Goal Attainment Scaling in rehabilitation: An educational review providing a comprehensive didactical tool box for implementing Goal Attainment Scaling

CONTEXT

Goal Attainment Scaling (GAS) is a person-centered and collaborative approach, allowing to assess the effectiveness of an intervention on personally relevant goals. However, GAS is not a "scale" but a heterogeneous group of methodologies, including many variations and lack of consensus on high quality GAS.

OBJECTIVE

The aim of this communication is to: 1. provide updated didactical information on GAS use in PRM practice and research; 2. increase awareness of GAS methodological challenges; 3. guide use of GAS as an integrated process of rehabilitation after goal setting and; 4. provide updated resources for self-directed learning and extensive supplemental material to increase knowledge and practical skills in GAS use.

METHODS

Educational literature review about current GAS applications relevant to PRM fields.

RESULTS

Practical advice is provided regarding clinical challenges in GAS: definition of 0 level, time-frame and means employed to attain the goal, dealing with unforeseen pattern of improvement, synthesizing the numerous significations of "SMART" goal acronym to guide best use of GAS, and thinking flexibility on the type of relevant goals that can be set. Challenges with GAS in rehabilitation research are presented in order to promote researcher's and reviewer's awareness on reliable use of GAS and encouraging best-use of GAS.

High-intensity downhill running exacerbates heart rate and muscular fatigue in trail runners

This study explores the cardiorespiratory and muscular fatigue responses to downhill (DR) vs uphill running (UR) at similar running speed or similar oxygen uptake (⩒O₂). Eight well-trained, male, trail runners completed a maximal level incremental test and three 15-min treadmill running trials at ±15% slope: i) DR at ~6 km·h^-1 and ~19% ⩒O_2max (LDR); ii) UR at ~6 km·h^-1 and ~70% ⩒O_2max (HUR); iii) DR at ~19 km·h^-1 and ~70% ⩒O_2max (HDR). Cardiorespiratory responses and spatiotemporal gait parameters were measured continuously. Maximal isometric torque was assessed before and after each trial for hip and knee extensors and plantar flexor muscles. At similar speed (~6 km·h^-1), cardiorespiratory responses were attenuated in LDR vs HUR with altered running kinematics (all p < 0.05). At similar ⩒O₂ (~3 l·min^-1), heart rate, pulmonary ventilation and breathing frequency were exacerbated in HDR vs HUR (p < 0.01), with reduced torque in knee (-15%) and hip (-11%) extensors and altered spatiotemporal gait parameters (all p < 0.01). Despite submaximal metabolic intensity (70% ⩒O_2max), heart rate and respiratory frequency reached maximal values in HDR. These results further our understanding of the particular cardiorespiratory and muscular fatigue responses to DR and provide the bases for future DR training programs for trail runners.

Charlie Chaplin and gesture training in severe aphasia: A controlled double-blind single-case experimental design

BACKGROUND

Aphasia following a stroke is a frequent and disabling condition that decreases quality of life. The use of gesture has been proposed as a way to enhance aphasia recovery.

OBJECTIVE

We aimed to explore whether 2 types of gesture interventions could improve communication in individuals with severe aphasia.

METHODS

This was a pilot study performed at home in routine care by an outreach team. The study had a controlled double-blind single-case experimental design (SCED): a controlled multiple baseline design across 3 participants and 2 behaviors (gesture and naming). Three male patients with stroke-induced severe chronic aphasia, non-functional perseverative speech and severe associated impairments underwent a passive gesture intervention, in which participants watched movies selected for their intensive use of gesture, and an active gesture intervention, in which they actively practiced gestures by using visual action therapy. The main outcome measures were naming score, gesture score and nonverbal subscale score of the Lillois Test of Communication, with 3-month follow-up.

RESULTS

In all 3 participants, gesture interventions improved the ability to gesture a list of words (Tau-U=0.38-0.67 for combined gesture intervention effect) and increased nonverbal communication activity. Benefits were maintained at 3-month follow-up.

