Coordination between pelvis and shoulder girdle during walking in bilateral cerebral palsy

BackgroundStudies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated.MethodsThe gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124 months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial–temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis–shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison.Findings: Children with bilateral cerebral palsy walk with lower velocity (P = 0.01), shorter steps (P < 0.0001), larger base of support (P < 0.01) and increased duration of the double support phase (P = 0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle (P = 0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane.Interpretation: Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking.     

Mechanical muscle and tendon properties of the plantar flexors are altered even in highly functional children with spastic cerebral palsy

BackgroundRecent ultrasound studies found increased passive muscle stiffness and no difference in tendon stiffness in highly impaired children and young adults with cerebral palsy. However, it is not known if muscle and tendon mechanical properties are already altered in highly functional children with cerebral palsy. Therefore, the purpose of this study was to compare the mechanical and material properties of the plantar flexors in highly functional children with cerebral palsy and typically developing children.MethodsBesides strength measurements, ultrasonography was used to assess gastrocnemius medialis and Achilles tendon elongation and stiffness, Achilles tendon stress, strain, and Young's modulus in twelve children with cerebral palsy (GMFCS levels I and II) and twelve typically developing peers during passive dorsiflexion rotations as well as maximum voluntary contractions.FindingsDespite no difference in ankle joint stiffness (P > 0.05) between groups, passive but not active Achilles tendon stiffness was significantly decreased (− 39%) and a tendency of increased passive muscle stiffness was observed even in highly functional children with cerebral palsy. However, material properties of the tendon were not altered. Maximum voluntary contraction showed reduced plantar flexor strength (− 48%) in the cerebral palsy group.InterpretationEven in children with mild spastic cerebral palsy, muscle and tendon mechanical properties are altered. However, it appears that the Achilles tendon stiffness is different only when low forces act on the tendon during passive movements. Although maximum voluntary force is already decreased, forces acting on the Achilles tendon during activity appear to be sufficient to maintain typical material properties.     

(Re)organisation of the somatosensory system after early brain lesion: A lateralization index fMRI study

ObjectiveTo evaluate the relationship between neural (re)organization of the somatosensory cortex and impairment of sensory function (2-point discrimination [2PD]) in individuals with unilateral cerebral palsy.MethodsWe included 21 individuals with unilateral cerebral palsy. 2PD thresholds were evaluated on thumb pads, and activation of the somatosensory cortex was recorded by functional MRI (fMRI) during passive movements of the affected hand. A lateralization index (LI) was calculated for the primary sensory (S1) and secondary sensory (S2) cortices and the correlation between the LI and 2PD thresholds was analysed.ResultsWe found a significant negative correlation between the 2PD thresholds and the S2 LI (r = −0.5, one-tailed P-value = 0.01) and a trend towards a negative correlation with the S1 LI (r = −0.4, one-tailed P-value = 0.05).ConclusionHigh levels of activation in the contralesional hemisphere were associated with high levels of sensory impairment in individuals with unilateral cerebral palsy. The interhemispheric (re)organization of the somatosensory system may not effectively compensate for somatosensory impairment.     

Squat test performance and execution in children with and without cerebral palsy

BackgroundKnowledge on lower extremity strength is imperative to informed decision making for children with cerebral palsy (CP) with mobility problems. However, a functional and clinically feasible test is not available. We aimed to determine whether the squat test is suitable for this purpose by investigating test performance and execution in children with cerebral palsy and typically developing (TD) peers.MethodsSquat test performance, defined by the number of two-legged squats until fatigue (max 20), was assessed in twenty children with bilateral CP (6–19 years; gross motor function classification system I–III) and sixteen TD children (7–16 years). Muscle fatigue was assessed from changes in electromyography (EMG). Joint range-of-motion and net torque were calculated for each single squat, to investigate differences between groups and between the 2nd and last squat.FindingsFifteen children with CP performed < 20 squats (median = 13, IQR = 7–19), while all TD children performed the maximum of 20 squats. Median EMG frequency decreased and amplitude increased in mm. quadriceps of both groups. Ankle and knee range-of-motion were reduced in children with CP during a single squat by 10 to 15°. No differences between 2nd and last squat were observed, except for knee range-of-motion which increased in TD children and decreased in children with CP.InterpretationSquat test performance was reduced in children with CP, especially in those with more severe CP. Muscle fatigue was present in both children with CP and TD peers, confirming that endurance of the lower extremity was tested. Minor execution differences between groups suggest that standardized execution is important to avoid compensation strategies. It is concluded that the squat test is feasible to test lower extremity strength in children with CP in a clinically meaningful way. Further clinimetric evaluation is needed before clinical implementation.     

