A survey of medical and paramedical involvement in children with cerebral palsy in Britanny: preliminary results.

AIM: To describe the amount of medical and paramedical involvement in a sample of Breton children with cerebral palsy as a function of the Gross Motor Function Classification System (GMFCS). MATERIALS AND METHODS: This is a transversal descriptive study. All children with cerebral palsy in Brittany were eligible. Parents who accepted to participate were asked to fill in a questionnaire regarding medical and paramedical involvement with their child. RESULTS: One hundred and thirty-three parents participated. 40.6% of the children were level I on the GMFCS, 20.3% II, 12.03% III, 13.53% IV and 13.53% were level V. Thirty-nine percent of the children took at least one medication (of which 43% were antiepileptic drugs). 33.1% of the children had received at least one injection of botulinum toxin within the year. Forty-four percent used a mobility aid. Eighty-five percent of the children had at least one orthotic device, most often a night ankle-foot orthosis. The median number of rehabilitation sessions per week was 3.85 [0.5-11.5]. The frequency and type of sessions were mostly related to the GMFCS level. CONCLUSION: This study reports high levels of medical and paramedical involvement. Studies must attempt to define optimal practice.

[Two cases of rehabilitation in Ehler-Danlos syndrome]. / Prise en en charge rééducative de la maladie d'Elhers-Danlos: à propos de deux cas.

PURPOSE: Ehlers-Danlos syndrome is rare and little known. It comprises a heterogeneous group of heritable connective tissue disorders characterized by articular hypermobility, skin extensibility and tissue fragility. Diagnosis may be difficult and often delayed. CASE REPORT: Here we describe 2 cases of women with Ehlers-Danlos syndrome. The first had scoliosis with back pain and joint hypermobility. The second presented with hypermobility and joint dislocation, which increased during pregnancy. In these 2 cases, rehabilitation management produced clinical improvement. DISCUSSION: Orthopaedic complications such joint pain, joint swelling, joint dislocation, back pain, with walking and hand function disability are the main problems in Ehlers-Danos syndrome. Surgery may be necessary to correct dislocated joints but is often not sufficient to resolve the handicap, and physical therapy has an important place in management. CONCLUSION: Ehlers-Danlos syndrome is an evolving disease that can lead to great impairment. Thus, physicians must be aware of this syndrome to offer the best management, with the appropriate use of orthotic devices, specific strengthening routines, education in proper body mechanics and assistive devices, to prevent joint dislocation and subluxations responsible for pain and handicap.

[Multiple sclerosis and physical activities]. / Activité sportive et sclérose en plaques.

INTRODUCTION: Multiple sclerosis (MS) is a neurological disease of the central nervous system that most often affects young people. It is characterized by various debilitating symptoms. The aim of this study was to assess physical activities in patients with MS and how these affect their quality of life. METHODS: Forty-five patients were questioned about their physical activities. The following were taken into account: the characteristics of MS within each patient, the level of disease severity (EDSS score) and the quality of life (on the SEP-59 questionnaire). RESULTS: Fifteen patients had to give up a physical activity because of their illness but more so due to ataxia, fatigue and muscular weakness. Fifteen patients take part in a physical activity, the principal motivation being for their personal well-being. The mean EDSS was 4.2. Answers on the SEP-59 revealed found that patients with MS who took part in a physical activity had significantly better well-being in general. DISCUSSION AND CONCLUSION: Physical activities seem to improve the quality of life of patients with MS who, in general, already have a poor quality of life in relation to the general population. Knowing that muscular function is improved through exercise in patients with an EDSS less than 6, it would seem advantageous for them to take part in a regular physical activity.

[Charcot-Marie-Tooth disease associated with syringomyelia revealed by urinary disorders]. / Association de maladie de Charcot-Marie-Tooth et de syringomyélie révélée par la survenue de troubles urinaires.

