Essai d''évaluation de l''alexie spatiale après cérébrolésion vasculaire hémisphérique droite

This paper repons the findings of a pilot study that estimated the prevalence and the characteristics of spatial alexia after a vascular lesion of the right hemisphere. The reading tests included reading of words and pseudowords, numbers, letters, numeral, and text. Errors in reading tasks were noted for 57% within the 35 patients who were examined at 50 days post stroke onset (18 showing neglect and 17 without neglect). The severity of spatial alexia was strongly related to the intensity of neglect. High-frequency and / or short words were read with greater accuracy than low frequency or long words. Performances were also better with words than with pronounceable nonwords. The majority of errors in single-words were substitutions in which overall word length was roughly preserved. This set of data emphasizes the need of a specific assessment and rehabilitation of spatial alexia after a right cerebrovascular accident.     

Traitement chirurgical du pied varus équin spastique par transferts et allongements tendineux Étude rétrospective de 65 pieds opérés

The authors evaluate the efficiency of the surgical technique of split anterior tibialis transfer, describe the long-term functional results of the operation, and discuss the indications of this method of treatment. The results were very satisfactory: after surgery, 51 of 56 patients had normal shoes, 48 patients had improvement of their level of autonomy. The morbidity was very low, no patient had aggravation of the neurologic disease or general complications. The authors conclude that this operation should be employed more frequently in these disabled patients who can find definite improvement.     

Limitation et arrêt des traitements en réanimation : comment évaluer et améliorer nos pratiques

Witholding and withdrawing of life support is a daily question for intensive care unit physicians. Accordingly with recent French laws, theses procedures must be formalized and organized in each intensive Care Unit. In order to allow local organisation and procedures evaluation, three documents have been made available by the Ethic Committee of the Société de réanimation de langue française. These documents called évaluation des pratiques professionnelles are presented herein (also available on: http://www.srlf.org/Data/ModuleGestionDeContenu/application/848.pdf) and may be utilized for retrospective and prospective evaluation of the witholding and withdrawing of life support procedures.     

Pronostic vital de patients rééduqués après hémiplégie vasculaire

By means of a questionnaire, the authors investigated (74±6 months after discharge) the functional status of a representative population of 74 post-stroke hemiplegic patients (male: 42; female; 32, age: 61±14 years) who had returned home after discharge (83% of the rehabilitation department's hemiplegic patients had returned home). During hospitalisation the patients had been assessed with the Toulouse Motor Score (a validated personal motor score which assesses out of 100: the trunk's and limbs'motility, the gait, the spasticity and the cooperation); the Barthel index (BI). Twenty-four patients had died since discharge over a period of 30 months (3–75 months). Fifty patients were still alive (72±6 months). In comparing the deceased patients with those patients still alive, we observed first that the deceaded patients were older (71±15 vs 58 ±8 years, P < 0.001). Their hospital stay had been longer (96±43 vs 69±48 days, P < 0.01). They also had a poorer functional independence at admittance (BI: 23±20 vs 43±19, P < 0.05) and at discharge (Bl: 42±19 vs 76±31, P < 0.001). At discharge, their motor function remained more impaired (TMS: 58±19 vs 80±26, P < 0.005), the motility of their trunk was more severely impaired (18±8 vs 25±9, P < 0.01) and their gait was less efficient (10±7 vs 17±8, P < 0.005). At admittance their motor function was not significantly different. We did not observe differences according to sex. In this population, several risks and/or neurological factors played no role (hypertension, chronic occlusive coronary disease, diabetes mellitus, chronic occlusive arterial disease, hemianopsia, aphasia, sensory disturbances). In conclusion, in this population the life prognosis was linked with the age and the severity of the neurological impairment of the patients (with a severe functional impairment and a lack of motor recovery).     

La prévention des chutes: évaluation de l''équilibre avec stabilométrie et tests posturaux chez les patients hémiplégiques

Posture and balance have been studied in 50 hemiplegic patients according to Berg and Tinetti scales and stabilometry. There is a good correlation between the Berg and Tinetti scales when they are the highest, assessing a quite sufficient motor recovery. The same correlations are found between these scales and the results of stabilometry.     