CONCLUSIONS

Mute films that use intensive nonverbal communication may be a useful add-on to speech therapy for individuals with aphasia. Improving naming in severe and chronic aphasia may not be feasible, and more effort could be devoted to improving gesture-based and nonverbal communication.

Cardiorespiratory Responses to Downhill Versus Uphill Running in Endurance Athletes

PURPOSE

Mountain running races are becoming increasingly popular, although our understanding of the particular physiology associated with downhill running (DR) in trained athletes remains scarce. This study explored the cardiorespiratory responses to high-slope constant velocity uphill running (UR) and DR.

METHOD

Eight endurance athletes performed a maximal incremental test and 2 15-min running bouts (UR, +15%, or DR, -15%) at the same running velocity (8.5 ± 0.4 km·h^-1). Oxygen uptake ([Formula: see text]O₂), heart rate (HR), and ventilation rates ([Formula: see text]_E) were continuously recorded, and blood lactate (bLa) was measured before and after each trial.

RESULTS

Downhill running induced a more superficial [Formula: see text]_E pattern featuring reduced tidal volume (p < .05, ES = 6.05) but similar respiratory frequency (p > .05, ES = 0.68) despite lower [Formula: see text]_E (p < .05, ES = 5.46), [Formula: see text]O₂ (p < .05, ES = 12.68), HR (p < .05, ES = 6.42), and bLa (p < .05, ES = 1.70). A negative slow component was observed during DR for [Formula: see text]O₂ (p < .05, ES = 1.72) and HR (p < .05, ES = 0.80).

CONCLUSIONS

These results emphasize the cardiorespiratory responses to DR and highlight the need for cautious interpretation of [Formula: see text]O₂, HR, and [Formula: see text]_E patterns as markers of exercise intensity for training load prescription and management.

Lasting relief of chronic anterior knee pain in young adult after ten weekly inductive physiotherapy sessions: A case report

BACKGROUND

Patellofemoral pain syndrome particularly impairs quality of life in young, physically active subjects. The exact etiology remains unknown, and so this syndrome is a challenging condition to treat. Some patients continue to experience pain and dysfunction after receiving one or more guidelines-compliant conservative treatments. Reducing the likelihood of patellofemoral pain syndrome is an important way of preventing the onset of debilitating anterior knee pain at all ages of life.

CASE

A 24-year-old sportswoman with a 15-month history of anterior knee pain and failure of previous guidelines-compliant treatments. We treated this patient with techniques derived from the paradigm of inductive physiotherapy, in which tone disorders with a central origin may contribute to musculoskeletal disorders. One distinctive feature of inductive physiotherapy relates to the fact that the painful area is not manipulated directly.

RESULTS

The effects of physiotherapy were evaluated after ten weekly sessions and then 15 months later. The changes in the visual analogue pain scale score and the Knee Lequesne Index were clinically significant. We also observed an unexpected reduction in the static varus misalignment.

CONCLUSION

This case could pave the way to an innovative neurological approach to the management of patellofemoral pain syndrome in the young adult.

High-intensity interval training combined with resistance training improves physiological capacities, strength and quality of life in multiple sclerosis patients: a pilot study

BACKGROUND

Numerous studies have shown that mild-to-moderate intensity or resistance exercise training improves physical capacities such as, peak oxygen consumption, maximal tolerated power and strength in multiple sclerosis patients. However, few studies have evaluated the effects of high-intensity interval training (HIIT) associated to with resistance training. Only few studies have analyzed difference between men and women before and after combined training. Moreover, the evaluation of exercise between ambulatory multiple sclerosis patients without disability (Expanded Disability Status Score [EDSS] 0-3) and patients with disabilities (EDSS 3.5-5) was not largely published.

AIM

The main objective of our study was to determine if HIIT combined with resistance training improved aerobic and strength capacities as well as quality of life in multiple sclerosis patients and if gender and disabilities play a role in these changes.

