RESUMO
Current microbiome investigations of patients with pressure ulcers (PU) are mainly based on wound swabs and/or biopsy sequencing, leaving the colonization scenario unclear. Urinary microbiota has been never studied. As a part of the prospective ESCAFLOR study, we studied urinary microbiota of spinal cord injury (SCI) patients with PU without any urinary tract infection at the inclusion, collected at two times (at admission [D0] and after 28 days [D28]) during the patient's care, investigated by 16S rDNA metagenomics next generation sequencing. Subgroup analyses were carried out between patients with wounds showing improved evolution versus stagnated/worsened wounds at D28. Analysis was done using EPISEQ® 16S and R software. Among the 12 studied patients, the urinary microbiota of patients with improved wound evolution at D28 (n = 6) presented a significant decrease of microbial diversity. This modification was associated with the presence of Proteobacteria phylum and an increase of Escherichia-Shigella (p = 0.005), as well as the presence of probiotic anaerobic bacteria Lactobacillus and Bifidobacterium. In contrast, Proteus abundance was significantly increased in urine of patients with stagnated/worsened wound evolution (n = 6) (p = 0.003). This study proposes urinary microbiota as a complementary factor indirectly associated with the wound evolution and patient cure. It opens new perspectives for further investigations based on multiple body microbiome comparison to describe the complete scenario of the transmission dynamics of wound-colonizing microorganisms.
Assuntos
Microbiota , Úlcera por Pressão , Traumatismos da Medula Espinal , Humanos , Úlcera por Pressão/complicações , Estudos Prospectivos , Traumatismos da Medula Espinal/complicaçõesRESUMO
Spinal cord injury (SCI) induces severe losses of trabecular and cortical volumetric bone mineral density (vBMD), which cannot be discriminated with conventional dual-energy X-ray absorptiometry (DXA) analysis. The objectives were to: (i) determine the effects of SCI on areal BMD (aBMD) and vBMD determined by advanced 3D-DXA-based methods at various femoral regions and (ii) model the profiles of 3D-DXA-derived parameters with the time since injury. Eighty adult males with SCI and 25 age-matched able-bodied (AB) controls were enrolled in this study. Trabecular and cortical vBMD, cortical thickness and derived strength parameters were assessed by 3D-SHAPER® software at various femoral subregions. Individuals with SCI had significantly lower integral vBMD, trabecular vBMD, cortical vBMD, cortical thickness and derived bone strength parameters (p < 0.001 for all) in total proximal femur compared with AB controls. These alterations were approximately to the same degree for all three femoral subregions, and the difference between the two groups tended to be greater for cortical vBMD than trabecular vBMD. There were minor differences according to the lesion level (paraplegics vs tetraplegics) for all 3D-DXA-derived parameters. For total proximal femur, the decreasing bone parameters tended to reach a new steady state after 5.1 years for integral vBMD, 7.4 years for trabecular vBMD and 9.2 years for cortical vBMD following SCI. At proximal femur, lower vBMD (integral, cortical and trabecular) and cortical thickness resulted in low estimated bone strength in individuals with SCI. It remains to be demonstrated whether these new parameters are more closely associated with fragility fracture than aBMD.
Assuntos
Densidade Óssea , Traumatismos da Medula Espinal , Adulto , Masculino , Humanos , Absorciometria de Fóton/métodos , Fêmur/patologia , Osso e Ossos , Traumatismos da Medula Espinal/complicaçõesRESUMO
BACKGROUND: Early Mobilization in Intensive Care Units (ICUs) enhances patients' evolution, but has been rarely studied in neurological ICUs. The aim of this study was to assess gait training with body-weight support (BWS) in neuroICU, and to report on its safety, feasibility and on delays before walking with and without BWS. METHODS: This study was an observational one-year single-center study. Inclusion criteria were adults with a neurological injury requiring mechanical ventilation. Exclusion criteria were early death or ICU transfer. After weaning from ventilation, patients were screened for indications of BWS walking using predefined criteria. RESULTS: Patients' conditions were mostly brain injuries: 32% subarachnoid hemorrhages, 42% focal strokes, and 12% traumatic brain injuries. Out of 272 admissions, 136 patients were excluded, 78 were eligible, and 33 performed BWS walking. Among non-eligible patients, 36 walked unsuspended upon ventilation weaning, 17 presented too severe impairments. Among the 45 eligible patients who did not receive BWS training, main reasons were workload and weekends (31%), medical barriers (29%), and early ICU discharge (22%). 78 BWS sessions were performed on the 33 beneficiaries (median sessions per patient 2, max 10). Pre-session, most patients had inadequate response to pain, orders, or simple orientation questions. Sitting without support was impossible for 74%. Most pre-post changes in hemodynamic, respiratory, and pain parameters were small, and recovered spontaneously after the session. Eight sessions were interrupted; reasons were pain, fatigue or major imbalance (4), syncope (1), occurrence of stool (2), and battery failure (1). None of these adverse events required medical intervention, patients recovered upon session interruption. Median session duration was 31 min, patients walked on median 17 m. First BWS session occurred on median 3 days after ventilation weaning, and 11 days before patients were able to walk unsuspended. CONCLUSIONS: Verticalization and walking using a suspension device in patients in neuroICU allows early gait training, despite challenging neurological impairments. It is safe and generally well tolerated. TRIAL REGISTRATION: ClinicalTrials database (ID: NCT04300491).
