The effect of 8-weeks proprioceptive exercise program in postural sway and isokinetic strength of ankle sprains of Tunisian athletes.

OBJECTIVE: Our objective is to investigate the effects of proprioceptive exercises rehabilitation on isokinetic strength and postural balance in athletes with sprain ankle. MATERIALS AND METHODS: The ankles of 16 subjects were tested: eight in the functional instability (FI) group and eight non-injured (NI) subjects in the control group. Subjects were asked to take part in a testing session. The test order for the postural stability and isokinetic strength tests was randomized to avoid learning or fatigue effects. The testing session started with a 5-minute warm-up. Subjects were then instructed to perform several lower body flexibility exercises. The test procedure consisted in static assessments, where single-limb (right and left) stance postural stability was assessed. Three practice trials were allowed for each subject. The assessment quantifies postural sway velocity while the athlete stands calmly on one foot on the force plate, for each leg. They were asked to stand as still as possible for 30s, upper limbs along the body. The subjects were requested to maintain balance with eyes open and then with the eyes closed on the firm surface. The sway velocity (in degrees per second) is given for all trials. Subjects were allowed a 1-minute rest between tests. The regime of isokinetic evaluation of dorsi-plantar flexions is concentric, with three successive speeds: slow (30°/s, reps 5), average (60°/s, reps 10), and fast (120°/s, reps 15), according to the protocol established by European Group for the development and the isokinetic research and the procedural guidelines. Relative moment of strength and times of acceleration and deceleration were calculated for each set of isokinetic testing repetitions per body side, muscle group and testing speed. RESULTS: The results of tests-retest and between both groups (injured vs. healthy) show that after eight weeks of proprioceptive work, significant increase of maximal strength, decrease in times of acceleration and deceleration at the level of plantar flexors and better stability of the injured limb at slow and average (P<0.05). For the healthy limb, improvements varying from 1 to 39% were obtained between test and retest on all the variables. However, these variations were not statistically significant. CONCLUSION: Proprioceptive training exercises can effectively stabilize an unstable ankle above for muscular and postural control. However, 8 weeks does not assess whether we have achieved maximum effect. In addition, we do not know to what extent these effects will continue over time. It would be interesting to later re-evaluate the athletes for the effect of this treatment, which is based on a proprioceptive training program on a year or more.

[Necessity of physical activities restriction after lumbar diskectomy]. / Intérêt d'une approche active dans la prise en charge rééducative a la suite d'une première chirurgie rachidienne pour hernie discale.

BACKGROUND: Necessity of physical activities restriction after lumbar discectomy have been described in the literature. AIM: The aim of this study was to determine if early rehabilitation could favorably influence the prognosis of military patients who had undergone lumbar disk surgery. METHODS: We performed a retrospective study involving patients who have had lumbar disk surgery, and had undergone physical rehabilitation program. A clinical evaluation, an assessment of pain and a functional assessment by the Arabic version amended self-questionnaire Oswestry have been made for these patients before and after a rehabilitation program started since the 40th postoperative day. RESULTS: We have collected 50 cases: 40 men and 10 women of average age 30 years. All these patients have been improved after surgery with no radiculalgies, but with persistence lumbar pain syndrome. After rehabilitation program, we noted a reduction of 42.85% of pain and functional improvement with a reduction in the average score of Oswestry index of 61.18%. The average work incapacity was 4 months. A workstation adaptation was indicated for all patients. CONCLUSION: Intensive rehabilitation program started early after lumbar disk surgery can improve the functionality of patients operated, and allows early return to professional activities with reduction of the healthcare cost.

Total knee arthroplasty in a spinal cord-injured patient: a case report.

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as "water on the knee"), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

[Neurogenic urinary bladder in patients with spinal cord injury. Protocol of surveillance and management]. / La vessie neurologique du blessé médullaire: protocole de surveillance et de prise en charge.

