Equations for estimating the oxygen cost of walking in stroke patients: Systematic review.

OBJECTIVE: To report all equations that can potentially be used to estimate the oxygen cost of walking (Cw) without using a respiratory gas exchange analyzer and to provide the level of reliability of each equation. DATA SOURCES: Webline, Medline, Scopus, ScienceDirect, Bielefeld Academic Search Engine (BASE), and Wiley Online Library databases from 1950 to August 2019 with search terms related to stroke and oxygen cost of walking. METHODS: This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the methodological quality of included studies was determined with the Critical Appraisal Skills Programme (CASP). RESULTS: We screened 2065 articles, and 33 were included for full-text analysis. Four articles were included in the data synthesis (stroke individuals=184). Analysis reported 4 equations estimating Cw that were developed from logistic regression equations between Cw and self-selected walking speed. The equations differed in several methodological aspects (characteristics of individuals, type of equation, Cw reference measurement methods). The Compagnat et al. study had the highest quality (CASP score=9/9). CONCLUSIONS: This literature review highlighted 4 equations for estimating Cw from self-selected walking speed. Compagnat et al. presented the best quality parameters, but this work involved a population restricted to individuals with hemispheric stroke sequelae.

Validity of wearable actimeter computation of total energy expenditure during walking in post-stroke individuals.

BACKGROUND: Recent studies reported that wearable sensor devices show low validity for assessing the amount of energy expenditure in individuals after stroke. OBJECTIVE: We aimed to evaluate the validity of energy expenditure calculation based on the product of energy cost and walked distance estimated by wearable devices in individuals after hemispheric stroke. METHODS: We recruited individuals with hemispheric stroke sequelae who were able to walk without human assistance. The participants wore a tri-axial accelerometer (Actigraph GT3x) and a pedometer (ONStep 400) on the unaffected hip in addition to a respiratory gas exchange analyzer (METAMAX 3B) during 6min of walking at their self-selected walking speed and mode. The energy expenditure was calculated from the product of energy cost measured by the METAMAX 3B and the distance estimated by wearable devices. It was compared to the energy expenditure measured by the METAMAX 3B and the energy expenditure values recorded by the devices according to the manufacturer's algorithms. The validity was investigated by Bland-Altman analysis (mean bias [MB], root mean square error [RMSE], limits of agreement [95%LoA]), and Pearson correlation analysis (r). RESULTS: We included 26 participants (mean [SD] age 64.6 [14.8] years). With the pedometer, the energy expenditure calculated from the product of energy cost and walked distance showed high accuracy and agreement with METAMAX 3B values (MB=-1.6kcal; RMSE=4.1kcal; 95%LoA=-9.9; 6.6kcal; r=0.87, P<0.01) but low accuracy and agreement with Actigraph GT3x values (MB=15.7kcal; RMSE=8.7kcal; 95%LoA=-1.3; 32.6kcal; r=0.44, P=0.02) because of poorer estimation of walked distance. With the pedometer, this new method of calculation strongly increased the validity parameter values for estimating energy expenditure as compared with the manufacturer's algorithm. CONCLUSIONS: This new method based on the energy cost and distance estimated by wearable devices provided better energy expenditure estimates for the pedometer than did the manufacturer's algorithm. The validity of this method depended on the accuracy of the sensor to measure the distance walked by an individual after stroke.

Age and gender differences in motor imagery.

BACKGROUND: Few studies have explored the effects of ageing and gender in the dimensions of motor imagery (MI) such as vividness (vivid images and sensations of mental movements) and timing (the duration of an imagined movement). This study aims 1) to investigate the effect of age and gender effect in vividness and timing capabilities on MI, and 2) to examine the relationship between these two dimensions of MI. METHODS: A population of 72 (47% of males) good imagers including 41 young subjects and 31 older subjects were assessed on MI vividness using the Vividness of Movement Imagery Questionnaire (VMIQ-2) and on MI timing using the performances of the real Timed Up and Go (rTUG) test and its imagined version (iTUG). The main outcome variables were the VMIQ-2 score and the delta-TUG, i.e. the difference between rTUG and iTUG. RESULTS: Mental vividness was affected by ageing with a loss of visual dominance in favor of kinesthetic imagery in older subjects compared to younger ones; however, no difference between both groups was found in timing measured by delta-TUG. Vividness capabilities were similar between men and women, but women performed better in timing. VMIQ-2 scores were not associated with delta-TUG; only gender was significantly associated with delta-TUG. CONCLUSIONS: This study revealed 1) an age-related transfer from a visual to a kinesthetic MI ability, but no impact on timing of MI; 2) a gender effect on timing with no impact on mental vividness; 3) no association between vividness and timing capabilities.

