Efficacy of intensive, hospital-based rehabilitation in cases of thoracic outlet syndrome that failed to respond to private-practice physiotherapy.

BACKGROUND: Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery - a complex procedure with potential complications. OBJECTIVE: We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered. METHODS: We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or gathered in a phone interview. RESULTS: Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1-12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits. CONCLUSION: An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS - even after private-practice physiotherapy had failed.

Evaluation of muscle oxygenation by near infrared spectroscopy in patients with facioscapulohumeral muscular dystrophy.

UNLABELLED: The purpose of the study was to determine muscle metabolism adaptation to exercise in facioscapulohumeral muscular dystrophy patients (FSHD) and to study the correlation with clinical functional status (6-min walk test). 8 FSHD patients and 15 age-matched healthy controls (Controls) performed two isokinetic constant-load knee extension exercises: (1) at 20% of their maximal extensors' peak torque (i.e., the same relative workload) and (2) at (20N⋅m) (the same absolute workload) for up to 4 min. All exercises consisted of rhythmic, voluntary, isokinetic, concentric contractions of the quadriceps femoris at 90°/s, whereas the flexion was performed passively at the same speed. Muscle oxygenation in the vastus lateralis was evaluated using near-infrared spectroscopy (NIRS). The FSHD patients displayed a lower maximal peak torque than controls (-41%, p < 0.05). During the two-exercise modalities, deoxygenated haemoglobin (HHb) and total haemoglobin volume (tHb) were lower in the FSHD patients (p < 0.05). The initial muscle deoxygenation time delay was shorter in the control group (FSHD: 15.1 ± 4.1 s vs. CONTROLS: 10.4 ± 2.1 s, p < 0.05). Mean response time and maximal peak torque were both correlated with functional impairment (walking endurance). The results suggest that FSHD patients present an impairment in their capacity to deliver or to use oxygen.

Fate of abstracts presented at the 2008 European Congress of Physical and Rehabilitation Medicine.

The subsequent full-text publication of abstracts presented at a scientific congress reflects the latter's scientific quality. The aim of this paper was to evaluate the publication rate for abstracts presented at the 2008 European Congress of Physical and Rehabilitation Medicine (ECPRM), characterize the publications and identify factors that were predictive of publication. It is a bibliography search. We used the PubMed database to search for subsequent publication of abstracts. We screened the abstracts' characteristics for features that were predictive of publication among abstracts features, such the status of the authors, the topic and the type of work. We performed univariate analyses and a logistic regression analysis. Of 779 abstracts presented at ECPRM 2008, 169 (21.2%) were subsequently published. The mean time to publication was 12±15.7 months and the mean impact factor of the publishing journals was 2.05±2.1. In a univariate analysis, university status (P<10-6), geographic origin (P=10-3), oral presentation (P<10-6), and original research (P<10-6) (and particularly multicentre trials [P<0.01] and randomized controlled trials [P=10-3]) were predictive of publication. In a logistic regression analysis, oral presentation (odds ratio [OR]=0.37) and university status (OR=0.36) were significant, independent predictors of publication. ECPRM 2008 publication rate and impact factor were relatively low, when compared with most other national and international conferences in this field. University status, the type of abstract and oral presentation were predictive of subsequent publication.

Collection of normative data for spatial and temporal gait parameters in a sample of French children aged between 6 and 12.

OBJECTIVE: Normative data on gait is essential for clinical practice - especially in children whose gait pattern changes over time. Sets of normative gait data in healthy children vary significantly from one country to another. We decided to generate a specific reference database of gait parameters for French children. METHOD: Three hundred and eighty-two children (228 boys and 154 girls, aged between 6 and 12) were asked to walk as naturally as possible and at a self-selected speed on a GAITRite track. Velocity, step count, cadence, step time, step length, cycle time, stride length, base width, swing time, stance time, single support time and double support time were recorded. Parameters were analyzed by age group, height group and BMI. RESULTS: Velocity, step and stride length increased regularly with advancing age and height. Cadence decreased with height. All temporal parameters (except for double support) differed significantly (P<0.05) when comparing the 6-year-old group or the 7-year-old group with the 9-year-old group and older groups. A small number of temporal parameters (cadence, step time, cycle time and stance time) differed significantly when comparing 7-year-olds and 8-year-olds. Temporal parameters appeared rise in proportion height from 110 cm to 130 cm and then reached a plateau. Overweight was associated with a longer stance time and more double support. CONCLUSION: The gait pattern in French children aged between 6 and 12 differs from those recorded elsewhere in the world; although gait parameters appear to change in much the same way with age worldwide, our values (even when normalized) are different. Our local database should be of value in French studies of childhood gait disorders. Given that gait patterns do not appear to mature by the age of 12, it would be valuable to study gait patterns in a population of teenagers.

Treatment of dystonia in extensor hallucis longus and digitorum muscles with neurotomy of the branches of the deep fibular nerve: Preliminary results.

