Assessment of muscle strength in chronic low back pain patients: Comparison between isocinetic rehabilitation and conventional rehabilitation.

INTRODUCTION: Chronic low back pain is a public health problem in view of its functional repercussions and the functional rehabilitation is an integral part of its management. AIM: To compare the evolution of muscle strentgh of spinal extensors and flexors in chronic low back pain patients after an isokinetic rehabilitation protocol and a conventional rehabilitation one. METHOD: This was a prospective and comparative study carried out in the Physical Medicine Department of the Tunis Military Hospital over a period of 7 months. Fifty patients were included, randomly divided into two groups of 25. The first group (G1) benefited from an isokinetic rehabilitation protocol and the second one (G2) from a classic active physiotherapy. We performed a clinical (Sorensen test and Shirado test) and isokinetic evaluation of the trunk muscles before and after rehabilitation. RESULTS: The mean age of the general population was 42±8.6 years old. Clinical evaluation showed a deficit in the extensor and flexor muscles of the spine, more important in the extensors in both groups. After rehabilitation, there was a significant improvement in clinical tests of muscular endurance in G1 and G2. Isokinetic assessment showed a greater muscle deficit in the extensors in both groups. After isokinetic rehabilitation, peak torque for flexors and extensors increased by 21% and 23% respectively, power was 34% and 37% higher, and total work increased by 26% and 47%. On the other hand, the (F/E) ratios were unchanged for all three speeds. In Group 2, peak torque values for flexors and extensors increased by 22 and 15% respectively, power was higher by 31 and 23% and total work was also up by 29 and 17%, while F/E ratios were also unchanged. Group 1 showed the greatest improvement in extensor strength at 60°/s, and in power at 90°/s for the various muscles. CONCLUSION: In our study, we concluded that endurance and muscular strength improved the most after isokinetic rehabilitation.

Botulinum toxin and hyperhidrosis of the amputation stump in war amputees.

INTRODUCTION: Stump hyperhidrosis is a common condition after lower limb amputation. It affects the prosthesis use, and the quality of life of patients. Several case reports tried to prove benefit of using Botulinum toxin in its treatment. AIM: This study was to conduct a larger workforce clinical trial and to demonstrate benefits of botulinum toxin injection in the treatment of stump hyperhidrosis. METHODS: A prospective study was conducted. War amputees who complained of annoying excessive sweating of the stump were included. They received intradermal injection of botulinum toxin A in the residual limb area in contact with prosthetic socket. Abundance of sweating and degree of functional discomfort associated with it were assessed before, after 3 weeks, 6 and 12 months. RESULTS: Seventeen male patients, followed for post-traumatic limb amputation were included in the study. Discomfort and bothersome in relation to Hyperhidrosis did decrease after treatment (p<0,001). Reported satisfaction after 3 weeks was 73,33%. Improvement of prothesis loosening up after 3 weeks was 72,5% [±15,6]. Mean injection-induced pain on the visual analogue scale was 5.17/10 (±1.58). The mean interval after the onset of improvement was 5.13 days [min:3, max:8]. The mean time of improvement was 10.4 months after the injection [min:6, max:12]. No major adverse events were reported following treatment. CONCLUSION: Intradermal injections of botulinum toxin in the symptomatic treatment of stump hyperhidrosis are effective and have few adverse effects. It improves the quality of life of our patients thanks to a better tolerance of the prosthesis.

Cerebral palsy of the child in rehabilitation environment: epidemiologic and clinical profile and therapeutic modalities.

