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La FÉdération des Services d'Urgence de la Main (FESUM) est un réseau européen de centres d'urgences de la main (appelés centres SOS main) en France, Belgique et au Luxembourg. Le réseau de la FESUM comporte 64 centres SOS main en France. Dans notre hôpital universitaire, le SOS main labellisé FESUM fait partie du service de chirurgie plastique depuis 2001. Il inclut, depuis 2016, les étudiants de 3e cycle (« internes ») en formation en chirurgie de la main qui participent en autonomie supervisée au circuit des patients. L'objectif de cette étude était d'analyser les caractéristiques du suivi postopératoire des patients blessés de la sain et leur satisfaction avec ce mode de fonctionnement. L'objectif secondaire était l'étude des caractéristiques de la population de patients prise en charge par notre centre. Nous avons mené une étude sur le suivi des patients opérés en urgence de la main, prospective, monocentrique, déclarative, anonymisée, entre mai et octobre 2021 au centre SOS main de notre CHU à la consultation des internes « SOS Main ». Les données démographiques, les principales caractéristiques de la pathologie, les éléments de prise en charge initiale et du suivi des patients ainsi que leur satisfaction ont été analysés, de même la satisfaction des internes en rapport avec cette consultation de suivi. Nous avons inclus 323 patients. La population des patients pris en charge correspondait globalement à un homme jeune, travailleur manuel, ayant été pris en charge initialement en service ambulatoire ou en consultation SOS Main. Les lésions les plus souvent représentées étaient les fractures (24 %), les plaies tendineuses (18 %) et les plaies sans atteinte des tissus nobles (16 %). Les consultations de suivi avaient lieu principalement à 15 jours de l'intervention en urgence, duraient en moyenne 10 minutes et ne présentaient pas de retard excessif. La satisfaction des patients (91,2 %) et des internes (87,2 %) était élevée. Le suivi kinésithérapique postopératoire était cependant insuffisant de même que l'autorééducation. L'intégration des internes en stage dans un service universitaire de chirurgie plastique à la prise en charge des patients SOS Main semble bénéfique pour tous les acteurs et pour leur formation. Les caractéristiques des consultations de suivi par l'interne en autonomie supervisée correspondaient aux standards de qualité de la FESUM et les patients montraient un taux de satisfaction élevé. Une meilleure valorisation de cette consultation sous forme d' office surgery est à envisager. Federation of Hand Emergency Services (FESUM) is a European network of hand emergency centers (called SOS hand centers) in France, Belgium and Luxembourg. The FESUM network includes 64 SOS Hand centers in France. In our university hospital, the FESUM-certified SOS hand has been part of the plastic surgery department since 2001. It has included, since 2016, postgraduate students ("residents") training in hand surgery who participate independently in the patient follow-up. The objective of this study was to analyze the characteristics of this population of patients with hand injuries and their satisfaction with this mode of follow-up. The secondary objective was to study the characteristics of the patient population treated by our center. We conducted a study on the follow-up of patients undergoing emergency hand surgery, prospective, single-center, declarative, anonymized, between May and October 2021 at the SOS main center of our university hospital at the "SOS Main" intern consultation. The demographic data, the main characteristics of the pathology, the elements of initial care and follow-up of the patients as well as their satisfaction were analyzed, as well as the satisfaction of the interns. We included 323 patients. The population of patients treated generally corresponded to a young man, manual worker, who was initially treated in an outpatient department or in an SOS Hand consultation. The lesions most often represented were fractures (24%), tendon wounds (18%) and wounds without damage to noble tissues (16%). Follow-up consultations took place mainly 15 days after the emergency intervention, lasted on average 10 minutes and did not present excessive delays. Patient (91.2%) and post-graduate student (87.2%) satisfaction was high. However, postoperative physiotherapy follow-up was insufficient, as was self-rehabilitation. The integration of post-graduate student in a university plastic surgery department into the care of SOS Hand patients seems beneficial for all those involved, and for their training. The characteristics of the follow-up consultations by the intern in autonomous supervision corresponded to the high quality standards of the FESUM. The patients showed a high satisfaction rate. Better valorization of this consultation in "office surgery" should be considered. [ABSTRACT FROM AUTHOR]