Assuntos
Marcha , Caminhada , Adulto , Humanos , Estudos de Viabilidade , Caminhada/fisiologia , Marcha/fisiologia , Cuidados Críticos , DorRESUMO
BACKGROUND: Pressure ulcers are a risk for bedridden patients and various supports exist to prevent them. The Pressure Relief Index (PRI) evaluates pressure relief of dynamic mattresses over time. This study compared the PRI of the SUMMIT mattress (AKS-France) and the NIMBUS 3 (HNE Medical). METHODS: In this non-blinded, randomized, crossover, non-inferiority study, patients aged ≥60 with a BMI of 16-35 kg/m2, predominantly confined to bed, able to walk with aid and with pelvic symmetry were recruited from a hospital rehabilitation department from March-April 2012. Exclusion criteria included past or present pressure ulcers, inability to remain supine and deep vein thrombosis. Peak pressures of the sacrum were recorded at 0.1 Hz during a single complete 10-min inflating cycle on both mattresses, with the order determined via electronic randomization allocation. RESULTS: Thirty-one subjects were included and randomized; with 14 finally analyzed in the SUMMIT-NIBMUS 3 order group and 16 in the NIMBUS 3-SUMMIT group. The difference in PRI <30 mmHg between the two mattresses was 13.2% [0.3-26.1] (p < 0.05), allowing a non-inferiority - superiority switch. The SUMMIT mattress demonstrated a significantly higher percentage of time <30 mmHg (p = 0.0454). No significant difference in mean minimal pressure was seen (p = 0.3231) and mean maximal pressure was in favor of SUMMIT mattress (p = 0.0096). BMI did not affect pressure profile. There were no adverse events. CONCLUSIONS: Evaluated by the PRI, the SUMMIT mattress had a better interface pressure profile than the NIMBUS 3 in older patients. The PRI is a promising tool for clinical decision-making and research, warranting validation.
Assuntos
Úlcera por Pressão , Idoso , Leitos , França , Humanos , Úlcera por Pressão/prevenção & controle , Sacro , Higiene da PeleRESUMO
BACKGROUND: Visual and molecular changes occurring upon aging are rather well characterized. Still, aging signs show great significant inter-individual variations, and little is known concerning the link between perceived age and cutaneous microcirculation. MATERIALS AND METHODS: To investigate this point, we recruited Caucasian women in their mid-50's to mid-70's and subsampled women looking older or younger than their age. We studied their facial skin color, as well as their microvascular reactivity to local heating assessed in the forearm skin. We also used skin biopsies from some of these women for gene expression or immunohistochemical analysis. RESULTS: Clinical and instrumental analysis of skin color revealed that subjects who look 5 years younger differ only by a higher glowing complexion. Our most striking result is that subjects looking 5 years younger than their age present a higher microcirculation reactivity in forearm skin. Transcriptome comparison of skin samples from women looking older or younger than their age revealed 123 annotated transcripts differentially expressed, among which MYL9 relates to microcirculation. MYL9 is downregulated in the group of women looking younger than their real age. Microscopy shows that the labeling of MYL9 and CD31 are altered and heterogeneous with age, as is the morphology of microvessels. CONCLUSION: Therefore, assessing generalized vascular reactivity in non-photo-exposed skin to focus on the intrinsic aging allows subtle discrimination of perceived age within elderly healthy subjects.