INTRODUCTION: Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture causing activity limitation. AIM: To evaluate the epidemiological, clinical, and radiological profile of children with CP and to study the therapeutic modalities in daily clinical practice. METHOD: This was a retrospective, descriptive study, carried out in a physical medicine and rehabilitation department, including all the patients referred with the diagnosis of cerebral palsy between January 2000 and December 2016. We used pre-established records to collect data. The missing data were collected from the files of the pediatric department. To classify cerebral palsy, we used a motor impairment classification, topographic classification according to the affected limb and the GMFCS - ER. RESULTS: Fifty patients were included with a gender ratio of 1.23. The mean age of patients was 7.8 years old. The risk factors for CP were mainly represented by perinatal asphyxia (55%) and prematurity (37%). The spastic form was predominant (74%). Quadriplegia was the most severe clinical form (61%). Neuro-orthopedic deformations were found in 78% of cases. Half of the children had GMFCS score between 1 and 2. Brain MRI lesions were dominated by anoxic-ischemic sequelae (34%). Physical therapy was prescribed for all patients. The most prescribed devices were the dynamic ankle foot orthosis (60%). Baclofen was prescribed in 5% of cases and botulinum toxin injection was performed in 30% of children. CONCLUSION: The cerebral palsy defines the clinical and functional disorders caused by non-progressive developmental damage to the brain of the infant which requires a multidisciplinary management.

Neuropathic pain in patients with knee osteoarthritis: Relation with comorbidities and functional status.

OBJECTIVES: The aim of this study was to evaluate the prevalence of neuropathic pain components of knee osteoarthritis (OA) patients and to identify the relation between associated neuropathic pain and comorbidities, pain intensity, function, and radiographic severity of knee OA. METHODS: This cross-sectional study enrolled patients with knee OA (ACR criteria 1986). Visual Analog Scale (VAS), DN4 questionnaires were performed for each patient. A score of DN4≥4/10 was classified as diagnostic for neuropathic pain. Functional impairment was estimated using the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) ad radiographs were rated using the Kellgren Lawrence (KL). RESULTS: We recruited 101 patients with a sex ratio was 0.1. The mean age was 65.5±10.8 years [41-95]. The mean duration of symptoms was 3.5 years. At least one comorbidity was revealed for 88.1% of patients. Mean VAS pain was 6.5±1.69. The mean DN4 score was 4.8± 2.4. The prevalence of NP (DN4≥4) was detected in 68.3%. The most frequently described NP characteristic was the sensation of burning (74%). The mean KOOS-PS score was 46.4±19.2. Based on KL grading, 78.2% of OA were classified grade III-IV. Female gender, number of comorbidities, bilateral knee OA, mean VAS pain, and mean KOOS-PS score were significantly higher in the neuropathic pain group when compared to the group without neuropathic (respectively: p=0.01,p=0.04, p=0.017, p=0.00, p=0.00). In multivariate regression, KOOS-PS and bilateral knee OA were independently associated with NP. CONCLUSION: Our results highlight the frequent NP in patients with knee OA (68.3%) and its relation with function and comorbidities.

Functional repercussion of polyarthrosis of the elderly in tunisia.

INTRODUCTION: Osteoarthritis (OA) is the most common degenerative joint disease in the elderly. The often multifocal location at this age can be a source of pain, limitation of everyday activities, thus affecting their quality of life. AIM: To evaluate functional status of aged people with generalized OA in Tunisia, and to detect the main factors associated with a poor function in order to optimize their medical care. METHODS: A cross-sectional, descriptive study done between January and March 2017. Fifty patients were included, aged 65 years and over followed for generalized osteoarthritis. The functional repercussions of polyarthrosis was assessed by functional independence measure (FIM), the Lequesne Algofunctional Index, the Womac index for hip and knee OA, and the Oswestry questionnaire for low back pain. RESULTS: The mean age of patients was 71.94 ± 0.8 years with a sex ratio of 0.42.The functional status of patients with polyarthrosis were altered to varying degrees. The most impaired dimensions of FIM were self-care, transfers and locomotion. Activities of daily living of the Lequesne index was the most impaired section with an average of 5.28. The three dimensions of the Womac index were affected, particularly the pain section with an average of 49.18/100. The Oswestry index was altered with an average of 18.89 / 40. Factors associated with poor functional status were: Female gender (p<0,05), age of development (p<0,05), spinal arthrosis (p<0,05) and history of falls(p<0,05). CONCLUSION: Polyarthrosis is accompanied by functional impairment in the elderly. Factors associated with functional impairment should be considered in the Patient Management Program.