Patient transfer from a rehabilitation hospital to an emergency department : A retrospective study of an American trauma center

ObjectiveTo analyze medical indications and conditions for patients transferred from a rehabilitation hospital to an emergency department (ED). Are there differences in terms of which patients go to the ED during their stay and which do not? Specifically, what type of patient is most likely to be transferred?MethodologyA retrospective study was conducted at an American adult and pediatric urban trauma center that serves 40,000 patients per year. This study compared randomly selected samples of 534 patients having been transferred to the ED from a rehabilitation hospital and 500 patients who were directly admitted to the ED from the community. Variables examined were: demographics, ED diagnosis and level of care, length of hospital stay, costs, discharge condition and return within 60 days to the ED.ResultsThe patients transferred from the rehabilitation hospital were older (P < 0.01), differed with regard to ethnicity (83% African American; P < 0.01), the reason for hospitalization (P < 0.01; the majority presented with cardiovascular disease, respiratory disease or altered mental status), had longer and more expensive stays (average: 4–8 days, P < 0.01), required a higher level of care (P < 0.01), were more often admitted to surgery or telemetry, and, lastly, were more likely to be discharged in a frail or poor condition (P < 0.01).ConclusionsThe patients transferred from a rehabilitation hospital had complex, intense medical (and often psychological) issues. These patients’ medical needs required a high level of resources in the ED. They frequently left the hospital in sub-optimal conditions, making it likely that they would return to the hospital via the ED prior to completing their treatment within the rehabilitation hospital.     

Assessment of bimanual performance in 3-D movement analysis: Validation of a new clinical protocol in children with unilateral cerebral palsy

BackgroundThe “Be an Airplane Pilot” (BE-API) protocol is a novel 3-D movement analysis (3DMA) protocol assessing the bimanual performance of children during a game.ObjectiveThis study aimed to investigate the reliability and validity of this protocol in children with unilateral cerebral palsy (uCP).MethodsAngular waveforms (WAVE), maximum angles (MAX) and range of motion (ROM) of the trunk, shoulder, elbow and wrist joints were collected in children with uCP and in typically developing children (TDC) during 4 tasks of the BE-API protocol designed to explore specific degrees of freedom (DoF). The inter-trial reliability for children with uCP was assessed with the coefficient of multiple correlation (CMC) for WAVE and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for MAX and ROM. Clinical performance-based measures, including the Assisting Hand Assessment (AHA) and ABILHAND-Kids scores, were used to explore correlations between clinical measures and kinematic parameters in children with uCP.Results20 children with uCP (13 boys; mean age 12.0 [SD 3.2] years) and 20 TDC (11 boys; mean age 11.9 [SD 3.4] years) were included. In children with uCP, most kinematic parameters showed high reliability (WAVE: CMC ≥ 0.82; MAX and ROM: ICC ≥ 0.85, SEM ≤ 4.7°). Elbow extension, forearm supination, and wrist adduction were reduced and wrist flexion was increased for children with uCP versus TDC (P < 0.01). In children with uCP, MAX and ROM values were moderately correlated with clinical assessments (AHA score: r = 0.48–0.65; ABILHAND-Kids score: r = 0.48–0.49).ConclusionsThe BE-API protocol is a 3DMA-bimanual performance-based assessment that is highly reliable in children with uCP. Children with uCP and TDC significantly differed in some clinically relevant kinematic parameters. The BE-API is a promising playful tool, helpful for better understanding upper-limb motor movement abnormalities in bimanual conditions and for tailoring treatments to individual deficits.     

Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial

ObjectiveTo compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA).MethodsRandomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12 months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint.ResultsTwo hundred and forty patients were included (February–June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6 ± 15 at day 0 versus 46.5 ± 22.4 at 12 months, P < 0.001), but not in the non-thermal group (64.1 ± 15 at day 0 versus 62 ± 29 at 12 months, P = 0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (P = 0.08). However, at 12 months, the thermal cure group was significantly more improved (P = 0.000).ConclusionIn our study, crenobalneotherapy had resulted, at 12 months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.     

Mobile health and supervised rehabilitation versus mobile health alone in breast cancer survivors: Randomized controlled trial

BackgroundSurvival rates in cancer are increasing exponentially, with a corresponding increase/influence in disability-adjusted life-years. Efforts should be made to explore the optimal balance between unsupervised/distance-based and supervised/onsite approaches to cancer care.ObjectiveThis study aimed to compare the clinical efficacy of the BENECA mobile Health (mHealth) lifestyle application combined with a supervised rehabilitation program (BENECA and supervised rehabilitation) versus the BENECA mHealth lifestyle application alone on quality of life (QoL) and functional outcomes of breast cancer survivors.MethodsThis randomized controlled trial included 80 survivors of breast cancer diagnosed at stage I–IIIA, who completed adjuvant therapy and were overweight or obese at diagnosis. Participants were randomly allocated (ratio 1:1, 3 waves) to BENECA mHealth and rehabilitation for 2 months (n = 40) or BENECA mHealth and usual care (BENECA mHealth alone; n = 40). Participants completed a questionnaire at baseline (T1), 8-weeks post-intervention (T2) and 6-month follow-up (T3). The primary outcome was QoL assessed with the EORT QLQ-C30. Secondary outcomes included upper-limb functionality and body composition. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention to treat.ResultsBoth groups showed improved outcomes, but global QoL was significantly better with BENECA mHealth and rehabilitation than BENECA mHealth alone (mean difference, 12.76; 95% confidence interval 4.85; 20.67; P = 0.004), with a moderate-to-large effect size (d = 72). The proportion of participants reporting reliable clinical improvement on global QoL at T2 was higher with BENECA mHealth and rehabilitation than BENECA mHealth alone (57.5% vs 26.3%, P = 0.008). Improvement in subjective and objective upper-limb functionality was also higher with BENECA mHealth and rehabilitation.ConclusionsThe BENECA mHealth lifestyle application with a supervised rehabilitation program had a statistically and clinically significant effect on QoL and upper-limb functionality in breast cancer survivors and is a unique and important promising new approach.     

Strict versus liberal insulin therapy in the cardiac surgery patient: An evidence-based practice development,implementation and evaluation project

BackgroundHyperglycemia post-cardiac surgery is associated with poor clinical outcomes. Recent studies suggest maintaining liberal glycemic control (< 180 mg/dL) using a continuous insulin infusion (CII) versus strict control achieves optimal outcomes and prevents hypoglycemia.PurposeTo develop, implement and evaluate a nurse managed liberal CII protocol.MethodsRetrospective review of 144 strict CII patient records and 147 liberal CII patient records.ResultsMean blood glucose was 159.8 mg/dL (liberal CII) compared to 143.3 mg/dL (strict CII) (p ≤ 0.001). No surgical site infections occurred in either group. Mean ICU length of stay was 4.5 days (liberal) versus 4.4 days (strict) (p = 0.74). Two 30-day mortalities occurred for the liberal cohort compared to no deaths in the strict group (p = 0.49). Hypoglycemia incidence within 24 h after surgery was 0.1% (liberal) compared to 0.3% (strict) compared to (p = 0.16).ConclusionUse of a nurse managed liberal CII resulted in similar outcomes with fewer incidents of hypoglycemia.     