Assuntos
Antebraço , Microcirculação , Envelhecimento da Pele , Pele/irrigação sanguínea , Idoso , Face , Feminino , Antebraço/irrigação sanguínea , HumanosRESUMO
BACKGROUND: Flap surgery for deep pelvic pressure ulcers has already shown its effectiveness. Most studies relating to the postoperative period assessed complications rates and associated risk factors, but none focused on delayed wound healing. The objective of this study was to describe wound healing delay after primary flap surgery in patients with spinal cord injury (SCI) and to assess associated risk factors. METHODS: This observational retrospective study based on medical charts included all persons with SCI operated for primary flap surgery for pelvic PU in the Hérault department of France between 2006 and 2014. Overall, 100 biomedical, psychological, socioeconomics and care management factors were studied. The primary outcome was wound healing delay, defined as time from surgery to complete cutaneous closure. RESULTS: 85 patients were included. Median healing time was 48 days (R: 20-406). Healing rate was 70% at 3 months and 90% at 4 months. After a multivariate analysis three factors were significantly associated with delayed wound healing: duration of hospitalization in the acute care unit (HR = 2.68; p = 0.004), local post-operative complication (HR = 10.75; p = 0.02), and post-operative sepsis (HR = 2.18; p = 0.02). CONCLUSION: After primary skin flap surgery for PU in persons with SCI, delayed wound healing is related to local or general complications as well as care management organization. The risk of delayed wound healing justifies the implementation of a coordinated pre-operative management to prevent complications and a structured care network for an earlier transfer to a SCI rehabilitation center.
Assuntos
Úlcera por Pressão/fisiopatologia , Traumatismos da Medula Espinal/complicações , Fatores de Tempo , Cicatrização/fisiologia , Adulto , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia. METHODS: We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects. We scanned a set of multicontact neural stimulation cuff electrode configurations, pre-computed through modeling simulations. We reported the obtained isolated and functional movements that were considered useful for the subject (different grasping movements). RESULTS: In eight subjects, we demonstrated that selective stimulation based on multicontact cuff electrodes and optimized current spreading over the active contacts provided isolated, compound, functional and strong movements; most importantly 3 out of 4 had isolated fingers or thumb flexion, one patient performed a Key Grip, another one the Power and Hook Grips, and the 2 last all the 3 Grips. Several configurations were needed to target different areas within the nerve to obtain all the envisioned movements. We further confirmed that the upper limb nerves have muscle specific fascicles, which makes it possible to activate isolated movements. CONCLUSIONS: The future goal is to provide patients with functional restoration of object grasping and releasing with a minimally invasive solution: only two cuff electrodes above the elbow. Ethics Committee / ANSM clearance prior to the beginning of the study (inclusion period 2016-2018): CPP Sud Méditerranée, #ID-RCB:2014-A01752-45, first acceptance 10th of February 2015, amended 12th of January 2016. TRIAL REGISTRATION: (www.clinicaltrials.gov): #NCT03721861, Retrospectively registered on 26th of October 2018.
Assuntos
Terapia por Estimulação Elétrica/métodos , Nervo Mediano/cirurgia , Quadriplegia/terapia , Nervo Radial/cirurgia , Traumatismos da Medula Espinal/terapia , Adulto , Eletrodos Implantados , Antebraço/fisiopatologia , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicações , Adulto JovemRESUMO
OBJECTIVES: Explore the perceptions and beliefs related to pressure ulcers (PU), their prevention and treatment strategies, in order to discuss potential learning objectives for PU-related therapeutic education in persons with spinal cord injury (SCI). DESIGN: Qualitative study, using grounded theory for the analysis of data collected via a questionnaire. SETTING: Nine SCI referral centers, inpatient care. PARTICIPANTS: 131 persons with SCI were included. 76% were male, and 65% presented with paraplegia. The median age was 48 years (33.5; 58) and median time since injury was 11 years (3; 24.5). 70% had experience with PU. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Data collection via an open-ended questionnaire on the representation of PU, its prevention and life experience of having a PU. RESULTS: Six categories were identified: (1) identifying what might become problematic, (2) daily preventive actions, (3) detecting the early signs, (4) managing the early signs, (5) need for care, (6) experience with PU and being bedridden. Pressure ulcers have dramatic consequences on psychosocial health. Prevention and treatment require self-management skills, such as self-risk assessment abilities, self-detection skills and problem-solving strategies, to optimise daily PU prevention in persons with SCI. CONCLUSION: PU prevention tackled by persons with SCI bears some specificities that the physician must take into account in the construction of a self-management program in this high-risk population.