L'objectif de cet article était de présenter les traitements pouvant être proposés en première intention pour HAV en France en 2023. Une revue de la littérature a été effectuée par deux relecteurs en utilisant la base de données Medline/PubMed et SCOPUS sans restriction de période mais en limitant la recherche aux travaux en anglais ou en français. La recherche a été réalisée à partir des mots-clés suivants seuls ou en combinaison : « overactive bladder », « treatment », « conservative », « first-line ». Le traitement de l'HAV évolue de plus en plus vers une approche individualisée. Il existe donc un large panel de traitements qui peuvent être proposés en première intention allant des mesures hygiéno-diététiques à la neurostimulation tibiale postérieure en passant par les traitements pharmacologiques (anticholinergiques, mirabegron, tadalafil chez l'homme), la rééducation périnéale, l'œstrogénothérapie locale ou le pessaire. Un interrogatoire détaillé et un examen physique attentif suffisent dans la majorité des cas à orienter la prescription thérapeutique de première intention. Les options non pharmacologiques sont à privilégier en première intention dans la majorité des cas. Une approche centrée sur le souhait et les attentes du patient en appliquant le concept de décision médicale partagée doit permettre d'orienter le patient vers le meilleur traitement possible dès la première ligne. Il existe un large éventail de traitement pouvant être prescrit dès la première ligne chez les patients ayant une HAV en prenant soin d'essayer au maximum d'individualiser la prescription à la typologie clinique de chaque patient. The objective of this article was to present the treatments that can be offered as first-line therapy for overactive bladder (OAB) in France in 2023. Two reviewers conducted a review of the literature using the Medline/PubMed and SCOPUS databases without period restriction, but limiting the search to works in English or French. The search was performed using the following keywords alone or in combination: "overactive bladder", "treatment", "conservative", "first-line". The treatment of OAB is evolving more and more towards an individualized approach. There is therefore a wide range of treatments that can be proposed as first-line treatment, ranging from lifestyle modifications to posterior tibial nerve stimulation, including pharmacological treatments (anticholinergics, mirabegron, tadalafil in men), pelvic floor muscle training, local estrogen or pessaries. detailed clinical interview and a careful physical examination are sufficient in most cases to guide the first-line therapeutic prescription. Nonpharmacological options are preferred in the majority of cases. A patient-centered approach, using shared medical decision making, should enable the patient to be guided towards the best possible treatment from the first line. There is a wide range of treatments that can be prescribed as first line for patients with OAB, taking care to individualize the prescription to patients' profile and characteristics. [ABSTRACT FROM AUTHOR]

La prise en charge rééducative en cas de rhumatisme inflammatoire tient toujours une place importante et ce malgré les progrès de la prise en charge pharmacologique des rhumatismes inflammatoires. La stratégie du traitement à la cible associée aux biothérapies a montré certaines limites dans l'amélioration de la qualité de vie des patients justifiant la prise en charge rééducative des patients. Cette prise en charge va être différente en fonction de la présentation phénotypique. Il existe un socle commun avec une indication à une réhabilitation cardiorespiratoire associée à un renforcement musculaire et des exercices d'assouplissement. Dans les formes articulaires périphériques, la rééducation des mains ainsi que l'électrothérapie n'ont plus leur place alors que la cryothérapie montre des données intéressantes. Enfin, la balnéothérapie montre uniquement des effets bénéfiques sur la qualité de vie des patients. Dans les formes axiales, la cryothérapie corps entier a montré un effet sur l'activité de la maladie. Enfin, dans le rhumatisme psoriasique, l'application de bains de boue ainsi que l'eau salée ont permis une amélioration de l'activité de la maladie. Enfin, dans les enthésites en rapport avec un rhumatisme inflammatoire, les ondes de choc ainsi que les ultrasons sont utiles et efficaces. Ainsi, la prise en charge rééducative garde une place de choix dans l'amélioration de la qualité de vie des patients avec des spécificités en fonction du phénotype. Rehabilitation management of inflammatory rheumatism still has a major place, despite the progress in pharmacologic management of inflammatory rheumatism. The strategy of treating to target associated with biotherapy has shown some limitations in the improvement of the quality of life of the patients justifying the physical therapy. This management will differ according to the phenotypic