[Outcome of the Aquitaine Unit for Evaluation, Training and Social and Vocational Counselling (UEROS) at 5-year follow-up in young adults with brain damage]. / Programme d'aide à la réinsertion sociale et professionnelle de jeunes adultes cérébrolésés: résultats à cinq ans du réseau UEROS-Aquitaine.

INTRODUCTION: Difficulties in social and vocational adjustment are common in adults with brain damage. A French government-funded program, UEROS (Unit for Evaluation, Training and Social and Vocational Counselling), was developed to improve cognitive adjustment, social autonomy and return to work for these people. OBJECTIVES: To describe the outcome and satisfaction with life after 5 years for patients who participated in the UEROS-Aquitaine network program. MAIN OUTCOME MEASURES: EBIS Document to evaluate people with traumatic brain injury. RESULTS: Seventy-five of the 102 patients participating in UEROS from 1997 to 1999 were assessed during a phone-structured interview based on the EBIS Document. The sample consisted of young adults (mean age 28.5 years), most (65, 85%) with brain injury and moderate disability (Glasgow Outcome Scale 2: 57%) or severe disability (Glasgow Outcome Scale 3: 42%). On entering the program, 33% of the subjects needed no help physically or cognitively. None were employed. At the end of the program, 9% were students or were learning a job, 8% worked full-time, 16% were in sheltered conditions, and 13% had volunteer activities. At 5-year follow-up, 50% of the subjects were independent, 4% were in school, 10.6% worked full-time, and 26.7% were in sheltered conditions. Playing sports was associated with good social adjustment. The professional status at 5 years was significantly correlated with following the UEROS program (r=0.30, P<0.01) and status at the end of the program (r=0.29, P<0.05). However, 41.3% of the subjects were still unsatisfied with their conditions of life. DISCUSSION-CONCLUSION: In patients with brain damage, the UEROS-Aquitaine network program improves independence in daily living and allows for nearly one inactive adult in two (42%) to be engaged in an activity or a job.

Satisfaction of life and late psycho-social outcome after severe brain injury: a nine-year follow-up study in Aquitaine.

In view of assessing their late outcome and satisfaction of life, 79 out of 158 severe traumatic brain injury (STBI) patients who received inpatient rehabilitation in Aquitaine in 1993 were followed by phone interview. Results showed that 9 years on average after their injury, 65 to 85% of these patients were independent for daily living, whereas 35 to 55% only were independent in social life. Most of the patients were satisfied with their autonomy (67%), family life (66%) and financial status (41%), but they were dissatisfied with leisures (36%), vocational adjustment (28%) and sexual life (32%). Satisfaction of life was mostly related to age, gender, physical autonomy, need of help because of cognitive impairment and functional outcome as assessed by the Glasgow Outcome Scale. Severe traumatic brain injury (STBI) stands in industrialised countries as a major Public Health problem and a dreadful human drama for the patients, their families and the community [2]. A great number of STBI patients survive with severe disability, most of them being young adults. The most severely impaired may live only with their parents or in high-cost nursing homes. From a psychological point of view, STBI causes a total and sudden breakdown of the mental states, personality and conditions of life. Life plans and projects are definitively disrupted, satisfaction of life is deeply changed. Rehabilitation aims at improving functional outcome of persons with STBI, and at improving their overall quality of life. Planning for rehabilitation and re-entry into community of STBI patients need to be provided with precise data on their late outcome and disability level. Despite that the concepts of quality and satisfaction of life are difficult to define and moreover to assess, these are also major factors to take into account. The aims of the present study were to assess the late psycho-social outcome of patients hospitalized in Aquitaine for rehabilitation of a STBI 7 to 10 years after their injury, and to ask for their satisfaction of life and subjective feeling of quality of life.

[Life satisfaction and psychosocial outcome in severe traumatic brain injuries in Aquitaine]. / Satisfaction de vie et devenir psychosocial des traumatisés crâniens graves en Aquitaine.

