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

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

Abstract: Bensoussan L, Viton J-M, Schieppati M, Collado H, Milhe de Bovis V, Mesure S, Delarque A. Changes in postural control in hemiplegic patients after stroke performing a dual task. Objective: To determine the effects of an attentional task on hemiplegic patients’ postural control performances. Design: Retrospective study. Setting: Department of physical and rehabilitation medicine at a university hospital. Participants: Twenty-three hemiplegic patients and 23 healthy age- and sex-matched control subjects. Interventions: Not applicable. Main Outcome Measures: Sway area and sway path of the center of pressure were measured during 30 seconds in standing subjects and patients under 3 conditions: eyes open (EO), EO while performing a simple arithmetic task (EO-AT), and eyes closed (EC). Results: In the hemiplegic patients, the body sway area increased significantly with EC (P<.001) and during the EO-AT task (P<.017) in comparison with EO. Sway area with EO-AT remained, however, significantly smaller than with EC (P<.014). In the healthy subjects, the body sway did not differ significantly between the EO-AT and EO tasks (P<.42). The increase observed in the sway area and path in the hemiplegic population during the EO-AT task correlated significantly with age. Conclusions: The postural performances of hemiplegic patients decreased during both the arithmetic task and the EC task. The cognitive task had no effect on healthy subjects’ postural performances. This study is the first to show the combined effects of age and dual task on the postural performances of hemiplegic subjects. [Copyright &y& Elsevier]