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Détermination biomécanique d’indicateurs de dégradation précoce de la locomotion chez des patients présentant une Sclérose en Plaques

Abstract : Despite patients complaints, the rehabilitation of people with Multiple Sclerosis (MS) at an early stage of the disease is challenging due to the difficulty of describing locomotor disorders through clinical tests. The general objective of this thesis work was to provide an answer to this clinical challenge by using the tools of biomechanics. Five studies were set up, with the following objectives: (i) to compare the net muscular moment at the stance limb during the gait initiation in patients with early MS (EDSS <4 ) to healthy controls, (ii) to compare the spatio temporal, kinematic and kinetic parameters occurring at the first stance during walking in MS patients to healthy controls, (iii) to compare the head and trunk accelerations during tandem gait between early-stage MS patients and healthy controls, (iv) to describe the construction of 2 indexes based on the amount of linear moments to assess the contribution of each body segment and their loss of effectiveness to tandem gait, (v) to compare the spatio-temporal parameters and the 2 indexes calculated from linear moments during tandem gait in early-stage MS patients with healthy controls. The first study showed that MS patients had significant net muscular moment alterations at the stance ankle and knee joints during gait initiation compared to healthy people. MS patients’ net muscular moments were characterized by a near absence of modulation during the anticipatory postural adjustments phase. These alterations are the reflect of a modification of the gait initiation motor program. The second study, focusing on the first stances after gait initiation, demonstrated that MS patients had significantly shorter first and second steps, while maintaining a gradual increase of their walking speed compared to healthy subjects. This could constitute an adaptive strategy displayed by MS patients to increase their stability especially during the transition periods and could be related to co-contractions around the ankle. The third study showed that head and trunk accelerations allowed to discriminate early stage MS patients from healthy controls. The fourth and fifth studies described the methodology for constructing the contribution and inefficiency indexes from linear momentum. The application of these two indexes to MS patients in comparison to healthy controls, during tandem gait, showed a significant increase in upper limbs movements in the MS group. These indexes could be used for screening and monitoring early stage balance disorders in MS. The results of these studies showed that the net muscular moments of the stance limb during gait initiation and the use of contribution and inefficiency indexes could be used as early biomechanical markers for screening and monitoring the progression of locomotor disability in MS patients. Based on their use, specific rehabilitation programs could be developed to reduce the impact of locomotor disorders in early stage MS patients.
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Submitted on : Monday, December 6, 2021 - 6:03:57 PM
Last modification on : Sunday, June 26, 2022 - 3:23:03 AM

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Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives 4.0 International License

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  • HAL Id : tel-03467953, version 1

Citation

Caroline Massot. Détermination biomécanique d’indicateurs de dégradation précoce de la locomotion chez des patients présentant une Sclérose en Plaques. Biomécanique [physics.med-ph]. Université Polytechnique Hauts-de-France; Institut national des sciences appliquées Hauts-de-France, 2021. Français. ⟨NNT : 2021UPHF0031⟩. ⟨tel-03467953⟩

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