1
|
Devoogdt N, De Vrieze T, Heroes AK, Bechter-Hugl B, Fieuws S, Godderis L, Segers K, Maleux G, Deltombe T, Frippiat J, Servaes M, Berners A, Fosseprez P, Krug B, Kayser F, Falticeanu A, Randon C, Monten C, Van Landuyt K, De Pypere B, Degraeve L, Decorte T, De Schryver M, Van Besien V, Devos D, Suominen S, Ayala JM, Pons G, Fourneau I, Thomis S. SurLym trial: study protocol for a multicentre pragmatic randomised controlled trial on the added value of reconstructive lymphatic surgery to decongestive lymphatic therapy for the treatment of lymphoedema. BMJ Open 2024; 14:e078114. [PMID: 38729754 DOI: 10.1136/bmjopen-2023-078114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Lymphoedema is a chronic condition caused by lymphatic insufficiency. It leads to swelling of the limb/midline region and an increased risk of infection. Lymphoedema is often associated with mental and physical problems limiting quality of life. The first choice of treatment is a conservative treatment, consisting of exercises, skin care, lymph drainage and compression. Reconstructive lymphatic surgery is also often performed, that is, lymphovenous anastomoses, lymph node transfer or a combination. However, robust evidence on the effectiveness of reconstructive lymphatic surgery is missing. Therefore, the objective of this trial is to investigate the added value of reconstructive lymphatic surgery to the conservative treatment in patients with lymphoedema. METHODS AND ANALYSIS A multicentre randomised controlled and pragmatic trial was started in March 2022 in three Belgian university hospitals. 90 patients with arm lymphoedema and 90 patients with leg lymphoedema will be included. All patients are randomised between conservative treatment alone (control group) or conservative treatment with reconstructive lymphatic surgery (intervention group). Assessments are performed at baseline and at 1, 3, 6, 12, 18, 24 and 36 months. The primary outcome is lymphoedema-specific quality of life at 18 months. Key secondary outcomes are limb volume and duration of wearing the compression garment at 18 months. The approach of reconstructive lymphatic surgery is based on presurgical investigations including clinical examination, lymphofluoroscopy, lymphoscintigraphy, lymph MRI or CT angiography (if needed). All patients receive conservative treatment during 36 months, which is applied by the patient's own physical therapist and by the patient self. From months 7 to 12, the hours a day of wearing the compression garment are gradually decreased. ETHICS AND DISSEMINATION The study has been approved by the ethical committees of University Hospitals Leuven, Ghent University Hospital and CHU UCL Namur. Results will be disseminated via peer-reviewed journals and presentations. TRIAL REGISTRATION NUMBER NCT05064176.
Collapse
Affiliation(s)
- Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - An-Kathleen Heroes
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Beate Bechter-Hugl
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven - University of Leuven, Leuven, Belgium
| | - Lode Godderis
- Centre for Environment and Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Katarina Segers
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, Centre de Reference du Lymphoedème, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Jacqueline Frippiat
- Department of Physical Medicine and Rehabilitation, Centre de Reference du Lymphoedème, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Maxime Servaes
- Department of Plastic and Reconstructive Surgery, CHU UCL Namur - Site St-Elisabeth, Namur, Belgium
| | - Aline Berners
- Department of Plastic and Reconstructive Surgery, CHU UCL Namur - Site St-Elisabeth, Namur, Belgium
| | - Philippe Fosseprez
- Department of Plastic and Reconstructive Surgery, CHU UCL Namur - Site St-Elisabeth, Namur, Belgium
| | - Bruno Krug
- Nuclear Medicine Department, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Francoise Kayser
- Department of Radiology, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Ana Falticeanu
- Department of Radiology, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Chris Monten
- Department of Radiotherapy, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Koen Van Landuyt
- Department of Plastic and Reconstructive Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Bernard De Pypere
- Department of Plastic and Reconstructive Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Liesl Degraeve
- Department of Plastic and Reconstructive Surgery, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Tina Decorte
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Mieke De Schryver
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Vickie Van Besien
- Department of Physical Medicine and Rehabilitation, Lymphedema Clinic, Ghent University Hospital, Ghent, Belgium
| | - Daniel Devos
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jaume Masia Ayala
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau and the Hospital del Mar of Barcelona, Barcelona, Spain
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau and the Hospital del Mar of Barcelona, Barcelona, Spain
| | - Inge Fourneau
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery, Centre for Lymphedema, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Fostier M, Gustin T, Deltombe T. Case Study of Intrathecal Baclofen Pump Motor Shutdown Secondary to the Effect of the Magnetic Field Created by a Personal Digital Tablet and Magnetic Cover. Am J Phys Med Rehabil 2023; 102:e160-e161. [PMID: 37205746 DOI: 10.1097/phm.0000000000002285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
ABSTRACT We present the case of a posttraumatic C6 AIS A tetraplegic patient with spasticity treated with an intrathecal baclofen pump, who noticed a transient increase in his spasticity each time he used a digital tablet (Ipad) protected by a magnetic shell placed on his abdomen. Telemetry confirmed transient motor shutdown responsible for withdrawal symptoms each time the tablet was used. Symptoms resolved after the removal of the protective shell. Effects of magnetic fields like magnetic resonance imaging are known to stall the pump rotor, which recover at the end of magnetic resonance imaging. Other sources of magnetic fields like laptops or new smartphones with magnet charging technology may also interfere with implanted devices. We therefore recommend patients to avoid close contact of magnetic devices with the intrathecal baclofen pump. More robust studies are warranted to assess the effect of the new magnetic technologies on the function of intrathecal pumps.
Collapse
Affiliation(s)
- Michele Fostier
- From the Department of Anesthesiology, CHU UCL Namur Site Godinne, Yvoir, Belgium (MF); Department of Neurosurgery, CHU UCL Namur Site Godinne, Yvoir, Belgium (TG); and Department of Physical Medicine and Rehabilitation, CHU UCL Site Godinne, Yvoir, Belgium (TD)
| | | | | |
Collapse
|
3
|
Jacinto J, Balbert A, Bensmail D, Carda S, Draulans N, Deltombe T, Ketchum N, Molteni F, Reebye R. Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool. Toxins (Basel) 2023; 15:676. [PMID: 38133180 PMCID: PMC10748217 DOI: 10.3390/toxins15120676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/17/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spasticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patient-centred goal-setting; an algorithm for setting SMART (specific, measurable, attainable, realistic, and timed) treatment goals; goal-related target muscles and botulinum toxin type A dose determinants; goal attainment follow-up, scoring, and interpretation; and the multimodal approach to spasticity management. The Tool can enhance clinical practice by providing guided assistance with goal-setting and target muscle selection for botulinum toxin type A treatment. It also provides support with the follow-up evaluation of goal attainment and calculation of treatment success. The Tool is designed to be used by clinicians with varying levels of expertise in the field of neurological rehabilitation and post-stroke spasticity management, from those who are new to the field to those with many years of experience. A case study is presented in the Results Section of the article to illustrate the utility of the Tool in setting SMART treatment goals in the management of patients with post-stroke spasticity.
