Jean-Yves Salle

Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: a prospective study.

Daviet JC, Preux PM, Salle JY, Lebreton F, Munoz M, Dudognon P, Pelissier J, Perrigot M: Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: A prospective study. Am J Phys Med Rehabil 2002;81:34–39. ObjectiveTo evaluate clinical prognostic factors of complex regional pain syndrome type I (CRPS I) in patients with stroke in an attempt to improve the Perrigot score, which does not include shoulder subluxation, unilateral neglect, or depression. DesignThis was a prospective study. The initial clinical data (first month) included motor index, Ashworth scale, de Bats score for shoulder subluxation, Montgomery-Asberg Depression Rating Scale, and sensory disorders evaluation. The prognosis of CRPS I was evaluated from the Perrigot score. A score of CRPS I severity was measured on entry and 3 mo later. ResultsOf the 71 patients with hemiplegia who were included, 34.8% had a CRPS I. The five main clinical factors in the prognosis of CRPS I were motor deficit, spasticity, sensory deficits, and initial coma. The prognostic score of Perrigot was strongly correlated with the CRPS I severity and was predictive of subsequent progression. ConclusionShoulder subluxation, unilateral neglect, and depression did not seem to be determinant predictive factors of CRPS I severity.

Physical Factors Associated With Fatigue After Stroke: An Exploratory Study

Abstract Objective: To look for a relationship between physical fatigue and physical parameters in patients at least 3 months post stroke. Methods: We conducted a prospective cross-sectional study of 32 poststroke patients (average duration of stroke 40 months) who were recruited among in- and outpatients followed by the Department of Physical and Rehabilitation Medicine of a university hospital. Fatigue was defined as a Fatigue Severity Scale (FSS) score of 4 or more. The parameters studied were age, sex, time since stroke, Demeurisse Motor Index, Barthel Index score, new Functional Ambulation Category, Berg Balance Scale, 10-meter walk test, 6-minute walk test, Dijon Physical Activity Score, Montgomery and Asberg Depression Rating Scale, Epworth Sleepiness Scale, presence of pain, and length and area of the center of pressure displacement obtained posturographically. Results: Two-thirds of patients (65.6%) were fatigued. The mean FSS score was 4.3 ± 1.8. Fatigue was not associated with the physical parameters studied; notably, there was no correlation with motor impairment, autonomy and walking capacity, or balance and physical activity. However, after multivariate analysis, we found an association between physical fatigue and time since the occurrence of stroke (P = .05). Conclusions: Our study revealed a relationship between pain and physical fatigue, as reported by 2 other studies. Poststroke fatigue management should include appropriate pain management. Further studies are necessary to determine the causes of physical fatigue after stroke.

Evaluation of a multidisciplinary consultation of diabetic foot

OBJECTIVES To evaluate the effectiveness of a multidisciplinary consultation of diabetic foot in terms of ulcer healing rate and podiatric complications prevention. METHODS A longitudinal observational study was conducted on 78 patients consulting multidisciplinary clinic of diabetic foot between the 1st January 2005 and the 31th December 2006. There were two evaluations: the first one in June 2008, the second one in January 2010, at a medium follow-up of 48 months. RESULTS 30.8% of diabetic patients were addressed in primary prevention, 53.8% for treatment of foot ulcer, and 15.4% in secondary prevention. The global healing rate was 76.19% after a medium follow-up of 29 months, and the recurrence rate at a medium follow-up of 48 months was 9.52%. Healing was achieved in 63.6% of patients with off-loading shoes versus 81.8% of whom with fiberglass cast boot. CONCLUSION Care and follow-up of diabetic patients with foot at risk in multidisciplinary consultation seem to be effective not only in curative treatment, but also in primary and secondary prevention. The economic benefits need to be evaluated.

Acute stroke phase voluntary cough and correlation with maximum phonation time.

Objective This study aimed to assess cough effectiveness after a stroke and to propose a bedside screening test. Design Patients who had had ischemic hemispheric stroke were recruited and followed up for 2 mos. Maximum phonation time (MPT) was assessed during the first 10 days. Aspiration was evaluated on days 2 and 10 after stroke. Lung function testing was performed on day 10. Peak cough flow less than 160 liters/min was defined as the criterion for cough ineffectiveness. Correlation between peak cough flow and MPT was determined, and the optimal cutoff value relating MPT to effective cough was determined using receiver operating characteristic analysis when referring to peak cough flow. Results Of the 70 patients, 6 developed pneumonia (mean time, 1.7 ± 2.4 days). Lung function assessment in 32 cases revealed general reduced cough effectiveness. MPT was correlated with peak cough flow (r = 0.413, P = 0.025), and an MPT cutoff of 10 secs was identified. Forty-seven patients were able to perform MPT on day 2; 49 were able to perform on day 10. Patients with MPT of 10 secs or longer had less frequent aspiration on both day 2 (5.9% vs. 36.7%, P = 0.034) and day 10 (2.9% vs. 26.6%, P = 0.026). Conclusions Cough effectiveness was reduced at the time of greatest risk for pneumonia. MPT provides a reliable bedside screening test of cough effectiveness.

Physical Activity Level Among Stroke Patients Hospitalized in a Rehabilitation Unit

The current literature contains little information about the level of physical activity of hospitalized patients who have had a stroke. Improving knowledge in the area could help optimize rehabilitation.

Pain management: what's the more efficient model?

