Rehabilitation of arm function after stroke. Morris et al. In the articles mentioned by these authors, the methods employed include both manual and instrument-assisted muscle strengthening techniques.
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Reported results are encouraging in terms of both strength level of the trained muscles and function, but heterogeneity of the studies precludes elaboration of precise recommendations on how to concretely implement such programs. The objective of this work is to review existing literature on the use of IMS in rehabilitation of hemiparetic patients, in order to directly apply it in current clinical use, particularly with regard to the upper limb. Sixty-eight articles were found. Only the studies mentioning use of IMS for stroke rehabilitation were selected 17 studies , and no distinction was made between its application to the lower or the upper limbs.
We did not keep works simply proposing isokinetism as a tool for assessing muscle strength of paretic limbs nine articles , nor did we keep studies mentioning IMS as one among other techniques of rehabilitation three articles , since they did not address the question of the interest of IMS as such. Finally, we selected only six studies dealing with isokinetic rehabilitation IMS in hemiparetic patients. Isokinetic dynamometers may be used as instrumental muscle strength assessment devices or as muscle strengthening tools.
These devices are regularly used in osteo-articular disorders or in the framework of sports training programs. In the upper limb, rotators and abductors of the shoulder are generally involved, as are, to a markedly lesser extent, peri-articular muscles of the elbow. Most of the isokinetic machines used in pathology are rotating dynamometers. Results of an isokinetic assessment are generally expressed as the peak torque value developed by the tested muscle group.
It is also possible to evaluate the work provided by the same muscle group and the power developed at the joint. Assessment and isokinetic strengthening protocols are generally described in terms of mode of muscle contraction concentric or eccentric , value of imposed angular velocity, and number of repetitions. The choice of the working protocol depends on the subject and on the required objectives, as well for the upper and for the lower limb. The concentric mode is the most widely employed because it is easy to use and well tolerated.
The eccentric mode has been less regularly proposed, because this mode of contraction is difficult for patients, and may lead to musculo-tendinous micro-injuries especially aches or delayed onset muscle soreness: [DOMS] , which are more frequent than in concentric work. The choice of the working speed determines the level of strength that the muscle is supposed to produce. In the coupling that is characteristic of the concentric mode, strength and speed are inversely related: the higher the speed, the less the muscle develops strength.
In the eccentric mode, this relation is reversed. Consequently, training that aims at increasing strength is carried out at low speed, while exercises at high speed demand more muscle power. It should also be noted that slow speeds engender more joint stress but are closer to normal muscle physiology.
More generally speaking, the choice of speed depends on both the objectives of the training program and on the function of the to-be-trained muscle group. Due to the fatigue induced in trained muscles, the number of repetitions for low speeds generally does not exceed five. For higher speeds, the number of repetitions varies from five to ten. We have identified four pertinent studies, which main results are summarized in Table 1.
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The four publications deal with the strengthening of the peri-articular muscles of the knee, quadriceps and hamstrings. Only Kim et al. From an overall standpoint, increased strength of the reinforced muscle groups has been reported by all authors. Moreover, Kim et al. The authors did not demonstrate any significant difference between the two groups of patients as regards to enhanced strength or functional improvement. Reported side effects are rare and limited to muscle aches. Rouleaud et al. These two works are summarized in Table 2. It should be noted that the study by Chang et al.
The study by Patten et al. Concerning the upper limb, the installation described by Chang et al. The patient is in a seated position with the back of the chair slightly backwards tilted. In the two studies, weak grip of patients requires fixation of the hand on the distal effector with an elastic bandage. Clark et al. They showed that the reproducibility of their results was comparable to the reproducibility attained in a group of control subjects.
Similar results were reported by Tripp et al. Conversely, Hsu et al. These authors showed that measurement reproducibility varied in accordance with the selected speed and the muscle group being tested.
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Both concentric and eccentric contractions are used. A one-minute recovery interval between series is described in all studies. The number of repetitions varies, with programs of up to 15 series not exceeding ten contractions within each.
Only the study by Engardt et al. Results reported by the authors suggest that, in spite of greater difficulty in implementation, work in the eccentric mode seems to be more effective. None of the identified studies provided comparison of the results recorded at different speeds. The different protocols identified in the literature are summarized in Table 3. Concerning the upper arm, the few studies found in the literature deal only with muscular strengthening in the shoulder or in the elbow.