Collapse
Affiliation(s)
- Jorge Jacinto
- Alcoitão Medical Rehabilitation Centre, Rua Conde Barão, 2649-506 Alcabideche, Portugal
| | - Alexander Balbert
- Department of Adaptive Physical Training, Ural University of Physical Education, Sverdlovsk Regional Hospital for War Veterans, 620014 Yekaterinburg, Russia
| | - Djamel Bensmail
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Teaching Hospital, APHP, Université Paris-Saclay, 92380 Garches, France
- Unité INSERM 1179, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-Le-Bretonneux, France
| | - Stefano Carda
- Department of Clinical Neurosciences, Service of Neuropsychology and Neurorehabilitation, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Nathalie Draulans
- Department of Rehabilitation, Libra Rehabilitation and Audiology, 5022 KE Tilburg, The Netherlands
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, Université Catholique de Louvain, Centre Hospitalier Universitaire de Namur, Godinne Site, Avenue Docteur G Therasse, 5530 Yvoir, Belgium
| | - Nicholas Ketchum
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, 9200 W., Milwaukee, WI 53226, USA;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, 23845 Costa Masnaga, Italy;
| | - Rajiv Reebye
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| |
Collapse
|
4
|
Lamora JP, Deltombe T, Gustin T. Effects of Diagnostic Tibial Nerve Block and Selective Tibial Nerve Neurotomy on Spasticity and Spastic co-contractions: A Retrospective Observational Study. J Rehabil Med 2023; 55:jrm4850. [PMID: 37309226 DOI: 10.2340/jrm.v55.4850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/14/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVE To assess the effects of diagnostic nerve block and selective tibial neurotomy on spasticity and co-contractions in patients with spastic equinovarus foot. METHODS Among 317 patients who underwent a tibial neurotomy between 1997 and 2019, 46 patients who met the inclusion criteria were retrospectively screened. Clinical assessment was made before and after diagnostic nerve block and within 6 months after neurotomy. A total of 24 patients underwent a second assessment beyond 6 months after surgery. Muscle strength, spasticity, angle of catch (XV3), passive (XV1) and active (XVA) ankle range of motion were measured. The spasticity angle X (XV1-XV3) and paresis angle Z (XV1-XVA) were calculated with the knee in flexed and extended positions. RESULTS Tibialis anterior and triceps surae strength remained unchanged, while both Ashworth and Tardieu scores were highly reduced after nerve block and neurotomy at all measurement times. XV3 and XVA increased significantly after block and neurotomy. XV1 increased slightly after neurotomy. Consequently, spasticity angle X and paresis angle Z decreased after nerve block and neurotomy. CONCLUSION Tibial nerve block and neurotomy improve active ankle dorsiflexion, probably by reducing spastic co-contractions. The results also confirmed a long-lasting decrease in spasticity after neurotomy and the predictive value of nerve blocks.
Collapse
Affiliation(s)
- Jean-Philippe Lamora
- UCLouvain Faculty of Motor Sciences, Place Pierre de Coubertin, BE-1348 Louvain-la-Neuve, Belgium; La Musse School of Physiotherapy, La Renaissance Sanitaire - Hopital La Musse, CS 20119, 27180 Saint-Sebastien de Morsent, France.
| | - Thierry Deltombe
- Physical Medicine and Rehabilitation Department, Université catholique de Louvain, CHU UCL Namur site Godinne, BE-5530 Yvoir, Belgium
| | - Thierry Gustin
- Neurosurgery Department, Université catholique de Louvain, CHU UCL Namur site Godinne, BE-5530 Yvoir, Belgium
| |
Collapse
|
5
|
Salga M, Gatin L, Deltombe T, Gustin T, Carda S, Marque P, Winston P, Reebye R, Wein T, Esquenazi A, Keenan MA, Molteni F, Zerbinati P, Picelli A, Coroian F, Coulet B, Sturbois-Nachef N, Fontaine C, Yelnik A, Parratte B, Henry P, Venkatakrishnan S, Rigoard P, David R, Denormandie P, Schnitzler A, Allart E, Genet F. International Recommendations to Manage Poststroke Equinovarus Foot Deformity Validated by a Panel of Experts Using Delphi. Arch Phys Med Rehabil 2023; 104:372-379. [PMID: 36030892 DOI: 10.1016/j.apmr.2022.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/27/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To establish international recommendations for the management of spastic equinovarus foot deformity. DESIGN Delphi method. SETTING International study. PARTICIPANTS A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). INTERVENTIONS Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. MAIN OUTCOME MEASURES A consensus was established when at least 80% of experts agreed on a statement RESULTS: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. CONCLUSION The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.
Collapse
Affiliation(s)
- Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Laure Gatin
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium; Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Neurological Rehabilitation, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theodore Wein
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Alberto Esquenazi
- MossRehab and Albert Einstein Medical Center, Elkins Park, Pennsylvania
| | - Mary-Ann Keenan
- Penn Neuro-Orthopaedics Service, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Paolo Zerbinati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; U.O. Neuroortopedia, Ospedale Santa Maria Multimedica Castellanza, Varese, Italy
| | - Alessandro Picelli
- Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Flavia Coroian
- Physical and Rehabilitation Medicine Department, Montpellier University Hospital, Montpellier, France; Euromov, Montpellier University, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Christian Fontaine
- Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Alain Yelnik
- Department of Physical and Rehabilitation Medicine, Université de Paris, AP-HP Hospital Fernand Widal, Paris, France
| | - Bernard Parratte
- Department of Physical and Rehabilitation Medicine, CHRU Jean Minjoz, Besançon-Franche-Comté University, Besançon, France
| | - Prakash Henry
- Department of Neurological Rehabilitation, Christian Medical College, Vellore, India
| | | | - Philippe Rigoard
- Institut Pprime CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Spine and Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - Romain David
- Department of Physical and Rehabilitation Medicine, University Hospital Center of Poitiers, PRISMATICS Lab, Poitiers, France
| | - Philippe Denormandie
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Alexis Schnitzler
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Etienne Allart
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Neurorehabilitation Unit, Lille, France
| | - François Genet
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France.
| |
Collapse
|
6
|
Schillebeeckx F, Mills PB, Ip A, Schinwelski M, Marten Teixeira JE, Ashford S, Bayle N, Chemello E, Jacinto J, Nayar M, Suzigan E, Deltombe T. Worldwide Survey of Clinician Practice on use of Adjunctive Therapies Following Botulinum Toxin Injection for Spasticity. J Rehabil Med 2022; 54:jrm00320. [PMID: 35801863 PMCID: PMC9511365 DOI: 10.2340/jrm.v54.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Non-pharmacological adjunctive therapies can be used alongside botulinum toxin injection to enhance its efficacy. The objective of this global study was to determine the current practice and perception among clinicians of the use of adjunctive therapies after botulinum toxin injections for the treatment of limb spasticity. Methods A questionnaire with 22 questions on clinical practice demographics, self-reported use and clinician opinion on barriers to the use of complementary therapies, and priorities for future research was translated into 7 languages and distributed worldwide through national and international professional associations concerning (neuro)rehabilitation. Results A total of 527 clinicians from 52 countries responded to the survey. Most commonly used physical interventions were: active exercise programmes at home (81%), stretching programmes at home (81%), and splinting (70%), followed by active movement exercises (65%) and within 30 min of botulinum toxin injection and constraint induced movement therapy (63%). The main barriers reported by clinicians to provision of these interventions were clinicians’ lack of time, limited financial resources, and lack of evidence. Future research should focus primarily on immediate active movement exercises and passive stretching. Conclusion Worldwide, clinicians often recommend adjunctive therapies after a botulinum toxin injection to reduce spasticity. The most commonly used physical interventions among clinicians were active exercises at home, stretching at home, and splinting. Lack of evidence, time and financial constraints were identified as barriers to providing these interventions.
Collapse
|
7
|
Nguyen V, Bollens B, Moyaux Z, Deltombe T. Spontaneous non-traumatic hip dislocation in patients with stroke. BMJ Case Rep 2022; 15:15/7/e249549. [DOI: 10.1136/bcr-2022-249549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This is a unique clinical case of a spontaneous non-traumatic hip dislocation in a patient with stroke with a hip and knee flexion pattern. This case highlights the role of spasticity as a cause of hip dislocation and the need to combine focal spasticity treatment and surgery to restore ambulation.