INTRODUCTION: Dystonia in extensor hallucis and/or digitorum muscles can be observed in pyramidal and extrapyramidal lesions and results in pain in these toes, spontaneous or when walking, problems and discomfort when putting on shoes and socks, and cutaneous lesions on the toes. The objective of this study was to assess the efficacy and safety of deep fibular nerve neurotomy for the extensor hallucis longus (EHL) and/or the extensor digitorum longus (EDL) branches in the treatment of extension dystonia of the hallux and/or other toes. PATIENTS AND METHODS: A deep fibular nerve neurotomy was performed in 20 patients (n=19 for the EHL, n=6 for the EDL). We retrospectively analyzed the treatment's efficacy and safety and assessed the patients' self-reported improvement and overall treatment satisfaction. RESULTS: Dystonia totally disappeared in 15 cases (75%); it persisted at a minimal level in the other patients. The patients reported a decrease in pain (P<0.01) and fewer difficulties putting on shoes and socks (P<0.001) and had a high median level of satisfaction (8.5/10). Adverse effects were rare and transient. The identification of the nerve branches was sometimes difficult. DISCUSSION: Deep fibular nerve neurotomy for the EHL and/or EDL branches seems to be an effective treatment for extension dystonia of the hallux and/or other toes and its consequences for the adult neurological patient. However, these encouraging preliminary results should be confirmed by prospective, longer-term studies.

Botulinum toxin treatment of pes cavovarus in a child suffering from autosomal recessive axonal Charcot-Marie-Tooth neuropathy (AR-CMT2).

In a 12-year old girl suffering from autosomal recessive axonal Charcot-Marie-Tooth (CMT) neuropathy, pes cavovarus was treated with botulinum toxin injection in the tibialis posterior. The patient underwent a clinical evaluation, video analysis of spatiotemporal gait parameters and dynamic foot plantar pressure assessment before treatment and then two weeks, three months and six months thereafter. The video gait analysis revealed a decrease in varus during the swing phase of gait. The dynamic foot plantar pressure decreased by 50% in the excessive pressure at the side of the foot six months after the injection (maximal pressure=42.6N/cm2 before treatment and 18.9 N/cm2 after 6 month). Botulinum toxin injection appears to be an efficacious means of correcting pes cavovarus in CMT disease. A larger-scale clinical trial is now required to evaluate the putative longer-term preventive effect of this treatment on the pes cavus deformity.

The Functional Reach Test: strategies, performance and the influence of age.

BACKGROUND: The Functional Reach Test (FRT) is a clinical assessment of the risk of falls in elderly or disabled subjects. However, the FRT is complex (involving the leg, hip and trunk joints) and previous studies have shown that several different strategies can be used to complete the test. OBJECTIVES: To describe the strategies used by healthy, adult subjects when performing the FRT and to assess the influence of age on choice of the strategy. METHOD: This was a pilot study in which 29 non-fallers (18 under-50s and 11 over-75s) were asked to perform the FRT on a force platform in a motion analysis laboratory. A total of 18 reflective markers were placed on the body. The main outcome measures were the FRT score, the centre of pressure (CoP) excursion, and kinetic and kinematic test data. The two age groups were compared using a non-parametric, two-sample Mann-Whitney U test. A cluster analysis of the entire population grouped subjects together according to their functional similarities. RESULTS: The older subjects displayed a smaller CoP anteroposterior displacement (P<0.01), greater backwards displacement of the pelvis (P<0.05) and less trunk rotation during the FRT (P=0.024) than the younger subjects. The cluster analysis split the population into two groups, which differed in terms of age, FRT score, pelvis translation, and CoP displacement. CONCLUSION: Our results suggest that at the moment of trunk flexion, elderly subjects use pelvic translation in order to limit forward displacement of the CoP and prevent forward imbalance.

[Muscle biopsy in children: Usefulness in 2012]. / Intérêt de la biopsie musculaire chez l'enfant en 2012.

Muscle biopsy is a mainstay diagnostic tool for investigating neuromuscular disorders in children. We report the yield of pediatric muscle biopsy in a population of 415 children by a retrospective study of 419 biopsies performed between 1/01/2000 and 31/12/2009 in a neuropediatric department, including mitochondrial respiratory chain analysis for 87 children. Two hundred and fifty-five biopsies were from boys (61%) 164 from girls (39%). Their mean age at biopsy was 6.5years; 155 (37%) biopsies were obtained before the child was 5years old. Final histopathological diagnoses were: congenital myopathy (n=193, including 15 structural congenital myopathies); progressive muscular dystrophy (n=75 [18%] including 57 dystrophinopathies); congenital muscular dystrophy (n=17, including six primary merosinopathies); dermatomyositis (n=11); spinal muscular atrophy (n=9, including six atypical spinal muscular atrophies); metabolic myopathy (n=32, including 19 mitochondrial myopathies); encephalomyopathy (n=53 [13%], including 27 with a mitochondrial respiratory chain defect). Pathological diagnosis remained undetermined in 16 cases. In 184 patients (44%), the muscle biopsy revealed specific histopathological anomalies (dystrophic process; specific ultrastructural abnormalities; perifascicular atrophy; neurogenic atrophy; metabolic anomalies) enabling a precise etiological diagnosis. For 85% of progressive muscular dystrophies, the biopsy resulted in a genetic diagnosis after identification of the protein defect. In 15% of the congenital myopathies, histopathological anomalies focused attention on one or several genes. Concerning dystrophinopathies, quantification of dystrophin deficiency on the biopsy specimen contributed to the definition of the clinical phenotype: Duchenne, or Becker. In children with a myopathy, muscle biopsy is often indispensable to establish the etiological diagnosis. Based on the results from this series, muscle biopsy can provide a precise orientation in 45% of patients, leading to a genetic hypothesis.