presentation. There is a common basis with an indication for cardiorespiratory rehabilitation associated with muscle strengthening and flexibility exercises. In peripheral joint forms, hand rehabilitation and electrotherapy are no longer appropriate, whereas cryotherapy shows interesting data. Finally, balneotherapy only shows beneficial effects on the patients' quality of life. In axial disease, whole body cryotherapy has shown an effect on disease activity. Finally, in psoriatic arthritis, the application of mud baths as well as salt water has led to an improvement in disease activity. Finally, in enthesitis related to inflammatory rheumatism, shock waves and ultrasound are useful and effective. Thus, rehabilitative treatment has a key role to play in the improvement of patients' quality of life, with specificities depending on the phenotype. [ABSTRACT FROM AUTHOR]

La clinique des atteintes cérébrales soulève des questions épineuses d'un point de vue épistémologique, clinique et thérapeutique. L'organisation d'un dispositif thérapeutique à visée de rééducation se fixe souvent des objectifs ciblés mais elle n'en concerne pas moins le sujet et son fonctionnement psychique dans son ensemble. De fait, si l'accent mis sur la rééducation a toute son importance, la nécessité de ne pas sacrifier la réalité psychique sur l'autel de la stimulation des fonctions cognitives, et de préoccupations adaptatives et performatives demeure un enjeu clinique et éthique majeur. À l'appui d'expériences cliniques complémentaires, en cabinet libéral et en service hospitalier, les auteurs montrent comment ils ont été interpelés par les mouvements inhérents aux dispositifs thérapeutiques, saisis par la réalité psychique singulière des patients. En effet, bousculés par l'expérience d'atteintes cérébrales, de troubles somatiques et cognitifs, ces patients se confrontent de surcroît aux contraintes du cadre du travail de rééducation et de ses attendus, efforts à fournir, performances à réaliser, etc. Conjointement, ils sont mis au travail tant par la façon dont leur réalité psychique est ébranlée par cette réalité événementielle nouvelle et souvent inattendue que par la façon dont elle traite le traumatisme. Analysant les changements observés chez des patients au cours de séances de rééducation ou de psychothérapie psychanalytique, les auteurs saisissent la façon dont ces différentes réalités qui cohabitent chez le patient sont susceptibles de se télescoper, de se répondre, de se conjuguer. La dimension actuelle et matérielle du traumatisme ne suffit pas à rendre compte des états de souffrance psychique des patients qui peuvent les conduire, malgré leur bonne volonté, à des conduites d'opposition qui malmènent le cadre et les objectifs rééducatifs. En effet, la remobilisation de problématiques psychiques inconscientes liées à des vécus d'impuissance, de dépendance, d'emprise, d'abandon, joue un rôle nodal dans le déroulement du projet thérapeutique. Ces effets d'après-coup permettent de saisir combien la réalité d'un événement accidentel rencontre l'effectivité de motivations internes qui peuvent échapper au patient. Peut ainsi se découvrir combien le problème neurologique vient renforcer la résistance psychique aux potentialités de changement et d'élaboration psychiques, et inversement. Non prises en compte et non mises au travail, ces problématiques et ces défenses psychiques peuvent constituer des entraves à la qualité du projet de réhabilitation cognitive, à la réhabilitation de l'estime de soi, voire au rétablissement de la santé psychique. Seule l'écoute du patient permet de saisir ce qui, de sa réalité psychique, est meurtri et ravivé. Elle permet de souligner l'importance d'un dialogue entre neuropsychologie et psychanalyse qui ne peuvent s'affranchir totalement l'une de l'autre dans un tel contexte clinique. Leur éclairage mutuel permet le dépassement d'une vision monolithique des facteurs étiopathogéniques et garantit la prise en compte de la singularité du sujet. C'est ainsi que les dispositifs thérapeutiques, mis à l'épreuve par la complexité du fonctionnement cognitif et psychique du patient, permettent à ce dernier de se mettre au travail en déployant une activité mentale où s'expriment de concert les séquelles cognitives et les processus psychiques. C'est parce qu'il pourra mobiliser ses processus d'élaboration du trauma que le patient pourra assouplir ses défenses et ses résistances et réinvestir les exercices de rééducation dont la nécessité s'impose encore. Différentes, et parfois en désaccord, psychanalyse et neuropsychologie ont comme objet commun le sujet singulier. La possibilité d'un dialogue permettant l'écoute de la causalité psychique tout en prenant acte des atteintes cérébrales sous-jacentes aux troubles cognitifs s'avère une condition précieuse d'accompagnement du patient dans les tourments et les paradoxes qui sont les siens. Il en va de la qualité des soins