OBJECTIVE: To assess late outcome and satisfaction of life of patients with severe traumatic brain injury (TBI) patients who received inpatient rehabilitation in Aquitaine. DESIGN AND PATIENTS: Seventy-nine consecutive patients out of the 158 who were hospitalized for rehabilitation in 1993 were asked for in 2000 by a phone interview including standardised scales and free talk as well. RESULTS: The results showed that nine years on average after their injury, 65 to 85% of patients were independent for daily living, whereas 35 to 55% only were independent in social life. Most of them were satisfied with their autonomy (67%), family life (66%) and financial status (41%), but they were dissatisfied with leisure (36%), vocational adjustment (28%) and sexual life (32%). CONCLUSION: Return to work, leisure and sexuality are major parameters of satisfaction of life after a severe TBI, and should be emphasized in goal-directed rehabilitation programs.

Returning to work after a stroke: a retrospective study at the Physical and Rehabilitation Medicine Center La Tour de Gassies.

OBJECTIVE: To study work re-entry by patients having suffered a stroke at least 3 years previously. PATIENTS AND METHODS: This was a retrospective survey in which a questionnaire was administered to all patients admitted after a first stroke to the "La Tour de Gassies" Centre for Physical and Rehabilitation Medicine (CPRM) in France between January 2005 and June 2007 and who were in work at the time of the incident. RESULTS: Fifty-six of the 72 included patients (78%) completed and returned the survey questionnaire. The mean age at the time of the stroke was 48.3±10.1. Eighteen (32.1%) of the 56 patients returned to work after their stroke (mean post-stroke time interval: 19.2±13.4 months). Negative prognostic factors for a return to work were living alone, the presence of severe functional impairment and the presence of speech disorders. Positive prognostic factors included specific, professional support and early involvement of the occupational physician. Patients who resumed driving were more likely to return to work and there was a positive correlation between the time to work re-entry and the time to resumption of driving. CONCLUSION: Close cooperation between occupational health services and CPRM appears to be necessary to speed the return to work by stroke patients.

[Noncompressive myelopathy and dysglobulinemia. A fortuitous association? Discussion of 3 new cases]. / Myélopathies non compressives et dysglobulinémies. Association fortuite? Discussion de trois nouveaux cas.

Three new cases of myelopathy without compression associated with paraproteinemia are reported. The neurologic picture was that of spinal muscular atrophy in one case and chronic spinal combined sclerosis in two. The nature of the paraproteinemia is discussed: all three patients seem to have had benign monoclonal dysglobulinemia. One patient died from cardiovascular disease five years after onset, and another from complications related to decubitus seven years after onset. Postmortem examination was not possible in either case. Spinal muscular atrophy has been reported in certain carcinomas (lung, stomach, breast) and, less frequently, in macroglobulinemia. As benign dysglobulinemia is common after sixty, coincidental association cannot be outruled. However, data from the literature and the response to cancer chemotherapy in two patients suggest an original pathologic association. Recent demonstration of demyelinating neuropathies associated with benign paraproteinemia provide further evidence in support of such an association.

Early prognostic factors for walking in spinal cord injuries.

The authors present a prospective analysis with 1 year follow-up of about 157 consecutive spinal cord injured patients admitted to the Bordeaux CHU, over a 3 year period (1982-1985). They present a method of analysing the walking status recovery in patients with spinal cord injuries from the early factors recorded on initial clinical examination. Twenty eight per cent of all patients are 'functional walkers', 1 year after injury. Three early factors were selected: age; the level of injury; and the initial Yale Scale Score. Only the age and the initial Yale Scale Score are independent predictive factors, according to the Cox model. The authors present a model of walking status recovery, 1 year after the injury, predicted from age and the initial Yale Scale Score.

Unilateral neglect syndrome rehabilitation by trunk rotation and scanning training.

