Fitness and walking outcomes following aerobic and lower extremity strength training in facioscapulohumeral dystrophy: a case series.

Facioscapulohumeral muscular dystrophy (FSHD) is a common form of adult muscular dystrophy often resulting also in cardiorespiratory deconditioning and weakness of the lower limbs. Although previous studies examined outcomes of interventions aimed at improving either cardiorespiratory fitness or muscle strength, the potential benefits of a rehabilitation program targeting both remain unexplored. Thus, the aim of this study was to evaluate changes following participation in a rehabilitation program combining aerobic and strength exercises. We conducted a retrospective analysis of 10 subjects with FSHD who participated in our rehabilitation program during 2018 and 2019. Each of the 20 sessions consisted of aerobic training on a cycloergometer and a moderate lower limb strength exercises on an isokinetic machine in combination with conventional therapy. The primary outcomes were walking speed, aerobic performance and isokinetic strength of the knee extensors and flexors. The secondary outcomes were fatigue, insomnia. VO2max and walking speed increased significantly by 2.125 ml·kg-1·min-1 [95% confidence interval (CI): 0.75-3.62, P = 0.022] and 0.28 m/s (95% CI: 0.16-0.4, P = 0.002), respectively. The effect size was small for V02max (Hedge's g, 0.44; 95% CI: -0.5 to 1.37) and large for walking speed (Hedge's g, 0.99; 95% CI: 0.06-1.92). The knee flexor strength significantly increased at rehabilitation discharge (repeated measures analysis of variance P = 0.004). Positive changes in fatigue and insomnia were also observed. Our preliminary results provide evidence that a relatively short course of a comprehensive rehabilitation program targeting both cardiorespiratory fitness and knee muscle strength can be beneficial for people with FSHD, which warrants further prospective studies.

The effect of selective dorsal rhizotomy on the improvement of the quality of life of children with stage GMFCS IV and V cerebral palsy: Pain, nursing, positioning, and dressing.

AIM: The objective of this study is to evaluate the benefit of selective dorsal rhizotomy on the quality of life of patients with severe spasticity with significant impairment of gross motor functions (GMFCS stages IV and V) according to 4 items: pain, nursing care, positioning, and dressing. MATERIALS AND METHODS: We conducted a monocentric retrospective cohort study including patients who underwent selective dorsal rhizotomy between March 2008 and May 2022 at the University Hospital of Marseille. RESULTS: Seventy percent of patients showed an improvement in quality of life criteria: dressing, nursing, positioning, and pain at the last follow-up. A small proportion of patients still showed a worsening between the first 2 follow-ups and the last follow-up. Postoperatively, 27.3% of patients were free of joint spasticity treatment, and we have shown that there was a significant decrease in the number of children who received botulinum toxin postoperatively. However, there was no significant reduction in the number of drug treatments or orthopaedic procedures following RDS. For the CPCHILD© scores, an overall gain is reported for GMFCS IV and V patients in postoperative care. The gain of points is more important for GMFCS IV patients. Improvement was mainly observed in 2 domains, "comfort and emotions" and "hygiene and dressing". For the "quality of life" item, only 3 parents out of the 8 noted a positive change. CONCLUSION: Our study shows an improvement in nursing care, positioning, and dressing which are associated with a reduction in pain in children with a major polyhandicap GMFCS IV and V who have benefited from a selective dorsal rhizotomy.

Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial.