Assuntos
Úlcera por Pressão/etiologia , Traumatismos da Medula Espinal/complicações , Adulto , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores de Risco , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia , Inquéritos e QuestionáriosRESUMO
Individuals who sustained a spinal cord injury often lose important motor skills, and cannot perform basic daily living activities. Several assistive technologies, including robotic assistance and functional electrical stimulation, have been developed to restore lost functions. However, designing reliable interfaces to control assistive devices for individuals with C4-C8 complete tetraplegia remains challenging. Although with limited grasping ability, they can often control upper arm movements via residual muscle contraction. In this article, we explore the feasibility of drawing upon these residual functions to pilot two devices, a robotic hand and an electrical stimulator. We studied two modalities, supra-lesional electromyography (EMG), and upper arm inertial sensors (IMU). We interpreted the muscle activity or arm movements of subjects with tetraplegia attempting to control the opening/closing of a robotic hand, and the extension/flexion of their own contralateral hand muscles activated by electrical stimulation. Two groups were recruited: eight subjects issued EMG-based commands; nine other subjects issued IMU-based commands. For each participant, we selected at least two muscles or gestures detectable by our algorithms. Despite little training, all participants could control the robot's gestures or electrical stimulation of their own arm via muscle contraction or limb motion.
Assuntos
Força da Mão/fisiologia , Contração Muscular/fisiologia , Quadriplegia/fisiopatologia , Adulto , Algoritmos , Braço/fisiologia , Estimulação Elétrica , Eletromiografia , Humanos , Masculino , Pessoa de Meia-Idade , Robótica , Ombro/fisiologia , Adulto JovemRESUMO
STUDY DESIGN: Cross-sectional psychometrics study. OBJECTIVES: To determine the construct validity and internal consistency of the revised Skin Management Needs Assessment Checklist (revised SMnac). SETTING: Six spinal cord rehabilitation centers. METHODS: One-hundred and thirty-two community-dwelling individuals with spinal cord injury (SCI) were included. Construct validity was assessed by a Spearman's rank correlation coefficient between the revised SMnac and several questionnaires: Rosenberg Self-Esteem Scale, Ways of Coping Questionnaire, Hospital Anxiety and Depression Scale (HADS), Braden scale; or clinical variables: educational level, presence of a pressure ulcer (PU), history of multiple PUs, time since injury, and pain. RESULTS: The study evidenced construct validity with a fair to moderate correlation coefficient between the revised SMnac and Rosenberg scale (rs = 0.25; p = 0.03), active coping (rs = 0.29; p = 0.001), HADS (rs = -0.43; p < 0.0001), and time since injury (rs = 0.49; p < 0.0001). The presence of PU and history of multiple PUs were strongly correlated with the revised SMnac score (respectively, p = 0.01 and 0.001). Internal consistency was excellent (α = 0.907). CONCLUSION: These results show that the revised SMnac is a valid tool to assess PU self-management in individuals with SCI. Further studies are needed to assess the revised SMnac's responsiveness to change.
Assuntos
Lista de Checagem , Avaliação das Necessidades , Dermatopatias/diagnóstico , Dermatopatias/prevenção & controle , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Autogestão , Dermatopatias/psicologia , Dermatopatias/reabilitação , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Adulto JovemRESUMO
BACKGROUND: This article is a prospective review of patients with spinal cord injury who underwent multidisciplinary consultation from January 2005 to September 2013 for pain in one or both shoulders. METHODS: We performed clinical, functional, and lesion evaluations of 38 patients with paraplegia and quadriplegia presenting with rotator cuff pathologies. RESULTS: Surgery was indicated and performed on 38 shoulders in 28 patients. The lesion assessment during surgery showed injuries that were more severe than one would have thought based on imaging data. The mean pain intensity rating in the operative and nonoperative groups was 0 and 1.6, respectively, at rest and 2 and 4.9, respectively, during paroxysmal peaks. On average, for patients who had surgery, the Functional Independence Measure score decreased by 2.3. The mean satisfaction index in operated patients was 8.5 of 10. CONCLUSIONS: When the surgical indication was based on a multidisciplinary decision, no negative results were reported that could have challenged the validity of this decision. Pain relief was the primary benefit reported after surgery. The functional status was modified because of the technical aids needed to prevent shoulder overuse. There are several arguments in favor of rotator cuff surgery for wheelchair-bound patients with spinal cord injury. Because of their functional impairments, wheelchair-bound patients will continue to overburden their shoulders after rotator cuff surgery. A multidisciplinary approach emerges as the solution to inform and educate patients to limit the risk of recurrence.