Collapse
|
8
|
Gerardin E, Bontemps D, Babuin NT, Herman B, Denis A, Bihin B, Regnier M, Leeuwerck M, Deltombe T, Riga A, Vandermeeren Y. Bimanual motor skill learning with robotics in chronic stroke: comparison between minimally impaired and moderately impaired patients, and healthy individuals. J Neuroeng Rehabil 2022; 19:28. [PMID: 35300709 PMCID: PMC8928664 DOI: 10.1186/s12984-022-01009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022] Open
Abstract
Background Most activities of daily life (ADL) require cooperative bimanual movements. A unilateral stroke may severely impair bimanual ADL. How patients with stroke (re)learn to coordinate their upper limbs (ULs) is largely unknown. The objectives are to determine whether patients with chronic supratentorial stroke could achieve bimanual motor skill learning (bim-MSkL) and to compare bim-MSkL between patients and healthy individuals (HIs). Methods Twenty-four patients and ten HIs trained over 3 consecutive days on an asymmetrical bimanual coordination task (CIRCUIT) implemented as a serious game in the REAplan® robot. With a common cursor controlled by coordinated movements of the ULs through robotic handles, they performed as many laps as possible (speed constraint) on the CIRCUIT while keeping the cursor within the track (accuracy constraint). The primary outcome was a bimanual speed/accuracy trade-off (biSAT), we used a bimanual coordination factor (biCO) and bimanual forces (biFOP) for the secondary outcomes. Several clinical scales were used to evaluate motor and cognitive functions. Results Overall, the patients showed improvements on biSAT and biCO. Based on biSAT progression, the HI achieved a larger bim-MSkL than the patients with mild to moderate impairment (Fugl-Meyer Assessment Upper Extremity (FMA-UE): 28–55, n = 15) but not significantly different from those with minimal motor impairment (FMA-UE: 66, n = 9). There was a significant positive correlation between biSAT evolution and the FMA-UE and Stroke Impact Scale. Conclusions Both HI and patients with chronic stroke training on a robotic device achieved bim-MSkL, although the more impaired patients were less efficient. Bim-MSkL with REAplan® may be interesting for neurorehabilitation after stroke. Trial registration: ClinicalTrial.gov identifier: NCT03974750. Registered 05 June 2019. https://clinicaltrials.gov/ct2/show/NCT03974750?cond=NCT03974750&draw=2&rank=1 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01009-3.
Collapse
Affiliation(s)
- Eloïse Gerardin
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium. .,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium. .,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium.
| | - Damien Bontemps
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Nicolas-Thomas Babuin
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Faculty of Motor Sciences, UCLouvain, Louvain-La-Neuve, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Adrien Denis
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of Mechanics, Materials and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit (USS), UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium
| | - Audrey Riga
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
| | - Yves Vandermeeren
- Neurology Department, Stroke Unit, UCLouvain, CHU UCL Namur (Godinne), Yvoir, Belgium.,Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium.,Institute of NeuroScience (IoNS), NEUR Division, UCLouvain, Brussels, Belgium
| |
Collapse
|
9
|
Francisco G, Deltombe T. Comprehensive curriculum on spasticity assessment and management. J Int Soc Phys Rehabil Med 2022. [DOI: 10.4103/jisprm.jisprm-000154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
10
|
Deltombe T, Gavray T, Van Roy O, Wautier D, Gustin T. Medico-surgical management of the spastic equinovarus foot deformity in adults: A retrospective series of 622 patients. J Int Soc Phys Rehabil Med 2022. [DOI: 10.4103/ijprm.jisprm-000182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
|
11
|
Ketchum N, Carda S, O'Dell M, Säterö P, Jacinto J, Deltombe T, Francisco G. Module 4: Optimizing outcomes in spasticity treatment. J Int Soc Phys Rehabil Med 2022. [DOI: 10.4103/2349-7904.347810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Gross R, Verduzco-Gutierrez M, Draulans N, Zimerman M, Francisco G, Deltombe T. Module 3: Surgical management of spasticity. J Int Soc Phys Rehabil Med 2022. [DOI: 10.4103/2349-7904.347809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
13
|
Escaldi S, Bianchi F, Bavikatte G, Molteni F, Moraleda S, Deltombe T, Francisco G. Module 1: Pathophysiology and assessment of spasticity; Goal setting. J Int Soc Phys Rehabil Med 2022. [DOI: 10.4103/2349-7904.347807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
14
|
Reebye R, Balbert A, Bensmail D, Walker H, Wissel J, Deltombe T, Francisco G. Module 2: Nonsurgical management of Spasticity. J Int Soc Phys Rehabil Med 2022. [DOI: 10.4103/2349-7904.347808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
15
|
Deltombe T, Schillebeeckx F, Ip A, Schinwelski M, Teixeira JM, Ashford S, Bayle N, Chemello E, Jacinto J, Nayar M, Suzigan E, Mills P. Worldwide clinician survey on practice patterns and perceptions on use of adjunct therapies following botulinum toxin injection for limb spasticity. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
16
|
Francisco GE, Balbert A, Bavikatte G, Bensmail D, Carda S, Deltombe T, Draulans N, Escaldi S, Gross R, Jacinto J, Ketchum N, Molteni F, Moraleda S, ODell MW, Reebye R, Säterö P, Verduzco-Gutierrez M, Walker H, Wissel J. A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: An international group consensus. J Rehabil Med 2021; 53:jrm00134. [PMID: 33057730 PMCID: PMC8772370 DOI: 10.2340/16501977-2753] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This consensus paper is derived from a meeting of an international group of 19 neurological rehabilitation specialists with a combined experience of more than 250 years (range 4–25 years; mean 14.1 years) in treating post-stroke spasticity with botulinum toxin A. The group undertook critical assessments of some recurring practical challenges, not yet addressed in guidelines, through an extensive literature search. They then discussed the results in the light of their individual clinical experience and developed consensus statements to present to the wider community who treat such patients. The analysis provides a comprehensive overview of treatment with botulinum toxin A, including the use of adjunctive therapies, within a multidisciplinary context, and is aimed at practicing clinicians who treat patients with post-stroke spasticity and require further practical guidance on the use of botulinum toxin A. This paper does not replicate information published elsewhere, but instead aims to provide practical advice to help optimize the use of botulinum toxin A and maximize clinical outcomes. The recommendations for each topic are summarized in a series of statements. Where published high-quality evidence exists, the recommendations reflect this. However, where evidence is not yet conclusive, the group members issued statements and, in some cases, made recommendations based on their clinical experience. LAY ABSTRACT A group of doctors from around the world, who are experts in treating muscle stiffness and spasm (also called spasticity), reviewed the current scientific evidence supporting the effectiveness of using botulinum toxin injections in treatment of spasticity that results from a stroke. When evidence is not available, they discussed and agreed on the best way to treat spasticity using botulinum toxin. The recommendations made by these expert doctors can be used by less-experienced doctors as a guide to how best to use botulinum toxin injection in treating spasticity after a stroke.
Collapse
Affiliation(s)
- Gerard E Francisco
- Physical Medicine and Rehabilitation, University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX 77030, USA. E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Deltombe T, Richier Q, Foucher A, Roussin C, Randrianjohany A, Gerber A, Poubeau P, Raffray L. L’artérite à cellules géantes à La Réunion, un territoire cosmopolite de l’Hémisphère Sud. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
18
|
Carda S, Invernizzi M, Bavikatte G, Bensmaïl D, Bianchi F, Deltombe T, Draulans N, Esquenazi A, Francisco GE, Gross R, Jacinto LJ, Moraleda Pérez S, O'Dell MW, Reebye R, Verduzco-Gutierrez M, Wissel J, Molteni F. The role of physical and rehabilitation medicine in the COVID-19 pandemic: The clinician's view. Ann Phys Rehabil Med 2020; 63:554-556. [PMID: 32315802 PMCID: PMC7166018 DOI: 10.1016/j.rehab.2020.04.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Marco Invernizzi
- University of Eastern Piedmont, Department of Health Sciences, 28100 Novara, Italy
| | - Ganesh Bavikatte
- Neurorehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ United Kingdom
| | - Djamel Bensmaïl
- Physical and Rehabilitation Medicine Department, R.-Pointcaré Hospital, AP-HP Université Paris-Saclay, Team INSERM 1179, UFR de Santé Simone-Veil, Université de Versailles Saint-Quentin, Paris, France
| | - Francesca Bianchi
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute Milan, Italy
| | - Thierry Deltombe
- Service de Médecine Physique & Réadaptation, CHU UCL Namur site Godinne, 5530 Yvoir, Belgium
| | | | - Alberto Esquenazi
- Department of Physical Medicine & Rehabilitation, MossRehab Gait and Motion Analysis Lab, Elkins Park, PA, USA
| | - Gerard E Francisco
- Department of Physical Medicine & Rehabilitation, UTHealth McGovern Medical School, and TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Raphaël Gross
- Service de MPR Neurologique, CHU de Nantes, Hôpital Saint-Jacques, 44093 Nantes cedex, France; EA 43334 laboratoire Motricité, Interactions, Performance-UFR STAPS Nantes, 44300 Nantes, France
| | - Luis Jorge Jacinto
- Serviço de Reabilitação de Adultos 3, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Susana Moraleda Pérez
- Physical Medicine & Rehabilitation Department, La Paz University Hopital, Madrid, Spain
| | - Michael W O'Dell
- New York Presbyterian Hospital, Weill-Cornell Medical Centre, New York, NY, USA
| | - Rajiv Reebye
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Joe-R.-and-Teresa-Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Jörg Wissel
- Neurological Rehabilitation & Physical Therapy, Department of Neurology with Stroke Unit, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | - Franco Molteni
- Valduce Hospital, Villa Beretta Rehabilitation Centre, Costamasnaga (LC), Italy
| |
Collapse
|
19
|
Meyer C, Haustrate MA, Nisolle JF, Deltombe T. Heterotopic ossification in COVID-19: A series of 4 cases. Ann Phys Rehabil Med 2020; 63:565-567. [PMID: 33115691 PMCID: PMC7587134 DOI: 10.1016/j.rehab.2020.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/31/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022]
Affiliation(s)
- C Meyer
- Physical medicine and rehabilitation department, CHU UCL Namur site Godinne, 1, avenue Dr Therasse, 5530 Yvoir, Belgium
| | - M-A Haustrate
- Physical medicine and rehabilitation department, CHU UCL Namur site Godinne, 1, avenue Dr Therasse, 5530 Yvoir, Belgium
| | - J F Nisolle
- Radiology department, CHU UCL Namur site Godinne, 5530 Yvoir, Belgium
| | - T Deltombe
- Physical medicine and rehabilitation department, CHU UCL Namur site Godinne, 1, avenue Dr Therasse, 5530 Yvoir, Belgium.