BACKGROUND: Improving walking ability is one of the main goals of rehabilitation after stroke. When lower limb spasticity increases walking difficulty, botulinum toxin type A (BTx-A) injections can be combined with non-pharmacologic interventions such as intensive rehabilitation using a robotic approach. To the best of our knowledge, no comparisons have been made between the efficacy of robotic gait training and conventional physical therapy in combination with BTx-A injections. OBJECTIVE: To conduct a randomized controlled trial to compare the efficacy on gait of robotic gait training versus conventional physiotherapy after BTx-A injection into the spastic triceps surae in people after stroke. METHOD: Thirty-three participants in the chronic stroke phase with triceps surae spasticity inducing gait impairment were included. After BTx-A injection, participants were randomized into 2 groups. Group A underwent robotic gait training (Lokomat®) for 2 weeks, followed by conventional physiotherapy for 2 weeks (n = 15) and Group B underwent the same treatment in reverse order (n = 18). The efficacy of these methods was tested using the 6-minute walk test (6MWT), comparing post-test 1 and post-test 2 with the pre-test. RESULTS: After the first period, the 6MWT increased significantly more in Group A than in Group B: the mean difference between the interventions was 33 m (95%CI 9; 58 p = 0.007; g = 0.95), in favor of Group A; after the second period, the 6MWT increased in both groups, but the 30 m difference between the groups still remained (95%CI 5; 55 p = 0.019; g = 0.73). CONCLUSION: Two weeks of robotic gait training performed 2 weeks after BTx-A injections improved walking performance more than conventional physiotherapy. Large-scale studies are now required on the timing of robotic rehabilitation after BTx-A injection.

Use of his prostheses by a double upper limb amputee 6 years after amputation: From aesthetic to functional considerations, a case report.

BACKGROUND: Few studies have been published on the prosthetic management of bilateral upper limb amputees. Of particular interest is to study how a patient's use of his upper limb protheses had evolved over a 6-year period in the aim to decrease their rejection rate. CASE DESCRIPTION AND METHODS: Mr. D had undergone a bilateral upper limb amputation and had been fitted with 7 different prostheses in the past 6 years. Multiple validate instruments and analyses were then used to monitor the patient's fitting and choices. FINDINGS AND OUTCOMES: Initially, the left prosthesis was regarded as the dominant hand and the right one as the assistive power grip hand. However, the observational results showed that wearing only a left Greifer enabled the prosthetic user to perform the same tasks as with 2 prostheses. He has gained greater satisfaction and quality of life without losing his independence. CONCLUSION: The patient seemed to make a functional choice over his worrying about his physical appearance in favor of the efficiency of his prosthesis, which was essential for his everyday life, when he decided to wear only nonanthropomorphic prosthesis.

Riluzole for treating spasticity in patients with chronic traumatic spinal cord injury: Study protocol in the phase ib/iib adaptive multicenter randomized controlled RILUSCI trial.

BACKGROUND: Satisfactory treatment is often lacking for spasticity, a highly prevalent motor disorder in patients with spinal cord injury (SCI). Low concentrations of riluzole potently reduce the persistent sodium current, the post-SCI increase in which contributes to spasticity. The repurposing of this drug may therefore constitute a useful potential therapeutic option for relieving SCI patients suffering from chronic traumatic spasticity. OBJECTIVE: RILUSCI is a phase 1b-2b trial designed to assess whether riluzole is a safe and biologically effective means of managing spasticity in adult patients with traumatic chronic SCI. METHODS: In this multicenter double-blind trial, adults (aged 18-65 years) suffering from spasticity after SCI (target enrollment: 90 participants) will be randomly assigned to be given either a placebo or a recommended daily oral dose of riluzole for two weeks. The latter dose will be previously determined in phase 1b of the study by performing double-blind dose-finding tests using a Bayesian continuous reassessment method. The primary endpoint of the trial will be an improvement in the Modified Ashworth Score (MAS) or the Numerical Rating Score (NRS) quantifying spasticity. The secondary outcomes will be based on the safety and pharmacokinetics of riluzole as well as its impact on muscle spasms, pain, bladder dysfunction and quality of life. Analyses will be performed before, during and after the treatment and the placebo-controlled period. CONCLUSION: To the best of our knowledge, this clinical trial will be the first to document the safety and efficacy of riluzole as a means of reducing spasticity in patients with chronic SCI. TRIAL REGISTRATION: The clinical trial, which is already in progress, was registered on the ClinicalTrials.gov website on August 9, 2016 under the registration number NCT02859792. TRIAL SPONSOR: Assistance Publique-Hôpitaux de Marseille.

Prosthesis for bilateral equinus foot: A case study.