Predicting 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.

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

OBJECTIVE: To determine the long-term outcome of Peristeen's 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 Peristeen's 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.

Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly.

Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).

Vital and functional outcomes of the first-ever hemispheric stroke, epidemiological comparative study between Kunming (China) and Limoges (France).

BACKGROUND: Clinical outcomes and socioeconomic consequences after a stroke may differ between regions. METHODS: One cohort was established prospectively in Kunming (China) to compare with a cohort of 156 stroke patients included in Limoges (France). During 1 year, patients hospitalized within 48 hours for a first-ever hemispheric stroke were included. Demographic data and neurocardiovascular risk factors were registered. Hemiplegia was evaluated. Functional outcome was assessed using the Barthel Index (BI) after 3 months. RESULTS: One hundred and eighteen patients were included in Kunming. Patients of Kunming were younger (61.4 ± 13.4 vs 72.3 ± 14.6 years in Limoges, P<0.0001), more involved in professional activity (36.4% vs 12.8%, P<0.0001). Survival analysis indicated that mortality did not differ between cohorts, but independently predicted by coma at the 2nd day (HR=9.33, 95% CI [4.39, 19.78]) and age>70 years (HR=6.29, 95% CI [2.36, 16.59]). Despite a better baseline BI for patients of Kunming (50.0 ± 34.9 vs 37.4 ± 34.2, P=0.0031), after adjustment for confusing, patients in Limoges had a 2.11 OR 95% CI [1.03, 4.31]) to reach a BI>80 at 3 months. CONCLUSIONS: Functional recovery for patients of Kunming was not as good as expected. The socioeconomic consequences of stroke in Kunming are significant as they involved younger subjects who were still in work.

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.

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.

[Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly]. / Troubles de la déglutition du sujet âgé et pneumopathies en 14 questions/réponses.

Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).

What is the place of electroneuromyographic studies in the diagnosis and management of pudendal neuralgia related to entrapment syndrome?

Entrapment of the pudendal nerve may be at the origin of chronic perineal pain. This syndrome must be diagnosed because this can result in the indication of surgical decompression of the entrapped nerve for pain relief. Electroneuromyographic (ENMG) investigation is often performed in this context, based on needle electromyography and the study of sacral reflex and pudendal nerve motor latencies. The limits of ENMG investigation, owing to various pathophysiological and technical considerations, should be known. The employed techniques do not assess directly the pathophysiological mechanisms of pain but rather correlate to structural alterations of the pudendal nerve (demyelination or axonal loss). In addition, only direct or reflex motor innervation is investigated, whereas sensory nerve conduction studies should be more sensitive to detect nerve compression. Finally, ENMG cannot differentiate entrapment from other causes of pudendal nerve lesion (stretch induced by surgical procedures, obstetrical damage, chronic constipation...). Thus, perineal ENMG has a limited sensitivity and specificity in the diagnosis of pudendal nerve entrapment syndrome and does not give direct information about pain mechanisms. Pudendal neuralgia related to nerve entrapment is mainly suspected on specific clinical features and perineal ENMG examination provides additional, but no definitive clues, for the diagnosis or the localization of the site of compression. In fact, the main value of ENMG is to assess objectively pudendal motor innervation when a surgical decompression is considered. Perineal ENMG might predict the outcome of surgery but is of no value for intraoperative monitoring.

[The management of stroke in Phnom Penh, Cambodia]. / Prise en charge des accidents vasculaires cérébraux à Phnom Penh, Cambodge.

