D Pérennou

Validation of a Standardized Assessment of Postural Control in Stroke Patients: The Postural Assessment Scale for Stroke Patients (PASS)

BACKGROUND AND PURPOSE Few clinical tools available for assessment of postural abilities are specifically designed for stroke patients. Most have major floor or ceiling effects, and their metrological properties are not always completely known. METHODS The Postural Assessment Scale for Stroke patients (PASS), adapted from the BL Motor Assessment, was elaborated in concordance with 3 main ideas: (1) the ability to maintain a given posture and to ensure equilibrium in changing position both must be assessed; (2) the scale should be applicable for all patients, even those with very poor postural performance; and (3) it should contain items with increasing difficulty. This new scale has been validated in 70 patients tested on the 30th and 90th days after stroke onset. RESULTS Normative data obtained in 30 age-matched healthy subjects are presented. The PASS meets the following requirements: (1) good construct validity: high correlation with concomitant Functional Independence Measure (FIM) scores (r=0.73, P=10(-6)), with lower-limb motricity scores (r=0.78, P<10(-6)), and with an instrumental measure of postural stabilization (r=0.48, P<10(-2)); (2) excellent predictive validity: high correlation between PASS scores on the 30th day and FIM scores on the 90th day (r=0.75, P<10(-6)); (3) high internal consistency (Cronbach alpha-coefficient=0.95); and (4) high interrater and test-retest reliabilities (average kappa=0.88 and 0.72). CONCLUSIONS Our results confirm that the PASS is one of the most valid and reliable clinical assessments of postural control in stroke patients during the first 3 months after stroke.

The polymodal sensory cortex is crucial for controlling lateral postural stability : Evidence from stroke patients

In modern literature, internal models are considered as a general neural process for resolving sensory ambiguities, synthesising information from disparate sensory modalities, and combining efferent and afferent information. The polymodal sensory cortex, especially the temporoparietal junction (TPJ), is thought to be a nodal point of the network underlying these properties. According to this view, a pronounced disruption of the TPJ functioning should dramatically impair body balance. Surprisingly, little attention has been paid to this possible relationship, which was the subject of investigation in this study. Twenty-two brain-damaged patients and 14 healthy subjects were subjected to a self-regulated lateral balance task, performed while sitting for 8 s on a rocking platform. Their lateral body balance was analysed both with and without vision (darkness). Support displacements in the frontal plane were recorded by means of an accelerometer. Two criteria were taken into account to evaluate body stability in each trial: the number of aborted trials due to balance loss and the angular dispersion of the supporting surface. Lesions involving the temporoparietal junction were found to markedly increase body instability, both with and without vision. Therefore, the temporoparietal junction plays a pivotal role in lateral body stabilisation, irrespective of the sensory condition in which the task is performed. This suggests that body stability is controlled throughout internal model(s).

Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles.

Neurolytic blockade is one of the therapeutic possibilities to treat spasticity of various muscles. In patients with spasticity of the adductor thigh muscles, a percutaneous approach to the obturator nerve is often difficult. We describe a new approach to the obturator nerve and we examine its feasibility. The second objective was to assess the efficacy of obturator neurolysis for the management of adductor thigh muscle pain and spasticity associated with hemiplegia or paraplegia. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Neurolysis was performed by injection of 65% ethanol. We performed 27 blocks in 23 patients. Technical evaluation was achieved in terms of number of attempted needle insertions, time to accurate location of the nerve and success rate. The efficacy of the block was assessed using four scores: degree of alleviation of muscle spasm and triple flexion of the lower limb, improvement of gait and facilitation of hygienic care. Success rate of the technique was 100% with a time to accurate nerve location of 130 ± 35 s. Compared with scores measured immediately before the block, all studied parameters were significantly improved. Efficiency was significant on adductor muscle spasticity (p < 0.001 at 1 day and p < 0.01 at 60 and 120 months). Triple flexion was also significantly improved (p < 0.05 from 1 to 120 days), as well as gait (p < 0.02) and hygiene (p < 0.01) scores. No complications occurred. The combined approach of the obturator nerve represents a new technique which proved to be accurate, fast, simple, highly successful and reproducible. Obturator neurolysis was confirmed as an efficient and cost‐effective technique to reduce adductor muscle spasm and related pain and to improve gait and hygienic care in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neurone.