The protocols used are summarized in Table 4. The choices of number of weekly sessions three , their duration 40 to 45 minutes , the number of series three and the number of repetitions by series ten to 20 have drawn their inspiration from the protocols applied in IMS of the lower limbs. The few studies we found on the topic do not present sufficient methodological qualities, which would allow us to claim positive effects of IMS when this form of strengthening is used in rehabilitation of stroke patients.
In order to confirm its interest and, more particularly, to demonstrate its superiority in comparison with other already validated rehabilitation methods, randomized controlled trials would be necessary.
Since IMS is just a different way to conduct muscle strengthening, one may consider this kind of rehabilitation to be effective like other strengthening programs. There is no scientific evidence that IMS is of more interest than other muscle strengthening methods, especially in neurological patients. Concerning athletes, Croisier et al.
If it is to exercise sympathy or pay a debt to memory, then it quickly becomes clear that the exercise is hopeless, the debt overwhelming: there is no way to feel as much, remember as much, imagine as much as the dead justly demand. What remains as a justification is the future: the determination never again to allow something like the Nazi camps to exist. And for that purpose it is necessary not to think of the camps simply as a hellscape. Over the several phases of their existence, the Nazi camps took on the aspects of all of these, so that prisoners were treated simultaneously as inmates to be corrected, enemies to be combatted, and workers to be exploited.
When these forms of dehumanization were combined, and amplified to the maximum by ideology and war, the result was the Konzentrationlager , or K. The K. At its peak, in early , it housed more than seven hundred thousand inmates. It was Heinrich Himmler, the head of the S. Long before the Nazis took power, concentration camps had featured in their imagination.
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Wachsmann finds Hitler threatening to put Jews in camps as early as But there were no detailed plans for building such camps when Hitler was named Chancellor of Germany, in January, A few weeks later, on February 27th, he seized on the burning of the Reichstag—by Communists, he alleged—to launch a full-scale crackdown on his political opponents.
Euphemism, too, was to be a durable feature of the K. In the legal murk of the early Nazi regime, it was unclear who had the power to make such arrests, and so it was claimed by everyone: national, state, and local officials, police and civilians, Party leaders. The camp was guarded not by police but by members of the S.
The name, along with the skull-and-crossbones insignia, was meant to reinforce the idea that the men who bore it were not mere prison guards but front-line soldiers in the Nazi war against enemies of the people. Now, in the years before actual war came, the K. The metaphor of war encouraged the inhumanity of the S.
Particularly hated was the roll call, or Appell , which forced inmates to wake before dawn and stand outside, in all weather, to be counted and recounted. The process could go on for hours, Wachsmann writes, during which the S. The camps were outside ordinary law, answerable not to judges and courts but to the S.
At the same time, they were governed by an extensive set of regulations, which covered everything from their layout including decorative flower beds to the whipping of prisoners, which in theory had to be approved on a case-by-case basis by Himmler personally. Yet these regulations were often ignored by the camp S.
Strangely, however, it was possible, in the prewar years, at least, for a guard to be prosecuted for such a killing. In , Paul Zeidler was among a group of guards who strangled a prisoner who had been a prominent churchman and judge; when the case attracted publicity, the S. He was sentenced to a year in jail. In , Himmler agreed to allow the Red Cross to deliver food parcels to some prisoners in the camps. To send a parcel, however, the Red Cross had to mark it with the name, number, and camp location of the recipient; requests for these details were always refused, so that there was no way to get desperately needed supplies into the camps.
Even the distinction between guard and prisoner could become blurred. From early on, the S. This system spared the S. In some cases, Kapos became almost as privileged, as violent, and as hated as the S.
https://agendapop.cl/wp-content/numbers/ryjol-como-rastrear.php Mory was sentenced to death but managed to commit suicide first. At the bottom of the K. Once there, however, they found themselves subject to special torments, ranging from running a gantlet of truncheons to heavy labor, like rock-breaking. As the chief enemies in the Nazi imagination, Jews were also the natural targets for spontaneous S. The systematic extermination of Jews, however, took place largely outside the concentration camps. They had almost no inmates, since the Jews sent there seldom lived longer than a few hours.
By contrast, Auschwitz, whose name has become practically a synonym for the Holocaust, was an official K. The first people to be gassed there, in September, , were invalids and Soviet prisoners of war.