BACKGROUND: Although surgical treatment for equinus foot has been widely described in the literature, less attention has been paid to orthopedic treatment with prostheses, which constitutes an interesting alternative approach. It has been described in the literature for treating lower-limb inequality, but not for equinus foot. The aim of this article is to report that the use of prosthetics can be a valid means of managing bilateral equinus foot. CASE DESCRIPTION AND METHODS: In the present case report, we describe the management of an irreducible bilateral equinus in a 45-year-old patient with poliomyelitis sequelae, starting with orthoses and orthopedic shoes, followed by prostheses. We measured the evolution of the patient's spatiotemporal gait parameters, his autonomy, and his satisfaction with a QUEST score. FINDINGS AND OUTCOMES: Despite the deterioration of the patient's physical abilities due to the onset of a postpoliomyelitis syndrome, his gait parameters and his autonomy were maintained while using the prostheses. His tolerance of the prostheses improved even more greatly, as shown by his QUEST score, which increased from 2.95 to 4.67 of 5. CONCLUSION: The use of prostheses was at least as effective and even better tolerated than orthoses and orthopedic shoes by this patient. Despite the occurrence of a postpoliomyelitis syndrome, the prostheses helped to maintain his walking performances, while improving his satisfaction.

Multidisciplinary peer-led sexual and reproductive health education programme in France, a prospective controlled-study.

BACKGROUND: Sexual education is an international priority to promote sexual and reproductive health (SRH) and to reduce risky sexual behaviour. Experts recommend holistic and comprehensive SRH peer-led education. In 2018, the French government launched a new public peer-led health prevention programme called the "Service Sanitaire" (SeSa), consisting of health education provided by healthcare students (peer educators) to teenagers. For the first time in France, the impact of the programme was prospectively evaluated during its first year to examine whether the programme improved the SRH knowledge of healthcare students and teenagers. Risk perception and risky sexual behaviour among these populations were also evaluated. METHOD: A prospective multicentre controlled study was conducted from November 2018 to May 2019. SRH knowledge was compared before and after the SeSa programme, and the evolution of this knowledge was compared, with linear regression, between healthcare students part of the SRH SeSa programme and those who were part of another programme. The same analysis of knowledge was performed with respect to teenagers who received SRH interventions as part of the SeSa compared to teenagers who did not participate in a specific SRH education programme. Risk perception and risky behaviour were studied before and after the programme among healthcare students and teenagers. RESULTS: More than 70% of the targeted population participated in the study, with 747 healthcare students and 292 teenagers. SRH peer educators increased their knowledge score significantly more than other peer educators (a difference of 2.1 points/30 [95% CI 1.4-2.9] (p [between group] <  0.001)). Teenagers participating in the SeSa interventions also had a greater increase in their knowledge score than the other teenagers (+ 5.2/30 [95% CI 3.2-7.4] p [between group] < 0.001). There was no evidence of change in sexual risk behaviours for the healthcare student population. CONCLUSION: The "Service Sanitaire" programme significantly improved the sexual and reproductive health knowledge of peer-educator healthcare students and teenagers compared to a classic education programme. Longer and/or qualitative studies are needed to evaluate changes in sexual behaviour as well as positive impacts on sexuality.

Ultrasound-Guided Perimeniscal Injections: Anatomical Description and Feasibility Study.

OBJECTIVES: To anatomically describe the ultrasound (US)-guided perimeniscal injection technique, and evaluate its feasibility in the treatment of meniscal pain. METHODS: This work was initially undertaken in four cadaveric specimens with US-guided medial and lateral perimeniscal injection of China ink, followed by cadaveric dissection to assess injectate distribution, and potential injury to intra-articular and peri-articular structures. Then, 35 consecutive patients who underwent US-guided perimeniscal corticosteroid injection under local anesthesia for the treatment of symptomatic medial (30/35) or lateral (5/35) degenerative meniscal tear were retrospectively evaluated. Clinical outcome was assessed using a 0-10 numerical verbal rating scale (VRS) to evaluate severity of pain before, during, and after procedure at 6 weeks follow-up. RESULTS: Seven of eight (87.5%) ex vivo injections were accurate. A single inaccurate medial perimeniscal injection infiltrated the tibial collateral ligament instead of the perimeniscal area. No anatomical specimen exhibited intrameniscal injection or injury to regional structures. All procedures (35/35) performed clinically were technically successful. Median VRS scores were: 7 (range, 3-9) before procedure, 5 (range, 0-10) during procedure, and 1.5 (range, 0-9) after procedure at 6 weeks follow-up (P <.0001). No complication was observed. CONCLUSIONS: US-guided perimeniscal injections can accurately and safely deliver injectates in the perimeniscal area. In addition, our data suggest that perimeniscal corticosteroid injection provides significant symptom relief at 6 weeks in patients with meniscal pain. Further studies with long-term follow-up will be required to evaluate the role of perimeniscal injections in the nonoperative management of meniscal pathology.

