic joint infection probability.

Results: The EBJIS score was positive in 68 patients, IDSA score in 50 patients, MSIS score in 41 patients, and ADLF in 40 patients. The ADLF sensitivity was 87.8% compared with MSIS, 70% compared with IDSA, and 55.8% compared with EBJIS. The ADLF specificity was in the range of 94%-97%. A good correlation was observed between synovial fluid cultures and ADLF (r = 0.73). Low to excellent correlations were recorded between ADLF and the EBJIS (r = 0.58), IDSA (r = 0.68), and MSIS (r = 0.84) scores. The synovial fluid's white blood cell count was proven to be the biological test that most influenced the probability of a positive culture (P value: .005).

Discussion: The ADLF sensitivity was variable, whereas its specificity was excellent. The EBJIS score results significantly differed from those obtained via cultures, which possibly explains the ADLF low sensitivity compared with that of the EBJIS score.
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http://dx.doi.org/10.1016/j.arth.2019.12.010DOI Listing
May 2020

DYSKIMOT: An Ultra-Low-Cost Inertial Sensor to Assess Head's Rotational Kinematics in Adults during the Didren-Laser Test.

Sensors (Basel) 2020 Feb 4;20(3). Epub 2020 Feb 4.

CeREF, Chaussée de Binche 159, 7000 Mons, Belgium.

Various noninvasive measurement devices can be used to assess cervical motion. The size, complexity, and cost of gold-standard systems make them not suited to clinical practice, and actually difficult to use outside a dedicated laboratory. Nowadays, ultra-low-cost inertial measurement units are available, but without any packaging or a user-friendly interface. The so-called DYSKIMOT is a home-designed, small-sized, motion sensor based on the latter technology, aiming at being used by clinicians in "real-life situations". DYSKIMOT was compared with a gold-standard optoelectronic system (Elite). Our goal was to evaluate the DYSKIMOT accuracy in assessing fast head rotations kinematics. Kinematics was simultaneously recorded by systems during the execution of the DidRen Laser test and performed by 15 participants and nine patients. Kinematic variables were computed from the position, speed and acceleration time series. Two-way ANOVA, Passing-Bablok regressions, and dynamic time warping analysis showed good to excellent agreement between Elite and DYSKIMOT, both at the qualitative level of the time series shape and at the quantitative level of peculiar kinematical events' measured values. In conclusion, DYSKIMOT sensor is as relevant as a gold-standard system to assess kinematical features during fast head rotations in participants and patients, demonstrating its usefulness in both clinical practice and research environments.
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http://dx.doi.org/10.3390/s20030833DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7038751PMC
February 2020

Lower Limb Kinematics Using Inertial Sensors during Locomotion: Accuracy and Reproducibility of Joint Angle Calculations with Different Sensor-to-Segment Calibrations.

Sensors (Basel) 2020 Jan 28;20(3). Epub 2020 Jan 28.

Institue of Neurosciences (IONS), Université Catholique de Louvain, Secteur des Sciences de la Santé, Place Pierre de Coubertin 1, B-1348 Louvain-la-Neuve, Belgium.

Inertial measurement unit (IMU) records of human movement can be converted into joint angles using a sensor-to-segment calibration, also called functional calibration. This study aims to compare the accuracy and reproducibility of four functional calibration procedures for the 3D tracking of the lower limb joint angles of young healthy individuals in gait. Three methods based on segment rotations and one on segment accelerations were used to compare IMU records with an optical system for their accuracy and reproducibility. The squat functional calibration movement, offering a low range of motion of the shank, provided the least accurate measurements. A comparable accuracy was obtained in other methods with a root mean square error below 3.6° and an absolute difference in amplitude below 3.4°. The reproducibility was excellent in the sagittal plane (intra-class correlation coefficient (ICC) > 0.91, standard error of measurement (SEM) < 1.1°), good to excellent in the transverse plane (ICC > 0.87, SEM < 1.1°), and good in the frontal plane (ICC > 0.63, SEM < 1.2°). The better accuracy for proximal joints in calibration movements using segment rotations was traded to distal joints in calibration movements using segment accelerations. These results encourage further applications of IMU systems in unconstrained rehabilitative contexts.
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http://dx.doi.org/10.3390/s20030715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039222PMC
January 2020

Predicting physical activity recovery after hip and knee arthroplasty? A longitudinal cohort study.