Assuntos
Manguito Rotador/cirurgia , Traumatismos da Medula Espinal/complicações , Traumatismos dos Tendões/cirurgia , Adulto , Idoso , Artralgia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Equipe de Assistência ao Paciente , Estudos Prospectivos , Quadriplegia/complicações , Lesões do Manguito Rotador , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Traumatismos dos Tendões/complicaçõesRESUMO
Cervical spinal cord injury (SCI) causes dramatic sensorimotor deficits that restrict both activity and participation. Restoring activity and participation requires extensive upper limb rehabilitation focusing elbow and wrist movements, which can include motor imagery. Yet, it remains unclear whether MI ability is impaired or spared after SCI. We investigated implicit and explicit MI ability in individuals with C6 or C7 SCI (SCIC6 and SCIC7 groups), as well as in age- and gender-matched controls without SCI. Inspired by previous studies, implicit MI evaluations involved hand laterality judgments, hand orientation judgments (HOJT) and hand-object interaction judgments. Explicit MI evaluations involved mental chronometry assessments of physically possible or impossible movements due to the paralysis of upper limb muscles in both groups of participants with SCI. HOJT was the paradigm in which implicit MI ability profiles differed the most between groups, particularly in the SCIC6 group who had impaired elbow movements in the horizontal plane. MI ability profiles were similar between groups for explicit MI evaluations, but reflected task familiarity with higher durations in the case of unfamiliar movements in controls or attempt to perform movements which were no longer possible in persons with SCI. Present results, obtained from a homogeneous population of individuals with SCI, suggest that people with long-term SCI rely on embodied cognitive motor strategies, similar to controls. Differences found in behavioral response pattern during implicit MI mirrored the actual motor deficit, particularly during tasks that involved internal representations of affected body parts.
Assuntos
Cotovelo , Imaginação , Movimento , Traumatismos da Medula Espinal , Humanos , Masculino , Feminino , Adulto , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Pessoa de Meia-Idade , Imaginação/fisiologia , Cotovelo/fisiopatologia , Movimento/fisiologia , Desempenho Psicomotor/fisiologia , Lateralidade Funcional/fisiologia , Julgamento/fisiologia , Mãos/fisiopatologia , Mãos/fisiologiaRESUMO
BACKGROUND: There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. OBJECTIVES: The objective of this study was to determine whether rehabilitation under N2O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). METHOD: A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). PRIMARY OUTCOME: improvement in shoulder function at day 14 (D14) (Constant-Murley score). RESULTS: Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (-11.6, p = 0.053) but not for the placebo group (-4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). CONCLUSION: Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. TRIAL REGISTRATION: Clinical Trial registration number NCT01087229.