proposés à ces femmes et à ces hommes meurtris dans leur corps et leur psyché : le dialogue interdisciplinaire repose sur une alliance de la rigueur et de la souplesse théoriques, cliniques, quel que soit par ailleurs le dispositif proposé. Clinical work with brain injuries (stroke, traumatic brain injury, tumor...) raises thorny questions from epistemological, clinical, and therapeutic points of view. The organization of a therapeutic setting for rehabilitation purposes often requires setting targeted objectives, but it is equally concerned with the patients and their psychical functioning as a whole. If the emphasis placed on the rehabilitation of disorders and deficits is important, the need to resist sacrificing the patient's psychical reality on the altar of the stimulation of cognitive functions, and of adaptive and performative concerns, remains a major clinical and ethical issue. Based on their clinical experiences in neuropsychological rehabilitation, in private practice, and in psychotherapy in a rehabilitation department, the authors show how they were challenged by the movements inherent to therapeutic settings, seized by the singular psychical reality of their patients. Indeed, their lives disrupted by the experience of cerebral damage, as well as somatic and cognitive disorders, these patients are also confronted with the constraints of the setting of the rehabilitation work, with expectations in terms of efforts to be made, performances to be achieved, etc. At the same time, these patients are put to work both by the way their psychical reality is disturbed by this new and often unexpected event and by the way it deals with the trauma. Analyzing the changes observed in patients during rehabilitation or psychoanalytical psychotherapy sessions, the authors discern the way in which these different realities may collide, respond to each other, combine. The diversity of the clinical situations shows how the present and material dimension of the trauma is not enough to account for the patients' states of psychical suffering which may lead them, despite their good will, to mobilize behaviors of manifest opposition (aggressiveness) or latent opposition (depression) that interfere with the setting and the rehabilitation objectives. Indeed, the remobilization of past, unconscious psychical conflicts, linked to experiences of powerlessness, dependence, mastery, abandonment, plays a nodal role in the development of the therapeutic plan. These deferred actions make it possible to understand how cognitive difficulties are not reducible to neurological damage, and may be aggravated by the psychical conflicts reactivated during the proposed treatments. The reality of an accidental event meets the effects of internal motivations which may, unbeknownst to the patients, question their potential implication in the accident. Thus, clinicians can discover to what extent the neurological issue reinforces the psychical resistance to the potentialities of change and psychical elaboration, and vice versa. If not considered nor put to work, these psychical issues and defenses can constitute obstacles to the quality of the cognitive rehabilitation plan, to the rehabilitation of self-esteem, and even to the re-establishment of mental health. Cognitive disorders of cerebral origin encounter a psychical reality that is always singular, full of fragilities and resources. Only listening to the patients allows us to grasp what is bruised and revived in their psychical reality. This listening highlights the importance of a dialogue between neuropsychology and psychoanalysis, which cannot be totally separated from each other in a clinical context. Their combined perspectives allow the overcoming of a monolithic vision of the etiopathogenic factors and guarantee that the patient's subjectivity is taken into consideration. This is how therapeutic settings, challenged by the complexity of the patients' cognitive and psychical functioning, allow the latter to put themselves to work by mobilizing a mental activity where both the cognitive disorders and the psychical processes treating anxiety and depression in particular are expressed. Thanks to their ability to use their psychical processes of elaboration of the trauma, the patients can soften their defenses and their resistances, thereby mobilizing themselves for the exercises of rehabilitation that remain necessary. Although different, and sometimes in disagreement, psychoanalysis and neuropsychology have as common object the singularity of each patient. The possibility of a dialogue allowing for a listening to the psychical causality while taking note of the brain injuries underlying the cognitive disorders proves to be a precious condition of clinicians' capacity to accompany their patients in their torments and paradoxes. The quality of the care offered to these men and women, whose bodies and psyches have been damaged, depends on it: interdisciplinary dialogue within the same therapist or between two therapists is based on an alliance of theoretical and clinical rigor and flexibility, whatever the proposed setting. [ABSTRACT FROM AUTHOR]