OBJECTIVE: Assessment of a new rehabilitation method for unilateral neglect syndrome (UNS), using a specific device (Bon Saint Come's device) that associates exploratory reconditioning with voluntary trunk rotation. DESIGN: Study 1, randomized control trial during 2 months; study 2, nonrandomized control trial during 2 months. SETTING: Neurorehabilitation units in private and public center. PATIENTS: In study 1, 22 consecutive patients with UNS resulting from recent stroke (< 3 months) were randomly assigned to an Experimental Group (11 patients) or to a Control Group (11 patients). The 2 groups were very similar in terms of general and neurological data. In study 2, 5 consecutive patients with chronic UNS resulting from an old stroke (> 6 months) showing the same characteristics were included. INTERVENTION: In study 1, patients in Group E followed the experimental program 1 hour a day for 1 month (20 hours) and Group C followed usual neurorehabilitation during the same time. In study 2, every patient followed the experimental program 1 hour a day for 1 month (20 hours). MAIN OUTCOME MEASURES: Assessment in both studies was done at day 0, day 30, and day 60 using a battery of UNS tests (Albert, Scheckenberg, bell) and an activities of daily living (ADL) test (the Functional Independence Measure [FIM]). Mean scores of each test were compared between the 2 groups with the Wilcoxon nonparametric test. RESULTS: In study 1 all UNS test results and the FIM improved significantly more in Group E than in Group C. In Group E, UNS disappeared in 5 patients and improved in 6. In Group C, UNS disappeared in 1 patient, improved in 4, and was unchanged in 6. In Study 2, UNS remitted in 2 patients, improved in 2 patients, and was unchanged in 1. CONCLUSION: The Bon Saint Come method seems to significantly improve recent and chronic UNS, as well as ADL function. These encouraging results could have resulted from a synergistic effect of spatial reconditioning and voluntary trunk rotation. It must be assessed by a new study with more patients.

A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients.

OBJECTIVE: To confirm the apparent effectiveness of botulinum toxin (BTX) in hemiparetic patients with ankle plantar flexors and foot invertor spasticity. METHODS: Twenty three hemiparetic patients with spasticity of the ankle plantar flexors and foot invertors were included in a randomised double blind, placebo controlled study with BTX. Patients were examined on days 0, 30, 90, and 120 and received one injection of BTX and one of placebo in a random order at day 0 and day 90. RESULTS: Patients reported a clear subjective improvement in foot spasticity after BTX (P = 0.0014) but not after placebo. Significant changes were noted in Ashworth scale values for ankle extensors (P < 0.0001) and invertors (P = 0.0002), and for active ankle dorsiflexion (P = 0.0001). Gait velocity was slightly but not significantly (P = 0.0731) improved after BTX injections. The severity of spasticity did not modify treatment efficacy, but BTX was less effective in patients with longer duration of spasticity (P = 0.0081). CONCLUSION: The efficacy of BTX injections in the treatment of spastic foot suggests that BTX may be particularly useful during the first year after a stroke.

Rehabilitation of postural disturbances of hemiplegic patients by using trunk control retraining during exploratory exercises.

OBJECTIVE: To assess use of the Bon Saint Côme device for axial postural rehabilitation in hemiplegic patients, a technique based on voluntary trunk control during exploratory retraining. DESIGN: A 3-month randomized controlled trial. SETTING: A public neurorehabilitation center. PATIENTS: Twenty consecutive hemiplegic patients with axial postural disturbance resulting from recent stroke were randomly assigned to a device group (DG) or control group (CG). The 2 groups of 10 patients were similar. INTERVENTION: For 1 month, the DG patients followed an experimental program for 1 hour daily and conventional neurorehabilitation for 1 hour daily, whereas CG patients had conventional neurorehabilitation for 2 hours daily. For the next 2 months, all 20 patients had conventional neurorehabilitation for 2 hours daily. MAIN OUTCOME MEASURES: Patients were assessed on days 0, 30, and 90 by using a battery of postural tests, gait evaluation, the Bells neglect test, and the FIM instrument. RESULTS: On day 30, postural and neglect tests improved significantly more in DG than in CG. The benefit remained at day 90. Gait improved earlier in DG than in CG. FIM scores improved equally. CONCLUSIONS: Voluntary trunk control retraining during spatial exploration with the Bon Saint Côme device appears to be a useful approach for rehabilitation of postural disorders in hemiplegic patients. Treatments designed to improve spatial cognition deficits probably enhance postural disorder recovery in hemiplegia.