| |
Collapse
|
20
|
Esquenazi A, Brashear A, Deltombe T, Rudzinska-Bar M, Krawczyk M, Skoromets A, O'Dell MW, Grandoulier AS, Vilain C, Picaut P, Gracies JM. The Effect of Repeated abobotulinumtoxinA (Dysport®) Injections on Walking Velocity in Persons with Spastic Hemiparesis Caused by Stroke or Traumatic Brain Injury. PM R 2020; 13:488-495. [PMID: 32741133 PMCID: PMC8246752 DOI: 10.1002/pmrj.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022]
Abstract
Background Botulinum toxin (BoNT) injections were shown to improve muscle tone of limbs in patients with spasticity. However, limited data are available regarding the effects of repeated BoNT injections on walking ability. Objective To assess changes in walking velocity (WV), step length, and cadence under different test conditions after repeated treatment with abobotulinumtoxinA (aboBoNT‐A; Dysport) in spastic lower limb muscles. Design Secondary analysis of an open‐label, multiple‐cycle extension (National Clinical Trials number NCT01251367) to a phase III, double‐blind, randomized, placebo‐controlled, single‐treatment cycle study, in adults with chronic hemiparesis (NCT01249404). Setting Fifty‐two centers across Australia, Belgium, the Czech Republic, France, Hungary, Italy, Poland, Portugal, Russia, Slovakia, and the United States. Patients 352 Ambulatory adults (18‐80 years) with spastic hemiparesis and gait dysfunction caused by stroke or traumatic brain injury, with a comfortable barefoot WV of 0.1 to 0.8 m/s. Interventions Up to four aboBoNT‐A treatment cycles, administered to spastic lower limb muscles. Main Outcome Measurements Changes from baseline in comfortable and maximal barefoot and with shoes WV (m/s), step length (m/step), and cadence (steps/minutes). Results At Week 12 after four injections, WV improved by 0.08 to 0.10 m/s, step length by 0.03 to 0.04 m/step, and cadence by 3.9 to 6.2 steps/minutes depending on test condition (all P < .0001 to .0003 vs baseline). More patients (7% to 17%) became unlimited community ambulators (WV ≥0.8 m/s) across test conditions compared with baseline, with 39% of 151 patients classified as unlimited community ambulators in at least one test condition and 17% in all four test conditions. Conclusions Clinically meaningful and statistically significant improvements in WV, step length, and cadence under all four test conditions were observed in patients with spastic hemiparesis after each aboBoNT‐A treatment cycle.
Collapse
Affiliation(s)
| | | | - Thierry Deltombe
- Service de Médecine Physique et Réadaptation, Centre Hospitalier Universitaire UCL, Yvoir, Belgium
| | - Monika Rudzinska-Bar
- Department of Neurology, Faculty of Medicine and Health Service, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | | | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| |
Collapse
|
21
|
Deltombe T, Leeuwerck M, Jamart J, Frederick A, Dellicour G. Gait improvement in adults with hemiparesis using a rolling cane: A cross-over trial. J Rehabil Med 2020; 52:jrm00078. [PMID: 32556348 DOI: 10.2340/16501977-2705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the changes in gait parameters in adults with hemiparesis using a rolling cane (quadripod cane with small wheels; Wheeleo®) compared with a classical quadripod cane. DESIGN A prospective, multicentric, cross-over randomized trial. PARTICIPANTS Thirty-two ambulatory adults with hemiparesis. METHODS Participants were assessed using a quadripod cane and a rolling cane. Outcome measures were changes in: walking speed during a 10-m walk test and a 6-min walk test; frequency of 2-step gait; physiological cost index; number of therapist interventions to control the balance; perceived exertion; and participant satisfaction. RESULTS The following outcomes were improved with the use of a rolling cane: walking speed during a 10-m walk test at comfortable (+22%: p<0.001) and maximal (+30: p<0.001) speeds; walking speed (+50%: p<0.001) and distance (+49%: p<?0.001) during a 6-min walk test; and the frequency of 2-step gait. The physiological cost index, perceived exertion, and number of therapist interventions to control the balance remained unchanged. Participant satisfaction improved. CONCLUSION A rolling cane, Wheeleo®, increases walking speed in adults with hemiparesis without additional risk of falls.
Collapse
Affiliation(s)
- Thierry Deltombe
- Physical Medicine and Rehabilitation Department, Université catholique de Louvain, Cliniques universitaires de Mont-Godinne, BE-5530 Yvoir, Belgium. E-mail:
| | | | | | | | | |
Collapse
|
22
|
Carda S, Invernizzi M, Bavikatte G, Bensmaïl D, Bianchi F, Deltombe T, Draulans N, Esquenazi A, Francisco GE, Gross R, Jacinto LJ, Moraleda Pérez S, O'dell MW, Reebye R, Verduzco-Gutierrez M, Wissel J, Molteni F. COVID-19 pandemic. What should Physical and Rehabilitation Medicine specialists do? A clinician's perspective. Eur J Phys Rehabil Med 2020; 56:515-524. [PMID: 32434314 DOI: 10.23736/s1973-9087.20.06317-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
COVID-19 pandemic is rapidly spreading all over the world, creating the risk for a healthcare collapse. While acute care and intensive care units are the main pillars of the early response to the disease, rehabilitative medicine should play an important part in allowing COVID-19 survivors to reduce disability and optimize the function of acute hospital setting. The aim of this study was to share the experience and the international perspective of different rehabilitation centers, treating COVID-19 survivors. A group of Physical Medicine and Rehabilitation specialists from eleven different countries in Europe and North America have shared their clinical experience in dealing with COVID-19 survivors and how they have managed the re-organization of rehabilitation services. In our experience the most important sequelae of severe and critical forms of COVID-19 are: 1) respiratory; 2) cognitive, central and peripheral nervous system; 3) deconditioning; 4) critical illness related myopathy and neuropathy; 5) dysphagia; 6) joint stiffness and pain; 7) psychiatric. We analyze all these consequences and propose some practical treatment options, based on current evidence and clinical experience, as well as several suggestions for management of rehabilitation services and patients with suspected or confirmed infection by SARS-CoV-2. COVID-19 survivors have some specific rehabilitation needs. Experience from other centers may help colleagues in organizing their services and providing better care to their patients.