PURPOSE: Charcot-Marie-Tooth (CMT) disease is characterized by genetic and clinical heterogeneity. The occurrence of urinary disorders is unusual and requires further investigation. CMT disease and syringomyelia are not usually associated. Moreover, primary urinary signs in syringomyelia are not frequent. CASE REPORT: An 11-year-old girl with CMT disease 1A duplication presented with motor deficit of the leg associated with urinary disorders. Urodynamic study revealed neurogenic detrusor overactivity, and magnetic resonance imaging confirmed syringomyelia extending from T11 to an L1 located conus. DISCUSSION: Review of the literature confirmed the possibility of primary urinary signs in syringomyelia, with only one case of CMT and urinary signs described. In this case, the diagnosis was radicullar and medullar compression by a hypertrophic nerve formation called an "onion bulb" reflecting the demyelinisation and remyelinisation cycle. CONCLUSION: Urinary signs in CMT disease are exceptional and require investigation into the possibility of a central lesion.

[Influence of temperature changes on clinical symptoms in multiple sclerosis: an epidemiologic study]. / Influence des variations de la température sur la symptomatologie clinique dans la sclérose en plaques: étude épidémiologieque.

UNLABELLED: The effects of the modifications of temperature are well known in patients affected by multiple sclerosis (MS). They are variable and can influence daily living. This sensibility can be used in the management of the disabilities. METHOD: An epidemiological study was realized on a cohort of 191 patients suffering from MS referred to the MS clinic of Rennes (France). All the patients were questioned about the influence of heat and cold on their clinical symptoms (fatigue spasticity, walking disorders, vision, em leader ). Correlations with the main clinical characteristics were studied. POPULATION: One hundred ninety-one patients, 129 women and 62 men with an average age of 47.6 +/- 10 years were interviewed. Average score EDSS was of 5.2 +/- 1.5. The mean duration of MS was 13.5 +/- 10 years. RESULTS: One hundred forty-seven patients (77%) reported a sensibility to the temperature. Heat deteriorated function in 104 cases and 82 patients improved with cold. Paradoxically 20 patients reported to be deteriorated with cold and 19 improved with heat. Fatigue and walking were the most sensitive to temperature fluctuations. No particular clinical profile could be established. Fifty percent of the patients used this sensibility with therapeutic aim in everyday life. DISCUSSION: The clear influence of temperature fluctuations on the clinical symptom was confirmed in this study. However, there is a great variability from one patient to another. Different hypotheses have been evoked to explain this phenomenon. The most likely is an influence on the nervous specific conductivity. In routine practice cold physiotherapy will be proposed on case by case basis and still has an interesting place in the rehabilitation management.

[Interest of visual biofeedback training in rehabilitation of balance after stroke]. / Intérêt de la rééducation par biofeedback visuel sur plateforme de stabilométrie dans la prise en charge des troubles posturaux des hémiplégiques vasculaires.

OBJECTIVE: The aim of this study was the assessment of visual biofeedback in the management of balance disorders after stroke. MATERIAL AND METHODS: This is a prospective randomised trial, which compares visual biofeedback training and traditional balance training. Twenty-seven patients took part in this study: 13 in the first group and 14 in the second group. The rehabilitation program in the first group consists in an association of visual biofeedback and traditional training during 3 weeks. For the second group traditional training was used alone. Clinical, functional and forceplate assessments were performed before and after the program of rehabilitation. RESULTS: All the patients had a clinical and functional improvement. However, patients who have benefited from biofeedback training had a significant improvement of the forceplate parameters with closed eyes. DISCUSSION AND CONCLUSION: Those results confirm the interest of rehabilitation in balance disorders after stroke. The use of biofeedback training incorporated into functional physiotherapy affords added benefits probably by a best integration of proprioceptive informations.

[The properties of precipitation reactions between secretion products in the oviduct of pleurodeles: identification of a lectin]. / Caractéristiques des réactions de précipitation entre les produits de sécrétion de l'oviducte du Pleurodèle: identification d'une lectine.

The properties of two precipitation reactions occurring between secretory products from the oviduct of Pleurodeles waltl have been studied. It has been demonstrated that a lectin is involved in one of the reactions. This lectin precipitated glycogen and starch and required calcium; the most potent saccharide inhibitors were 2-amino-2-deoxy-D-glucose and D-glucose, respectively. The other reaction was related to glycoproteins (probably sulfated glycoproteins) that contained sulphur. The properties of this reaction were not the same as purely ionic interactions; basic protein-acidic polysaccharide interactions have been compared. A lectin was probably implicated but this could not be demonstrated because no saccharide inhibitor was found. There are several similitudes between this reaction and the lectin-galactoside reaction which occurs in the reaction between cortical granule content and egg jellies in anurans.