[Capacity and performance: ambulatory monitoring under controlled and real-life conditions]. / Evaluation des capacités et des performances: contribution des monitorages de la locomotion en situation d'exercice et de vie réelle.

OBJECTIVES: To determine the value of ambulatory monitoring in assessing human gait. To describe the sensors, the parameters and the ambulatory devices. MATERIALS AND METHODS: Literature review and practical experience about techniques, principles, objectives and limits. RESULTS: Accelerometry is the main technique for ambulatory monitoring because of its reliability, pertinence of signals and software developed for interpretation. Simultaneous monitoring of heart rate response is clinically relevant. Pedometers and actimeters can answer precise clinical questions about amount of walking activity. CONCLUSION: Ambulatory monitoring during long periods (one day or more) is important, especially for rehabilitation medicine because it measures the actual patient activity performed and participation. The simultaneous monitoring of environmental conditions of activity should improve the interpretation of the data collected.

[An anthropological approach to how Tchaman people in the Côte-d'Ivoire view hemiplegia]. / Approche anthropologique de l'hémiplégie chez le peuple Tchaman en Côte-d'Ivoire.

OBJECTIVE: Investigate the underlying beliefs, knowledge and therapeutic attitudes toward hemiplegia of the Tchaman people of the Ivory Coast. MATERIAL AND METHODS: A descriptive and cross-sectional study conducted over 10 months in 20 Tchaman village communities in the Ivory Coast. Three groups of people were interviewed: patients with hemiplegia, the circle and close neighbourhood of patients and traditional doctors. The questionnaire asked about epidemiological characteristics; the definition, origin and sociocultural causes of hemiplegia; attitude toward therapy; and developmental aspects of hemiplegia after treatment. RESULTS: The word "awoyo" was most often used (53.3%) to refer to hemiplegia whose origin is most of the time attributed to a curse (57%). For 45% of the people interviewed, hemiplegia is a severe disease that can cause death and is associated with the development of a stationary evolution after treatment. The Tchaman follow modern and traditional methods of treatment for hemiplegia. CONCLUSION: Need to sensitize the Tchaman people to functional rehabilitation for effective assistance to patients with hemiplegia.

Eye movements and visuoverbal descriptions exhibit heterogeneous and dissociated patterns before and after prismatic adaptation in unilateral spatial neglect.

This prospective study examined the effects of prismatic adaptation on visual exploration strategies in patients with left unilateral spatial neglect (USN). Photo-oculographic gaze recordings were obtained, as the subjects (28 brain-damaged; 15 control) performed a free visual exploration task before and after a session of prismatic adaptation. (i) Before prismatic adaptation, the pattern of visual exploration described two subgroups of patients (symmetrical exploration of hemispaces - similar to the control subjects, deficient exploration of left hemispace). Twelve of 20 patients failed to describe significant elements in the left part of the displayed image. Several visuoverbal patterns were observed, some dissociating visual exploration and verbal description. (ii) Immediately after prismatic adaptation, patients with asymmetrical visual exploration presented a significant increase in the number of point fixations and saccades in the left hemispace. Patients with symmetrical exploration presented the opposite pattern. Improved pattern of visual exploration contrasted with an absence of improved verbal description. Eye movements and visuoverbal descriptions exhibit heterogeneous and dissociated patterns before and after prismatic adaptation. This results demonstrate that prismatic adaptation has no effect in certain patients, suggesting that therapeutic indications and evaluation of prismatic test results should take into consideration the heterogeneous nature of USN.

Functional asymmetries of the lower limbs. A comparison between clinical assessment of laterality, isokinetic evaluation and electrogoniometric monitoring of knees during walking.

We used bilateral electrogoniometric gait monitoring of the knees to demonstrate the existence of an angular asymmetry between the two legs in healthy subjects. We also searched for correlations between this asymmetry and handedness, footedness and ocular laterality and isokinetic strength of the flexor-extensor muscles of the two knees. Among the 40 subjects studied, 25 (62.5%) showed an asymmetric maximal knee flexion: the difference being superior or equal to 5 degrees between the knees. There was no correlation between this asymmetry and the lateralities studied. We termed this type of asymmetry 'angular preponderance' to differentiate it from the laterality defined by clinical tests. Isokinetic strength of the knee flexors and extensors was correlated with the gender and speed, but not with side or laterality. Appropriate interpretation of lower limb examination should take into consideration angular gait asymmetry in the healthy subject.

[Pituitary abscess, treated by medication]. / Abcès hypophysaire traité médicalement.

Pituitary abscesses are rare. The case reported here concerns a 28-year old African. Gradual development of diplopia over 6 months was the first clinical manifestation. Three months later this development had reached a more severe and infectious context, with complete right ophthalmoplegia, meningitis and coma (GCS = 9). CT scan showed an image in favour of a pituitary abscess with suprasellar extension, associated with thrombophlebitis of the cavernous sinus. An antibiotic therapy consisting of cefotaxime and metronidazole administered for 1 month, and netilmicin for 15 days succeeded in controlling the infectious syndrome. This resulted in cure of visual disorders, reduction in size of the CT scan image and reconstruction of the pituitary sella which had been destroyed. The diagnosis of pituitary abscess should be made when confronted with an infectious syndrome (unexplained fever, repeated meningitis). CT does not recognize the nature of the hypophyseal mass it shows: necrosis of a pituitary adenoma, giant aneurysm or craniopharyngioma may mimic local infection. Surgery confirms the diagnosis and is regarded as the best treatment. The patient's life is threatened when meningitis is present, and the functional prognosis is poor when recovery from visual disorders is compromised due to late diagnosis. In this paper a comparative analysis of the clinical course of the disease and therapeutic data in our patient is presented and compared with other reported cases.

[Implementation of palliative care in Ivory Coast]. / Mise en place de la politique nationale des soins palliatifs en Côte d'Ivoire.

Ivory Coast adhered to the strategy of the primary cares of health whose leading principles served basis to the definition of the National politics of sanitary development, exposed in the National plan of sanitary development 1996-2005. The improvement of the quality of the cares is the main objective of this plan. The attack of this objective cannot make itself without the hold in account of the palliative cares that are a component of the cares for the patients affected by chronic and incurable affections, since the diagnosis until the death and even after the death. Conscious of the necessity to develop the palliative cares to improve the quality of life of the patients and their families, the ministry in charge of health, in collaboration with the partners to the development, initiated a project of development of the palliative care in Ivory Coast. It is about an innovating gait in Ivory Coast concerning politics of health. This work has for goal to present the big lines and the setting in which this politics has been put in place.