OBJECTIVES Conduct a literature review on the organization models for the chronic neuropathic pain management of spinal cord injury (SCI) patients. METHODS Bibliographical research on Medline based on the following keywords: chronic neuropathic pain in spinal cord injury-comprehensive management-multidisciplinary approaches. RESULTS AND DISCUSSION No data was found in the literature on this specific topic. We took the option to report the data from the French laws regarding chronic non-cancer pain management. Chronic pain in SCI patients needs a specific and rigorous approach, justifying the role of the physical medicine and rehabilitation (PM&R) physician within specialized pain management centers as a key referent physician and coordinator for this type of patient. Furthermore, SCI pain is a chronic pain and as such requires a global care management; engulfing its emotional, affective, cognitive and behavioral aspects. These particular aspects need to be evaluated within specialized centers dedicated to chronic pain that provide specific therapies such as behavioral and cognitive therapies. CONCLUSION Specific pain management centers or hospital units remain the benchmark place for chronic pain in SCI patients. PM&R physicians play a key role in the care management of chronic SCI pain. The partnership PM&R-Pain management center aims to provide the most efficient and coordinated care for SCI patient.

Long-term transanal irrigation's continuation at home. Preliminary study

OBJECTIVE To determine the long-term outcome of Peristeens home use. METHOD Retrospective study on the 16 first patients treated by Peristeen in the department of physical and readaptation medicine of Limoges universitary hospital, by the mean of phone interviews. RESULTS Successful outcome was achieved in 62.5% patients after a mean follow-up of 2.6 years. All patients had neurogenic bowel disorders, including 75% of constipation. Most of cases of Peristeen discontinuation occurred at the treatment beginning, one month after introduction in two thirds of cases. In patients who were still using transanal irrigation (TAI), mean grade of satisfaction with the Peristeen system was 9.12/10, despite the high rate of technical problems (77.8% of cases). CONCLUSION This study highlights the limits of Peristeens long-term using and suggests the interest of a specific therapeutic education to Peristeen and of a systematic control consultation within the 3 first months of treatment.

Central motor conduction and glutamate deshydrogenase: activity in olivo-ponto-cerebellar atrophy.

Central motor conduction was investigated by way of magneto-electric cortico-spinal stimulation in 6 patients with sporadic olivo-ponto-cerebellar atrophy. Two patients were found to have reduced leucocyte GDH activity. Only the 3 patients with corticospinal deficits displayed increased central conduction rates, which were predominant in the lower limbs. The duration of the disease is statistically longer in patients with corticospinal deficit compared to patients with no corticospinal deficit. In OPCA, evoked motor potentials are useful in assessing the corticospinal deficit which does not appear to be linked to reduced leucocyte GDH activity.

Prediction of the oxygen cost of walking in hemiparetic stroke patients

OBJECTIVE To verify the relation between spontaneous walking speed (Sfree) and oxygen cost of walking at Sfree (Cwfree) in post-stroke hemiparetic patients and to test the validity of a prediction model to estimate Cwfree based on Sfree. DESIGN We included 26 participants (mean age 65.1 years [SD 15.7]) with mild to moderate disability after stroke who walked at Sfree using mobility aids if necessary for 6min. The Cwfree was measured at a stabilized metabolic rate by indirect calorimetry with the Metamax 3B spiroergometry device. The relation between Sfree and Cwfree was analyzed by the correlation coefficient (r) and coefficient of determination (R2). The Cwfree prediction model was developed from a regression equation, then tested on a second population of 29 patients (mean age 62.1 years [SD 13.4]) with the same inclusion and exclusion criteria. RESULTS For the 26 participants, the Sfree and Cwfree were highly correlated (r=-0.94 and R2=0.97), which allowed for formulating a regression equation and developing the Cwfree prediction model based on Sfree. The prediction model tests yielded accurate results (mean bias -0.02mL.kg-1.m-1; 95% limits of agreement -0.31 to 0.26mL.kg-1.m-1). The relation between Cwfree estimated by the model and measured by Metamax was high (R2=0.98). CONCLUSION Cwfree was strongly correlated with Sfree, which allowed for the development of a valid Cwfree prediction model. A practitioner could estimate the energy expenditure of walking for a patient without using an indirect calorimeter.

Outcome 4 years after non-operative and operative treatment of posterior cruciate ligament (PCL) injuries

taux optimum de vitamine et seulement 14 % une hypovitaminose. L’année suivante en février 2012 et juin 2012, nous avons retrouvé des chiffres similaires. Après supplémentation en novembre 2012, 94 % des sujets présentaient un taux supérieur à 30 ng/mL en février 2013. Discussion.– Comme Galan [1] l’avait déjà démontré en 2012, un taux sériqu de 25(OH)D3 d’environ 48,5 ng/mL est nécessaire à la mi-octobre pour assurer suffisance en vitamine D 30 ng/mL au début de février. La pratique intensive d’un sport d’extérieur n’exclut pas le risque d’hypovitaminose D, d’autant plus que les patients sont d’origine africaine. Il serait intéressant de corréler ces résultats aux apports quotidiens en vitamine D et calcium du sportif. Conclusion.– Les footballeurs professionnels ont un risque élevé d’hypovatimanose D, majoré chez les footballeurs de d’origine africaine, bien qu’ils pratiquent un sport intensif en extérieur. Cette réflexion attire des questions sur le statut vitaminique du sportif. Cela mériterait de poursuivre notre étude sur une éventuelle relation avec les blessures et la contre-performance. Référence [1] Galan F. Serum25-hydroxyvitamin D in early autumn to ensure vitamin D sufficiency in mid-winter in professional football players. Clin Nutr 2012;132–6.