DESIGN

This study was an open-label uncontrolled study.

SETTING

The study was performed outside from conventional care facilities and including homebased training.

POPULATION

Twenty-six multiple sclerosis patients have completed the program (19 women, 7 men; mean age 44.6±7.9 years, EDSS 2 [0-5]).

METHODS

We conducted a 12-week program of high-intensity interval training combined with resistance training at body weight. Peak oxygen consumption, maximal tolerated power, lactates, isokinetic strength of quadriceps and hamstrings (at 90°/s, 180°/s, and 240°/s) and quality of life were evaluated before and after the program.

RESULTS

Peak oxygen consumption and maximum tolerated power improved by 13.5% and 9.4%, respectively. Isokinetic muscle strength increased in both quadriceps and hamstrings at each speed, with a rebalancing of strength between the two legs in quadriceps. Quality of life was also enhanced in three domains. Women showed better improvements than men in V̇O2peak, maximal tolerated power, lactates at the end of test, and heart rate peak, strength in both quadriceps and hamstrings mostly at low speed, and quality of life. The two EDSS groups increased V̇O2peak and strength.

CONCLUSIONS

Our study has shown that HIIT combined with resistance exercise training induced an improvement in physical capacity and quality of life. Moreover, this study allowed patients, irrespective of their sex or EDSS score, to resume exercise autonomously.

CLINICAL REHABILITATION IMPACT

The results of the study showed that aerobic training at moderate intensity is not the single type of training tolerated by multiple sclerosis patients. High-intensity interval training is well tolerated too and can be used in clinical rehabilitation with resistance training, in both men and women with and without disabilities.

High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial

OBJECTIVE

This study compared the effects of high-force versus low-force lumbar traction in the treatment of acute lumbar sciatica secondary to disc herniation.

METHODS

A randomized double blind trial was performed, and 17 subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50% body weight (BW; LT50, n = 8) or low force traction at 10% BW (LT10, n = 9) for 10 sessions in 2 weeks. Radicular pain (visual analogue scale [VAS]), lumbo-pelvic-hip complex motion (finger-to-toe test), lumbar-spine mobility (Schöber-Macrae test), nerve root compression (straight-leg-raising test), disability (EIFEL score), drug consumption, and overall evaluation of each patient were measured at days 0, 7, 1, 4, and 28.

RESULTS

Significant (P < .05) improvements were observed in the LT50 and LT10 groups, respectively, between day 0 and day 14 (end of treatment) for VAS (-44% and -36%), EIFEL score (-43% and -28%) and overall patient evaluation (+3.1 and +2.0 points). At that time, LT50 specifically improved in the finger-to-toe test (-42%), the straight-leg-raising test (+58), and drug consumption (-50%). No significant interaction effect (group-by-time) was revealed, and the effect of traction treatment was independent of the level of medication. During the 2-week follow-up at day 28, only the LT10 group improved (P < .05) in VAS (-52%) and EIFEL scores (-46%). During this period, no interaction effect (group-by-time) was identified, and the observed responses were independent of the level of medication.

CONCLUSIONS

For this preliminary study, patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned. The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up.

Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer

[Purpose] To compare measurements of knee extensor and flexor muscle strength performed using a hand-held dynamometer and an isokinetic dynamometer in apparently healthy subjects. [Subjects and Methods] Thirty adult volunteers underwent knee muscle strength evaluation using an isokinetic or a hand-held dynamometer. [Results] Strong positive correlations were found between the 2 methods, with correlation coefficients r ranging from 0.72 (95% confidence interval [CI], 0.48-0.86) to 0.87 (95% CI, 0.75-0.94), depending on the muscle group and the isokinetic evaluation mode. The reproducibility of the hand-held dynamometer findings was good, judged by a coefficient of variation of 3.2-4.2%. However, the correlation between the 2 methods for the assessment of flexor/extensor ratios ranged from -0.04 to 0.46. [Conclusion] Knee extensor and flexor muscle strength recorded with a hand-held dynamometer is reproducible and significantly correlated with the isokinetic values, indicating that this method may in some cases be a useful replacement for isokinetic strength measurement. However, for strength ratio assessment, and when judged against the isokinetic standard, a hand-held dynamometer is not a valid option.

