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

Objective In 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 methods Monocentric 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). Results A 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. Conclusion When compared to ultrasound detection, localization by electrostimulation appears to increase the overall pain caused during injections of botulinum toxin in children

Social Functioning and Self-Esteem in Young People with Disabilities Participating in Adapted Competitive Sport

Aims: The aim of this study was to investigate social functioning quality of life and self-esteem in young people with disabilities taking part in adapted competitive sport.Method: A sample of 496 athletes (mean age 16 years 4 months, range: 9 years to 20 years 9 months) was obtained from the 540 participants (91.8%) involved in a French national championship. The main outcome measurements were a social functioning inventory (PedsQL 4.0 social functioning) and a self-esteem inventory in physical areas (physical self inventory 6 PSI-6). Results: The mean PedsQL SF score was 74.6 (SD: 17.7). Comparisons of PedsQL SF according to gender, age, self mobility and training revealed no significant differences between the groups. PedsQL SF was weakly but significantly correlated with all subscales of the PSI-6 in the total population. PSI-6 scores were significantly different between boys and girls, with better self-esteem for boys on general self-esteem (7.7 vs. 6.9, p=0.018), physical condition (6.8 vs. 6.0, p=0.023) and attractive body subscores (6.5 vs. 5.1, p<0.001). Conclusion: Social functioning scores were significantly higher in this population than in the samples of young people with disabilities available in the literature. Interactions between self-concept, social functioning quality of life and participation in adapted sport activities require further studies

Regards croisés sur le polyhandicap: de la création du terme aux représentations actuelles

National audienceIntroduction: “Polyhandicap” is a French term used since the 1960s originally in the context of medico-social institutions. Its closest english translation is “Profound Intellectual and Multiple Disabilities” but these terms may reflect a slightly different approach. Recent recommendations were issued by the French “Haute Autorité de santé”. The objective of this study is to explore the representations of different french stakeholders associated with “polyhandicap”, in order to better define the concept and facilitate international publications. Methods: This study is based on 33 semi-structured interviews conducted from January to April 2021 with medical doctors, rehabilitation workers, caregivers, and administrative staff involved with such patients. The interview explored the respondents’ opinion regarding the definition, assessment and management of “polyhandicap”. Results: Forty-five percent of the respondents include profound intellectual disability in the core-definition of “polyhandicap”. Other respondents highlight the variability of the importance of mental retardation and some associate this item to the difficulties encountered in communication. Coexisting disabilities are more or less extensively listed. Fifty-eight percent of the respondents state that the term of “polyhandicap” should not be restricted to injuries taking place during early brain development. Fifty-five percent consider that the needs of such patients are not adequately met. Discussion: These multiple representations, source of confusion, can be detrimental to people with “polyhandicap”. This French concept, comprising three levels of analysis (medical, functional and social), and imperfectly covering other terms used abroad, is difficult to transpose internationally. © 2022 Elsevier Masson SASIntroduction: Le polyhandicap est un terme français apparu dans les années 1960 dans le contexte des institutions médico-sociales. La traduction anglaise la plus proche est PIMD « Profound Intellectual and Multiple Disabilities », mais ces termes reflètent une approche légèrement différente. Des recommandations récentes ont été émises par la Haute Autorité de Santé. L'objectif de cette étude est d'explorer les représentations de différents acteurs français associés au polyhandicap, afin de mieux définir le concept et faciliter les publications à l'international. Méthodes: Cette étude est basée sur 33 entretiens semi-structurés menés de janvier à avril 2021 avec des médecins, des rééducateurs, des aidants et du personnel administratif impliqués auprès de ces patients. Les entretiens ont permis d'explorer leur opinion concernant la définition, l’évaluation et la prise en charge du polyhandicap. Résultats: Quarante-cinq pour cent des personnes interrogées intègrent le retard mental profond dans la définition de base du polyhandicap. D'autres répondants soulignent la variabilité de l'importance du retard mental et certains associent cet item aux difficultés de communication. Les handicaps co-existants sont plus ou moins répertoriés. Cinquante-huit pour cent déclarent que le polyhandicap ne devrait pas être limité aux lésions cérébrales survenant au début du développement cérébral. Cinquante-cinq pour cent considèrent que les besoins de ces patients ne sont pas suffisamment pris en charge. Discussion: Ces multiples représentations du polyhandicap sont sources de confusion et peuvent être préjudiciables aux personnes polyhandicapées. Ce concept, plutôt français, comprenant trois niveaux d'analyse (médicale, fonctionnelle et sociale), et couvrant imparfaitement d'autres termes utilisés à l’étranger, rend difficile sa transposition à l'international. © 2022 Elsevier Masson SA

The added value of large-eddy and storm-resolving models for simulating clouds and precipitation

This study investigates, if atmospheric models with horizontal resolutions of 100 m to 2 km are able to better simulate key features, like clouds and precipitation, of the climate system than currently used models employing much coarser resolution and parameterized convection. Precipitation characteristics are much more realistic in the simulations with explicitly convection, already at kilometer resolutions. Increasing resolution to hectometer scales improves the simulation of precipitation only modestly, but substantially improves the simulation of clouds. The results suggest that new climate models, which explicitly resolve convection and the interaction with its environment, offer exciting opportunities to learn about the climate system