L''incontinence urinaire chez la femme sportive nullipare. Enquête épidémiologique. À propos de 105 cas

One hundred and five nulliparous top-level young sportswomen (average age: 21.5 years) responded to an inquiry by means of questionnaire designed to investigate a possible relationship between urinary incontinence due to effort (UIE) and sports activities. Sixty-six sportswomen (62.8%) stated having UIE, which infrequently interfered with their normal sports activities; whereas 63 (60%) declared that they were coping with UIE on a daily basis. These two types of UIE are closely related. A comparative study on a similar population of 105 non-athletic women performed in parallel with this study showed that only 38 (34%) subjects declared having urinary incontinence, confirming therefore the influence of sport practice. Using the χ² and student's t-test, we investigated a relationship between UIE and different factors (age, duration of physical exercise, duration and type of sport practised, abdominal exercises, presence of acuneresis in children, presence of constipation). Only the presence of enuresis in children together with the presence of constipation led to statistically significant relationship. Being frustrated by taboos and considering the troubles as pathological, only a few sportswomen talked openly about this problem. Both information and effective control of the perineum could help prevent this condition. © 1998 Elsevier, Paris     

Coût énergétique de la marche à vitesse confortable et adaptation respiratoire dans deux groupes de personnes jeunes et âgées

The purpose was to measure the energy cost and the cardiorespiratory responses while walking in two age groups of healthy women in order to assess the effects of ageing (group I: 43.5±2.5 years; n=11 — group II: 74.7±4 years; n=8). The subjects underwent a twelve minute walking test at their comfortable walking speed. The velocity and distance walked decreased significantly (−10%) in group II in comparison with group I because of the decline in stride length (−7%). The time necessary to perform one step was hardly modified between the two groups, expressing a relative constancy of the gait pacing. The energy expenditure per unit distance was clearly increased (+24%) in group II, but the energy expenditure per minute or per step and the cardiorespiratory responses were not significantly modified. It could be suggested that the gait activity is regulated to maintain the energy expenditure and the cardiorespiratory stimulation within confined limits while maintaining the gait pacing, whatever the age of the subjects.     

Troubles optomoteurs de l''ancien prématuré. Résultats du traitement au long cours à propos de 45 enfants

Twenty-three children among 45, prematurely born and with difficulties in learning to walk, with no significant intellectual impairment, were able to walk at a functional speed at the end of a period of ocular rehabilitation. The persistance of the results after some months was observed in nine cases, which seemed to depend on the quality of the initial results.     

Gymnastique d''endurance pour hémiplégiques

Gymnastic endurance for hemiplegic patients is a protocol of rehabilitation which shows good efficiency and low cost. It may improve qualitative and quantitative motor performances in sequellar hemiplegia. Group dynamics is interesting for the acceptation of the handicap.     

La posture et le contrôle postural du patient cérébrolésé vasculaire: une revue de la littérature

After a stroke, the recovery of balance may be considered a critical component of the motor behavior for achieving autonomy in activity of daily living. The balance deficiency encountered by hemiplegic patients has been extensively reviewed in this paper, from both clinical and scientific points of view. Postural control is organized to build up and update the body orientation (posture) and ensure that balance is maintained. This complex function is based on four components [82]: reference frames for organizing posture and/or movement toward given target, multisensory inputs regulating orientation and stabilization of body segments, postural reactions or anticipations for balance recovery after disturbance, postural stabilization during voluntary movements. In the light of recent works concerning hemiplegic patients, some characteristics are emerging in each of these four fields. In the present paper, special attention was given to head and trunk orientation, sitting posture, dynamic equilibrium, and retraining balance and recoverey after a cerebrovascular accident. The authors have made an attempt to clarify the causes of balance impairment in hemiplegic patients, based on the new trends in the topic.     

Détermination du coût énergétique de la marche chez le sujet amputé de jambe: pied Copy III versus pied Sach

The oxygen consumption and the total quantity of oxygen consummed were measured continuously during a hard test of inclined walking, in four young traumatic below-knee amputees. The test consisted of an 18 minute walk with twice a 12 to 15% gradient according to the performance level of the subject. A Sach foot was compared to a Copy III prothesis. The quantity of oxygen consummed was systematically weaker with the Copy III foot. The differences were more clear as the oxygen consumption increased. These results suggest the necessity to use tests of relatively intense walking to evaluate the benefit of a new type of prothesis, the interest of energy-storing prosthetic feet in young subjects having regular physical activities.     

IRM et névromes des moignons damputation des membres inférieursMRI and leg stump neuroma.