Braz J Phys Ther 2021 Jan-Feb;25(1):30-39. Epub 2019 Dec 18.

Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Université Catholique de Louvain, Avenue Mounier 53, B-1200 Brussels, Belgium.

Background: Recovery of physical activity (PA) after telerehabilitation following knee and hip arthroplasty (TKA-THA) has rarely been studied. An improved understanding of PA recovery is needed, as it could be influenced by many factors such as age, gender or pre-operative physical function.

Objectives: To assess PA recovery weekly for 3 months after TKA-THA and to determine perioperative factors that could help predict PA recovery at 3 months.

Methods: From one week before until 3 months after surgery, 132 patients wore a fitness tracker continuously. Each patient received personalized and daily exercises and feedback through a tablet. Before and after surgery, patient-reported outcome measures of symptoms, pain, activities of daily living and quality of life were recorded. A one-way repeated-measure ANOVA was used to assess the time effect on step count for each post-operative week. To predict the absolute step count at 3 months post-surgery, a backward multiple linear regression was used.

Results: Patients reached their pre-operative PA level at week 7, with no significant additional improvement by 3 months post-surgery. Pre-operative step count, the number of days using crutches and pre-operative symptoms explained 35% of the variability of step count at 3 months.

Conclusion: This patient population receiving telerehabilitation reached their pre-operative PA level at 7-week post-surgery with no further improvement over the subsequent 5 weeks. The PA level at 3 months could be predicted by pre-operative step count, duration of crutches use, and pre-operative symptoms.
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http://dx.doi.org/10.1016/j.bjpt.2019.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817856PMC
April 2021

Anatomical evidence supporting the revision of classical landmarks for genicular nerve ablation.

Reg Anesth Pain Med 2020 08 5;45(8):672-673. Epub 2019 Dec 5.

Neuro-Musculo-Skeletal Pole, Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium.

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http://dx.doi.org/10.1136/rapm-2019-101103DOI Listing
August 2020

Effects of Fampridine in People with Multiple Sclerosis: A Systematic Review and Meta-analysis.

CNS Drugs 2019 11;33(11):1087-1099

Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.

Background: Prolonged-release (PR) fampridine is a potassium channel blocker used as a symptomatic treatment for walking disability in patients with multiple sclerosis (MS). Its clinical effects in such patients have not been systematically reviewed, and may be more wide-ranging than expected.

Objectives: To summarize the evidence on the effects of PR fampridine in patients with MS.

Methods: A systematic search of Pubmed, Scopus (including EMBASE), and PsycINFO (completed in 01/2019) was carried out to identify randomized controlled trials (RCT) that compared PR fampridine to placebo. When appropriate, data were pooled using a random-effects model, and standardized mean differences (SMD) were computed. Study quality was assessed using the Downs and Black checklist. PRISMA guidelines were followed. All retrieved functional outcomes were categorized according to the International Classification of Functioning, Disability and Health (ICF).

Results: A total of 706 articles were screened for inclusion. Twenty RCTs involving 2616 patients met the eligibility criteria. Most studies were of good-to-excellent quality. PR fampridine administration resulted in significant benefits in relation to walking short distances (SMD: 1.23 (95% IC 0.65-1.81)) and perceived walking capacity (0.64 (0.27-1.02)). Its effects on muscle strength and middle-distance walking were not significant (0.53 (- 0.04 to 1.10) and 0.31 (- 0.18 to 0.80), respectively). No effect on higher-level cognitive functions (- 0.07 (- 0.58 to 0.45)) or hand and arm use (0.16 (- 0.33 to 0.64)) was observed. Individual studies reported effects on other outcomes across the ICF domains.

Conclusions: There is strong evidence that PR fampridine exerts strong effects on the ability to walk short distances and on perceived walking capacity. Other effects of PR fampridine according to the ICF are possible but still unclear.
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http://dx.doi.org/10.1007/s40263-019-00671-xDOI Listing
November 2019

Validation of a robot serious game assessment protocol for upper limb motor impairment in children with cerebral palsy.

NeuroRehabilitation 2019 ;45(2):137-149

Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.

Background: The ROBiGAME project aims to implement serious games on robots to rehabilitate upper limb (UL) motor function in children with cerebral palsy (CP). Serious game characteristics (target position, level of assistance/resistance, level of force) are typically adapted based on the child's assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength).