Collapse
Affiliation(s)
- Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland -
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Ganesh Bavikatte
- Neurorehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Djamel Bensmaïl
- Department of Physical and Rehabilitation Medicine, R. Pointcaré Hospital, AP-HP Université Paris-Saclay, Team INSERM 1179, UFR de Santé Simone Veil, Université de Versailles Saint-Quentin, Versailles, France
| | | | - Thierry Deltombe
- Service of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | | | - Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Lab, Elkins Park, PA, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, UTHealth McGovern Medical School, and TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Raphaël Gross
- Service de MPR Neurologique, CHU Nantes Hôpital Saint Jacques, Nantes cedex / EA 43334 laboratoire Motricité, Interactions, Performance - UFR STAPS Nantes, Nantes, France
| | - Luis J Jacinto
- Service of Rehabilitation for Adults 3, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Susana Moraleda Pérez
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, Madrid, Spain
| | - Michael W O'dell
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | | | - Jörg Wissel
- Unit of Neurological Rehabilitation and Physical Therapy, Department of Neurology with Stroke Unit, Vivantes Hospital Spandau, Berlin, Germany
| | - Franco Molteni
- Valduce Hospital, Villa Beretta Rehabilitation Center, Costamasnaga, Lecco, Italy
| |
Collapse
|
23
|
De Vrieze T, Frippiat J, Deltombe T, Gebruers N, Tjalma WAA, Nevelsteen I, Thomis S, Vandermeeren L, Belgrado JP, De Groef A, Devoogdt N. Cross-cultural validation of the French version of the Lymphedema Functioning, Disability and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL). Disabil Rehabil 2020; 43:2797-2804. [PMID: 31990592 DOI: 10.1080/09638288.2020.1716271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Upper limb lymphedema is a vexing morbidity that can occur after the treatment for breast cancer. The Lymphedema Functioning, Disability and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL) is a valid and reliable tool assessing problems in functioning in patients with breast cancer-related lymphedema. Until now, a French-language version was lacking. The aim of this study was to perform a cross-cultural validation of the French version of the Lymph-ICF-UL questionnaire. METHODS A forward-backward translation process between the original language (Dutch) and the target language (French) was performed. Psychometric properties of this final French version were examined in 50 participants. RESULTS Intraclass correlation coefficients for test-retest reliability ranged from 0.66 to 0.95. Cronbach's alpha coefficients for internal consistency were higher than 0.77. Face and content validity were very good because the scoring system was clear for all participants (100%), questions were understandable (100%), and all complaints due to BCRL were mentioned by 78% of the participants. Construct validity was moderate. Convergent validity was established since 3 out of 5 expected domains of the Lymph-ICF-UL showed a moderate correlation with expected domains of the 36-item Short-Form Health Survey. There was satisfactory divergent validity as 6 out of 9 hypotheses assessing divergent validity were accepted. CONCLUSION The French version of the Lymph-ICF-UL is a reliable and valid questionnaire and ready for use in clinical as well as in scientific practice.Implications for rehabilitationSince the introduction of more effective treatment modalities increasing the number of breast cancer survivors, the amount of patients dealing with lymphedema is rising likewise up to a pooled incidence rate of more than 16% of the women treated for breast cancer.The French version of the Lymph-ICF-UL is a reliable and valid questionnaire for assessing problems in functioning of patients with breast cancer-related lymphedema of the arm and/or hand.As the questionnaire provides patient information in the different domains of the International Classification of Functioning, Disability and Health, it facilitates evaluating the impact of breast cancer-related lymphedema on daily functioning.Based on the outcomes of the Lymph-ICF-UL treatment goals can be set, where after the questionnaire can be used to monitor long-term results of this treatment and self-care.
Collapse
Affiliation(s)
- Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
| | - Jacqueline Frippiat
- Department of Physical Medicine and Rehabilitation, Centre de Référence du Lymphoedème, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, Centre de Référence du Lymphoedème, CHU UCL Namur - Site Godinne, Yvoir, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium.,Multidisciplinary Oedema Clinic, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium
| | - Wiebren A A Tjalma
- Multidisciplinary Oedema Clinic, University of Antwerp & Antwerp University Hospital, Antwerp, Belgium.,Department of Medicine, University of Antwerp, MIPRO, Antwerp, Belgium.,Multidisciplinary Breast Clinic, Antwerp University Hospital, Edegem, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Sarah Thomis
- Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| | - Liesbeth Vandermeeren
- Lymphology Research Unit, BLLC - Centre for Lymphedema and Lipedema Brussels & Université libre de Bruxelles, Brussels, Belgium
| | - Jean-Paul Belgrado
- Lymphology Research Unit, Saint-Pierre University Hospital, Lymphology Clinic of Brussels & Université libre de Bruxelles, Brussels, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphedema, UZ Leuven - University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
24
|
Goffin N, Nguyen V, Fostier M, Gustin T, Deltombe T. Serotonin Syndrome Mimicking Intrathecal Baclofen Withdrawal in a Patient with Hereditary Spastic Paraparesis. ACTA ACUST UNITED AC 2020; 3:1000026. [PMID: 33884128 PMCID: PMC8008723 DOI: 10.2340/20030711-1000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
Context Serotonin syndrome is a drug-induced condition related to an increased level of serotonin in the brain, which may induce neuromuscular, autonomic and mental symptoms. Case report A 40-year-old woman with hereditary spastic paraparesis (Strumpell-Lorrain disease) with an implanted intrathecal baclofen pump for severe spasticity. Two days after starting a medication known to inhibit serotonin re-uptake (paroxetine), she developed a sudden increase in lower limb spasticity with continuous spasms, fever, tachycardia and hypertension. Intrathecal baclofen withdrawal was excluded, confirming serotonin syndrome. Conclusion Medications that inhibit serotonin reuptake may induce serotonin syndrome, resulting in increased spasticity in patients with spinal cord lesions, and should be prescribed with caution.
Collapse
Affiliation(s)
- Nicolas Goffin
- Physical Medicine & Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Virginie Nguyen
- Physical Medicine & Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | | | - Thierry Gustin
- Neurosurgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Thierry Deltombe
- Physical Medicine & Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| |
Collapse
|
25
|
Martens G, Deltombe T, Foidart-Dessalle M, Laureys S, Thibaut A. Clinical and electrophysiological investigation of spastic muscle overactivity in patients with disorders of consciousness following severe brain injury. Clin Neurophysiol 2018; 130:207-213. [PMID: 30580243 DOI: 10.1016/j.clinph.2018.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The clinical and electrophysiological profile of spastic muscle overactivity (SMO) is poorly documented in patients with disorders of consciousness (DOC) following severe cortical and subcortical injury. We aim at investigating the link between the clinical observations of SMO and the electrophysiological spastic over-reactivity in patients with prolonged DOC. METHODS We prospectively enrolled adult patients with DOC at least 3 months post traumatic or non-traumatic brain injury. The spastic profile was investigated using the Modified Ashworth Scale and the Hmax/Mmax ratio. T1 MRI data and impact of medication were analyzed as well. RESULTS 21 patients were included (mean age: 41 ± 11 years; time since injury: 4 ± 5 years; 9 women; 10 traumatic etiologies). Eighteen patients presented signs of SMO and 11 had an increased ratio. Eight patients presented signs of SMO but no increased ratio. We did not find any significant correlation between the ratio and the MAS score for each limb (all ps > 0.05). The presence of medication was not significantly associated with a reduction in MAS scores or Hmax/Mmax ratios. CONCLUSIONS In this preliminary study, the Hmax/Mmax ratio does not seem to reflect the clinical MAS scores in patients with DOC. This supports the fact they do not only present spasticity but other forms of SMO and contracture. SIGNIFICANCE Patients with DOC are still in need of optimized tools to evaluate their spastic profile and therapeutic approaches should be adapted accordingly.
Collapse
Affiliation(s)
- G Martens
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
| | - T Deltombe
- Departments of Physical Medicine and Rehabilitation, CHU UCL (Université catholique de Louvain) Namur site Godinne, Belgium
| | - M Foidart-Dessalle
- Departments of Physical Medicine and Rehabilitation, University and University Hospital of Liege, Liege, Belgium
| | - S Laureys
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
| | - A Thibaut
- Coma Science Group, GIGA Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium
| |
Collapse
|
26
|
Francisco GE, Bensmail D, Deltombe T, Jacinto J, Molteni F, O'Dell M, Wissel J. Toxnet curriculum for assessment and management of spasticity. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Deltombe T, Lejeune T, Gustin T. Botulinum toxin type A or selective neurotomy for treating focal spastic muscle overactivity? Ann Phys Rehabil Med 2018; 62:220-224. [PMID: 30107243 DOI: 10.1016/j.rehab.2018.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/21/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To discuss the effectiveness, indications, limitations and side effects of botulinum toxin type A and selective neurotomy for treating focal spastic muscle overactivity to help clinicians choose the most appropriate treatment. METHODS Expert opinion based on scientific evidence and personal experience. RESULTS Botulinum toxin type A can decrease muscle tone in different types of spastic muscle overactivity, which allows for treating a large variety of spastic patterns with several etiologies. The toxin effect is sometimes insufficient to improve functional outcome and is transient, thereby requiring repeated injections. Selective neurotomy is a permanent surgical treatment of the reflex component of the spastic muscle overactivity (spasticity) that is effective for spastic equinovarus foot. The neurotomy provides a greater and more constant reduction in spasticity. However, the long-lasting effect on the non-reflex muscle overactivity, especially dystonia, is doubted. The effectiveness, clinical indications, advantages, side effects and limitations of both techniques are discussed. CONCLUSION Botulinum toxin type A has the highest level of evidence and the largest range of indications. However, the botulinum toxin effect is reversible and seems less effective, which supports a permanent surgical treatment such as selective neurotomy, especially for the spastic foot. Further research is needed to compare the effect of botulinum toxin type A and selective neurotomy for the different types of spastic muscle overactivity and clinical patterns.
