Immobility causes joint contractures, loss in range of motion (ROM), notably in elderly and bed-ridden patients. In a rat knee immobilization flexion contracture (FC) model, the posterior capsule contributes to irreversible limitation of ROM. Through microarray, extracellular matrix and collagen pathways were identified as differentially expressed in the posterior capsule of knees with FC. We hypothesized that intra-articular injection of collagenases in rats with knee FC will interfere with collagen in the capsule and allow increased ROM. After four weeks of hind-limb immobilization, rats develop knee FC; two weeks of remobilization with collagenase treatment showed increased ROM compared to buffer injected knees of 8.043° (p-value=0.046). Histological analysis of knee sections revealed changes in collagen content of the extracellular matrix in posterior capsule. In vitro incubation of rat capsules with collagenases confirmed changes in collagen. Along with current rehabilitation methods, treatment with collagenase may augment ROM recovery from knee joint contractures.

Yes / Background: Cerebral Palsy (CP) is the most common childhood disorder affecting four percent of children born in the UK. It is common for children with CP to have reduced range of movement (ROM) due to spasticity and contractures. Stretching is commonly used in physiotherapy programmes to manage this. Aim: This critical review aims to evaluate the evidence base behind the use of stretching for children with CP. Methods: A systematic literature search of AMED, CINAHL, MEDLINE and Cochrane Library Trials was conducted. Returned searches were assessed against strict criteria according to a predefined PICOS (Population, Intervention, Comparison, Outcome, Study). These studies were then critically appraised to assess the validity, reliability and clinical relevance. Findings: There is evidence supporting the use of stretching in children with CP. However there is also some evidence to suggest very little or no positive change. All of the included studies have methodological limitations, which questions the validity of the results. Conclusions/Recommendations: The research suggests some positive outcomes for the use of stretching in CP, studies that did not find positive outcomes found no adverse effects; however further research in the area is required to validate the effectiveness of stretching to maintain ROM in children with CP.

Our research is focused on using orthotic devices in patients with Duchenne muscular dystrophy (DMD), particularly in the ambulant phase of the disease. DMD is the most common hereditary muscle disorder in childhood. The typical symptoms are progressive muscle weakness and contractures that lead to loss of ability of independent walking, typically among the age of 9 to 13 years. The theoretical part is focused on pattern of standing and walking in these patients, the posibilities of useing the orthotic devices in various stages of the disease, and on the problems of contractures and deformities. The other teoretical part of the work is devoted to certain physiotherapy interventions and to associated physical activities. The practical part of the research is based on assesment of effect of physiotherapy and use of the nigt orthesis AFO (Ankle- Foot-Orthesis) in group of 10 DMD boys in the average age 9,1 ± 2,7 years. All boys were examined before and after 6 month of therapy. In examinations the following tests were used: NSAA (North Star Ambulatory Assessment), BI (Barthel index) measurements of muscle strength by hand held myometr and measurement of PROM (passive range of motion). The practical part also includes analysis of questionnaire datas from 19 patients with DMD collected in year 3/2013, questions...

Les arthrogryposes multiples congénitales (AMC), limitations articulaires multiples survenant au cours du développement et présentes à la naissance, sont un ensemble hétérogène de maladies dont le dénominateur commun est une diminution des mouvements fœtaux. Dans la majorité des cas, l'AMC est liée à un mécanisme impliquant le système neuromusculaire. Les causes sont dans un grand nombre de cas d'origine génétique. La connaissance de cette cause permet de proposer un conseil génétique avec une évaluation précise du risque de récurrence et éventuellement un diagnostic anténatal. La connaissance du mécanisme sous-jacent participe à l'évaluation du pronostic et permet d'élargir les connaissances sur la mise en place du système neuromusculaire. Mes travaux de thèse ont porté sur ces deux aspects. Dans un premier temps, j'ai étudié l'expression du récepteur de la ryanodine RyR1 dans le muscle squelettique fœtal humain. Les mutations de RYR1 sont responsables de myopathies congénitales. Dans les formes sévères précoces, une AMC peut être occasionnellement associée. L'expression de RyR1 est détectée dès 14 semaines d'aménorrhée dans le muscle fœtal humain. Ce résultat confirme l'expression précoce de RyR1 chez l'homme et permet d'expliquer la possibilité de limitations articulaires. Dans un second temps, j'ai étudié une famille consanguine avec trois enfants atteints d'arthrogrypose distale à la recherche de la cause génétique sous-jacente. L'analyse pangénomique m'a permis de lier pour la première fois le gène ECEL1, codant une endopeptidase, à une pathologie humaine. La recherche de mutations d'ECEL1 dans une cohorte de 20 patients a permis d'identifier cinq autres familles. Toutes les mutations sont transmises sur un mode autosomique récessif et conduisent à une perte de fonction de la protéine. L'ensemble des patients présentent un phénotype clinique et IRM semblable et distinct des autres tableaux d'arthrogrypose distale. Au total, ces travaux confirment l'expression précoce de RyR1 chez l'homme et identifient le gène ECEL1 comme une cause récurrente d'un type particulier d'arthrogrypose distale autosomique récessive. / Arthrogryposis multiplex congenita (AMC) is a heterogeneous group of disorders characterised by multiple joint contractures at birth due to diminished foetal movements. In most cases, the underlying mechanism involves the neuromuscular system. Genetic causes are frequent. Identifying the genetic cause is paramount for precise recurrent risk assessment, genetic counselling and prenatal diagnosis. Elucidating the underlying mechanism allows for prognostic evaluation and expands our knowledge on the development of the human neuromuscular system. My thesis focused on these two aspects. First I studied the expression of the ryanodine receptor 1 in human foetal skeletal muscle. RYR1 mutations cause congenital myopathies. AMC can occasionally be associated with severe forms of RYR1 related congenital myopathies. RyR1 is expressed at 14 weeks of gestational age in human skeletal muscle. Thus it confirms the early expression of RyR1 in human and can account for the occurrence of joint contractures. Second, in order to identify an underlying genetic cause, I studied a consanguineous family with three affected children showing a distal arthrogryposis phenotype. The genome wide linkage study allowed me to link for the first time the endopeptidase coding gene ECEL1 to a human disease. Five other families were shown to carry ECEL1 mutations after screening a cohort of 20 families with distal arthrogryposis. All mutations were recessive and predicted to lead to a loss of function of the protein. All patients showed a recognisable clinical and MRI phenotype that differed to that of currently known distal arthrogryposes. Altogether, these results confirm the early expression of RyR1 in human and identify ECEL1 as a recurrent cause of a distinct type of distal arthrogryposis.