Fate of abstracts presented at the 2008 congress of the French Physical and Rehabilitation Medicine Society.

UNLABELLED: Publication of abstracts presented at a scientific meeting is a measure of the latter's scientific quality. OBJECTIVES: To evaluate the publication rate for abstracts presented at the 2008 congress of the French Physical and Rehabilitation Medicine Society (SOFMER) and to identify (i) factors that were predictive of publication and (ii) the main reasons for non-publication. METHODS: We searched the PubMed database for publications related to SOFMER 2008 abstracts. We then screened the abstracts' characteristics for features that were predictive of publication. Authors of abstracts that had not been published were contacted (by e-mail) in order to establish the reason(s) for non-publication. RESULTS: Of the 231 abstracts presented at SOFMER 2008, 49 (21.2%) had been published. Original studies submitted by French university teams were more likely to be published. Most of the unpublished abstracts had never been submitted to scientific journals. A heavy workload (limiting the time available for drafting a publication) and unwillingness to submit incomplete or preliminary studies were the main barriers to submission for publication. CONCLUSION: SOFMER 2008s abstract publication rate was lower than those of other national or international medical congresses. University status and the performance of original research were predictive of publication.

An unusual cause of foot clonus: spasticity of fibularis longus muscle.

The functional consequences of spasticity can be corrected by local, pharmacological or surgical treatments once the spastic muscle has been identified. However, this diagnosis can be tricky when the muscle in question is rarely involved in spasticity or when its mechanical action is unusual or poorly characterized. Here, we present the case of a man presenting with left hemiplegia after an ischaemic stroke. His gait was perturbed by foot clonus in the sagittal plan, which persisted after selective neurotomy of the gastrocnemius and soleus but disappeared after neurotomy of the peroneus longus. Clonus triggered by pushing up under the whole of the forefoot in the direction of dorsiflexion may not be related to spasticity of the triceps surae. We recommend screening for foot clonus by first pushing up on the sole of the foot under all five metatarsals. In a second step, selectively pushing up under the first metatarsal joint enables the physician to evidence spasticity of the peroneus longus.

Evaluation of muscle oxygenation by near-infrared spectroscopy in patients with Becker muscular dystrophy.

Several authors have reported alterations in vasodilation during effort in patients with dystrophinopathies, in which a lack of neuronal NO synthase is thought to lead to functional muscle ischemia. In order to determine changes in muscle oxygenation during effort in patients with Becker muscular dystrophy (BMD) and assess the parameters' links with disease severity and functional status, 10 BMD patients and 10 age-matched controls performed isokinetic, constant-load knee extension exercises at (i) 20% of their extensors' peak torque (i.e. the same relative load) and (ii) the same absolute load (20 Nm). Muscle oxygenation was evaluated noninvasively using near-infrared spectroscopy (NIRS), with the time course of deoxygenation as the main criterion. As expected, BMD patients displayed a lower peak torque than controls (-62%). During both types of exercise, initial muscle deoxygenation was faster (by 27-41%) in BMD patients than in controls. Greater disease severity (according to the Motor Function Measure) and functional impairment (walking endurance) were associated with a faster second deoxygenation phase (τ). The validity and relevance of muscle deoxygenation parameters and the alteration of vasodilatation by nNOS deficiency in dystrophinopathies should be assessed by further studies.

Impact of a rehabilitation program on muscular strength and endurance in peripheral arterial occlusive disease patients.

UNLABELLED: Rehabilitation care and physical exercise are known to constitute an effective treatment for chronic peripheral arterial occlusive disease (PAOD) at the intermittent claudication (IC) stage. Improvements in functional capacities and quality of life have been reported in the literature. We decided to assess the effects of hospital-based exercise training on muscle strength and endurance for the ankle plantar and dorsal flexors in this pathology. PATIENTS AND METHODS: This prospective study included 31 subjects with chronic peripheral arterial occlusive disease (PAOD) and IC who followed a 4-week rehabilitation program featuring walking sessions, selective muscle strengthening, general physical exercise and therapeutic patient education. An isokinetic assessment of ankle plantar and dorsal flexors strength was conducted on the first and last days of the program. We also studied the concentric contractions at the angular velocity of 30°/s and 120°/s for muscle strength and at 180°/s for muscle fatigue. We also measured the walking distance for each patient. RESULTS: Walking distance improved by 246%. At baseline, the isokinetic assessment revealed severe muscle weakness (mainly of the plantar flexors). The only isokinetic parameter that improved during the rehabilitation program was the peak torque for plantar flexors at 120°/s. CONCLUSION: All patients presented with severe weakness and fatigability of the ankle plantar and dorsal flexors. Our program dramatically improved walking distance but not muscle strength and endurance.