Cerebral palsy of the child in rehabilitation environment: epidemiologic and clinical profile and therapeutic modalities.

INTRODUCTION: Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture causing activity limitation. AIM: To evaluate the epidemiological, clinical, and radiological profile of children with CP and to study the therapeutic modalities in daily clinical practice. METHOD: This was a retrospective, descriptive study, carried out in a physical medicine and rehabilitation department, including all the patients referred with the diagnosis of cerebral palsy between January 2000 and December 2016. We used pre-established records to collect data. The missing data were collected from the files of the pediatric department. To classify cerebral palsy, we used a motor impairment classification, topographic classification according to the affected limb and the GMFCS - ER. RESULTS: Fifty patients were included with a gender ratio of 1.23. The mean age of patients was 7.8 years old. The risk factors for CP were mainly represented by perinatal asphyxia (55%) and prematurity (37%). The spastic form was predominant (74%). Quadriplegia was the most severe clinical form (61%). Neuro-orthopedic deformations were found in 78% of cases. Half of the children had GMFCS score between 1 and 2. Brain MRI lesions were dominated by anoxic-ischemic sequelae (34%). Physical therapy was prescribed for all patients. The most prescribed devices were the dynamic ankle foot orthosis (60%). Baclofen was prescribed in 5% of cases and botulinum toxin injection was performed in 30% of children. CONCLUSION: The cerebral palsy defines the clinical and functional disorders caused by non-progressive developmental damage to the brain of the infant which requires a multidisciplinary management.

Functional repercussion of polyarthrosis of the elderly in tunisia.

INTRODUCTION: Osteoarthritis (OA) is the most common degenerative joint disease in the elderly. The often multifocal location at this age can be a source of pain, limitation of everyday activities, thus affecting their quality of life. AIM: To evaluate functional status of aged people with generalized OA in Tunisia, and to detect the main factors associated with a poor function in order to optimize their medical care. METHODS: A cross-sectional, descriptive study done between January and March 2017. Fifty patients were included, aged 65 years and over followed for generalized osteoarthritis. The functional repercussions of polyarthrosis was assessed by functional independence measure (FIM), the Lequesne Algofunctional Index, the Womac index for hip and knee OA, and the Oswestry questionnaire for low back pain. RESULTS: The mean age of patients was 71.94 ± 0.8 years with a sex ratio of 0.42.The functional status of patients with polyarthrosis were altered to varying degrees. The most impaired dimensions of FIM were self-care, transfers and locomotion. Activities of daily living of the Lequesne index was the most impaired section with an average of 5.28. The three dimensions of the Womac index were affected, particularly the pain section with an average of 49.18/100. The Oswestry index was altered with an average of 18.89 / 40. Factors associated with poor functional status were: Female gender (p<0,05), age of development (p<0,05), spinal arthrosis (p<0,05) and history of falls(p<0,05). CONCLUSION: Polyarthrosis is accompanied by functional impairment in the elderly. Factors associated with functional impairment should be considered in the Patient Management Program.

Evaluation after two years of functionnal restoration for chronic low back pain : Tunisian experience.

INTRODUCTION: functional restoration of the spine is a proven method in the short-term management of chronic low back pain. The aim of our study  was to evaluate the effect of a functional restoration program at two years of evolution. METHODS: retrospective study of patients enrolled in a functional restoration program during 2014 and summoned after two years,  in 2016. Patients have had the same clinical and functional evaluation before the program, at five weeks and  at two years. RESULTS: Thirty patients were enrolled in the study. The average age was 45 years. Eighty % of the patients were overweight. Significant improvement for all clinical and functional parameters at five weeks was noted. This gain was maintained significantly for some parameters at two years. CONCLUSION: The results of the functional rehabilitation of the spine are satisfactory at two years of evolution.

Transported neonates in Tunisia.

