Sexual disorders post-stroke: Description of a cohort of patients followed in rehabilitation.

INTRODUCTION: The impairments resulting from a stroke can be multiple, including urinary and/or sexual dysfunctions. This acquired brain injury disrupts neurological control of sexual responses. MAIN OBJECTIVE: to describe sexual disorders, after a first episode of stroke, in a population followed in a physical medicine and rehabilitation (PMR) center. SECONDARY OBJECTIVES: to gather patients' expectations and PMR physicians' opinions on this subject. METHOD: Observational, retrospective study in two PRM centers. Post-stroke sexuality was assessed using two validated questionnaires [for men: International Index of Erectile Function 15 (IIEF15) and for women: Female Sexual function Index (FSFI)]. Patients were asked 3 questions to approximate their expectations, and PRM physicians were asked 2 questions for their opinions. RESULTS: Twenty-four subjects included (17 men/7 women). Thirteen had no post-stroke sexuality. Erectile function was analysable in 4 subjects, 3 of whom had moderate to severe erectile dysfunction. In women, female sexual dysfunction concerned 6/7 women, including lubrication. Ninety-six percent of subjects had never discussed sexuality with their PRM physician. Only 33% would have liked information on this subject. Our PRM physicians rarely discuss post-stroke sexual disability. CONCLUSION: Post-stroke sexual disorders occur in both sexes. All areas of sexuality may be affected. A large-scale, prospective, controlled, multicenter study is needed to establish stroke as the direct neurological cause of sexual impairment.

Can external work during walking in scoliosis patients be estimated from spatiotemporal parameters?

BACKGROUND: Patients with scoliosis present gait impairments compared to healthy subjects. Clinically, spine deformity is evaluated with Cobb angle, a standard measurement to determine and track the progression of scoliosis. Scoliosis is a biomechanical trouble, dependant of external forces and muscular activity. External work is currently analyzed in patients with scoliosis because this work sums up consequences and evolutions of spine deformity. Habitually, biomechanics approach is used to compute this work. For asymptomatic subjects, a regression model let to compute external work. So, considering the area of research to facilitate the follow-up at lower cost, this regression function could be applied to patients with scoliosis but need to be validated. RESEARCH QUESTION: can external work during walking in scoliosis patients be estimated from spatiotemporal parameters with a regression model? METHOD: This retrospective study included twenty untreated patients with idiopathic scoliosis and sixteen asymptomatic participants. We used a regression model defined in case of asymptomatic subjects in literature and proposed a new specific model in case of patients with scoliosis. FINDINGS: The external work in patients with scoliosis calculated with the Wirta's regression eq. (0.23 ± 0.04 J.kg-1.m-1) was underestimated compared to the external work calculated using a biomechanical method (0.33 ± 0.06 J.kg-1.m-1). A new regression model including Cobb angle and spatio-temporal parameter presents a high coefficient of determination. INTERPRETATION: In opposition to biomechanical method, our new model let to compute external work without expensive gait laboratory. This specific model is more reliable than the model developed from asymptomatic subjects.

Hip loading asymmetry in Lenke type 1 idiopathic scoliosis: Effect of spinal fusion and sex.

BACKGROUND: Thoracic curvatures are most common in patients with idiopathic scoliosis. The literature highlights an imbalance of hip joint moments in the frontal plane quantified with a symmetry index. Spinal arthrodesis can reduce this symmetry index which then tends towards 0. Furthermore, asymptomatic women present lower hip moment in the frontal plane than asymptomatic men. This difference could influence the symmetry index in the case of patients with idiopathic scoliosis. Therefore, the main objective of this study was to show a significant positive effect of spinal arthrodesis on the symmetry index. The secondary objective was to compare the symmetry index between sexes before spinal fusion. METHOD: The retrospective study included 20 patients with Type-1 Lenke curve idiopathic scoliosis, who performed a gait analysis before and one year after spinal fusion. The gait analysis consisted of walking back and forth at spontaneous speed. FINDINGS: While significantly lower curvatures were depicted, the symmetry index showed a significantly lower value after spinal fusion (p < 0.03). The symmetry index showed no significant difference between sexes (p > 0.05). INTERPRETATION: The study shows the effect of surgical fusion on the symmetry index, although the latter remains significant compared to the norm. Literature reveals that spinal fusion tends to the symmetrisation of the body's center of mass and increases ranges of motion on the trunk and pelvis. This could favour symmetry of hip moment in the frontal plane. Future research should investigate other Type Lenke curves before and after surgery, and the effect of braces on this symmetry index.

Does spinal fusion influence lateral oscillations in scoliosis patients? Unstable equilibrium analysis.

BACKGROUND: Patients with Idiopathic Scoliosis demonstrate vestibular and proprioceptive system perturbations. Scoliosis can be treated through spinal fusion. Does spinal fusion present significant effect of dynamic equilibrium in case of lateral oscillations? METHODS: Using an unstable platform in frontal plane, dynamic equilibrium in patients with idiopathic scoliosis (before and one year after spinal fusion) was analyzed against a population of asymptomatic subjects. RESULTS: A significant group effect was observed on Center of Mass in case of Eyes Opened. CONCLUSION: In relation to sensory integration, spinal fusion coupled to rehabilitation program is associated to better dynamic equilibrium.

Does spinal fusion influence vestibular information in scoliosis patients? Unstable equilibrium analysis.

BACKGROUND: Idiopathic scoliosis is described as the most common postural deformity to affect adolescents. These patients demonstrate vestibular system perturbations. Scoliosis can be treated through spinal fusion. Does spinal fusion coupled to rehabilitation program present significant effect of dynamic equilibrium? METHODS: An unstable platform was used to analyze dynamic equilibrium in patients with idiopathic scoliosis (before and one year after spinal fusion) against a population of asymptomatic subjects. RESULTS: A significant group and condition effect was observed on Center of Mass. CONCLUSION: In relation to vestibular system, spinal fusion coupled to rehabilitation program is associated to better dynamic equilibrium.