Relation between capacities and bimanual performance in hemiplegic cerebral palsied children: Impact os synkinesis

ObjectiveTo analyse the link between unimanual capacities and bimanual performance in cerebral-palsied (CP) hemiplegic children, aged between 5 and 18 years old, studying specifically the impact of synkinesis.Material and methodsSeventy-one CP hemiplegic children (35 boys and 36 girls, mean age 8,5 years; MACS levels from I to III; GMFCS from I to IV) took part in a transversal study, assessed – Melbourne Test (MUUL) for unimanual capacities, and Assisting Hand Assessment (AHA) for bimanual performance – with a specific scale to analyze synkinesis during Box and Block test for affected and healthy hands, collecting synkinesis type, duration and intensity.ResultsThere is a strong correlation between unimanual capacities (MUUL) and bimanual performance (AHA) (r=0.871). Neither age nor gender contribute to bimanual performance (AHA). Multiple linear regression shows that MUUL contributes to bimanual performance variance (AHA) by 70%. Synkinesis partly correlated to capacities (MUUL) and accounts for 10% of the variance of the gap between capacities and bimanual performance.ConclusionA high relationship between unimanual capacities and bimanual performance is confirmed by this study; some authors demonstrated impact of sensory troubles [1], we demonstrate that synkinesis influences the use of unimanual capacities in bimanual performance

Posterior Decompression and Fusion: Whole-Spine Functional and Clinical Outcomes

The mobility of the spine and the change in the angle of the curvatures are directly related to spinal pain and spinal stenosis. The aim of the study was the evaluation of morphology and mobility of the spine in patients who were subjected to decompression and posterior fusion with pedicle screws. The treatment group consisted of 20 patients who underwent posterior fixation of lumbar spine (one and two level fusion). The control group consisted of 39 healthy subjects. Mobility and curvatures of the spine were measured with a non-invasive device, the Spinal Mouse. Pain was evaluated with the Visual Analogue Scale (VAS). The Oswestry Disability Index (ODI) and the SF-36 were used to evaluate the degree of the functional disability and the quality of life, respectively. The measurements were recorded preoperatively and at 3, 6 and 12 months postoperatively. The mobility of the lumbar spine in the sagittal plane increased (p = 0.009) at 12 months compared to the measurements at 3 months. The mobility of the thoracic spine in the frontal plane increased (p = 0.009) at 12 months compared to the preoperative evaluation. The results of VAS, ODI and SF-36 PCS improved significantly (p<0.001). The levels of fusion exhibited a strong linear correlation (r = 0.651, p = 0.002) with the total trunk inclination in the upright position. Although pain, quality of life and spinal mobility in the sagittal and frontal planes significantly improved in the treatment group, these patients still had limited mobility and decreased curves/angles values compared to control group

La prévention secondaire des lombalgies chez les professionnels hospitaliers

La lombalgie est une affection fréquente chez les professionnels de santé hospitaliers, avec un taux important de récurrence à un an estimé entre 24 et 84 % selon les études. Prévenir la chronicisation de la lombalgie est donc un enjeu de santé publique tant les coûts associés sont élevés (ex. consommations de soins, arrêts de travail associés, pensions d’invalidité)

Représentations cognitives des patients lombalgiques chroniques intégrés dans un programme de restauration fonctionnelle du rachis (intérêt du Coping Strategies Questionnaire pour outil diagnostique)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Botuloscope: 1-year follow-up of upper limb post-stroke spasticity treated with botulinum toxin

International audienceBackground: Botuloscope is a cohort study supported by a French public grant and aiming to evaluate a 1year treatment of the post-stroke spastic upper limb with botulinum toxin type A (BoNT-A) in terms of individual satisfaction with respect to personalized goals and quality of life. Methods: This was an open-label prospective, multicentric study (11 French centres) that followed 330 adults [mean (SD) age 53.7 (13.7) years] over 1 year; participants had ranked 5 therapeutic goals at inclusion [mean (SD) 5.1 (7.3) years post-stroke], had severe hemiparesis [median motricity index (MI) 40 (Q1-Q3 24 to 60)], and were assessed at inclusion (M0) and at month 3 (M3) and M12. Outcome criteria were: spasticity, range of motion, pain [visual analog scale (VAS)], motor function [Modified Ashworth Scale (MAS)] and activities (MI; Frenchay Arm Test), and overall satisfaction with the achievement of each goal (VAS) and quality of life (Reintegration to Normal Life Index). Criteria at M0 and M12 were compared. Adverse effects were also collected, as were medication changes. Results: The primary goal was comfort and activities for 63% of participants and motor function for 36%. Participants underwent a mean of 2.4 injection sessions, 19% causing adverse effects. The greatest spasticity attenuation occurred with wrist flexors (median decrease in MAS À2 [Q1-Q3; À2 to À1], P < 10 À3). Fewer individuals took oral anti-spastic drugs (56% at M12 vs 50% at M0; P < 10 À2). Range of motion increased by 168, on average (13 to 19; P < 10 À3) for wrist extension. Pain prevalence decreases at rest (29% at M0 vs. 19% at M12; P < 10 À4) and during mobilization (64% vs. 43%; P < 10 À4), and fewer participants took analgesics (25% vs. 17%; P < 10 À3). Satisfaction was high for the goals ''hand hygiene'' and ''pain release'' and moderate for ''improvement in upper limb function''. However, function was more improved for participants who selected this goal as the first priority than others (P < 10 À2). Overall, 22% had the goal ''improving gait and balance'', which was reasonably achieved at M12. Quality of life improved markedly [median 8 (4 to 11) vs. 6 (3 to 10); P < 10 À4 ]. Prevalence of complete dissatisfaction with the first objective was 10% to 15%. Conclusion: This is the first long-term follow-up of BoNT-A treatment for upper limb spasticity involving a large cohort independent of industry. Quality of life was improved by treating upper limb spasticity with BoNT-A, even at 5 years post-stroke. Personalizing objectives of the treatment amplified its efficacy. BoNT-A was a powerful analgesic when pain was spasticity-related. Treating the spastic upper limb also improved balance and gait abilities