Histoire Du Traitement Des Brûlures En France. La Place De L'Hôpital Léon Bérard (Hyères) : Rééducation, Société Savante, Association De Patients.

In the 50s and 60s, before burn centres appeared, burn patients were primarily treated in surgical departments. They were then referred to sanatorium-type institutions, moving towards functional rehabilitation but without a really structured service. In the early 70s, Jean-Pierre Jouglard, Marseille Surgeon, Head of the Burn Treatment Center of the University Hospital of Marseille, collaborated with Dr. Madeleine Malavaud, in an RRF establishment, the Léon Bérard Hospital in Hyères (Var), to create, in 1974, the first French service dedicated to the rehabilitation of burn patients. The Léon Bérard hospital's burn rehabilitation service, which is still active today, helped spread new techniques from the United States of America to France in the 80s, by training young doctors to become rehabilitators. In 1979, it contributed to the creation of the French Society for the Study and Treatment of Burns, enabling patients to compare their experience by promoting the creation of the Association des Brûlés de France in 1983. The Léon Bérard hospital's burn rehabilitation service therefore occupies a prominent place in the history of burn rehabilitation in France.

Résumé Des Tables Rondes Du 39ème Congrès De La SFB.

This congress shared 3 main topics: inflammation - especially in the rehabilitation phase, fires and smoke inhalation, and flaps in sequelae. The first is reported by Valérie Chauvineau, the second by Ronan Le Floch and the third by Louise Pasquesoone.

Asymmetric standing posture after stroke is related to a biased egocentric coordinate system.

BACKGROUND: Weakness and somatosensory deficits have long been known to be involved in the postural instability of subjects with stroke. Recently, it has been shown that impaired representations of the orientation of the longitudinal axis of the body (LBA, egocentric reference) and of verticality (allocentric reference) may also play a role. The objective of the present study was to determine whether these two references were independently linked to postural asymmetry in standing stroke patients. METHODS: Twenty-two subjects were tested after a first hemispheric stroke (13 +/- 7.5 weeks). The LBA perception was investigated in the supine position by adjusting the orientation of a luminous rod in the frontal plane to correspond to the subjective LBA. The subjective visual vertical (SVV) was assessed by adjusting the orientation of a luminous line in the frontal plane to correspond to the SVV in upright patients. Weight distribution was measured in the standing position for about 2 minutes and 45 seconds by two separate force platforms under the feet. RESULTS: LBA and SVV were strongly associated (r = 0.7; p < 0.001). The estimate of the LBA was a better predictor (r = -0.52: p < 0.02) of weight bearing asymmetry than was SVV (r = -0.41; p = 0.074) when adjusted for motor weakness and hypoesthesia. CONCLUSION: Contralesional rotation of the longitudinal axis of the body could lead to unequal distribution of loading on the feet. This novel interpretation of weight bearing asymmetry underlines the complexity of control of the erect stance following stroke and brings new perspectives for rehabilitation programs.

Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship?

The relationships between perception of verticality by different sensory modalities, lateropulsion and pushing behaviour and lesion location were investigated in 86 patients with a first stroke. Participants sat restrained in a drum-like framework facing along the axis of rotation. They gave estimates of their subjective postural vertical by signalling the point of feeling upright during slow drum rotation which tilted them rightwards-leftwards. The subjective visual vertical was indicated by setting a line to upright on a computer screen. The haptic vertical was assessed in darkness by manually setting a rod to the upright. Normal estimates ranged from -2.5 degrees to 2.5 degrees for visual vertical and postural vertical, and from -4.5 degrees to 4.5 degrees for haptic vertical. Of six patients with brainstem stroke and ipsilesional lateropulsion only one had an abnormal ipsilesional postural vertical tilt (6 degrees ); six had an ipsilesional visual vertical tilt (13 +/-.4 degrees ); two had ipsilesional haptic vertical tilts of 6 degrees . In 80 patients with a hemisphere stroke (35 with contralesional lateropulsion including 6 'pushers'), 34 had an abnormal contralesional postural vertical tilt (average -8.5 +/- 4.7 degrees ), 44 had contralesional visual vertical tilts (average -7 +/- 3.2 degrees ) and 26 patients had contralesional haptic vertical tilts (-7.8 +/- 2.8 degrees ); none had ipsilesional haptic vertical or postural vertical tilts. Twenty-one (26%) showed no tilt of any modality, 41 (52%) one or two abnormal modality(ies) and 18 (22%) a transmodal contralesional tilt (i.e. PV + VV + HV). Postural vertical was more tilted in right than in left hemisphere strokes and specifically biased by damage to neural circuits centred around the primary somatosensory cortex and thalamus. This shows that thalamo-parietal projections have a functional role in the processing of the somaesthetic graviceptive information. Tilts of the postural vertical were more closely related to postural disorders than tilts of the visual vertical. All patients with a transmodal tilt showed a severe lateropulsion and 17/18 a right hemisphere stroke. This indicates that the right hemisphere plays a key role in the elaboration of an internal model of verticality, and in the control of body orientation with respect to gravity. Patients with a 'pushing' behaviour showed a transmodal tilt of verticality perception and a severe postural vertical tilt. We suggest that pushing is a postural behaviour that leads patients to align their erect posture with an erroneous reference of verticality.