Parents' Experiences of Pediatric Palliative Care and the Impact on Long-Term Parental Grief

ContextApproximately 25% of children diagnosed with cancer eventually die. Losing a child puts parents at increased risk for developing psychological problems.ObjectivesTo explore parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement) and symptom management during the pediatric palliative phase, and to investigate the influence on long-term grief in parents who lost a child to cancer.MethodsA total of 89 parents of 57 children who died of cancer between 2000 and 2004 participated in this retrospective cross-sectional study by completing a set of questionnaires measuring grief (Inventory of Traumatic Grief), parents' perceptions of the interaction with health care professionals (communication, continuity of care, and parental involvement), and symptom management during the palliative phase. Care was assessed on a five point Likert scale (1 = disagree and 5 = agree).ResultsParents highly rated communication (4.6 ± 0.6), continuity of care (4.3 ± 0.6), and parental involvement (4.6 ± 0.7) during the palliative phase. Parents' most often reported physical and psychological symptoms of their child during the palliative phase were fatigue (75%), pain (74%), anxiety to be alone (52%), and anger (48%). Higher ratings of parents on communication (β = −9.08, P = 0.03) and continuity of care (β = −11.74, P = 0.01) were associated with lower levels of long-term parental grief. The severity of the child's dyspnea (β = 2.96, P = 0.05), anxiety to be alone (β = 4.52, P < 0.01), anxiety about the future (β = 5.02, P < 0.01), anger (β = 4.90, P < 0.01), and uncontrolled pain (β = 6.60, P < 0.01) were associated with higher levels of long-term parental grief. Multivariate models combining the interaction with health care professionals and symptom management showed a significant influence of both aspects on long-term parental grief.ConclusionBoth interaction with health care professionals, especially communication and continuity of care, and symptom management in children dying of cancer are associated with long-term parental grief levels.     

Outcomes for older adults in inpatient specialist neurorehabilitation

BackgroundInpatient specialist neurorehabilitation in the United Kingdom is based on providing a service to “working-age” adults (<65 years), with little evidence for outcomes for older adults involved with these services.ObjectiveThe aim of this study is to determine any difference in outcome after inpatient neurorehabilitation between younger and older adults assessed as having rehabilitation potential.MethodsA two-centre retrospective review was performed comparing patients aged < 65 and ≥ 65 years by diagnostic group in terms of length of stay, changes in UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores and discharge destination.ResultsSix hundred and sixteen patients (32% ≥ 65 years) were included. The 2 age groups did not differ in length of stay (median difference 7 days, 95% confidence interval [CI] −2 to 15, P = 0.112), but both UK FIM + FAM change and efficiency were higher for the older than younger group (median difference 7, 95% CI 2–13, P = 0.006 and 0.10, 0.01–0.19, P = 0.031 respectively). Older age was associated with discharge to long-term care (6% < 65 years; 11% ≥ 65 years, x² = 4.10, P = 0.043). Results and trends were similar in patients with acquired brain injury (n = 429), spinal cord injury (n = 59) and peripheral neuropathy (n = 34) but not progressive neurological disorders (n = 70).ConclusionOlder adults considered to have rehabilitation potential may have greater functional gains from inpatient specialist inpatient rehabilitation than younger adults. Age alone should not exclude admission to inpatient specialist neurorehabilitation.     

Patterns of hip migration in non-ambulant children with cerebral palsy: A prospective cohort study

BackgroundIn children with cerebral palsy (CP), we have little information on when hip migration (HM) starts, what causes hip displacement, how HM changes over time, and how to halt this migration to avoid surgery.ObjectivesWe aimed to estimate the prevalence of HM percentage (HMP) >4 0% in a homogeneous population of non-ambulant children with CP and model the changes in HMP over a 2.6-year mean follow-up.MethodsFrom September 2009 to September 2015, this observational, prospective, multicenter cohort study recruited 235 children from 51 centers who were 3 to 10 years old and had levels IV and V of the Gross Motor Function Classification System for CP. The outcomes were yearly HMP measurements by the Reimers index. Only children with at least one hip with HMP ≤ 40% at baseline were included in trajectory modeling. Comparisons of chidren's characteristics between trajectory groups were adjusted by the false discovery rate method.ResultsThe prevalence of children with at least one hip with HMP > 40% was estimated at 24.3% (95% confidence interval 18.6–30.0). Pelvic obliquity was observed in 51.4% and 24.4% of children with asymmetric and symmetric HMP (P = 0.002). The trajectory modelling identified 3 types of MP changes over time. Many children (67.4% and 79.3% for the right and left hip) could be assigned to the “stable” trajectory group.ConclusionsIn non-ambulant children with CP, the prevalence of HM requiring surgery is low and most hips remain practically stable over time.     

