M Munoz

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.

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.

Experience with a process for acquiring assistive technology devices with testing in a semi-ecological situation

Assistive technology (AT) refers to ‘‘any product (including any item, piece of equipment, instruments, technology and software) specially manufactured or existing on the market intended to prevent, to compensate, to control, to alleviate or neutralize deficiencies, activity limitations and participation restrictions’’ (International Organization for Standardization [ISO]: https:// www.iso.org/fr/standard/60547.html). The French National Authority for Health recommends a process for AT acquisition based on a multidisciplinary assessment of the disability and requirements of the disabled person [1]. Nevertheless, we lack a consensus method or any universal method for such acquisition. The acquisition of AT by a person in a disability situation involves complex mechanisms respecting the requirements and the acceptance of the AT [2,3]. Moreover, numerous obstacles include lack of finances and no way to test the AT in an ecological situation. Not many studies have assessed the effectiveness of the process of AT acquisition [4]. The AT tools have been well described [5,6]. Knowledge of the reasons for the non-acquisition and abandonment of AT is essential to improve the acquisition process. The description of what some teams have done could improve the practices [4]. In the department of physical medicine and rehabilitation (PM&R) of Centre Hospitalier et Universitaire Limoges (CHU Limoges), our AT acquisition process includes a multidisciplinary recommendation and testing in an semi-ecological situation. However, the efficiency of this process is unclear. In this context, we sought to share our experience and reflections on this subject. Our recommendation procedure involves 3 phases: