Épidémiologie des pieds varus et/ou équin un an après un premier accident vasculaire cérébral hémisphérique : à propos d'une cohorte de 86 patients

OBJECTIVE

To determine the frequency and the functional consequences of varus equinus in stabilized vascular hemiplegia.

METHODS

Prospective cohort study of 86 hemiplegic patients. All patients consecutively admitted for a first hemispheral stroke between July 2001 and January 2002 were included. The evaluation consisted in a clinical examination and a descriptive study of gait. The functional capacity of patients with and without varus equinus were compared using the Barthel index, the New Functional Ambulation Classification (NFAC), the confortable ten meters gait speed and gait perimeter.

RESULTS

The incidence of varus equinus was 18%. There was no difference in gait speed (0.8 m/s), NFAC or Barthel index between patients with or without varus equinus. Patients with varus equinus had had more specialized, intensive and prolonged rehabilitation. The only prognostic factor that could be identified was the motor impairment and the existence of spasticity.

DISCUSSION

The mechanism of varus equinus is thought to be mainly the over-activity of gastrocnemius and solaris compared to that of the tibialis anterior, associated to the weakness of fibular muscles. The role of tibialis posterior is thought to be less important. The frequency of varus equinus after a first hemispheral stroke was low and the consequences were limited. This could be in part explained by the access of these patients to early, specialized and prolonged rehabilitation care.

Facteurs prédictifs du devenir fonctionnel et du retour à domicile après un premier accident vasculaire cérébral hémisphérique

BACKGROUND AND PURPOSE

Several prognostic factors have been identified for outcome after stroke. We conducted a study to determine early predictive factors of functional outcome one year after stroke and to evaluate which factors are independent predictors, with an aim of specifying the role of age, aphasia, unilateral neglect, cognitive impairment and family social support.

METHODS

Observational cohort study of 156 patients. All patients admitted to the university hospital for initial unilateral hemispheric stroke were included. The study duration was two years (inclusion, one year, and follow-up, one year) . The initial evaluation of stroke was conducted at day 2 and day 15 and included the Motricity Index and Trunk Control Test, New Functional Ambulation Classification, Frenchay arm test, Mini-Mental State Examination, Boston Diagnostic Aphasia Examination, unilateral neglect evaluation, and depression. Data on functional recovery (Barthel Index) were collected at day 360.

RESULTS

The average age of patients was 72 years. Age was correlated to social situation (P<0.01) and previous neurological impairment (P<0.01). A multiple regression analysis, including 14 initial clinical factors correlated with the Barthel Index score at day 360, revealed 4 independent early predictive factors of outcome: initial score of Barthel Index at day 2 and its progression from day 2 to day 15, disorders of the executive functions and previous neurological impairment.

CONCLUSION

In our cohort, in accordance with previous studies, age, cognitive impairment, unilateral neglect, aphasia, depression and social situation are not independent factors of poor outcome after stroke as evaluated by the Barthel Index.

La continuité de prise en charge lors de la transition des soins de l'enfant à l'adulte handicapé

Most children born with a chronic health condition or disability are expected to live more than 20 years. Health care is provided for these children in paediatric units until they are 18 years old, and the transition to the adult health care system is difficult because of poor collaboration between specialists and families who sometimes wonder if the adult specialist will be competent, although young disabled people need specialised follow-up. This report discusses U.S. and English models in the transition in health care. Coordination between paediatricians and adult services is necessary. The neuromuscular disorders clinic is cited as an example.

Évaluation isocinétique chez le lombalgique. Rôle respectif de la familiarisation et de la rééducation dans l'évolution des performances

Isokinetic dynamometers put subjects in very different conditions from natural movement. Familiarization with the isokinetic device may therefore explain better performance without showing any improvement in strength.

OBJECTIVE

To determine the part of habituation and training in improved trunk isokinetic performance on isometric assessment after a back rehabilitation program for chronic low back pain.

METHODS

A total of 26 patients with chronic low back pain consecutively admitted to the same rehabilitation department for a 4-week rehabilitation program underwent isometric assessment of the trunk flexors and extensors on the day of admission and 2 days and 21 days after admission. The maximal torque and total work were registered at 30 degrees , 90 degrees and 120 degrees/s.

RESULTS

Values for all parameters, except flexor values at 30 degrees/s, were significantly improved between day 0 and day 2 after admission. Between day 2 and day 21 after admission, values for all parameters were improved significantly. Except for flexor values at 30 degrees/s, the parameter values at day 2 showed improvement ranging from 33% to 58% of the improvement seen at day 21.

DISCUSSION

The improvement in parameter values found on isokinetic assessment two days after a one-day rehabilitation program for low back pain is probably explained by a habituation effect. We can expect that increase in the maximal torque and total work after 3 weeks of rehabilitation is, at least in part, the consequence of the strengthening program.

CONCLUSION

We should interpret with caution the results of studies involving an isokinetic dynamometer to measure the strength of trunk muscles without a learning training.