AIMS: To describe the transport of sick neonates to a tertiary care hospital and evaluate their condition at arrival and outcome. METHODS: A multicenter, prospective cohort study was performed in 7 NICUs in Tunisia from 1st april to 31 July 2015.Demographic parameters, transport details and clinical features at arrival were recorded. All neonates were followed up till discharge or death. RESULTS: A total of 239 consecutive neonates were enrolled in the study representing 5.7% of all admitted infants. Maternal risk factors were present in 26% of neonates admitted. Sex-ratio was 1.46. Preterm infants represented 24% of transported babies. Seventeen percent of neonates had severe respiratory distress and 10% had hemodynamic troubles. Referred hospital was not informed in 24% of cases. Regarding the transport mode, 113 newborns (47.5%) were transported in ambulance accompanied by a nurse. Documentation during transfert was present in 14% of cases. Five babies expired on arrival despite resuscitation.  Rate mortality was 8.4%. CONCLUSION: Transporting neonates in developing countries is a challenge. Organized transport services in Tunisia are not always available. So, in cases of at-risk pregnancy, it is safer to transport the mother prior to delivery than to transfer the sick baby after birth.

[Isokinetic profile of knee muscles in Tunisian competitive footballers]. / Profil isocinétique des genoux des footballeuses compétitives tunisiennes.

BACKGROUND: During football several joints are greatly demanded, especially the knees.The interest of the isokinetic is to detect an imbalance between agonist and antagonist muscles of the muscle leg and between dominant and non dominant leg, in order to prevent injuries and to improve the physical fitness of young soccer players. AIM: evaluate the isokinetic profile of flexor and extensor muscles of the knee of competitive footballers Methods : Prospective study conducted in the department of Physical and Rehabilitation Medicine of the Military Tunis Hospital, including 15 competitive footballers and evaluated during the month of August 2012. All patients underwent an isokinetic assessment of agonist and antagonist muscles of the knees in concentric mode 3 speed 60 ° / 120 ° and 180 ° (with analysis of figures and curves), using a Biodex dynamometer. The selected parameters were the time of maximum force (MFM) of the knee flexors and extensors, and the agonists / antagonists ratio (IJ / Q). The data were analyzed by SPSS software. RESULTS: 15 competitive footballers were included. The average age is 23.20 years ± 3.99 years, ranging from 18 to 28 years. The average size is 167.13 cm ± 3.6 cm with a range of 163 and 172 cm. The average weight is 60.87 kg ± 5.97 with a range of 50 to 70 kg. The isokinetic evaluation showed a statistically significant superiority of the flexor muscles of the right knee compared with those of the left knee at the speed 60 / s (p = 0.046) and 120 / s (p = 0.031), whereas this difference has not been found for the extensors muscles. The values of the ratio of quadriceps to hamstring increases with the speed of movement performed, the maximum moment / weight moving in the opposite direction. CONCLUSION: The isokinetic evaluation allows an objective assessment of the flexor and extensor muscles of the knee footballers, in order to correct imbalance and preserve the sporting future of the young footballers.

[The contribution of the new scale for assessing disability]. / Apport de la nouvelle grille d'évaluation du handicap.

PROBLEM: The assessment of disability and its management is complex and problematic. With a view to ensuring equality of opportunity between disabled people and others, a new law adopted in August 2005 proposed a new method for assessing disability is applicable on a wider scale by GPs. AIM: Assessing the contribution of the new scale for assessing disability in patients suffering from debilitating diseases, to verify compliance in Tunisia. METHODS: Cross-sectional study on 60 hemiplegic, paraplegic and post traumatic head injuries. The patients underwent clinical evaluation and a functional assessment. The assessment tools used were: the classification of the American Spinal Injury Association, the Barthel Index, Glasgow Outcome Scale, Functional Independence Measure, the Health Assessement Questionnaire and the Social Function-36. Patients were also evaluated with the new scale of disability. RESULTS: concerning paraplegic patients, limitation of activity concerned mobility, maintenance staff, domestic life, social relationships, community life and major areas of life. On the hemiplegic, areas related to communication, mobility, maintenance staff, domestic life, social relationships, community life and major areas of life have been affected. We have noted a correlation between the new scale and the Barthel Index. Regarding traumatic brain injury, the areas most affected were those related to mobility, maintenance staff, domestic life and the major areas of life. A correlation was found between the new scale and the Functional Independence Measure in three populations, as well as the quality of life that has been correlated with disability. Disability was observed in 90% of paraplegics, 80% and 50% of hemiplegic patients with severe brain injury. The handicap was the heaviest seen in traumatic brain injury patients with a frequency of 20%. CONCLUSION: The new scale for assessing disability has reproduced disability and special needs of paraplegic patients, stroke patients and traumatic brain injury.