Évaluation de l'efficacité des injections locorégionales de buflomédil par la mesure de TcPO2 au cours du syndrome épaule-main de l'hémiplégique

The authors have evaluated the efficiency of loco-regional injections of buflomedil in the shoulderhand syndrome in hemiplegic patients by using a clinical score and the measure of transcutaneous pression of oxygen (TcPO₂) at wrist. The study was carried out in 15 patients who were given three injections of 100 mg on D1, D3, D5, five weeks post stroke. They were evaluated on D12 and D26 and their conditions were compared with five hemiplegic untreated patients. The study confirms the clinical efficiency of the treatment as regards pain and vasomotor disorders in algodystrophy. TcPO₂ data confirms the clinical improvement in vasomotor disorders. Indeed TcPO₂ initial decrease reflecting the local hypoxia notably improves thanks to treatment without returning to normal.     

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.     

Monitoring des potentiels évoqués moteurs neurogènes lors de la chirurgie correctrice de la scoliose

Neurogenic motor evoked potentials in association with somatosensory evoked potentials were used to assess the functional integrity of spinal cord during scoliosis surgery. They were elicited by a spinal electrical stimulation and recorded from peripheral nerves in 23 patients. Reproductible responses were obtained in every patient under anesthesia. In three patients a modification of neurogenic motor evoked responses occurred: in one case, loss of potentials associated with a postoperative tetraplegia; in two cases, transient amplitude decrease without major neurological complications. Although the real origin of these potentials remains to be determined (possible involvement of antidromic sensory pathway conduction), this technique seems to be easy to perform, reproductible, fast and sensible for assessment of spinal cord during scoliosis surgery.     

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.     

Vécu des adolescents dont l''un des parents est cérébrolésé : étude préliminaire

OBJECTIVE: To explore the impact of brain injury of a parent on adolescent behavioural and emotional symptoms and personal experience. PATIENTS AND SETTING: Eleven adolescents from 13 to 18 years old with a brain-injured parent with cognitive impairment. MAIN OUTCOME MEASURES: Multiple case report. Assessment of anxiety and depression on the R-CMAS scale and the BDI. Qualitative analysis of a semi-structured interview and of the family drawing. RESULTS: Pathological scores on the R-CMAS scale involved 36% of the cases and the BDI, 45%. Impulsivity involved 36% of cases, difficulties in learning at school 73%, and somatic symptoms 45%. Feeling of loneliness involved 64% of cases and difficulty for the adolescent to speak about feelings in the family 82%. The symbolic position of the brain-injured parent was maintained in all cases. In 45% of cases, the parent was unable to recognize the adolescent, and in 55%, some characteristics of the adolescent were linked to the illness of the parent. A feeling of insecurity pervaded all cases. The family drawing revealed abnormalities in the bodily representation of the family members, especially a lack of hands or a representation of amputated hands in 91% of the cases and unsteadiness of the family members, also represented as ghosts in 82% of cases. CONCLUSION: Living with a brain-injured parent increases depression disorders, a feeling of loneliness and insecurity in adolescents. The inability for the adolescent to recognize parent's personality and the identification with caracteristics of the parent due to the illness is worrying. Abnormalities in the bodily representation of the family members and their unsteadiness are characteristic signs.     

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.     

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.     

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.     

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).     

Intérêt du traitement par exercices rotatoires chez les patients atteints de syndrome de Ménière, méthode utilisée au service d’ORL des cliniques universitaires Saint-LucBenefit of rotational exercises for patients with Meniere’s syndrom, method used by the ENT department of St-Luc university clinic

OBJECTIVE: To date, the effectiveness of balanced rehabilitation for patients with Meniere's syndrome has not been unanimously acknowledged by all physicians and physiotherapists. The purpose of this study is to assess the therapeutic efficacy of rotational exercises in the treatment of disequilibrium for patients with unilateral Meniere's syndrome. METHODOLOGY: Rotational stimuli were used to symmetrize and reduce postrotatory nystagmic response. Three reference sources were used to assess the efficacy of this management: vestibulospinal function tests: pre- and post-treatment results at the Romberg test, the Unterberger-Fukuda stepping test, the Babinski-Weil test, and gait testing with eyes closed; rotational tests: pre- and post-treatment results; and the self-perceived impact of vertigo: assessed by the Dizziness Handicap Inventory (DHI) and a scale based on the guidelines of the Japanese Society of Equilibrium Research (JSER, 1993). The JSER scale provides quantitative vertigo evaluation; the DHI reflects the patient's perceptual evaluation of handicap. RESULTS: Patients required 11 sessions (mean value) to attain subjective improvement. Of the 23 patients, only seven required optokinetic stimulation (mean requirement: three sessions). Rotational tests and dynamic tests of the vestibulospinal function improved. The DHI and JSER results show that patients' post-rehabilitation perceptual evaluation significantly improved. CONCLUSION: The objective and subjective measures of disequilibrium in patients with unilateral Meniere's syndrome were significantly improved.     