Collapse
Affiliation(s)
- Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, B-5530 Yvoir, Belgium.
| | - Thierry Lejeune
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, NMSK, avenue Mounier 53, B-1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, service de médecine physique et réadaptation, avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, B-5530 Yvoir, Belgium
| |
Collapse
|
28
|
Deltombe T, Leeuwerck M, Jamart J, Frederick A, Dellicour G. Improvement in gait parameters in adults with spastic hemiparesis due to stroke or traumatic brain using Wheeleo crutch. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
29
|
Deltombe T, Gilliaux M, Peret F, Leeuwerck M, Wautier D, Hanson P, Gustin T. Effect of the neuro-orthopedic surgery for spastic equinovarus foot after stroke: a prospective longitudinal study based on a goal-centered approach. Eur J Phys Rehabil Med 2018; 54:853-859. [PMID: 29904043 DOI: 10.23736/s1973-9087.18.04993-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neuro-orthopedic surgery is recognized as an effective treatment to improve walking capacity in case of spastic equinovarus foot. However, the effect of surgery on the 3 domains of the International Classification of Functioning, Disability and Health (ICF) has never been studied. AIM The aim of this study was to assess the efficacy of the neuro-orthopedic surgery for spastic equinovarus foot after stroke based on a goal-centered approach and on the 3 domains of the International Classification of Functioning, Disability and Health (ICF). DESIGN Prospective, single blind, case-series, intervention study (before-after trial) with a 1-year follow-up. SETTING University Hospital of Mont-Godinne. POPULATION Eighteen hemiplegic patients with spastic equinovarus foot. METHODS A selective tibial neurotomy and/or an Achille tendon lengthening, and/or a tibialis anterior tendon transfer were performed to correct a disabling SEF. The primary outcome measure was the goal attainment scale. The secondary outcome measures included body function and structure (spasticity, strength, range of motion, pain, gait speed, ankle kinematics), activities (walking aids, functional ambulation category, functional walking category, ABILOCO) and social participation and quality of life (Satispart-Stroke, SF-36) assessment before and 2 months and 1 year after surgery. RESULTS An increase in the goal attainment scale score, in the body function and activity/participation domains of the ICF, a decrease in triceps spasticity and pain, an increase in ankle range of motion and gait speed, an improvement in equinus and a reduction in walking aids were observed. CONCLUSIONS This study confirms the efficacy of the neuro-orthopedic surgical treatment of spastic equinovarus foot after stroke to improve walking capacities and to achieve personal goals in the body function and activity/participation domains of the ICF. CLINICAL REHABILITATION IMPACT In case of post-stroke spastic foot, a personalized neuro-orthopedic surgical program including neurotomy, tendon lengthening and/or transfer improves patient-centered goals in the different domains of the ICF.
Collapse
Affiliation(s)
- Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium -
| | - Maxime Gilliaux
- Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium
| | - François Peret
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Mie Leeuwerck
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Delphine Wautier
- Department of Orthopedic Surgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Philippe Hanson
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| |
Collapse
|
30
|
Thibaut A, Wannez S, Deltombe T, Martens G, Laureys S, Chatelle C. Physical therapy in patients with disorders of consciousness: Impact on spasticity and muscle contracture. NeuroRehabilitation 2018; 42:199-205. [PMID: 29562552 DOI: 10.3233/nre-172229] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spasticity is a frequent complication after severe brain injury, which may prevent the rehabilitation process and worsen the patients' quality of life. OBJECTIVES In this study, we investigated the correlation between spasticity, muscle contracture, and the frequency of physical therapy (PT) in subacute and chronic patients with disorders of consciousness (DOC). METHODS 109 patients with subacute and chronic disorders of consciousness (Vegetative state/Unresponsive wakefulness syndrome - VS/UWS; minimally conscious state - MCS and patients who emerged from MCS - EMCS) were included in the study (39 female; mean age: 40±13.5y; 60 with traumatic etiology; 35 VS/UWS, 68 MCS, 6 EMCS; time since insult: 38±42months). The number of PT sessions (i.e., 20 to 30 minutes of conventional stretching of the four limbs) was collected based on patients' medical record and varied between 0 to 6 times per week (low PT = 0-3 and high PT = 4-6 sessions per week). Spasticity was measured with the Modified Ashworth Scale (MAS) on every segment for both upper (UL) and lower limbs (LL). The presence of muscle contracture was assessed in every joint. We tested the relationship between spasticity and muscle contracture with the frequency of PT as well as other potential confounders such as time since injury or anti-spastic medication intake. RESULTS We identified a negative correlation between the frequency of PT and MAS scores as well as the presence of muscle contracture. We also identified that patients who received less than four sessions per week were more likely to be spastic and suffer from muscle contracture than patients receiving 4 sessions or more. When separating subacute (3 to 12 months post-insult) and chronic (>12months post-insult) patients, these negative correlations were only observed in chronic patients. A logit regression model showed that frequency of PT influenced spasticity, whereas neither time since insult nor medication had a significant impact on the presence of spasticity. On the other hand, PT, time since injury and medication seemed to be associated with the presence of muscle contracture. CONCLUSION Our results suggest that, in subacute and chronic patients with DOC, PT could have an impact on patients' spasticity and muscles contractures. Beside PT, other factors such as time since onset and medication seem to influence the development of muscle contractures. These findings support the need for frequent PT sessions and regular re-evaluation of the overall spastic treatment for patients with DOC.
Collapse
Affiliation(s)
- A Thibaut
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium.,Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - S Wannez
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - T Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Mont-Godinne, (Université Catholique de Louvain), Yvoir, Belgium
| | - G Martens
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - S Laureys
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - C Chatelle
- Department of Neurology, Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium.,Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
31
|
Deltombe T, Wautier D, De Cloedt P, Fostier M, Gustin T. Assessment and treatment of spastic equinovarus foot after stroke: Guidance from the Mont-Godinne interdisciplinary group. J Rehabil Med 2018; 49:461-468. [PMID: 28451697 DOI: 10.2340/16501977-2226] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To present interdisciplinary practical guidance for the assessment and treatment of spastic equinovarus foot after stroke. RESULTS Clinical examination and diagnostic nerve block with anaesthetics determine the relative role of the factors leading to spastic equinovarus foot after stroke: calf spasticity, triceps surae - Achilles tendon complex shortening and dorsiflexor muscles weakness and/or imbalance. Diagnostic nerve block is a mandatory step in determining the cause(s) of, and the most appropriate treatment(s) for, spastic equinovarus foot. Based on interdisciplinary discussion, and according to a patient-oriented goal approach, a medical and/or surgical treatment plan is proposed in association with a rehabilitation programme. Spasticity is treated with botulinum toxin or phenol-alcohol chemodenervation and neurotomy, shortening is treated by stretching and muscle-tendon lengthening, and weakness is treated by ankle-foot orthosis, functional electrical stimulation and tendon transfer. These treatments are frequently combined. CONCLUSION Based on 20 years of interdisciplinary expertise of management of the spastic foot, guidance was established to clarify a complex problem in order to help clinicians treat spastic equinovarus foot. This work should be the first step in a more global international consensus.