Assuntos
Bursite , Articulação do Ombro , Adulto , Humanos , Óxido Nitroso/uso terapêutico , Dor , Modalidades de Fisioterapia , Qualidade de Vida , Amplitude de Movimento Articular , Dor de Ombro/etiologia , Dor de Ombro/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Balance disorders in older people cause falls, which can have serious functional and economic consequences. No existing scale relates fall risk to daily life situations. This study describes the development, psychometric properties and construct validity of the Balance in Daily Life (BDL) scale, comprising seven routine tasks including answering a phone, carrying a heavy bag, and sitting down and getting up from a chair. METHODS: Frail patients aged 65 years or more were prospectively recruited from the geriatric rehabilitation department of a French university hospital. Inclusion criteria included autonomous walking over 20 m and modified Short Emergency Geriatric Assessment score 8-11. Patients with motor skills disorders and comprehension or major memory difficulties were excluded. Patients were assessed on Day 3 and Day 30 with the Balance in Daily Life scale, Timed Up and Go, one-leg stance time, sternal nudge and walking-while-talking tests. The scale was assessed for acceptability, quality, unidimensionality, internal consistency, reliability, temporal stability, responsiveness and construct validity. RESULTS: 140 patients (83 ± 6 years) were recruited, of whom 139 were assessed at Day 0 and 133 at Day 30. Acceptability was satisfactory (134/139 patients completed the test), quality assessment showed a slight floor effect (6 % of patients with minimal score) and evaluation of item redundancy found no strong correlation (Spearman <0.7). Unidimensionality was verified (Loevinger H coefficient > 0.5 for all items except item 6 = 0.4728). Internal consistency was good (Cronbach alpha = 0.86). Reliability and temporal stability were excellent (ICC = 0.97 and ICC = 0.92). Responsiveness was verified by significant score change p < 0.0001 between Day 0 and Day 30 (decreased by 1 [0; 2] point), in line with other score changes. Construct validity revealed that the Balance in Daily Life scale was convergent with results of the timed up-and-go and one-leg stance time (p < 0.0001 for both) and tended to be higher for participants who had not fallen in the previous 6 months (p = 0.0528). The new questionnaire was divergent to sternal nudge tests (p = 0.0002) and not related to the walking-while-talking test (p = 0.5969). CONCLUSION: The Balance in Daily Life scale has good psychometric properties for this population. Its simplicity and innovative nature mean that it can be applied in institutions while being easily modifiable to domestic settings. Study registration on clinicaltrials.gov: NCT0334382.
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Atividades Cotidianas , Idoso Fragilizado , Avaliação Geriátrica , Equilíbrio Postural , Psicometria , Humanos , Feminino , Masculino , Idoso , Idoso de 80 Anos ou mais , Avaliação Geriátrica/métodos , Reprodutibilidade dos Testes , Acidentes por Quedas/prevenção & controle , Estudos Prospectivos , Caminhada , Inquéritos e Questionários/normasRESUMO
BACKGROUND: Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. AIM: To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. DESIGN: Cross-sectional study. SETTING: Montpellier University Hospital. POPULATION: Forty-seven PPS and 27 healthy controls. METHODS: PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1ß, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-ß, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. RESULTS: PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. CONCLUSIONS: Our results suggest that PPS is not a dysimmune disease. CLINICAL REHABILITATION IMPACT: Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.
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Poliomielite , Síndrome Pós-Poliomielite , Humanos , Estudos Transversais , Qualidade de Vida , Poliomielite/complicações , Dor , Fadiga/complicações , Debilidade Muscular/reabilitação , Fatores ImunológicosRESUMO
AIM: We report the comparative results of functional upper extremity surgery plans in patients with tetraplegia, including restoration of elbow extension and construction of a key grip in a "one-stage" or "two-stage" operation. MATERIALS AND METHODS: A series of 36 patients with tetraplegia, with a total of 45 operated upper limbs, was analyzed retrospectively with a mean follow-up of 23 months (13-39 months). We evaluated the analytical strength of elbow extension using the MRC (Medical Research Council) score, the strength of the key grip (kg/F) as well as the autonomy of the patients using functional scores; Lamb (/100) and QIF (Quadriplegia Index of Function) (/100). RESULTS: Sixteen upper limbs were included in the "one-stage" group and 29 in the "two-stage" group. The groups were comparable preoperatively. Elbow extension strength was 3.6/5 in the one-stage group versus 3.7/5, p=0.74. Grip strength was 1.8kg/F in the one-stage group versus 1.3kg/F, p=0.22. Regarding the functional scores, there was no statistically significant difference between the two groups for the Lamb score (p=0.46) and the QIF (p=0.42). There was no statistically significant difference in terms of the frequency of complications for the elbow (p=0.49) and for the hand (p=0.17). The total duration of the one-stage surgery plan averaged 7.5 months compared to 24.7 months for the two-stage plan, p<0.01. The mean follow-up for the one-stage group was 21 months versus 24 months for the two-stage group. CONCLUSION: The results of both plans are similar and indicate that the "one-stage" plan is a reliable option. This all-in-one surgical option reduces postoperative follow-up and dropout rates for patients during the plan timeframe. LEVEL OF EVIDENCE: IV; retrospective clinical series.
