How far do patients with sensory ataxia benefit from so-called “proprioceptive rehabilitation”?

A rehabilitation program including foot sensory stimulation, balance and gait training with limited vision was performed in 24 patients with clinically defined sensory ataxia. There were 15 patients with bilateral somatosensory loss related to chronic neuropathy and nine patients with unilateral loss-related to multiple sclerosis. After training, balance control assessed using the Berg Balance Test improved similarly in both groups, and Romberg's sign disappeared in some patients, suggesting an improvement in dynamic balance and in the proprioceptive contribution. Conversely, balance assessed on a static force platform remained similar in the open-eyes condition and improved in the closed-eyes condition only in patients with unilateral sensory loss. These results show that ataxic patients can improve their balance with better results in dynamic conditions and that the relative contribution of proprioceptive and visual inputs may depend on the extent of somatosensory loss.     

Traitement de la gonarthrose du jeune sportif

In the practice of sports, it is the traumatisms more than the over-sollicitation that induce arthrosis. The main principles of rehabilitation rest upon the conservation of range motion, decompression of the knee, muscular renforcement but also the control of overweight in the same time as the control of statical disorder by plantar orthesis. It seems important to distinguish two groups of arthrosis: the synovial manifestation in arthrosis for which the insers of NSAI in first intention seems logical (ponctions and local injection of corticoid) and the arthrosis with major bone manifestations (with the help of images) should be considered as a real osteo-chondral disease. It is theses types without swelling that the visco-induction should be used.     

Diversity of patient preparation activities before initiation of antiretroviral therapy in Cape Town,South Africa

Objective  To investigate patient education and counseling activities prior to the initiation of antiretroviral therapy (ART) at public sector services across Cape Town, South Africa. Methods  Key informant interviews and programme reviews were conducted with government bodies and non‐governmental organisations involved in patient preparation activities. Results  All 11 organisations in Cape Town involved in training and managing personnel to prepare patients for ART during 2010 participated. Each organisation reported a different approach to patient preparation within public sector clinics and in each aspect of patient preparation activities. The number of patient education sessions ranged from 3 to 7, and the delays to ART initiation introduced by patient preparation ranged from 3 to 6 weeks. Different patient education materials (pamphlets, posters and flipcharts) were used by various programmes, and all programmes reported that shortages in materials meant that patient preparation often took place without any educational materials. Each programme also reported attention to mental illness and alcohol/substance use disorders, but none employed formal screening tools consistently, and the handling of patients with potential mental health‐ or substance‐related problems varied. Conclusion  Approaches to prepare patients before ART initiation are wide ranging in one part of South Africa. Their relative value requires investigation, as there is little evidence for the impact of varying approaches. Moreover, the risks associated with delayed ART initiation may outweigh any benefits of patient education before the start of treatment.