BACKGROUND: Bladder dysfunction is constant in patients with spinal cord injury and this whatever is the injury level. They are characterized by a variable profile and changing in the course of the years. They constitute not only, an important cause of morbidity in this population but also mortality. AIM: The aim of this work is to emphasize the importance of the diagnosis and to study the bladder behaviour while clarifying the evolution of this type of bladder and to present a protocol of management of a neurogenic bladder. METHODS: retrospective study. 2 assessments in 6 months of interval were realized. The bladder evaluation consisted in a biological assessment, a urinary ultrasound, a cystography and urodynamic investigations. The management is initially realized there to hospital. RESULTS: Our study contains 62 persons with spinal cord injury of average age of 32, 4 years with post traumatic period average is of 41, 47 months. The various evaluations allowed us to conclude that there is a significant change of the neurological status as well as the urinary biological values with significant deterioration of the various ultrasound, cystography and urodynamic data. CONCLUSION: The diagnosis and the management of the neurological bladders of persons with spinal cord injury have to be besides the other deficiencies that these patients as well as neurological, orthopaedic, and cutaneous devices, because this is going to allow to improve their quality as well as their life expectation. Our results underline the importance and the necessity to establish a protocol of neurogenic bladder control rigorous and codified which remains to adapt according to every patient. This protocol is sometimes difficult to apply given the fact of the misunderstanding of this type of deficiency.

Single-leg assessment of postural stability and knee functional outcome two years after anterior cruciate ligament reconstruction.

OBJECTIVE: To analyse postural stability and the single-leg hop for distance in subjects 2 years after anterior cruciate ligament reconstruction (ACLR), in comparison with an age- and activity-matched control group. DESIGN AND SETTING: Subjects reported to a sports medicine or athletic training research laboratory for testing. SUBJECTS: Twenty-six subjects having undergone ACLR and 26 age- and activity-matched controls were selected to participate in this study. An arthroscopically-assisted, central, one-third bone-patellar tendon procedure was used to repair the ACLs. MEASUREMENTS: One-leg stance postural stability was measured with the NeuroCom Balance Master platform system. We recorded the single-leg hop for distance as an objective measure of function. RESULTS: We found a significant difference (p<0.05) between the ACLR and control subjects in terms of the one-leg stance sway velocity (knee fully extended) on the operated side. CONCLUSIONS: After ACLR (mean time postoperatively: 24+/-1 months), single-leg hop for distance score was normal, when compared with the contralateral limb. Our results indicate that 2 years after surgery, single-limb postural stability in the ACLR group differed significantly from that in the control group. The persistence of poor stability control may be correlated to an impairment in proprioception.

[Isokinetic, functional and proprioceptive assessment of soccer players two years after surgical reconstruction of the anterior cruciate ligament of the knee]. / Evaluation isocinétique, fonctionnelle et proprioceptive du footballeur à deux ans postopératoire de la reconstruction du ligament croisé antérieur du genou.

UNLABELLED: Injuries to the anterior cruciate ligament (ACL) of the knee are common in sport and are treated routinely in the world of sports medicine. In order to resume competitive sport in safety, it is important to know the actual level of performance achieved by the operated leg some time after the ligament repair. OBJECTIVES: The objective of this work was to evaluate the recovery of the operated leg in Tunisian sportsmen two years after surgery by using isokinetic testing (60 degrees s(-1)), the one-leg hop distance test (i.e. a functional activity that one often finds in sport) and proprioceptive assessment. A secondary objective was to detect any possible correlations between the various outcomes. MATERIALS AND METHOD: The ACL group was composed of 26 top-level Tunisian footballers having undergone ACL ligament repair. Two years after surgery, the following assessments were performed: an isokinetic test with an angular velocity of 60 degrees s(-1), a proprioceptive assessment in both active and passive modes and the functional one-leg hop distance test. RESULTS: Our investigations confirmed a muscle deficit of 16% in the hamstring muscles of the injured leg. In both active and passive modes, normal proprioception is observed at a flexion of 60 degrees and in total extension but not in a mid-way position. The performance level of the operated leg (in terms of distance) had an average symmetry value of 93.40+/-2.7%. CONCLUSION: Playing football appears to influence the isokinetic strength profile in sportsmen after ACL repair. The repair procedure leads to bilateral proprioceptive disruption at 15 degrees of knee flexion, on average.

[Role of the Neurocom Balance Master in assessment of gait problems and risk of falling in elderly people]. / Rôle du Neurocom Balance Master dans l'évaluation des troubles de l'équilibre et du risque de chute chez le sujet âgé.