Evaluation after two years of functionnal restoration for chronic low back pain : Tunisian experience.

INTRODUCTION: functional restoration of the spine is a proven method in the short-term management of chronic low back pain. The aim of our study  was to evaluate the effect of a functional restoration program at two years of evolution. METHODS: retrospective study of patients enrolled in a functional restoration program during 2014 and summoned after two years,  in 2016. Patients have had the same clinical and functional evaluation before the program, at five weeks and  at two years. RESULTS: Thirty patients were enrolled in the study. The average age was 45 years. Eighty % of the patients were overweight. Significant improvement for all clinical and functional parameters at five weeks was noted. This gain was maintained significantly for some parameters at two years. CONCLUSION: The results of the functional rehabilitation of the spine are satisfactory at two years of evolution.

Ground surface nature can influence visual information contribution in postural control.

BACKGROUND: In sport, the nature of ground surface is likely to influence the contribution of visual information on postural control. Boxing and wrestling are respectively practiced on firm and soft ground surfaces. The aim was to compare the postural control of boxers with that of wrestlers on stable (firm) and unstable (soft and dynamic) ground surfaces, with and without deprivation of vision. METHODS: Fifteen male international boxers and 15 male international wrestlers presenting the same anthropometrics characteristics and the same number of years of sports practice were recruited. Spatiotemporal parameters of displacement of the center of feet pressure (COP) were measured on a force platform in static (firm and foam surfaces with eyes open and eyes closed) and dynamic conditions (medio/lateral and antero-posterior directions with eyes open and eyes closed). RESULTS: The results mainly showed a significant vision × group interaction in the antero-posterior direction for the dynamic postural condition (P<0.017). This indicated that the contribution of visual information was greater for the boxers than for the wrestlers in challenging condition (P=0.030). CONCLUSIONS: Further studies are needed to confirm whether the nature of ground surface influences the contribution of visual information, which can be, in turn, affected by the specificity of motor skills.

[Isokinetic profile of knee muscles in Tunisian competitive footballers]. / Profil isocinétique des genoux des footballeuses compétitives tunisiennes.

BACKGROUND: During football several joints are greatly demanded, especially the knees.The interest of the isokinetic is to detect an imbalance between agonist and antagonist muscles of the muscle leg and between dominant and non dominant leg, in order to prevent injuries and to improve the physical fitness of young soccer players. AIM: evaluate the isokinetic profile of flexor and extensor muscles of the knee of competitive footballers Methods : Prospective study conducted in the department of Physical and Rehabilitation Medicine of the Military Tunis Hospital, including 15 competitive footballers and evaluated during the month of August 2012. All patients underwent an isokinetic assessment of agonist and antagonist muscles of the knees in concentric mode 3 speed 60 ° / 120 ° and 180 ° (with analysis of figures and curves), using a Biodex dynamometer. The selected parameters were the time of maximum force (MFM) of the knee flexors and extensors, and the agonists / antagonists ratio (IJ / Q). The data were analyzed by SPSS software. RESULTS: 15 competitive footballers were included. The average age is 23.20 years ± 3.99 years, ranging from 18 to 28 years. The average size is 167.13 cm ± 3.6 cm with a range of 163 and 172 cm. The average weight is 60.87 kg ± 5.97 with a range of 50 to 70 kg. The isokinetic evaluation showed a statistically significant superiority of the flexor muscles of the right knee compared with those of the left knee at the speed 60 / s (p = 0.046) and 120 / s (p = 0.031), whereas this difference has not been found for the extensors muscles. The values of the ratio of quadriceps to hamstring increases with the speed of movement performed, the maximum moment / weight moving in the opposite direction. CONCLUSION: The isokinetic evaluation allows an objective assessment of the flexor and extensor muscles of the knee footballers, in order to correct imbalance and preserve the sporting future of the young footballers.