Mitochondrial function following downhill and/or uphill exercise training in rats

INTRODUCTION

The goal of this study was to compare the effects of downhill (DH), uphill (UH), and UH-DH exercise training, at the same metabolic rate, on exercise capacity and skeletal muscle mitochondrial function.

METHODS

Thirty-two Wistar rats were separated into a control and 3 trained groups. The trained groups exercised for 4 weeks, 5 times per week at the same metabolic rate, either in UH, DH, or combined UH-DH. Twenty-four hours after the last training session, the soleus, gastrocnemius, and vastus intermedius muscles were removed for assessment of mitochondrial respiration.

RESULTS

Exercise training, at the same metabolic rate, improved maximal running speed without specificity for exercise modalities. Maximal fiber respiration was enhanced in soleus and vastus intermedius in the UH group only.

CONCLUSIONS

Exercise training, performed at the same metabolic rate, improved exercise capacity, but only UH-trained rats enhanced mitochondrial function in both soleus and vastus intermedius skeletal muscle. Muscle Nerve 54: 925-935, 2016.

[Difficulties experienced at work by patients with multiple sclerosis]

AIM

Multiple sclerosis (MS) is a disease of the central nervous system that affects young adults at a time when they launch into the workforce. The disease often has a great impact on working life. The objective of this survey was to identify the problems faced by people with multiple sclerosis in the context of their work.

METHODS

To describe the difficulties experienced at work by patients with multiple sclerosis, we carried out in 2010 a regional survey including neurology and functional rehabilitation centers.

RESULTS

Two hundred and seven MS patients of working age responded to the survey. The employment rate was 67.6%. Among difficulties expressed by patients, physical and mental fatigue appeared as the issues affecting work. For 41% of respondents, preventive measures at work could help maintain or resume employment.

CONCLUSION

Problems of fatigability put forward by MS patients are elements that can predict a loss of employment.

Effect of a kneeling chair on lumbar curvature in patients with low back pain and healthy controls: A pilot study

BACKGROUND

The concept of an ideal sitting posture is often used in practice but lacks a basis in evidence.

OBJECTIVE

We designed a cross-sectional, comparative, matched study to determine the effects of chair and posture on lumbar curvature in 10 patients with chronic non-specific low back pain (CLBP; mean pain duration 24 ± 18 months) and 10 healthy matched controls.

METHODS

Pelvic incidence, sacral slope and lumbar curvature were measured on computed radiographs by 2 blinded clinicians for subjects in 2 postures (upright vs slumped sitting) and on 2 chairs (usual flat chair vs kneeling chair).

RESULTS

The reliability of measures was excellent (intraclass correlation coefficient>0.9). As hypothesized, the expected sacral slope and lumbar lordosis changed between standing and sitting on a kneeling chair as compared with a usual chair (P<0.0001) and less in patients than controls (P=0.046) for lordosis only. In addition, as expected, changes were more pronounced with slumped than upright sitting (P<0.0001). An interaction between chairs and postures for lumbar lordosis (P=0.02) indicated more pronounced effects of the chair in slumped sitting. Therefore, lumbar lordosis was reduced less when sitting on a kneeling chair as compared with a usual chair.

CONCLUSIONS

Although healthy subjects showed more reduction in lordosis between standing and sitting, the chair effect was found in both CLBP patients and healthy subjects.

Effect of eccentric versus concentric exercise training on mitochondrial function

INTRODUCTION

The effect of eccentric (ECC) versus concentric (CON) training on metabolic properties in skeletal muscle is understood poorly. We determined the responses in oxidative capacity and mitochondrial H2 O2 production after eccentric (ECC) versus concentric (CON) training performed at similar mechanical power.