Assuntos
Cotovelo , Traumatismos da Medula Espinal , Força da Mão , Quadriplegia/cirurgia , Quadriplegia/etiologia , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Transferência Tendinosa/métodos , HumanosRESUMO
BACKGROUND: The increasing number of wheelchair users and their risk of medical complications such as pressure ulcers (PU) make it important to have a better understanding of their seating characteristics. However, while most studies tackling this issue are based on static measurements, wheelchair users are active in their wheelchairs when performing daily life activities. This suggests the need to assess the mechanical loads at the wheelchair user's body-seat interface during dynamic activities. OBJECTIVES: A scoping review was conducted to explore the existing data (shear load and pressure) and highlight significant parameters, relevant conditions and methodological strategies when studying wheelchair users performing a dynamic task. MATERIALS AND METHODS: The literature search was performed by applying the PRISMA methodology. RESULTS: A total of 11 articles met the inclusion criteria. Differences between static and dynamic data were found in the literature for peak pressure values, pressure distribution and the location of peak pressure. None measured tangential load at the seat/body interface, although two studies measured the shift of the ischial region. A significant impact of the type of pathology has been quantified, showing the need to perform experimental studies on diverse populations. The protocol and the pressure parameters studied were very diverse. CONCLUSION: Further studies carefully choosing interface pressure mapping parameters and investigating a broader range of pathologies are required. Additionally, researchers should focus on finding a way to measure seated tangential load.
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CONTEXT: Spinal-cord injury (SCI) induces bone loss and dramatically increases the risk of fracture. OBJECTIVES: Determine the effects of whole-body vibration (WBV) on areal bone mineral density (aBMD), whole body composition and bone biological parameters in individuals with chronic-state SCI. DESIGN: Randomized study. SETTING: Centre Neurologique PROPARA. PARTICIPANTS: Fourteen subjects were randomly assigned to a WBV or a control group. INTERVENTIONS: WBV (20-45â min, 30-45â Hz, 0.5â g) was performed in verticalized persons twice weekly for 6 months. OUTCOME MEASURES: aBMD was measured by DXA at baseline and 6 months and bone biological parameters at baseline, 1, 3 and 6 months. RESULTS: No significant aBMD change was found in either the WBV or control group after 6 months of follow-up. Similarly, periostin, sclerostin and bone turnover markers remained relatively stable throughout follow-up and no difference in variation was observed within-group and between groups. Except for whole-body fat mass, which showed a significant decrease in the WBV group compared to controls, no difference in changes was observed, whatever the localization for fat and lean body mass. CONCLUSIONS: During the chronic phase, aBMD and bone remodeling reach a new steady state. However, the DXA technique and the bone markers, including sclerostin and periostin, both of which reflect bone cell activity influenced by mechanical strain, showed that the bone tissue of individuals with SCI was insensitive to 6 months of WBV training at the study dose. Nevertheless, results of this preliminary study that was underpowered need to be confirmed and other modalities of WBV may be more effective in improving aBMD of this population. TRIALS REGISTRATION: N°IDRCB:2011-A00224-37.
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Two percent of the general population are wheelchair-dependent. The shoulder takes on the weight-bearing locomotor function, and tends with age to develop degenerative pathologies, notably in the rotator cuff. The association between weight-bearing shoulder and rotator cuff tear raises several questions: what are the mechanisms by which wheelchair propulsion and transfer overload the shoulder, and what specificities do the lesions display? They occur in younger patients than in the rest of the population, after about 15 years' fairly constant wheelchair use. As well as the classical supraspinatus damage, an anterior cuff extension is the most frequent case. Is there a particular clinical presentation of cuff tear in this population? As the shoulder cannot be functionally protected, pain is constant and asymptomatic cuff tear is rare. Any pain after 12 years' wheelchair use requires morphologic exploration. How does treatment strategy differ for the weight-bearing shoulder? More than the classic quest for compensation, in the weight-bearing shoulder, the rotator cuff should be protected against any local aggression by systematic surgical recalibration of the subacromial space, and all lesions should be repaired, to avoid extension. Are functional results to be expected to be poorer in this population? On condition that the suture is protected by postponing any transfer beyond 4 months and that the shoulder is protected on a daily basis, analytic results and healing rates are comparable to those in the general population. However, general complications and skin complications are more frequent and require postoperative care in a specialized center.
Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Dor , Manguito Rotador/patologia , Ruptura , Ombro , Suporte de CargaRESUMO
INTRODUCTION: Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population. MATERIALS AND METHODS: This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients' autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder. RESULTS: The 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change. DISCUSSION: Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion. LEVEL OF EVIDENCE: IV, retrospective study.