Orthèses de genou.Première partie : Évaluation des propriétés physiologiques à partir d’une revue de la littérature.Knee orthosis. First part : evaluation of physiological justifications from a literature review

INTRODUCTION: The aim of this work was to proceed to a literature review to determine the physiological justifications underlying knee orthosis use in medical practice.METHOD: An analysis of the international literature relating to the years 1980-2000 was carried out with the Medline data bank. We added extra articles focusing on the validity of the protocols used in the different evaluations.RESULTS: Five hundred and twelve articles were selected and 46 articles of experimental validation were retained. The experimental protocols are divided into in vitro studies and clinical studies carried out in both healthy subject and patients. Only the in vitro experimental data allowed to reach strain values simulating traumatisms of the articular structures. They allowed to define the interest and limits of the orthosis according to articular physiology. Measurements carried out in vivo were effective to characterize the parameters of stability and proprioception and to discriminate between the orthosis. These studies correspond to experimental situations with related constraints that remain far below lesional constraints, focusing on their clinical validity.CONCLUSION: This work point out many studies focusing on the physiological characterization of the knee orthosis. This evaluation of the orthosis through a single methodology remains difficult and justifies confrontation with clinical trials data.     

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.     

Techniques de neurostimulation et douleurs réfractaires

In the context of chronic pain, the technics of neuromodulation have a significative place especially when they are neuropathic with a precise selection of the indications according to the neurophysiological, anatomical and clinical data. The choice is essentially based upon the severity and the site of pain. They are totally conservative, adaptable and reversible but it is necessary to organize a very rigorous clinical and technical follow-up according to a multidisciplinary approach.     

Stimulation cérébrale profonde et maladie de Parkinson

Ten years after the therapeutic revolution that emerged from the discovery of l-dopa, some pioneer teams led the rebirth of a new nonablative stereotaxical surgical treatment, which came from the interest of high frequency stimulation. Three targets were retained as the main location of a reversible functional inhibition: Vim, GPI and STN. The unilateral or bilateral stimulation, adjustable and possibly reversible, led to an exceptional medicosurgical collaboration, within expert dedicated places, based on the control of the Parkinson's disease's (PD) triad. The stimulation was initially applied to the most advanced forms of PD, after the medical control period of the motor performance, when the pejorative effects of the evolution settled and/or when side effects of the treatment appeared. Subsequently, the research of selection criterions and the strict control of the stereotaxical procedure during the per- and postoperatory period, with the collaboration of the patient and his family, progressively brought different teams to an earlier indication of this new treatment option, up to now reserved for fully medicosurgical concerted cases. Apparition of cognitive and postural decline as well as the known resistance stage to l-dopa tend to become a real contra-indication. Despite the initial relative weakness of controlled studies with limited number of patients, the multiplication of follow-up studies among high quality multicentric cohorts enabled the validation of practices respecting the differences related to the initial background of each different team. In Europe first, the prevalence of the subthalamic target is now to be generally admitted. A new objective is now imposing itself: trying to maintain the patient's quality of life, beyond the only motor benefit. The social adaptation of a young patient is now also taken into account. If this exemplary clinical research approach, efficient for a few highly selected patients, has not transformed the long-term prognostic of the PD, it will continue to improve the comprehension of this degenerative pathology and its extension. It still remains hopeful for the future in the actual constant technological progress, and that probably beyond the only PD.     

Les textes réglementant l’activité en soins de suite et de réadaptation du décret du 9 mars 1956 aux décrets du 17 avril 2008. Place de la médecine physique et de réadaptation

In France, inpatient care is provided in three different sectors: "medicine, surgery and obstetrics", "follow-up care and rehabilitation" (soins de suite et de réadaptation=SSR) and "long-term care". Physical medicine and rehabilitation is involved mainly in SSR. As of April 2008, there are new regulations aiming to improve prior texts, to implement rules that will be identical for public and private sectors and to prepare for the new payment-by-the-act funding system (in place of the prior global funding). Now, all SSR structures have a common general basis in terms of purpose and means and specific rules for various specialties. For example, coordination of a multidisciplinary team in specialized facilities dealing with musculoskeletal and nervous system disorders must be conducted by a physical medicine and rehabilitation (PMR) specialist. Patient admission criteria still need to be defined, as does the assessment of therapeutic objectives. The expertise of SSR facilities is recognized by the possibility of direct admission from home for ambulatory patients. Nevertheless, many specifics are missing in these new decrees. These specifications will be elaborated on a regional basis, in future endeavours within regional healthcare organizations.     

Apport de l’arthrodistension dans la prise en charge de la capsulite rétractile primitive de l’épaule : étude comparative versus rééducation

Objectives

To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone.

Materials and methods

This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments’ efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score.

Results

Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p = 0.005), anterior elevation (p = 0.001), lateral elevation (p = 0.005), external rotation (p = 0.006) and the Constant score (p < 0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p < 0.001 for PF, RP, BP, SF and RE; p = 0.01 for GH and VT and p = 0.002 for MH).

Conclusion

Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.