Poststroke Postural Sway Improved by Botulinum Toxin: A Multicenter Randomized Double-blind Controlled Trial.

OBJECTIVE: To assess the effects of injecting botulinum toxin into the lower limb muscles of people with hemiparesis post stroke in terms of their sway areas. DESIGN: A multicenter randomized double-blind trial on the effects of active botulinum toxin treatment vs placebo. SETTING: Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. PARTICIPANTS: People with hemiparesis with chronic post stroke lower limb spasticity (N=40). INTERVENTIONS: Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. MAIN OUTCOME MEASURES: The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. RESULTS: Forty people post stroke were enrolled and randomized into 2 groups, one of which was treated with botulinum toxin (n=19) and the other with placebo (n=21). Spasticity decreased significantly in the treatment group (-0.7, P=.049 in the soleus muscles; -0.8, P=.035 in the gastrocnemii muscles). The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease (P=.005) in the sway area occurred in the treatment group (-3.11±6.92) in comparison with the placebo group (+0.27±3.57). CONCLUSION: Treating spasticity by injecting botulinum toxin into people's lower limb muscles post stroke seems to improve their postural sway. The dual task used here to assess sway seems to be a useful, sensitive test for this purpose.

Fostering the highest educational standards in Physical and Rehabilitation Medicine: The European PRM board strategy for ensuring overall quality of rehabilitation education and care.

The harmonization of staff education is a key element for ensuring the highest standard of rehabilitation care across Europe. With this aim, the European Union of Medical Specialists (UEMS) has created a Common Training Framework, which consists of a common set of knowledge, skills and competencies for postgraduate medical training. As a body linked to the Physical and Rehabilitation (PRM) Section of the UEMS, the European PRM Board is committed to promoting the harmonization of PRM physicians qualifications. The European PRM Board accomplishes this mission, not only by determining the theoretical knowledge necessary for the practice of the PRM specialty, and the core competencies (training outcomes) to be achieved at the end of training, but also by ascertaining that a standard level of education is achieved and maintained by PRM physicians, through a medically driven system of certification. This paper provides an overview of the methodology and outcomes of the European PRM Board examination, while showing how the approach to PRM education should be considered as a reference point by scientific societies, higher education institutions, health policymakers, patients associations, and all the other bodies caring for high-quality rehabilitation provision to disabled people, at the national and European level.

Knee-ankle-foot orthoses for treating posterior knee pain resulting from genu recurvatum: Efficiency, patients' tolerance and satisfaction.

OBJECTIVE: To assess the efficiency of knee-ankle-foot orthoses for treating painful genu recurvatum, and to determine users' tolerance and satisfaction. PATIENTS: Patients included in the study had a genu recurvatum during the stance phase, confirmed by a medical doctor on physical examination. A total of 27 patients with 31 knee-ankle-foot orthoses were included. METHODS: The main outcome was scored on a verbal numerical rating scale (VNRS) before and at least 3 months after a knee-ankle-foot orthosis was fitted, and scored on a verbal numerical pain rating scale (VRS). Secondary outcomes were rated with the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST). RESULTS: After fitting the knee-ankle-foot orthosis, the median VNRS pain score decreased from 85/100 to 25/100 (p ≤ 0.001) and the description of pain on the VRS decreased from "extreme" to "mild" (p ≤ 0.001). The QUEST total score was 4.0. CONCLUSION: Treating a painful genu recurvatum with a knee-ankle-foot orthosis reduced the pain efficiently whatever the patients' diagnosis, and high scores were obtained for patients' satisfaction.