Objective: This study developed an UL robotic motor assessment protocol to configure the serious game.

Methods: Forty-nine healthy children and 20 CP children participated in the study. The clinical assessment consisted of the child's UL length and isometric force. The robot assessment consisted of the child's UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances.

Results: Results showed that WA and UL isometric force were moderately to highly correlated with clinical measures. Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all children increased when they had to reach to targets placed more distant.

Conclusions: This protocol can be integrated into different serious games in order to continuously configure the game characteristics to a child's performance.

Trial Registration: The study was registered at ClinicalTrials.gov (NCT02543424), 12 August 2015.
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http://dx.doi.org/10.3233/NRE-192745DOI Listing
January 2020

Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks.

Reg Anesth Pain Med 2019 Aug 26. Epub 2019 Aug 26.

Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium.

Background And Objectives: Genicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and systematic reviews concluded that the anatomical basis for needle placement was unclear, incomplete and somewhat inaccurate. This study was designed to assess the accuracy of updated anatomical landmarks for fluoroscopy-guided blockade of the consistent genicular nerves in a cadaveric model.

Methods: Based on a comprehensive review of recent anatomical studies and prior dissection of 21 fresh cadaver knees, we defined bony landmarks with high likelihood of successful ablation of the five consistent genicular nerves (GN). We tested the accuracy of GNBs using the above-stated anatomical landmarks in 10 intact fresh cadaveric knees. Needle placement was guided by fluoroscopy and 0.5 mL of 0.1% methylene blue was injected at the site of each nerve. The knees were subsequently dissected to assess the accuracy of the injections. If the nerve was dyed with blue ink, the placement was considered accurate.

Results: The accuracy of our injections was 100% for the superior medial genicular nerve, inferior medial GN, infrapatellar branch of saphenous nerve and recurrent fibular nerve. The superior lateral GN was dyed in 90% of specimens.

Conclusion: This study provides physicians with precise anatomical landmarks for the five consistent GN for fluoroscopic-guided GNB. Our revised technique, which targets more nerves with increased accuracy, could potentially lead to improved therapeutic benefits on chronic knee pain.
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http://dx.doi.org/10.1136/rapm-2019-100451DOI Listing
August 2019

Head-neck rotational movements using DidRen laser test indicate children and seniors' lower performance.

PLoS One 2019 25;14(7):e0219515. Epub 2019 Jul 25.

Forme & Fonctionnement Humain Lab, CeREF, Haute Ecole Louvain en Hainaut, Charleroi, Belgium.

Sensorimotor control strategies during cervical axial rotation movements have been previously explored in narrow age ranges but never concurrently in Children and Seniors during a well-standardized task. However, the lifespan developmental approach provides a framework for research in human sensorimotor control of the head-neck complex. A cross-sectional design was used to investigate the influence of age on head-neck dynamic performance adopted by asymptomatic Children, Adults and Seniors using a standardized task (DidRen Laser test). Participants performed 5 cycles of left/right head-neck complex fast rotational movements toward 3 targets with 30° of angular separation. Dynamic performances were computed from total execution time of the test and kinematic variables derived from rotational motion of head measured by an optoelectronic system. Eighty-one participants, aged 8-85 yrs, were stratified in four groups: Children, Younger adults, Older adults and Seniors. Children were significantly slower than Younger (p<0.001) and Older adults (p<0.004) and Seniors slower than Younger adults (p<0.017) to perform the test. Children adopted a lower average speed compared to Younger (p<0.001) and Older adults (p<0.008). Children reached the peaks speed significantly later than Younger (p<0.004) and Older adults (p<0.04) and acceleration significantly later than Younger (p<0.001) and Older adults (p<0.013). From the peak acceleration, Children reached end of the cycle significantly slower than Younger (p<0.008) and Older adults (p<0.008). Children significantly differed from all other groups for rotational kinetic energy, with smaller values compared to Younger adults (p<0.001), Older adults (p<0.005) and Seniors (p<0.012). Variability was also significantly higher for Seniors and Children. In conclusion, age influences head-neck visually elicited rotational dynamics, especially in Children. These results suggest that age should be taken into account when establishing normative data and assessing dynamic head-neck sensorimotor control of patients with neck pain.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219515PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657844PMC
February 2020