METHODS

Forty-eight rats performed 5- or 20-day eccentric (ECC) or concentric (CON) training programs. Mitochondrial respiration, H2 O2 production, citrate synthase activity (CS), and skeletal muscle damage were assessed in gastrocnemius (GAS), soleus (SOL) and vastus intermedius (VI) muscles.

RESULTS

Maximal mitochondrial respiration improved only after 20 days of concentric (CON) training in GAS and SOL. H2 O2 production increased specifically after 20 days of eccentric ECC training in VI. Skeletal muscle damage occurred transiently in VI after 5 days of ECC training.

CONCLUSIONS

Twenty days of ECC versus CON training performed at similar mechanical power output do not increase skeletal muscle oxidative capacities, but it elevates mitochondrial H2 O2 production in VI, presumably linked to transient muscle damage.

Cryopreservation with dimethyl sulfoxide prevents accurate analysis of skinned skeletal muscle fibers mitochondrial respiration

Impact of cryopreservation protocols on skeletal muscle mitochondrial respiration remains controversial. We showed that oxygen consumption with main mitochondrial substrates in rat skeletal muscles was higher in fresh samples than in cryopreserved samples and that this difference was not fixed but grow significantly with respiration rates with wide fluctuations around the mean difference. Very close results were observed whatever the muscle type and the substrate used. Importantly, the deleterious effects of ischemia-reperfusion observed on fresh samples vanished when cryopreserved samples were studied. These data demonstrate that this technic should probably be performed only extemporaneously.

Microbiopsies versus Bergström needle for skeletal muscle sampling: impact on maximal mitochondrial respiration rate

INTRODUCTION

Microbiopsies are increasingly used as an alternative to the standard Bergström technique for skeletal muscle sampling. The potential impact of these two different procedures on mitochondrial respiration rate is unknown. The objective of this work was to compare microbiopsies versus Bergström procedure on mitochondrial respiration in skeletal muscle.

METHODS

52 vastus lateralis muscle samples were obtained from 13 anesthetized pigs, either with a Bergström [6 gauges (G)] needle or with microbiopsy needles (12, 14, 18G). Maximal mitochondrial respiration (V GM-ADP) was assessed using an oxygraphic method on permeabilized fibers.

RESULTS

The weight of the muscle samples and V GM-ADP decreased with the increasing gauge of the needles. A positive nonlinear relationship was observed between the weight of the muscle sample and the level of maximal mitochondrial respiration (r = 0.99, p < 0.05) and between needle size and maximal mitochondrial respiration (r = 0.99, p < 0.05).

CONCLUSION

Microbiopsies give lower muscle sample weight and maximal rate of mitochondrial respiration compared to the standard Bergström needle.Therefore, the higher the gauge (i.e. the smaller the size) of the microbiopsy needle, the lower is the maximal rate of respiration. Microbiopsies of skeletal muscle underestimate the maximal mitochondrial respiration rate, and this finding needs to be highlighted for adequate interpretation and comparison with literature data.

Intramuscular pressure before and after botulinum toxin in chronic exertional compartment syndrome of the leg: a preliminary study

BACKGROUND

Botulinum toxin A (BoNT-A) is used in the treatment of muscle hypertrophy but has never been used in chronic exertional compartment syndrome (CECS). The objective diagnostic criterion in this condition is an abnormally elevated intramuscular pressure (IMP) in the compartment. In this study, the IMP was measured 1 minute (P1) and 5 minutes (P5) after the exercise was stopped before and after BoNT-A injection.

