Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique最新文献

Objectives

To study the clinimetric properties of the Dijon Physical Activity Score (PAS) in patients with coronary artery disease (CAD).

Patients

Two populations of patients with CAD: one group of stabilized patients from the RICO county-wide monitoring program and one group in the initial phase of a cardiovascular rehabilitation program (CVR group).

Methods

The patients carried out a maximal effort test on a cycle ergometer, plus two walking tests (a six-minute walk test and a 200 m fast walk test). They completed the Dijon PAS questionnaire on two occasions at an interval of 10 days. The reproducibility of the score and the latter's correlations with physical parameters were analyzed.

Results

Sixty-seven subjects were included and 52 answered the questionnaire both times. The average time spent answering the questionnaire was 173 ± 37 seconds and reproducibility was satisfactory in the RICO group only. In this group, there were significant correlations between total score and maximal power during the effort test (r = 0.41; P < 0.05) and between the “sports/leisure activities” sub-score and maximal power (r = 0.57; P < 0.01). No correlations were found in the CVR group.

Conclusion

The Dijon PAS is a simple, generic, reproducible and reliable score for measuring physical activity in patients with stable coronary artery disease but, because of the conjunction of confounding factors, it is not suitable for subjects who experienced a recent acute cardiac event. It could thus be used in epidemiological studies to determine the impact of a sedentary lifestyle and the efficacy of methods intended to counter sedentariness and to help design personalized secondary prevention programs.

Constraint-induced movement therapy is a promising technique for improving upper limb function in adults with hemiplegia. It involves restraint of the non-involved limb and intensive movement practice with the paretic limb. Although the technique has been applied successfully to children with cerebral palsy, only two studies have used it in children with acquired brain injury.

Objective

To assess the feasibility and efficacy of constraint-induced movement therapy in children with acquired brain injury.

Methods

We used a single-subject experimental design in three children (aged five at the time of the intervention) with hemiplegia in the chronic phase following acquired brain injury. The intervention involved restraint of the unaffected arm with a Mayo Clinic elbow brace for seven hours a day in a hospital setting, together with three hours a day of physical and occupational therapy rehabilitation for five days a week for two weeks. The children were assessed twice at baseline and then once immediately post-treatment and again two months post-treatment. Assessment included a range of timed, quantitative measures of upper limb use, assessment of unilateral spatial neglect and qualitative assessment by therapists and parents in terms of activities of daily living.

Results

The three children completed the full protocol and improved significantly in all timed, quantitative tests of motor function. These improvements were partially maintained at two months. No improvement in unilateral spatial neglect was found in the paper-and-pencil tasks, although less spatial neglect was observed in activities of daily living such as eating and walking.

Conclusion

Constraint-induced movement therapy appears to be both feasible and efficient in children with acquired brain injury.

The goal of this study was to evaluate the impact of nociceptive stimuli upon the cervical proprioception ability.

Method

Thirty healthy young subjects performed a cervicocephalic relocation test (CRT) in two random conditions: the first one was based on a nociceptive electric stimulation called condition “pain”, whereas the second one was targeting a painless electric condition called condition “control”. The CRT consisted of repositioning the head on the trunk, after an active transversal movement of the head in the transverse field with closed eyes. The pointing was recorded at the beginning and at the end of each rotation using a custom video acquisition system.

Results

The average mean of error repositioning was worth 3.98 ± 0.99° (average mean, standard deviation) in the condition “pain”, and 1.75 ± 0.37° in the condition “control” (p < 0.01).

Conclusion

Acute pain provokes a disturbance of the cervical proprioception ability without damaging the anatomic structure. This observation suggests the interest of an early follow-up of the pain to avoid sensory disturbances, as well as the establishment of a cervical proprioceptive rehabilitation program after an algic event.

Objective

The goal of this study was to determine the benefits of a functional retraining programme (with or without daily isokinetic reinforcement of the trunk muscles) in patients with lower-back pain.

Method

Two groups of 30 patients took part in the study. The control group (CG) underwent a four-week reconditioning program in a day hospital, whereas a second interventional group (IG) additionally performed daily isokinetic training of the trunk muscles. Three evaluations were carried out: before hospitalization (T₁), immediately after hospitalization (T₂) and three months postrehabilitation (T₃).