Return to surfing using an adapted prosthesis: A case report.

BACKGROUND: Surfing with transfemoral knee prosthesis requires flexion of the hip, knee, and ankle and balance between flexibility and stiffness of the prosthetic limb. We report on Mr D, a transfemoral amputee, who wanted to surf again. Case Description and Methods: Technical specifications were based on Mr D's complaint. The prosthesis is salt water resistant and combines a shock absorber associated with elastic tendons to permit the knee to bend easily and to facilitate eccentric braking. Surfing was observed using videos of movements and subjective analysis of compensations. Findings and Outcomes: Mr D uses this prosthesis for surfing with good results and got back to his former level using compensations. During the takeoff, he cannot shorten his left leg. He makes a circumduction movement to put his leg in front of the board. CONCLUSION: This prosthesis is adapted for surfing and allows precise adjustments to surfing conditions. Clinical relevance Appropriate prosthesis design can enable return to surfing for a transfemoral amputee.

Intensive Early Rehabilitation in the Intensive Care Unit for Liver Transplant Recipients: A Randomized Controlled Trial.

OBJECTIVE: To validate the feasibility and tolerance of an intensive rehabilitation protocol initiated during the postoperative period in an intensive care unit (ICU) in liver transplant recipients. DESIGN: Prospective randomized study. SETTING: ICU. PARTICIPANTS: Liver transplant recipients over a period of 1 year (N=40). INTERVENTIONS: The "usual treatment group" (n=20), which benefited from the usual treatment applied in the ICU (based on physician prescription for the physiotherapist, with one session a day), and the experimental group (n=20), which followed a protocol of early and intensive rehabilitation (based on a written protocol validated by physicians and an evaluation by physiotherapist, with 2 sessions a day), were compared. MAIN OUTCOME MEASURES: Our primary aims were tolerance, assessed from the number of adverse events during rehabilitation sessions, and feasibility, assessed from the number of sessions discontinued. RESULTS: The results revealed a small percentage of adverse events (1.5% in the usual treatment group vs 1.06% in the experimental group) that were considered to be of low intensity. Patients in the experimental group sat on the edge of their beds sooner (2.6 vs 9.7d; P=.048) and their intestinal transit resumed earlier (5.6 vs 3.7d; P=.015) than patients in the usual treatment group. There was no significant difference between the 2 arms regarding length of stay (LOS), despite a decrease in duration in the experimental group. CONCLUSIONS: The introduction of an intensive early rehabilitation program for liver transplant recipients was well tolerated and feasible in the ICU. We noted that the different activities proposed were introduced sooner in the experimental group. Moreover, there is a tendency to decreased LOS in the ICU for the experimental group. These results now need to be confirmed by studies on a larger scale.

Orthopaedic shoes along with physical therapy was effective in Charcot-Marie-Tooth patient over 10 years.

BACKGROUND: The aim was to investigate the effectiveness of custom-made orthopaedic shoes (derby shoes) along with physiotherapy (twice a week) on a person with Charcot-Marie-Tooth over a period of 10 years. CASE DESCRIPTION AND METHODS: A 66-year-old woman with Charcot-Marie-Tooth disease, who did not have other health conditions, complained of pain and frequent falls. Physical examination, including ankle, knee and hip muscle strength; sensory evaluation of foot and joint range of motion; self-reported assessment of pain, frequency of falls and sprains; and gait analyses, including spatial and temporal parameters and motion analyses, were performed in 2001, 2007 and 2011. FINDINGS AND OUTCOMES: During the 10 years of follow-up, the physical examination parameters had stabilized since 2001; falls, sprains and walking distance had improved as compared to 2000; pain had alleviated since 2001 and gait parameters had improved up to 2007 and stabilized between 2007 and 2011. CONCLUSION: Bracing with orthopaedic shoes along with physical therapy was effective in treating pain, improving the gait and enhancing the walking distance (>500 m) without assistive device in a person with Charcot-Marie-Tooth disease. CLINICAL RELEVANCE: Orthopaedic shoes along with physical therapy can be a good option for treating Charcot-Marie-Tooth associated pain, foot drop, falls and sprains, improving the gait abnormalities and also increasing the walking distance.