Collapse
Affiliation(s)
- Thierry Deltombe
- Physical Medicine and Rehabilitation Department, Université catholique de Louvain, Cliniques universitaires de Mont-Godinne, , BE-5530 Yvoir, Belgium.
| | | | | | | | | |
Collapse
|
32
|
Marciniak C, McAllister P, Walker H, Brashear A, Edgley S, Deltombe T, Khatkova S, Banach M, Gul F, Vilain C, Picaut P, Grandoulier AS, Gracies JM. Efficacy and Safety of AbobotulinumtoxinA (Dysport) for the Treatment of Hemiparesis in Adults With Upper Limb Spasticity Previously Treated With Botulinum Toxin: Subanalysis From a Phase 3 Randomized Controlled Trial. PM R 2017. [DOI: 10.1016/j.pmrj.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
33
|
Theys S, Hennequart T, Aguilar Ferrandiz M, Deltombe T. Milking effect on lymphoedema fore-arm: Manual versus pneumatic drainages. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Gracies JM, Brashear A, Jech R, McAllister P, Banach M, Valkovic P, Walker H, Marciniak C, Deltombe T, Skoromets A, Khatkova S, Edgley S, Gul F, Catus F, De Fer BB, Vilain C, Picaut P. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial. Lancet Neurol 2015; 14:992-1001. [PMID: 26318836 DOI: 10.1016/s1474-4422(15)00216-1] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/15/2015] [Accepted: 08/03/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Resistance from antagonistic muscle groups might be a crucial factor reducing function in chronic hemiparesis. The resistance due to spastic co-contraction might be reduced by botulinum toxin injections. We assessed the effects of abobotulinumtoxinA injection in the upper limb muscles on muscle tone, spasticity, active movement, and function. METHODS In this randomised, placebo-controlled, double-blind study, we enrolled adults (aged 18-80 years) at least 6 months after stroke or brain trauma from 34 neurology or rehabilitation clinics in Europe and the USA. Eligible participants were randomly allocated in a 1:1:1 ratio with a computer-generated list to receive a single injection session of abobotulinumtoxinA 500 U or 1000 U or placebo into the most hypertonic muscle group among the elbow, wrist, or finger flexors (primary target muscle group [PTMG]), and into at least two additional muscle groups from the elbow, wrist, or finger flexors or shoulder extensors. Patients and investigators were masked to treatment allocation. The primary endpoint was the change in muscle tone (Modified Ashworth Scale [MAS]) in the PTMG from baseline to 4 weeks. Secondary endpoints were Physician Global Assessment (PGA) at week 4 and change from baseline to 4 weeks in the perceived function (Disability Assessment Scale [DAS]) in the principal target of treatment, selected by the patient together with physician from four functional domains (dressing, hygiene, limb position, and pain). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01313299. FINDINGS 243 patients were randomly allocated to placebo (n=81), abobotulinumtoxinA 500 U (n=81), or abobotulinumtoxinA 1000 U (n=81). Mean change in MAS score from baseline at week 4 in the PTMG was -0·3 (SD 0·6) in the placebo group (n=79), -1·2 (1·0) in the abobotulinumtoxinA 500 U group (n=80; difference -0·9, 95% CI -1·2 to -0·6; p<0·0001 vs placebo), and -1·4 (1·1) in the abobotulinumtoxinA 1000 U group (n=79; -1·1, -1·4 to -0·8; p<0·0001 vs placebo). Mean PGA score at week 4 was 0·6 (SD 1·0) in the placebo group (n=78), 1·4 (1·1) in the abobotulinumtoxinA 500 U group (n=80; p=0·0003 vs placebo), and 1·8 (1·1) in the abobotulinumtoxinA 1000 U group (n=78; p<0·0001 vs placebo). Mean change from baseline at week 4 in DAS score for the principal target of treatment was -0·5 (0·7) in the placebo group (n=79), -0·7 (0·8) in the abobotulinumtoxinA 500 U group (n=80; p=0·2560 vs placebo), and -0·7 (0·7) in the abobotulinumtoxinA 1000 U group (n=78; p=0·0772 vs placebo). Three serious adverse events occurred in each group and none were treatment related; two resulted in death (from pulmonary oedema in the placebo group and a pre-existing unspecified cardiovascular disorder in the abobotulinumtoxinA 500 U group). Adverse events that were thought to be treatment related occurred in two (2%), six (7%), and seven (9%) patients in the placebo, abobotulinumtoxinA 500 U, and abobotulinumtoxinA 1000 U groups, respectively. The most common treatment-related adverse event was mild muscle weakness. All adverse events were mild or moderate. INTERPRETATION AbobotulinumtoxinA at doses of 500 U or 1000 U injected into upper limb muscles provided tone reduction and clinical benefit in hemiparesis. Future research into the treatment of spastic paresis with botulinum toxin should use active movement and function as primary outcome measures. FUNDING Ipsen.
Collapse
Affiliation(s)
- Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est, Hospital Albert Chenevier-Henri Mondor, Service de Rééducation Neurolocomotrice, Créteil, France.
| | - Allison Brashear
- Wake Forest University School of Medicine, Department of Neurology, Winston-Salem, NC, USA
| | - Robert Jech
- Department of Neurology, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Peter McAllister
- New England Institute for Neurology and Headache, Stamford, CT, USA
| | - Marta Banach
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Peter Valkovic
- Second Department of Neurology, Comenius University and University Hospital, Bratislava, Slovakia
| | | | - Christina Marciniak
- Northwestern University and Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Thierry Deltombe
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire Dinant Godinne/Université catholique de Louvain Namur, Yvoir, Belgium
| | - Alexander Skoromets
- State Budgetary Educational Institution of Higher Professional Education, St Petersburg State Medical University I P Pavlov, St Petersburg, Russia
| | - Svetlana Khatkova
- Neurology Department, Federal State Hospital Treatments and Rehabilitation Center of Ministry of Health and Social Development of Russian Federation, Moscow, Russia
| | - Steven Edgley
- University of Utah School of Medicine, Division of Physical Medicine and Rehabilitation, Salt Lake City, UT, USA
| | - Fatma Gul
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | | | |
Collapse
|
35
|
Thibaut FA, Chatelle C, Wannez S, Deltombe T, Stender J, Schnakers C, Laureys S, Gosseries O. Spasticity in disorders of consciousness: a behavioral study. Eur J Phys Rehabil Med 2015; 51:389-397. [PMID: 25375186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Spasticity is a frequent complication after severe brain injury, which may impede the rehabilitation process and diminish the patients' quality of life. AIM We here investigate the presence of spasticity in a population of non-communicative patients with disorders of consciousness. We also evaluate the correlation between spasticity and potential factors of co-morbidity, frequency of physical therapy, time since insult, presence of pain, presence of tendon retraction, etiology and diagnosis. DESIGN Cross-sectional study. SETTING University Hospital of Liège, Belgium. POPULATION Sixty-five patients with chronic (>3 months post insult) disorders of consciousness were included (22 women; mean age: 44±14 y; 40 with traumatic etiology; 40 in a minimally conscious state; time since insult: 39±37 months). METHODS Spasticity was measured with the Modified Ashworth Scale (MAS) and pain was assessed using the Nociception Coma Scale-Revised (NCS-R). RESULTS Out of 65 patients, 58 demonstrated signs of spasticity (89%; MAS≥1), including 40 who showed severe spasticity (61.5%; MAS≥3). Patients with spasticity receiving anti-spastic medication were more spastic than unmedicated patients. A negative correlation was observed between the severity of spasticity and the frequency of physical therapy. MAS scores correlated positively with time since injury and NCS-R scores. We did not observe a difference of spasticity between the diagnoses. CONCLUSION A large proportion of patients with disorders of consciousness develop severe spasticity, possibly affecting their functional recovery and their quality of life. The observed correlation between degrees of spasticity and pain scores highlights the importance of pain management in these patients with altered states of consciousness. Finally, the relationship between spasticity and treatment (i.e., pharmacological and physical therapy) should be further investigated in order to improve clinical care. CLINICAL REHABILITATION IMPACT Managing spasticity at first signs could improve rehabilitation of patients with disorders of consciousness and maximize their chances of recovery. In addition, decreasing this trouble could allow a better quality of life for these non-communicative patients.