HYPOTHESIS

Botulinum toxin A reduces the IMP (P1 and P5) and eliminates the pain associated with CECS.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Botulinum toxin A was injected into the muscles of moderately trained patients with an anterior or anterolateral exertional compartment syndrome of the leg. The BoNT-A dose (mean ± SD) ranged from 76 ± 7 to 108 ± 10 U per muscle, depending on which of the 5 muscles in the 2 compartments were injected. The primary end point was IMP (P1, P5). Secondary end points were exertional pain, muscle strength, and safety. Follow-up was conducted up to 9 months.

RESULTS

A total of 25 anterior compartments and 17 lateral compartments were injected in 16 patients. The time interval (mean ± SD) between the BoNT-A injection and after BoNT-A injection IMP measurement was 4.4 ± 1.6 months (range, 3-9 months). In the anterior compartment, P1 and P5 fell by 63% ± 17% (P < .00001) and 59% ± 24% (P < .0001), respectively; in the lateral compartment, P1 and P5 fell by 68% ± 21% (P < .001) and 63% ± 21% (P < .01), respectively. Exertional pain and muscle strength were monitored, based on the Medical Research Council score. The exertional pain was completely eliminated in 15 patients (94%). In 5 patients (31%), the strength of the injected muscles remained normal. In 11 patients (69%), strength decreased from 4.5 (out of 5) to 3.5 (P < .01), although without functional consequences. In the conditions of this study, BoNT-A showed a good safety profile in patients with CECS.

CONCLUSION

In this case series, BoNT-A reduced the IMP and eliminated exertional pain in anterior or anterolateral CECS of the leg for up to 9 months after the intervention. The mode of action of BoNT-A is still unclear. A randomized controlled study should be carried out to determine whether BoNT-A can be used as a medical alternative to surgical treatment.

Use of Postural Reconstruction® physiotherapy to treat an adolescent with asymmetric bilateral genu varum and idiopathic scoliosis

OBJECTIVE

To document the effect of Postural Reconstruction® physiotherapy on two postural disorders commonly observed in adolescents: genu varum and idiopathic scoliosis.

PATIENT AND METHODS

A case report on a 16-year-old boy suffering from knee pain and presenting with bilateral genu varum and mild scoliosis. At the initial evaluation (T0), the intercondylar space was 7 cm and the Cobb angles for the right lumbar curve and left thoracic curve were 18° and 13°, respectively. The boy was treated with Postural Reconstruction(®), a neuromuscular physiotherapy intervention using facilitation/inhibition techniques. The outcomes used to quantify the effect of 6 months (T1), 12 months (T2) and 26 months (T3) of treatment were pain levels, the intercondylar space, the lumbar gibbosity and the lumbar and thoracic Cobb angles.

RESULTS

The knee pain disappeared rapidly. At T3, the intercondylar space had decreased by 4 cm, the lumbar gibbosity angle had decreased by 2° and the lumbar and thoracic Cobb angles had decreased by 8° and 7°, respectively.

CONCLUSION

This non-invasive physiotherapy intervention appears to have considerable promise for the long-term correction of postural disorders.

Factitious torsion dystonia in rehabilitation: a singular new case and literature review

We report a case of a 29-year-old woman suffering from chronic factitious disorder (FD) with torsion dystonia. For nearly five years, she traveled widely over the country, going from one hospital to another, taking serious medical risk in order to prolong her illness. After several admissions to Rehabilitation Units and multiple explorations, we find convincing evidence for factitious origin and the diagnosis of Munchausen syndrome was evoked. Such a clinical presentation is infrequent in Munchausen's syndrome. Indeed, most often the clinical picture is characterized by acute abdominal pain, fainting, hemoptysis, precordialgia, hematemesis or dermatological lesions. Physicians should be aware of this rare and potentially critical form of FD. Awareness in identifying these patients may lead to prevent unnecessary medical and/or surgical interventions.