Plastic changes in spinal synaptic transmission following botulinum toxin A in patients with post-stroke spasticity.

OBJECTIVE: The therapeutic effects of intramuscular injections of botulinum toxin-type A on spasticity can largely be explained by its blocking action at the neuromuscular junction. Botulinum toxin-type A is also thought to have a central action on the functional organization of the central nervous system. This study assessed the action of botulinum toxin-type A on spinal motor networks by investigating post-activation depression of the soleus H-reflex in post-stroke patients. Post-activation depression, a presynaptic mechanism controlling the synaptic efficacy of Ia-motoneuron transmission, is involved in the pathophysiology of spasticity. PATIENTS: Eight patients with chronic hemiplegia post-stroke presenting with lower limb spasticity and requiring botulinum toxin-type A injection in the ankle extensor muscle. METHODS: Post-activation depression of soleus H-reflex assessed as frequency-related depression of H-reflex was investigated before and 3, 6 and 12 weeks after botulinum toxin-type A injections in the triceps surae. Post-activation depression was quantified as the ratio between H-reflex amplitude at 0.5 and 0.1 Hz. RESULTS: Post-activation depression of soleus H-reflex, which is reduced on the paretic leg, was affected 3 weeks after botulinum toxin-type A injection. Depending on the residual motor capacity of the post-stroke patients, post-activation depression was either restored in patients with preserved voluntary motor control or further reduced in patients with no residual voluntary control. CONCLUSION: Botulinum toxin treatment induces synaptic plasticity at the Ia-motoneuron synapse in post-stroke paretic patients, which suggests that the effectiveness of botulinum toxin-type A in post-stroke rehabilitation might be partly due to its central effects.

A census of students with disabilities and the support provided at the University of Aix-Marseille.

Access to the college cycle for students with disabilities and their employability have become a priority for universities. The Handicap Mission manages it within the Aix-Marseille University (AMU). Few studies have focused on the students with disabilities' insertion/integration within the universities and on the compensations. The objective of this study is to analyze within the AMU the students with disabilities census and characteristics, and the Handicap Mission's operating. The census was conducted using a self-administered questionnaire (Handi need card: university curriculum, deficiencies, technical and social help, adjustments appealed for at the university). It was performed by the staff at the AMU's Mission Handicap Department/Office. If supporting measures seem to be necessary, the interdisciplinary team (comprised of representatives of the University teaching, Administrative and Technical staff, Mission Handicap staff, Preventive Medicine staff, and partners from associations involved in assisting people with disabilities) then defines and sets up suitable means of assistance. The Handicap Mission improves students with disabilities insertion, defines necessary adjustments, and promotes research on disability. A total of 551 students with disabilities were identified, 304 in law and human sciences. In all, 141 deficiencies encountered related to language disorders, among which 105 were not defined by the students ('Other' in the questionnaire). In all, 519 SWD benefited from extra time when sitting exams and 40 were helped to take notes by others students. Compensations and Handicap Mission improve the monitoring and the link between high school and university for the students with disabilities, promote their exam success, and support them in their working life.

Chronic ankle instability and common fibular nerve injury.

The lateral collateral ligaments of the ankle are often damaged in ankle inversion injuries. Ankle inversion may also cause injury to other structures located around the ankle or further away, such as the common fibular nerve. Few descriptions exist of common fibular nerve injury associated with ankle sprains and chronic ankle instability. We describe the case of a patient who sustained common fibular nerve injury during each of two ankle sprain recurrences involving the lateral collateral ligaments. Our objectives are to illustrate the links between common fibular nerve and lateral collateral ligament injuries and to emphasize the importance of the neurological evaluation in patients seen for ankle sprains or chronic ankle instability.