The Cognitive Assessment scale for Stroke Patients (CASP) vs. MMSE and MoCA in non-aphasic hemispheric stroke patients

INTRODUCTION CASP specifically assesses post-stroke cognitive impairments. Its items are visual and as such can be administered to patients with severe expressive aphasia. We have previously shown that the CASP was more suitable than the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in aphasic patients. Our objective was to compare the above scales in non-aphasic stroke patients, and assess to what extent the solely visual items of the CASP were problematic in cases of neurovisual impairments. METHODS Fifty non-aphasic patients admitted to Physical Medicine and Rehabilitation (PM&R) units after a recent left- or right-hemisphere stroke were evaluated with the CASP, MMSE and MoCA. We compared these three scales in terms of feasibility, concordance, and influence of neurovisual impairments on the total score. RESULTS Twenty-nine men and 21 women were included (mean age 63 ± 14). For three patients, the MoCa was impossible to administer. It took significantly less time to administer the CASP (10 ± 5 min) than the MoCA (11 ± 5 min, P=0.02), yet it still took more time than MMSE administration (7 ± 3 min, P<10(-6)). Neurovisual impairments affected equally the total scores of the three tests. Concordance between these scores was poor and only the CASP could specifically assess unilateral spatial neglect. CONCLUSION The sole visual format of the CASP scale seems suitable for administration in post-stroke patients.

Is there a place for general journals of rehabilitation

The number of scientific journals dedicated to rehabilitation has incredibly grew up the two last decades, accompanying the development of this new field of medicine. They may be categorized into, general journals, covering all domains of rehabilitation, and specific journals, specialized in one domain. Out of the 62 journals indexed in 2013 as a rehabilitation journals in the Journal Citation Index (ISI Web of Knowledge – Thomson Reuters), less than 25% are general. Among rehabilitation journals that recently obtained an impact factor (IF), most are focused on a specific domain. Since their IF has increased faster than that of general journals however more formerly established, one may wonder if there is still a place left for general journals of rehabilitation. The answer is yes. Many health professionals are involved in rehabilitation. Rehabilitation is the target activity of physiatrists, in collaboration with many other medicals specialists such as, rheumatologists, neurologists, geriatricians, pediatricians, cardiologists, angiologists, pneumologists, diabetologist, orthopedic surgeons, neurosurgeons, thoracic and vascular surgeons, urologists, etc. Rehabilitation is also the target activity of physiotherapists, occupational therapists, speech therapists, prosthetic fitters, psychologists, and many other care givers. By nature rehabilitation is multidisciplinary. In essence rehabilitation is also transversal, many severely disabled people needing rehabilitation cares combining activity limitations of several origins: neurologic, cardiovascular, respiratory, rheumatologic, orthopedic, urologic etc. General journals of rehabilitation are adequate vectors to convey this transversal approach, and facilitate synergies between jobs. In the clinicaltrial.gov database, 876 studies (interventional 757, observational 119) were registered into the domain ‘Rehabilitation’ with the status ‘recruiting’ (October 2012). They cover all fields of rehabilitation: neurologic, osteoarticular, cardiovascular, respiratory, pediatrics, geriatrics nutrition, urology, amputee, vision, psychiatry etc. Again this shows

Influence de la négligence spatiale sur la stabilisation corporelle

Discussion: En situation d’autor6gulation d’un equilibre la&alement instable, le cortex temporoparietal parait crucial pour le contr6le de la stabilisation corporelle. Cette region ctrkbraie pourrait &tre impliquke darts les mkutismes d’anticipation. Nous formulons done l’hypothese que I’instabilitb post&e consecutive aux lesions de la jonction temporopati&ale pourmit &re en partie due a une ah& ration du contr6le enfeed-forward de la stabilisation corporelle.