Perception of longitudinal body axis in patients with stroke: a pilot study.

BACKGROUND AND AIMS: To investigate the hypothesis that patients with a hemisphere stroke may perceive their longitudinal body axis (LBA) rotated in the frontal plane. This error in an egocentric frame of reference could be detrimental to posture, as tilted LBA would imply an unequal distribution of body mass about the true vertical. METHOD: 26 healthy subjects matched in age with 18 patients living with stroke participated in the study. The 18 patients were tested on average 80 days after a first left (n = 8) or right (n = 10) hemisphere stroke. Participants perceived their LBA by adjustments of the orientation of a luminous rod pivoting around a dorsonavel axis to the subjective direction of LBA. Participants were studied in the supine position to dissociate somaesthetic cues from graviceptive cues. RESULTS: Patients with stroke perceived their LBA rotated to the contralesional side in comparison with controls (p = 0.004). For all controls and 10 patients with stroke, the perceived LBA was very close to true LBA (mean (SD) 0.24 degrees (1.31 degrees)). For eight patients with stroke (six right stroke, two left stroke), the perceived LBA was rotated from true body orientation in the direction opposite to the lesioned side (range 3-9.5 degrees, mean 5.2 degrees). These eight patients provided similar estimates by tactile manipulation of the rod (without vision). The rotation of perceived LBA was more pronounced for right-hemisphere strokes. The magnitudes of perceptual rotations correlated with sensory loss, signs of spatial neglect and the degree of postural and gait disability. CONCLUSION: This is the first study showing that certain patients with a hemisphere stroke perceive their LBA rotated to the contralesional side. The consequences for perceptuomotor coordination have implications for their postural disorders.

[What is the place of diphosphonates in the treatment of complex regional pain syndrome I?]. / Quelle est la place des biphosphonates dans le traitement de l'algodystrophie sympathique réflexe? Analyse critique de la littérature.

OBJECTIVES: To evaluate the efficacy of biphosphonates (BPs) in complex regional pain syndrome I or reflex sympathetic dystrophy and to specify their place in this chronic painful syndrome. METHODS: A literature review of Medline and Embase with use of a combination of 3 key words: biphosphonates therapy, reflex sympathetic dystrophy, complex regional pain syndrome I, controlled study. Each article was classified by 2 independent reviewers according to Aguilar's method into high, middle or low quality. RESULTS: Three second-generation BPs were tested in the treatment of reflex sympathetic dystrophy: pamidronate, alendronate and clodronate. Many open studies investigated pamidronate, but only 2 were randomised and controlled: a low-quality trial comparing pamidronate with placebo and a middle-quality trial comparing pamidronate with calcitonine. Two high-quality trials were performed, 1 with alendronate and 1 with clodronate. Middle-quality trial and high-quality trials reported positive effects on pain with BPs in recent reflex sympathetic dystrophy (disease duration less than eight months). Side effects (fever, asymptomatic hypocalcemia) were observed frequently but disappeared quickly. CONCLUSION: BPs can be used in recent reflex sympathetic dystrophy when calcitonin is inefficient or when calcitonin injections are not well tolerated.