Collapse
Affiliation(s)
- F A Thibaut
- Coma Science Group, Giga Research, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium -
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Thibaut A, Deltombe T, Wannez S, Gosseries O, Ziegler E, Dieni C, Deroy M, Laureys S. Impact of soft splints on upper limb spasticity in chronic patients with disorders of consciousness: A randomized, single-blind, controlled trial. Brain Inj 2015; 29:830-6. [DOI: 10.3109/02699052.2015.1005132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
37
|
Deltombe T, Bleyenheuft C, Gustin T. Comparison between tibial nerve block with anaesthetics and neurotomy in hemiplegic adults with spastic equinovarus foot. Ann Phys Rehabil Med 2015; 58:54-9. [PMID: 25614022 DOI: 10.1016/j.rehab.2014.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effect of diagnostic motor nerve block with anaesthetics and of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic adults. METHODS In this prospective observational study, 30 hemiplegic adults with spastic equinovarus foot benefited from a diagnostic nerve block with anaesthetics followed by a selective tibial neurotomy performed at the level of the same motor nerve branches of the tibial nerve. Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion (ROM), gait parameters (10 meters walking test) and gait kinematics (video assessment) were assessed before and after the nerve block and two months and two years after selective tibial neurotomy. RESULTS The decrease in spasticity and the improvement in gait kinematics were similar after the diagnostic nerve block and two months and two years after neurotomy. The diagnostic nerve block did not revealed the slight increase in gait speed and in tibialis anterior muscle strength that was observed two years after neurotomy. CONCLUSION This study suggests that diagnostic nerve block with anaesthetics and selective neurotomy equally reduce spasticity and improve gait in case of spastic equinovarus foot in hemiplegic adults. Diagnostic nerve block can be used as a valuable screening tool before neurotomy.
Collapse
Affiliation(s)
- Thierry Deltombe
- Departments of Physical Medicine and Rehabilitation (Deltombe and Bleyenheuft) and Neurosurgery (Gustin), CHU-UcL Dinant Godinne (université catholique de Louvain), 5530 Yvoir, Belgium.
| | - Corinne Bleyenheuft
- Departments of Physical Medicine and Rehabilitation (Deltombe and Bleyenheuft) and Neurosurgery (Gustin), CHU-UcL Dinant Godinne (université catholique de Louvain), 5530 Yvoir, Belgium
| | - Thierry Gustin
- Departments of Physical Medicine and Rehabilitation (Deltombe and Bleyenheuft) and Neurosurgery (Gustin), CHU-UcL Dinant Godinne (université catholique de Louvain), 5530 Yvoir, Belgium
| |
Collapse
|
38
|
Zorowitz R, Wein T, Dunning K, Deltombe T, Olver JH, Evans C, Gillard PJ, Kissela B. Poster 435 Development of a Clinical Practice Screening Tool to Identify Disabling Spasticity. PM R 2014. [DOI: 10.1016/j.pmrj.2014.08.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Theodore Wein
- The Johns Hopkins University, Baltimore, MD, United States
| | - Kari Dunning
- The Johns Hopkins University, Baltimore, MD, United States
| | | | - John H. Olver
- The Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Brett Kissela
- The Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
39
|
Theys S, Cadel F, Aguilar Ferrándiz M, Otto S, Deltombe T. Obesity complicated or not by a lipo-edema: Is there any veno-lymphatic drainage due to lower limb oscillations by a KiMachine? Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
40
|
Theys S, Cadel F, Aguilar Ferrándiz M, Otto S, Deltombe T. Obésité compliquée ou non de lipœdème : réponse du drainage par oscillation des membres inférieurs produite par une KIMACHINE. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
41
|
Deltombe T, Gustin T, Lenfant P. The motor nerve blocks with anaesthetics in the assessment of the spastic upper limb. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
42
|
Deltombe T, Gustin T, de Cloedt P, Lenfant P, Fostier M. Le traitement neuro-orthopedique de la spasticité en 2014. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Deltombe T, Gustin T, De Cloedt P, Lenfant P, Fostier M. Neuro-orthopaedic care of spasticity in 2014. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
44
|
Deltombe T, Theys S, Aguilar Ferrandiz M, Genette A. Manual drainage versus Lymphassist® at 40mm Hg: Comparative plethysmographic study on upper limb lymphoedema. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
45
|
Deltombe T, Gustin T, De Cloedt P, Lenfant P, Fostier M, Ossemann M, Collard R, Leeuwerck M, Peret F, Vandenbroeck N, Hanson P. Arbre décisionnel de la prise en charge médicochirurgicale interdisciplinaire du pied varus équin spastique hémiplégique. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
46
|
Deltombe T, Gustin T, De Cloedt P, Lenfant P, Fostier M, Ossemann M, Collard R, Leeuwerck M, Peret F, Vandenbroeck N, Hanson P. Proposal guidelines for the medical and/or surgical interdisciplinary management of the equinovarus spastic foot among hemiplegic patients. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
47
|
Deltombe T, Gustin T, Stoquart G, Detrembleur C, Lejeune T, Bollens B. Article 24 Selective tibial neurotomy as a treatment for spastic foot: a randomized, assessor-blinded, controlled trial. Arch Phys Med Rehabil 2013. [DOI: 10.1016/j.apmr.2013.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
48
|
Deltombe T, Theys S, Aguilar Ferrandiz M, Genette A. Drainage manuel versus Lymphassist® à 40mmHg : étude pléthysmographique comparative sur des lymphœdèmes du membre supérieur. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
49
|
Bollens B, Gustin T, Stoquart G, Detrembleur C, Lejeune T, Deltombe T. A Randomized Controlled Trial of Selective Neurotomy Versus Botulinum Toxin for Spastic Equinovarus Foot After Stroke. Neurorehabil Neural Repair 2013; 27:695-703. [DOI: 10.1177/1545968313491002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Selective neurotomy is a permanent treatment of focal spasticity, and its effectiveness in treating spastic equinovarus of the foot (SEF) was previously suggested by a few nonrandomized and uncontrolled case-series studies. Objectives. This study is the first assessor-blinded, randomized, controlled trial evaluating the effects of this treatment. Methods. Sixteen chronic stroke patients presenting with SEF were randomized into 2 groups: 8 patients underwent a tibial neurotomy and the remaining 8 received botulinum toxin (BTX) injections. The soleus was treated in all patients, and the tibialis posterior and flexor hallucis longus were treated in about half of patients. The primary outcome was the quantitative measurement of ankle stiffness (L-path), an objective measurement directly related to spasticity. Participants were assessed by a blind assessor before their intervention and at 2 and 6 months after treatment. Evaluations were based on the 3 domains of the International Classification of Functioning, Disability and Health (ICF). Results. Compared with BTX, tibial neurotomy induced a higher reduction in ankle stiffness. Both treatments induced a comparable improvement of ankle kinematics during gait, whereas neither induced muscle weakening. Activity, participation, and quality of life were not significantly modified in either group. Conclusions. This study demonstrates that the tibial nerve neurotomy is an effective treatment of SEF, reducing the impairments observed in chronic stroke patients. Future studies should be conducted to confirm the long-term efficacy based on the ICF domains.
Collapse
Affiliation(s)
- Benjamin Bollens
- Université Catholique de Louvain, Institute of Neurosciences, Brussels, Belgium
- Université Catholique de Louvain, Physical Medicine and Rehabilitation Department, Brussels, Belgium
| | - Thierry Gustin
- Université Catholique de Louvain, Institute of Neurosciences, Brussels, Belgium
- Université Catholique de Louvain, CHU Mont-Godinne, Yvoir, Belgium
| | - Gaëtan Stoquart
- Université Catholique de Louvain, Institute of Neurosciences, Brussels, Belgium
- Université Catholique de Louvain, Physical Medicine and Rehabilitation Department, Brussels, Belgium
| | | | - Thierry Lejeune
- Université Catholique de Louvain, Institute of Neurosciences, Brussels, Belgium
- Université Catholique de Louvain, Physical Medicine and Rehabilitation Department, Brussels, Belgium
| | - Thierry Deltombe
- Université Catholique de Louvain, Institute of Neurosciences, Brussels, Belgium
- Université Catholique de Louvain, CHU Mont-Godinne, Yvoir, Belgium
| |
Collapse
|
50
|
Deltombe T, Gustin T. Comparaison de l’effet du bloc diagnostique aux anesthésiques et de la neurotomie tibiale en cas de pied varus équin spastique hémiplégique. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|