Sciatica, disk herniation, and neuroborreliosis. A report of four cases

We report four cases of sciatica in patients with same-level disk herniation confirmed by computed tomography and a final diagnosis of acute radiculitis caused by Borrelia burgdorferi, with a favorable response to ceftriaxone therapy. The neurological manifestations of Lyme disease are protean, and a potential contribution of concomitant disk disease to sciatica can lead to diagnostic wanderings. Disk lesions and infectious conditions that can cause sciatica are discussed. Whether a favorable response to antibiotic therapy should be taken as proof of B. burgdorferi radiculitis deserves discussion. In practice, in a patient with clinical manifestations suggesting disk-related nerve root pain and residing or having traveled to an endemic area, B. burgdorferi infection should be looked for, as both etiologies can coexist.

Le syndrome de loge d'effort

OBJECTIVES

To review the literature on chronic exertional compartment syndrome.

METHODS

We searched the Medline database with use of the keys words compartment syndrome, exertional, chronic, pressure, and fasciotomy.

RESULTS

Exertional compartment syndrome is characterized by pain on exertion, which recedes at rest, and by excessive increase in compartment intramuscular pressure. Intramuscular pressure measurement is the reference diagnostic tool, but it has not been standardized or evaluated. Pressure observed during the first 5 min after exertion stops is more often used in diagnosis. The first studies of noninvasive investigations (magnetic resonance imaging, thallium single-photon emission tomographic imaging, near infrared spectroscopy) revealed their inadequate diagnostic value. The pathophysiological features of exertional compartment syndrome remain unclear: increased muscle bulk, fascia thickness and stiffness, stimulation of fascial sensory stretch-receptors, poor venous return, micromuscular injuries, and small clinical myopathic abnormalities. Treatment includes decreased sport activity or fasciotomy with partial fasciectomy. Several authors have used endoscopically assisted fasciotomy, which retrospective studies have shown to be successful. Long-term outcome studies could investigate the persistence of exertional minor pain and recurrence of the compartment syndrome with this treatment.

CONCLUSION

Further studies are required to understand the physiopathology, standardize the intramuscular pressure test and evaluate the pressure threshold values, evaluate noninvasive investigations and specify the long-term outcome of fasciotomy.

[Rhizarthrosis and orthotic treatment. Review of literature]

OBJECTIVES

Trapeziometacarpal arthritis or rhizarthrosis is extremely frequent. Numerous treatments are available including drugs, physiotherapy, use of orthotic devices, surgery, etc. Few of these methods have been really evaluated. We propose a critical review of the literature on orthotic treatment in rhizarthrosis.

MATERIALS AND METHODS

Review of the results of hand splint used in rhizarthrosis from eight studies published over the last ten years.

RESULTS

Resting hand splints offer lasting and significant pain relief with a satisfactory compliance. They should be applied early in treatment and evaluated with regular follow-up. The drop-out rate is about 10%. Working hand splints, either alone or associated with a resting splint are also efficient. These is no modification in either the force or the ranges of motion. The functional benefit is satisfactory if the follow-up allows some tolerance and thus an optimal compliance.

CONCLUSION

The major interest of the use of splinting is analgesia. The pain releif obtained with splint is similar when used alone or with a working hand splint. Working hand splint can improve hand function during vocational and avocational activities.

[Spinal manipulation in the treatment of common low back pain]

Although the best designed studies have shown promising results, the efficacy of spinal manipulations has not as yet been proved. The mode of action may involve mechanical changes in the disk and facet joints, but neurological mechanisms probably play the key role. Complications of cervical spinal manipulations are rare. To protect patients, French legislation requires that spinal manipulations should only be performed by licensed physicians, who are capable of establishing the accurate diagnosis before undertaking manipulations.

[Polyneuropathy and neuromyopathy in intensive care. 4 new cases]

Neuromuscular complications acquired in the intensive care unit form a new clinical entity. Three neuromuscular deficits are described: so-called critical illness polyneuropathy where neuromyopathic changes are associated with corticosteroid and/or neuromuscular blocking agents, and catabolic myopathy. We report four new cases: three of them concerning polyneuropathy and one neuromyopathic change.