Do clowns attenuate pain and anxiety undergoing botulinum toxin injections in children?

ObjectiveBotulinum toxin injection (BTI) is the primary treatment for spasticity in children. Anxiety and pain are important concerns to address to attenuate the discomfort of BTI. The aim of this study was to compare the effectiveness of medical clowns and usual distractions, both added to nitrous oxide (N₂O) and analgesic cream, on pain and anxiety during BTI sessions in children.MethodsThe primary outcome was pain evaluated by the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Secondary criteria were pain rated on a Visual Analog Scale (VAS) by the child and parent, anxiety rated on a VAS before and during BTIs by the child and parent(s), rating of the success of the sessions on a 4-point Likert scale by the physician and parent(s), and rating of the benefits of the distraction by the parent(s). Non-parametric tests were used for between-group comparisons.ResultsBaseline group characteristics of the clown and control groups did not differ. During 88 BTI sessions (40 with clown distraction and 48 with control distraction) in 59 children (35 boys; 52 with cerebral palsy, 12 with moderate to severe cognitive disorders), median maximal FLACC score was 2.5 (interquartile range [IQR]: 1–4) in the clown group and 3 (IQR: 1–4.3) in the control group. VAS self-reported pain score was 2.5 (IQR: 0–5) and 3 (IQR: 1–6.3) in the clown and control groups (P = 0.56), and VAS proxy-reported pain score was 2.5 (IQR: 0.3–3.4) and 3 (IQR: 1–4.5) (P = 0.25). After BTI sessions, the 2 groups did not differ in VAS self- and proxy-reported anxiety (P = 0.83 and P = 0.81). Physician and parent ratings of the success of sessions were similar between the groups (P = 0.89 and P = 0.11). Parent ratings of the perceived benefits of distraction were higher in the clown than control group (P = 0.004).ConclusionsAlthough clown distraction was particularly appreciated by parents, it did not significantly reduce pain or anxiety in children as compared with usual distraction.Trial registrationClinicalTrials.gov ID: NCT03149263.     

The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: A prospective cohort study

BackgroundPatients with acute myocardial infarction (AMI) are at high risk for reinfarction and death. Therapies that have been shown to reduce these risks (secondary prevention) continue to be underutilized. Nurse practitioners are well positioned to provide secondary prevention during and following hospitalization.ObjectivesThe purpose of this study was to evaluate the effects of NP care on the rate of provider implementation and patient achievement of evidence-based secondary prevention target goals.DesignA prospective cohort design was used, which compared achievement of target goals between patients who received secondary prevention care from an NP to those who received usual care.ParticipantsThe sample consisted of 65 patients with AMI, admitted to a large community hospital. Patients meeting eligibility criteria were recruited consecutively.MethodsThe intervention was delivered by the NP before discharge from hospital and one week, two weeks, six weeks and 3 months after discharge. Data on patients’ achievement of goals were obtained before discharge from hospital and 3 months after discharge from both groups.ResultsThis study's results provide preliminary evidence that an NP delivered secondary prevention intervention can significantly improve achievement of the following target goals when compared to usual care: smoking cessation (OR 5), blood pressure (OR 15), attendance at cardiac rehabilitation (OR 7), physical activity five days a week (OR 17), physical activity ≥ five days a week (OR 34), achieving a glycated haemoglobin < 7% in those with diabetes (OR 10), triglyceride levels (p = .02), statin use at follow-up (p = .05), and number of weeks to cardiac rehabilitation (p = .05).ConclusionNP-led interventions such as this warrant duplication to evaluate reproducibility of the intervention and to determine if short-term improvements in secondary prevention goals translate into morbidity and mortality benefits.     

Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind,randomised, controlled trial

BackgroundUpper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).ObjectiveThis was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.MethodsWe randomized 45 patients with acute stroke into 2 groups (conventional therapy, n = 22, and RAT, n = 23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.ResultsIn total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P = 0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P = 0.02) and patient social participation (Stroke Impact Scale +18%; P = 0.01). Participants’ abilities to perform manual activities and activities of daily living improved similarly in both groups.ConclusionFor the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.     

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years

ObjectivesThe usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.MethodsThis was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.ResultsWe reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P < 0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P < 0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P < 0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P < 0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P < 0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P < 0.05).ConclusionsDisabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.     

Pain during injections of botulinum toxin in children: Influence of the localization technique

ObjectiveIn this study, we consider two localization techniques used in injections of botulinium toxin in children: electrical stimulation and ultrasound. The hypothesis of this work was that injections performed without stimulation would be less painful.Patients and methodsMonocentric prospective study, with 107 sessions of lower limb injections. Two groups of children were compared: localization by ultrasound only (60 children), detection by stimulation only or by stimulation combined with ultrasound (47 children). Pain assessment was performed by the child or an accompanying party using the Visual Analog Scale (VAS) and by a health care team using the Face, Legs, Activity, Cry, Consolability (FLACC).ResultsA significant difference between the two groups was found in both self-report and by means of the behavioral observational pain scale. Indeed, VAS average and FLACC average were significantly higher with detection by stimulation than with ultrasound alone: 4.5 cm ± 2.54 versus 2.7 cm ± 2.27; P < 0.001 for VAS scale and 3.7 ± 2.1 versus 2.7 ± 2.3; P < 0.05 for FLACC scale.ConclusionWhen compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children.     

Effects of a nurse-led transitional care program on clinical outcomes,health-related knowledge,physical and mental health status among Chinese patients with coronary artery disease: A randomized controlled trial

BackgroundCoronary artery disease is a major cause of morbidity and mortality among adults worldwide, including China. After a hospital stay, transitional care could help to ensure improved patient care and outcomes, and reduce Medicare costs. Nevertheless, the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainland China.ObjectivesTo examine the effectiveness of a nurse-led transitional care program on clinical outcomes, health-related knowledge, and physical and mental health status among Chinese patients with coronary artery disease.DesignRandomized controlled trial.MethodsThe Omaha system and Pender’s health promoting model were employed in planning and implementing this nurse-led transitional care program. The sample was comprised of 199 Chinese patients with coronary artery disease. The experimental group (n = 100) received nurse-led transitional care intervention in addition to routine care. The nurse-led transitional care intervention included a structured assessment and health education, followed by 7 months of individual teaching and coaching (home visits, telephone follow-up and group activity). The control group (n = 99) received a comparable length routine care and follow-up contacts. Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease, the medical outcomes study 36-item short-form health survey and clinical measures (blood pressure, blood glucose, lipids, body mass index). Data were collected between March and October 2014.ResultsCompared with the control group, participants in the experimental group showed significant better clinical outcomes (systolic blood pressure, t = 5.762, P = 0.000; diastolic blood pressure, t = 4.250, P = 0.000; fasting blood glucose, t = 2.249, P = 0.027; total cholesterol, t = 4.362, P = 0.000; triglyceride, t = 3.147, P = 0.002; low density lipoprotein cholesterol, t = 2.399, P = 0.018; and body mass index, t = 3.166, P = 0.002), higher knowledge scores for coronary artery disease (total knowledge score, t = −7.099, P = 0.000), better physical health status (t = −2.503, P = 0.014) and mental health status (t = −2.950, P = 0.004).ConclusionsThis study provides evidence for the value of a nurse-led transitional care program using both the Omaha system and Pender’s health promoting model as its theoretical framework. The structured interventions in this nurse-led transitional care program facilitate the use of this program in other settings.