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ABSTRACTS OF THE THREE WINNERS

OF THE MRT SESSION

MRT- INITIAL SEGMENT AND SPASTICITY IN RATS WITH SPINAL TRANSECTION

Marjorie Kerzoncuf1, Frédéric Brocard2, Laurent Bensoussan1, Alain Delarque1, Jean-Michel Viton1, Hélène Bras2

1Ap-hm, Marseille, France; 2Institut des neurosciences de la Timone, Marseille, France

Spasticity affects 70% of patients with spinal cord injury and is characterized by hypertonia resulting from an excitatory/inhibitory imbalance with an up regulation of the excitatory control in the sub-lesional spinal cord.

The initial segment of the axon plays a key role in the physiology of the neuron, being in particular the place of initiation of the action potential. The first question is what happens at the initial segment of the axon after a spinal transection in rats? Are there modifications in the morphometry or innervation of the initial segment?

For this purpose, we study the characteristics of the initial segment before and after spinal cord injury in adult rats, as well as inhibitory and excitatory innervations in immunohistochemistry.

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MRT - QUANTITATIVE ULTRASOUND FOR THE EVALUATION OF ACHILLES TENDON DEFORMATION

Stijn Bogaerts1 , Catarina De Brito Carvalho2, Lennart Scheys3, Kaat Desloovere4, Koen Peers1

1Dept. of Development & Regeneration, KU Leuven / Dept. of Physical Medicine & Rehabilitation, University Hospitals , Leuven, Belgium, 2ESAT/PSI & UZ Leuven, MIRC, KU and University Hospitals , Leuven, Belgium, 3Dept. of Development & Regeneration, Institute for Orthopedic Research and Training (IORT), KU / Div. of Orthopedics, University Hospitals , Leuven, Belgium, 4Dept. of Rehabilitation Sciences; Clinical Motion Analysis Laboratory, KU Leuven and University Hospitals, Leuven, Belgium

The Achilles tendon is the thickest tendon of the human body and structured in a hierarchical manner. Despite this design, Achilles tendinopathy remains a highly prevalent condition with mechanical loading being of crucial importance in management. However, rehabilitation exercises are often prescribed in a “one size fits all” principle. To improve this, tools are required to evaluate the tendon and tailor exercises to the patient’s tendon characteristics. The static evaluation of structural characteristics of tendons has become common clinical practice, but it is known that there is only a weak correlation between structural findings and therapeutic outcome. Unfortunately, the dynamic-functional evaluation of mechanical properties is less straightforward.

The breakthrough for in-vivo evaluation of mechanical properties came with technical improvements in ultrasound. Ultrasound was then used to track two reference points during an isometric contraction on a dynamometer leading to an estimation of global tendon mechanical properties.

While this improved insight for the global in-vivo mechanical behaviour of the whole tendon, recent advancements in ex-vivo research have provided valuable insight in local – intratendinous – mechanical behaviour, suggesting that the different hierarchical levels of tendons behave in distinct functional ways. However, quantification of these local tendon mechanics in-vivo has proven to be technically challenging.

Fortunately, recent advancements in the field of real-time ultrasound scanning now provide the possibility to perform in-vivo, non-invasive measurements by automated speckle-tracking algorithms. My PhD project investigated the possibility of using high spatial resolution ultrasound to allow for evaluation at lower hierarchical levels of the tendon.

Firstly, in a systematic review we synthesized an overview of the methods already used in the literature. Secondly, we validated the high-frequency ultrasound based speckle tracking technique. Results confirmed that the Achilles tendon displaces non-uniformly, with a higher displacement found in the deep layer of the tendon. Adding to this, results showed a non-uniform regional strain behaviour in the Achilles tendon during passive elongation, with the highest strain observed in the superficial layer.

Follow-up studies in this PhD project have then evaluated the interaction between the presence of tendon pathology and local tendon mechanics, and the influence of biomechanical changes (i.e. change in knee angle during ankle plantar flexion contraction) or ageing on the mechanical behaviour at local – intratendinous - level. Data have been acquired and results are currently being analysed.

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MRT - BODY WEIGHT-SUPPORTED TREADMILL TRAINING PROMOTES VERY EARLY AMBULATION IN PATIENTS IN THE INTENSIVE CARE UNIT: A FEASIBILITY STUDY

Juultje Sommers1, Denise Wieferink1, Dave Dongelmans2, Raoul Engelbert1,3, Frans Nollet1, Marike van der Schaaf1,3

1Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands, 2Department of Intensive Care Medicine, University Hospital Amsterdam (AMC), Amsterdam, Netherlands, 3ACHIEVE-Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, , Netherlands

Introduction: Critically ill patients with prolonged mechanical ventilation often develop Intensive Care Unit (ICU)-acquired weakness which is strongly associated with physical impairments.

It has been shown that early mobilization and ambulation of patients during ICU stay improve functional recovery.

However, the implementation of these interventions remains difficult, because of reduced muscle strength, the limited length of infusion lines, drains and mechanical ventilation tube.

To be able to start earlier with ambulation we developed a transportable body weight-supported treadmill (BWST) for the use in the ICU.

Purpose: To explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in ICU patients.

Method: Twenty patients of the ICU with muscle strength m. quadriceps MRC ≥ 2, sitting mobility, who had been on mechanical ventilation for more than 48 hours and who fulfilled the safety criteria for exercise according to the ‘Evidence Statement for ICU Physiotherapy’ were enrolled in the study.

The BWSTT consisted of walking on a treadmill positioned at the bedside of the patient. A safety harness with a weight bearing utility supported the patients. The BWSST was stopped if the patient was fatigued or safety criteria were violated.

Results: BWSTT was performed in twenty patients and 54 sessions. This study showed that BWSTT is feasible with patients in the ICU. There were no (S)AE’s, the patients were very satisfied with the BWST, were not anxious (median/ (IQR ) of NRS 0-10: 0 (0-5)) and the needed number of staff was 2 persons with a median duration of 25 minutes treatment time. All participants should not have been able to walk or should have walked shorter distance without the BWST.

Conclusions: BWSTT is feasible and safe and facilitates early ambulation with critically ill patients in the ICU. Moreover, in order to perform BWSTT less staff is necessary compared to ambulation without BWSTT.

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