OBJECTIVE: To describe RMI aspects of leg stump neuroma and to evaluate RMI scan interest for neuroma diagnosis and management.POPULATION AND METHOD: During a 2 years period, 224 amputated patients consulting for pain or prostetics problems were studied. In 10 cases, a characteristic pain leads to neurona diagnosis. This is described as a sensation of ascending or descending electric shock induced by the stimulation of an identified point with a reproducible topography. In all these cases, RMI scans were performed. In thirty two other cases, a RMI scan was performed to confirm a pathology (bursitis, bone abnormality) or in order to establish an etiologic diagnosis. Twelve neuromas were diagnosed.RESULTS: RMI scan showed a neuroma in the ten cases with a clinical suspicion and two asymptomatic neuromas were diagnosed out of the 32 patients without clinical suspicion. Medium delay between amputation and neuroma diagnosis is 11,6 year. In six cases, staking was modified and in six other cases, surgery was necessary. In aIl cases, clinical manifestations disappeared. Vanous RMI aspects ofneuromas are described and illustrated. Neuroma is observed on the extremity of a nerve that have a wavy aspect on its top. The neuroma is an oblong structure, with clear limits. There is an hyposignal with Ti sequence and variable signal with T2 and after gadolinium injection.DISCUSSION: RMI scan is a good way to diagnose amputee neuroma. It makes it possible to demonstrate the pathological character of the neuroma. It has to be performed when a neuroma is suspected. It enables to confirm the diagnosis and establish the exact topography and anatomic connection. Mechanical strains role as a factor of discovering the neuroma is discussed because of the concomitant evolution of associated lesions (bursitis, bone edema).Surgical repair takes place after correcting abnormal mechanical strains.     

Utilisation du matériel consommable en urodynamique : étude bactériologique prospectiveUse of urodynamic components: a prospective bacteriological study.

Introduction: Bacteriological study of circulating fluids in daily-use components of a urodynamic apparatus in order to evaluate a procedure for their use.Material and methods: Fifty series of fluid samples have been made at the end of half-day urodynamic explorations over an 11-month period without distinguishing clinical pathologies. Each series included four fluid samples of daily-use components: bladder and urethral pressure transducers, and bladder and urethral tubings of the bladder-urethral perfusion line above the transducers. The transducers have been sampled by syringe aspiration whereas the tubings were collected after perfusion flow. There samples were cultured in a nutrient broth and isolated bacteria were identified.Results: Two hundred samples were made; 197 samples could be evaluated and 13 (6.6%) had positive findings. Nine tubing samples were positive while the corresponding transducer fluid was sterile. The isolated bacteria were predominantly coagulase negative staphylococcus. One sample was positive for Pseudomonas sp. and another sample was positive for Lactobacillus acidophilus.Discussion and conclusion: Our bacteriological study showed a very low percentage of positive samples and some of them, particularly isolated positive tubing samples, were probably due to contamination during fluid collection. These results have not changed our current daily practice of components and did not urge us to use single-purpose components. The only condition is to respect strict hygienic rules during the assembly of tubular connexions and urodynamic instrumentations.     

Évaluation médico-économique du baclofène intrathécal chez les patients présentant une spasticité chronique sévère

A medicoeconomic evaluation of continuous intrathecal baclofen (Lioresal^®) infusion for symptomatic treatment of severe spinal spasticity was realised using a monocentric, comparative, retrospective approach where subjects were their own controls (n = 22). Study results confirm the efficacy of baclofen on symptoms, functional status of patients and on a non specific quality of life scale. Conversely, use of baclofen lead to a 67% increase of average annual costs of care for these patients and reaches around 173,500 French francs (~29,000 US$)/year. Such a cost seems to be acceptable with respect to clinical benefits. © 1998 Elsevier, Paris     

Tolérance locale et cardiovasculaire d'une séance de stimulation électrique des muscles des membres inférieurs chez les patients insuffisants cardiaques

Objective: to evaluate the haemodynamic and clinical tolerance of a session of low frequency electrical stimulation of inferior limbs muscles in patients with congestive heart failure. Patients and méthods: fifteen patients with congestive heart failure were treated with a one-hour session of electrical stimulation of quadriceps and calf muscles (10 Hz frequency, maximal amplitude tolerated, alternative 20 seconds on and off). The cardiac output, the heart rate, the blood pressure and the blood velocity in the femoral artery were evaluated at baseline and during stimulation. The cardiac rythm was evaluated using a 24-hour holter recording. A subjective evaluation of the quality of the induced contractions was performed. Results: electrical stimulation did not induce changes in cardiac output and rythem, in heart rate and in blood pressure. The electrical-induced contractions were of good quality in 11 patients. The mean blood velocity in femoral artery increased during stimulation (37.6% after 20 minutes, 39.6% after 35 minutes, and 41.6% after 50 minutes). Conclusion: a one-hour session of electrical stimulation of quadriceps and calf muscles with stimulation amplitudes sufficient to obtain good-quality contraction and an increase in femoral artery blood velocity does not induce rythmic or haemodynamics variations in patients with congestive heart failure.