Stroke ranks first among nervous pathologies in Kampuchea. It's a main cause of disability and mortality in our country. We conducted a prospective study including 100 patients hospitalized in the service of general medicine at the Calmette hospital in Phnom Penh. We analyzed the principal risk factors, clinical signs, nature of stroke, complications and markers of the vital and functional prognosis. This work shows the difficulties encountered in the initial care of stroke: delay or absence of hospitalization, cost of complementary examinations to be carried out to determine the nature and the aetiology of stroke and very low level of follow-up to ensure secondary prevention and functional rehabilitation. It can be explained in part by the socioeconomic and cultural level. Research like this one which assesses local needs for stroke prevention, treatment and rehabilitation should be conducted in developing countries to inform the planning and allocation of health care resources in order to reduce the burden of illness associated with stroke. The progressive improvement of the medical structures, and of the socioeconomic and cultural level will facilitate stroke care management.

[Beds dedicated to stroke patients in postacute care units. Are national guidelines followed?]. / Nombre de lits dédiés à la pathologie vasculaire cérébrale en soins de suite et de réadaptation. Les recommandations nationales sont-elles pertinentes?

OBJECTIVE: We sought to determine the number of beds necessary for stroke patients in postacute care units and to measure the relevance of the national guidelines on required number of beds. METHODOLOGY: We conducted an epidemiological follow-up of a cohort, what allowed for evaluating stroke care under real-life conditions. We applied the French guidelines for transfer of patients to postacute care wards. RESULTS: Of the 605 stroke patients hospitalised, 156 with a mean age of 72 years were included. A total of 64 (41%) could return home directly from the acute care wards and 73 (47%) were referred to postacute care wards. Among the latter patients, 31 (43%) were transferred to a physical medicine and rehabilitation (PMR) unit and 42 (57%) to a geriatric unit. The 19 remaining patients died in acute care. Of the 137 surviving patients, 46.7% returned directly home and 53.2% were referred to postacute care wards. Of patients older than 80 years, 74% were transferred to a geriatric unit, whereas 76% of the patients less than 80 years were transferred to a PMR unit. DISCUSSION-CONCLUSION: The national guidelines are based on a rate of discharge of about 24% of stroke patients to postacute care wards. In our study, we found that 47% were transferred to such wards. If the guidelines are applied, 19 beds dedicated to stroke patients would be necessary for postacute stroke care on a national level, or double that (36) on a regional level. Of these 36 beds, 16 to 24 should be PMR beds. The calculation of the number of beds necessary often rests on a simple transposition of the results of the studies and not on an objective evaluation according to the local context. Studies of longitudinal follow-up of cohorts such as this seem essential to evaluate needs and measure the relevance of the national guidelines.

[Early prediction of functional outcome one year after initial unilateral hemispheric stroke]. / Facteurs prédictifs du devenir fonctionnel et du retour à domicile après un premier accident vasculaire cérébral hémisphérique.

BACKGROUND AND PURPOSE: Several prognostic factors have been identified for outcome after stroke. We conducted a study to determine early predictive factors of functional outcome one year after stroke and to evaluate which factors are independent predictors, with an aim of specifying the role of age, aphasia, unilateral neglect, cognitive impairment and family social support. METHODS: Observational cohort study of 156 patients. All patients admitted to the university hospital for initial unilateral hemispheric stroke were included. The study duration was two years (inclusion, one year, and follow-up, one year) . The initial evaluation of stroke was conducted at day 2 and day 15 and included the Motricity Index and Trunk Control Test, New Functional Ambulation Classification, Frenchay arm test, Mini-Mental State Examination, Boston Diagnostic Aphasia Examination, unilateral neglect evaluation, and depression. Data on functional recovery (Barthel Index) were collected at day 360. RESULTS: The average age of patients was 72 years. Age was correlated to social situation (P<0.01) and previous neurological impairment (P<0.01). A multiple regression analysis, including 14 initial clinical factors correlated with the Barthel Index score at day 360, revealed 4 independent early predictive factors of outcome: initial score of Barthel Index at day 2 and its progression from day 2 to day 15, disorders of the executive functions and previous neurological impairment. CONCLUSION: In our cohort, in accordance with previous studies, age, cognitive impairment, unilateral neglect, aphasia, depression and social situation are not independent factors of poor outcome after stroke as evaluated by the Barthel Index.

