Effects of a primary rehabilitation programme on arterial vascular adaptations in an individual with paraplegia

AbstractObjectiveEvaluation of the effects of 6 weeks of wheelchair endurance training on arterial stiffness in an individual with paraplegia.MethodsA 22-year-old male patient with complete (ASIA A) paraplegia (T11) was tested before and after training (30minutes three times per week). Physical performance and cardiorespiratory response were evaluated during a maximal progressive test. Heart rate (HR), blood pressure, stroke volume and arterial carotid–wrist and carotid–ankle pulse wave velocity (PWV) were measured at rest.ResultsMaximal responses registered (maximal tolerated power, V˙O2 peak) during the exercise test were increased after training. At rest, HR as PWV decreased, whereas cardiac output and blood pressure remained constant.ConclusionContinuous exposure of the subject to a repeated high intensity exercise bout for 6 weeks elevated fitness level. Such a regular practice might also constitute a major way to trigger vascular remodelling beyond to the trained body part

Primary total knee arthroplasty in the management of epiphyseal fracture around the knee

SummaryIntroductionOver the past few years the use of arthroplasty was broadened to treating complex epiphyseal fractures at the shoulder and elbow joints. Similar trends to treat this type of fractures at the knee are less documented. Based on a multicenter retrospective series study, the aims of this work is to evaluate the short term clinical results of total knee prostheses in the management of comminuted epiphyseal fractures around the knee, to identify the technical issues and fine tune the indications.Material and methodsFollowing the initiative of the French Hip and Knee Society (SFHG) and the Traumatology Study Group (GETRAUM), 26 charts from eight different centers in France were included in this multicenter retrospective series. Inclusion criteria were: primary total knee arthroplasty (TKA) in the management of complex articular fractures involving the proximal end of the tibia or distal end of the femur. Surgical features were identified and complications were analyzed. The assessment protocol at last follow-up was standardized and included patient demographic data, analysis of the Parker and IKS scores.ResultsDuring the immediate postoperative period, six patients (23%) reported a general complication and four patients (15%) a local arthroplasty-related complication. At last follow-up (mean 16.2 months), the overall final Parker score was 6.3 (a mean decrease of 1.7) and the mean IKS knee score was 82 points for a mean function score of 54 points.DiscussionPrimary TKA is a suitable management option for complex fractures in autonomous elderly patients suffering from knee osteoarthritis. The key technical details of this procedure should be respected and meticulously planned to achieve optimal results and limit the risk of complications. This risk in these acute complex fractures remains higher than after conventional TKA but comparable to that observed after TKA for post-traumatic arthritis.Level of evidenceIV; retrospective cohort study

Clinical, ultrasonographic and CT markers for botulinum toxin injections into the piriformis muscle

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Reliability of 2D ultrasound imaging associated with transient ShearWave Elastography method to analyze spastic gastrocnemius medialis muscle architecture and viscoelastic properties

PurposeThe aim of the study was to assess the reliability of pennation angle (PA) and muscle thickness (MT) 2D measurements and of shear elastic modulus measurement, using ultrasound imaging (US). Those measurements were made on spastic gastrocnemius medialis muscle at rest and at maximal passive stretching, in post-stroke hemiplegic patients. The paretic side measurements were compared to non-paretic side.Material and methodsFourteen patients took part in 2 inter-session reliability experiments, realized at a 7 days interval by the same operator. The Aixplorer® Supersonic US scanner with the transient ShearWave Elastography (SWE) software was used. The stretching experiments were made manually and controlled by a goniometer.ResultsThe reliability of the 2D measurements was good. The coefficient of variation (CV) was 6.30% for MT measurement at rest, 6.40% and 8.26% for PA at rest and at maximal passive stretching respectively. The reliability of the shear elastic modulus measurement in the sagittal plane was good only at rest with a CV of 9.86%, versus 40.58% at stretching. None of the shear elastic modulus measurements in the axial plane were good. At rest, MT and PA were weaker on the paretic side (14.25±3.12mm and 17.32±5.10°) versus non-paretic side (16.30±3.19mm and 21.08±5.05°) (P<0.0001 and P=0.006). At rest, there was a small difference in the shear elastic modulus between the paretic side and the non-paretic side (5.40±1.67kPa versus 6.20±2.18kPa, P=0.041).DiscussionThis is the first description of muscle spastic structure using SWE with Supersonic Shear Imaging. 2D US associated with SWE shows promise in terms of muscular atrophy quantification and muscle histological quality assessment. These structural properties reflect some of the functional abilities regardless of motor control. It should enable further research on therapies, which impact muscle tissue quality, such as botulinum neurotoxin injections

Analysis of 8years activity of the mobile rehabilitation team in the Besançon University Hospital

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