Results

We observed an improvement in each parameter after rehabilitation, regardless of the group. A decrease in the DALLAS scores revealed a reduced impact of lower-back pain on the patients’ lives. Pain experienced fell by 24%, analgesic treatment was significantly decreased (CG: − 53%; IG: − 56%), muscle endurance was improved (quadriceps: + 30%, abdominal muscles: + 20%, paraspinal muscles: + 23%, quadratus lumborum: + 33%) and the patients were more supple, as revealed by a decrease in the finger-to-ground distance (at T₁, CG: 12.9 ± 6.1 cm; IG: 13.6 ± 5.5 cm at T₁; CG: 2.2 ± 5.4 cm; IG: 2.8 ± 5.1 cm at T₂). The sole difference for CG and IG at T₂ resulted from an improvement in the performance of the trunk extensor muscles, which was significantly greater in the IG (CG: + 14%; IG: + 20%). Three months after rehabilitation, the benefits were still present for the two groups and, indeed, were even greater for certain parameters.

Conclusion

Regardless of the protocol, the patients improved in both physical and psychological terms and these improvements were maintained over a short period, at least. Our results confirmed that one functional recovery programme is not superior to another for patients with lower-back pain.

Injections of botulinum toxin into the detrusor is a major evolution for treatment of neurogenic bladder. They are now considered as a treatment of choice, safe and efficient, in refractory neurogenic overactivity in catheterized patient. To date, there are no consensual practical guidelines for the follow-up of patients having been treated by intradetrusor botulinum toxin, whatever the indication of the treatment, functional, that is, for improving continence and overactive bladder syndrome or organic, that is, for treatment of high-detrusor pressure and their deleterious impact of urinary tract. This lack of guidelines leads to heterogeneity of treatment management and limit the definition of optimal modalities of intradetrusor botulinum toxin treatment in neurogenic patients. The aim of your work, prepared jointly with the International Francophone Neuro-Urological expert study group (GENULF), aimed at putting forward well-informed specific recommendations for the follow-up of patients having been treated by intradetrusor botulinum toxin for functional or organic indication of neurogenic detrusor overactivity.

Purpose

To describe the diagnosis and treatment of adhesive capsulitis of the hip (ACH).

Method

A literature review and consideration of three case reports.

Discussion

Adhesive capsulitis of the hip is a supposedly rare but probably underestimated condition which predominantly affects middle-aged women. Clinical assessment reveals a painful limitation of joint mobility. The diagnosis is confirmed by arthrography, where the crucial factor is a joint capacity below 12 ml. Osteoarthritis and complex regional pain syndrome type 1 are the two main differential diagnoses. Whether the treatment is pharmacological, physical or surgical depends on the aetiology of the condition. Physiotherapy is essential for limiting residual deficits and functional impairments.

Conclusion

Adhesive capsulitis of the hip is probably more common than suggested by the limited medical literature. The condition is frequently idiopathic but can be secondary to another joint pathology. The first-line treatment consists of sustained-release corticosteroid intra-articular injections and physical therapy. Arthroscopy and manipulation under anaesthesia may be useful in cases of ACH which are refractory to treatment.

Objective

To validate a new plantar pressure control device able to detect excessive plantar pressure on-line and to improve the subject's awareness of the gait pattern in order to correct and optimize the load distribution patterns. The aim of this study was to verify the feasibility of a deliberate and partial unload of the first metatarsal head.

Material and method

Eight healthy subjects were equipped with the plantar pressure sensors integrated in customized insoles. They were told to unload the first metatarsal head of the right foot by 5%. During the trials, the auditory and visual signals inform the subject of an excessive, insufficient or correct unload.

Results

Five subjects over eight succeeding in modifying significantly their gait pattern and in unloading by 5% the first metatarsal head. The unload is effective in 70.7% of the trials. However, the subjects were spontaneously inclined to reduce peak pressure under the first metatarsal head beyond the critical peak plantar pressure threshold (48.2% of the trials).

Discussion – conclusion

The results showed the feasibility of a partial and deliberate foot unloading in using biofeedback device but emphasized the subject's difficulty to control a discriminated and accurate unload of the first metatarsal head. That points out the necessity of learning period. The baropodometric biofeedback rehabilitation focuses on the subject's capacities to modify its own locomotor pattern. It would be used as primary and secondary prevention means of diabetic foot ulceration.