[Epidemiology and prognostic significance of bladder sphincter disorders after an initial cerebral hemisphere vascular accident]. / Epidémiologie et signification pronostique des troubles vésicosphinctériens après un premier accident vasculaire cérébral hémisphérique.

OBJECTIVE: To document incidence of poststroke urinary incontinence and retention and to determine its effect on 3 months outcome. METHODS: Prospective cohort study. One hundred fifty-five cases of first hemispherical stroke were classified by continence status, retention or incontinence, at D2 after stroke. Age, sex, stroke location and aetiology, hypertension, diabetes were noted. Outcome data collected at D15 and D90 included impairments, disabilities, quality of life and case fatality rates. Disabilities were measured with Barthel Index (BI), Franchay Arm Test (FAT), New Functional Ambulation Classification (NFAC) and quality of life with EuroQol. RESULTS: Of the 155 patients, 62 had initial urinary disorders. The incidence was 40% at D2, 32% at D15 and 19% at D90. Retention represented 36% of urinary disorders at D2 and D15 and only 19% at D90. Urinary disorders were associated with motor weakness, lower Barthel Index, dysphasia, aphasia, apraxia and unilateral neglect. There was no relation with sex, age, stroke aetiology and diabetes. At D90, patients with initial urinary disorders had higher case fatality rates 22% versus 16% (P < 0.0001) and greater disabilities: BI of 60 versus 90 (P < 0.0001), NFAC of five versus seven (P < 0.0001), FAT of four versus six (P = 0.0019). CONCLUSION: Poststroke urinary disorders were associated with stroke gravity and adversely affected D90 stroke survival rates and functional outcome. Retention was strongly associated with D90 survival rates.

[Epidemiology of pes varus and/or equinus one year after a first cerebral hemisphere stroke: apropos of a cohort of 86 patients]. / Epidémiologie des pieds varus et/ou équin un an après un premier accident vasculaire cérébral hémisphérique: à propos d'une cohorte de 86 patients.

OBJECTIVE: To determine the frequency and the functional consequences of varus equinus in stabilized vascular hemiplegia. METHODS: Prospective cohort study of 86 hemiplegic patients. All patients consecutively admitted for a first hemispheral stroke between July 2001 and January 2002 were included. The evaluation consisted in a clinical examination and a descriptive study of gait. The functional capacity of patients with and without varus equinus were compared using the Barthel index, the New Functional Ambulation Classification (NFAC), the confortable ten meters gait speed and gait perimeter. RESULTS: The incidence of varus equinus was 18%. There was no difference in gait speed (0.8 m/s), NFAC or Barthel index between patients with or without varus equinus. Patients with varus equinus had had more specialized, intensive and prolonged rehabilitation. The only prognostic factor that could be identified was the motor impairment and the existence of spasticity. DISCUSSION: The mechanism of varus equinus is thought to be mainly the over-activity of gastrocnemius and solaris compared to that of the tibialis anterior, associated to the weakness of fibular muscles. The role of tibialis posterior is thought to be less important. The frequency of varus equinus after a first hemispheral stroke was low and the consequences were limited. This could be in part explained by the access of these patients to early, specialized and prolonged rehabilitation care.

[Clinical factors associate with shoulder subluxation in stroke patients]. / Facteurs cliniques associés à la subluxation de l'épaule chez l'hémiplégique vasculaire.

OBJECTIVE: This study explores whether shoulder subluxation after stroke is related to age, hemiplegic side motor impairment, spasticity, sensory deficit, depression, unilateral neglect and length of stay in acute ward. METHOD: This prospective study included 57 patients with hemiplegia. The shoulder subluxation was systematically detected by radiography and quantified according to de Bats score. The complete clinical assessment of the upper limb on day 15 analyzed motricity (motricity index), spasticity of shoulder adductors and biceps (Ashworth), sensory deficit, unilateral neglect and depression (MADRS). Age, side of hemiplegia and the aetiology were also noted. We researched relations between shoulder subluxation and these clinical factors. Means were compared using Mann Whitney and chi(2) tests. Coefficients of correlation were estimated between two quantitative variables. A multiple regression analysis was also conducted including all significant parameters, the dependent variable being the shoulder subluxation. RESULTS: Shoulder subluxation was observed in 32% of hemiplegic patients. After multiple regression analysis, the main clinical factors related to subluxation were motor (p < 0.0001), spasticity of shoulder adductors (p = 0.028) and age (p = 0.036). Statistically, the risk of subluxation was divided by 1.62 (1.07, 2.43) for every five years age growth and by two (1.33, 2.94) when the motricity index went up by ten points. CONCLUSION: This study shows that the age could play an independent part. The loss of elasticity of the periarticular tissues when ageing could have a protective role.