INTRODUCTION: Falls in elderly people is currently a health service problem because of the multiple consequences. Numerous teams have been interested in predicting the risk of falling with clinical and instrumental tests. Our study investigated instrumental evaluation by use of the Neurocom Balance Master in the global assessment of gait problems and risk of falling in elderly people. PATIENTS AND METHODS: Transverse study concerning 60 subjects older than 65 years distributed in 2 groups of 30 subjects each according to the existence or not of falling incidents during the past year. Evaluation by the Balance Master involved the following items: 1) the modified Clinical Test for the Sensory Interaction on Balance (CTSIB), which estimates balance by measuring the speed of oscillation of the center of pressure (CP) with open then closed eyes and firm then mossy ground; 2) support monopodal 5" to the left then to the right, eyes open then closed in moderated speeds of oscillation of the CP; 3) passage from standing to sitting, in moderated speeds of oscillation of the CP; 4) limits of stability: the possibilities of moving the CP towards a predetermined target without moving the feet in moderated time and speed; 5) study of the step: determine length and width of the step as well as speed; 6) most about-turn: measure of speed of oscillation of the CP during the right then left about-turn; 7) clearing: the force of the impact and the oscillations of the CP during the clearing of an obstacle 10 cm high to measure leverage. RESULTS: The oscillation speed of the CP in the 2 groups during modified CTSIB, support monopodal 5", passage from standing to sitting, about-turn and clearing were significantly improved the group of the patients with falls (P < 0.05). The step, length and speed of these patients were significantly reduced, with no difference in width of the step between the 2 groups. In the evaluation of the limits of stability, only time necessary to reach the target was significantly increased in the group with falls. Finally, the indication of leverage and the force of impact on the ground measured by the test of clearing were more important in the group of fallers than in non-fallers. CONCLUSION: The Neurocom Balance Master estimates not only postural balance, but also the vestibulary system and reproduces the physiological conditions of daily life. It has a certain role in the early assessment of gait problems and the risk of falling. This system also allows for rehabilitation of the impaired balance and offers a profit with the biofeedback.

[Conservative management of full-thickness rotator cuff tears. A prospective study of 24 patients]. / Traitement conservateur des ruptures transfixiantes de la coiffe des rotateurs. Etude prospective ouverte. A propos de 24 patients.

OBJECTIVE: To evaluate the efficacy of conservative treatment of full-thickness rotator cuff tears. METHOD: A prospective open study of patients with full-thickness rotator cuff tears. The diagnosis was confirmed by ultrasonography examination. Therapeutic efficacy was evaluated before treatment, at the end of the treatment, and at 1, 3 and 6 months. Pain and handicap intensity were measured by a visual analogue scale, by the algo-functional Constant score, by articular mobility and, finally, by the resumption of daily and/or professional activities. Successful treatment was considered with a VAS pain scoreor=80. RESULTS: Twenty-four patients, mean age 59 years, with full-thickness rotator cuff tears for 9 months, on average, were included in the study. The parameters of pain function and handicap improved significantly since the end of treatment. The Constant score improved greatly, from 44.8 before treatment to 71.8 at the end of treatment and 74.2 at 6 months. This improvement continued until 3 months after treatment. The rate of success was 75% at 6 months. CONCLUSION: Despite the small sample size, our study confirm that rehabilitation should always be performed before a decision of surgical repair.

[Validity and reliability of spinal clinical measures in ankylosing spondylitis]. / Validité et reproductibilité des mesures cliniques rachidiennes dans la spondylarthrite ankylosante.

OBJECTIVES: To evaluate the validity and the reliability of the main clinical measures of mobility and sagittal spinal curves in ankylosing spondylitis (AS). METHODS: Criterion validity of the measure of the distance between C7 spinous process to plumbline (dorsal kyphosis), L3-plumb line (lumbar lordosis), lumbar, dorsolumbar and dorsal mobility. The gold standard was the value obtained from lateral radiological views of the dorsal and lumbar spine in standing position and maximum flexion. The correlation between radiological and clinical measures was assessed by a Spearman correlation coefficient (SCC). The reliability was assessed for all the clinical parameters and for chin-sternum distance (flexion, extension), chin-acromion distance (rotations) and chest expansion using the intraclass correlation coefficient (ICC) and the Bland and Altman method. Were included patients with AS and needing dorsal and lumbar Xrays. RESULTS: Twenty-two patients (21 men), 32 +/- 11 year old, 51 +/- 10 kg weight, with a mean duration of the disease of 120 +/- 60 months. The ICC values were good or excellent for all parameters except for the measures of dorsal mobility. The validity was evaluated in 18 patients. The value of the SCC between clinical and radiological measures was good except the measures of dorsal kyphosis and dorsal mobility. CONCLUSION: The clinical measures of mobility and sagittal curves have metrological properties good enough to be used in the monitoring of AS mainly for the follow-up and the evaluation of the rehabilitation. The measurement of dorsal mobility should be restricted to the lower part only. Although apparently not valid the distance C7-plumbline can be used in management of AS because of its excellent reliability.