[Reliability of TcPO(2) measurement in the upper limb]. / Evaluation de la reproductibilité de la mesure transcutanée de la pression partielle d'oxygène (TcPO(2)) au niveau de la main.

INTRODUCTION: Several reports suggest the usefulness of transcutaneous oxygen tension (TcPO(2)) in assessing the shoulder hand syndrome in stroke patients. But the literature presents a number of conflicting views on the variation of TcPO(2) values in this case. We found no report demonstrating the reliability of TcPO(2) measurements in the upper limb. The aim of this study was to evaluate the reliability of TcPO(2) measurements and investigate whether TcPO(2) can be used to evaluate the shoulder hand syndrome after stroke. MATERIAL AND METHODS: The TcPO(2) values were obtained on two separate occasions at one-day interval on 18 normal volunteers. Basal TcPO(2), local vasomotor reflex and reaction to ischemia were assessed. RESULTS: Thirty-six upper limbs were tested. The reliability was bad. We found that measurements of TcPO(2) varied by an average of 7.89 +/- 7.6 mmHg for a coefficient of variation of 96%. CONCLUSION: The reliability of TcPO(2) measurement was not sufficient to recommend this method in this indication.

[The shoulder-hand syndrome after stroke: clinical factors of severity and value of prognostic score of Perrigot]. / Algoneurodystrophie du membre supérieur de l'hémiplégique : facteurs cliniques de gravité et intérêt du score pronostique de Perrigot.

PURPOSE: The purposes of this study were to evaluate the prognostical factors of reflex sympathetic dystrophy in stroke patients in attempt to improve the Perrigot prognostical score. MATERIAL AND METHOD: This prospective study included 28 stroke patients with reflex sympathetic dystrophy. An initial clinical assessment including Perrigot score was made at the time of admission (before the end of the first month) and a second evaluation of reflex sympathetic dystrophy at the end of the third month. Patients were assessed using Motricity Index, Ashworth scale, de Bats grading (for glenohumeral alignment), Labrousse criteria (for reflex sympathetic dystrophy severity), and MADRS depression scale. Sensory deficit and unilateral neglect were noted. RESULTS: The length of stay in acute ward was 16 days. The Perrigot score was correlated with the reflex sympathetic dystrophy severity (r = 0.7, p < 0.0001). It predicted the result of therapy. A significant correlation was found between reflex sympathetic dystrophy severity and motor deficit (r = -0.591, p = 0.0007) and spasticity (p < 0.05). No relation was found with stroke side, unilateral neglect, depression or shoulder subluxation. It wasn't possible to improve the Perrigot prognostical score. CONCLUSION: Perrigot score predict reflex sympathetic dystrophy severity and the result of therapy. The shoulder subluxation which is not included in this score appears to be not predictive. Shoulder subluxation is simply a marker of a severe paresis.

Radioisotopic control for baclofen pump catheter failure.

STUDY DESIGN: Case report of Baclofen pump catheter failure investigated by radioisotope injection. OBJECTIVES: To report a safe and reliable method for evaluating catheter dysfunction. SETTING: France. METHODS: Single case report of failure of Baclofen pump investigated by radioisotope injection. RESULTS: The injection demonstrated the block in the catheter. The catheter failure was not visualised by plain X-ray nor by filling the pump with radio-opaque solution. CONCLUSION: Catheter failure is a common cause of intrathecal drug delivery problems and may be difficult to diagnose. When catheter disconnection, kink, or dislodgement is not visible on X-ray, radioisotopic control is a safe and reliable method for assessment.