L'amblyopie est un trouble du développement qui intéresse l'ensemble du système visuel et du cortex visuel au-delà du cortex extra-strié. Le principal retentissement fonctionnel est une altération de l'acuité visuelle de l'œil dominé. Mais, tous les paramètres de la fonction visuelle sont perturbés puisqu'il peut être mis en évidence un déficit de la sensibilité aux contrastes ou de la vision stéréoscopique et une hyperacuité visuelle Vernier au niveau de l'œil « sain ». Ce trouble du développement ne peut s'installer qu'au cours de la période critique du développement cérébral, période de maturation et de plus grande plasticité cérébrale, et plus volontiers lors du pic de celle-ci, avant l'âge de 3 ans. Cette période est également celle au cours de laquelle la rééducation est la plus efficace. L'amblyopie est due soit à une privation visuelle, soit à un strabisme soit enfin à une anisométropie. Elle peut également s'associer à des troubles organiques lors de formes dites « mixtes ». L'amblyopie est définie par une différence d'acuité visuelle d'au moins une ligne d'acuité visuelle LogMAR. Hormis lorsqu'il existe un strabisme franc, ce déficit visuel reste souvent méconnu chez un enfant qui ne se plaint pas et voit bien d'un œil. C'est dire l'importance du dépistage, cherchant toutes les situations à risques telles qu'une différence de réfraction entre les deux yeux ou des facteurs héréditaires. Dans tous les cas, la confirmation de sa présence est indispensable avant la mise en route de la rééducation. Cette mise en évidence repose sur la mesure de la réfraction sous cycloplégie, le bilan ophtalmologique et orthoptique. L'acuité visuelle ou l'acuité de résolution peuvent être mesurées, avec des contraintes liées à l'âge. La rééducation nécessite pour être efficace la coopération active des parents. Elle repose ensuite sur la prescription de la correction optique totale déterminée sous cycloplégie qui peut parfois suffire à corriger cette amblyopie. La rééducation en elle-même est basée sur l'occlusion ou la pénalisation de l'œil sain permettant à l'œil dominé de développer sa vision et doit être complétée par un traitement d'entretien jusqu'à la fin de la période critique. En son absence, il existe un risque de récidive. Amblyopia is a developmental disorder that affects the entire visual system and the visual cortex beyond the extra-striated cortex. The main functional manifestation is an impairment of visual acuity in one eye called "the dominated eye". However, all the parameters of visual function are disturbed since it can be demonstrated a deficit in contrast sensitivity or stereoscopic vision. In addition, a Vernier visual hyperacuity is frequently observed in the "healthy" eye. This developmental disorder can only occur during the critical period of brain development, a period of maturation and greater brain plasticity, and more readily at its peak, before the age of 3. Rehabilitation is also most effective during this period. Amblyopia is due either to visual deprivation, or to strabismus or finally to anisometropia. It can also be associated with organic disorders in so-called "mixed" forms. Amblyopia is defined as a difference in visual acuity of at least one LogMAR visual acuity line. Except when there is a manifest strabismus, this visual deficit is often unrecognised in a child who does not complain and sees well with one eye. This shows the importance of screening, looking for all risky situations, such as a difference in refraction between the two eyes or hereditary factors. In all cases, confirmation of its presence is essential before starting rehabilitation. This demonstration is based on the measurement of refraction under cycloplegia, the ophthalmological and orthoptic assessment. Visual acuity or grating acuity can be measured by specific method according to the age of the child, with age-related difficulties. In order to be effective, rehabilitation requires the active cooperation of parents. It is then based on the prescription of total optical correction determined under cycloplegia which may sometimes be sufficient to correct this amblyopia. The rehabilitation itself is based on the occlusion or penalisation of the healthy eye allowing the dominated eye to develop its vision and must be supplemented by maintenance treatment until the end of the critical period. In its absence, there is a risk of recurrence. [ABSTRACT FROM AUTHOR]

• L'activité physique adaptée est le traitement de 1ère intention dans l'arthrose • Son rapport bénéfice/risque est supérieur à celui des traitements médicamenteux • L'activité physique adaptée est un traitement ciblé, visant à réduire les facteurs de risque associés à l'arthrose et les symptômes prioritaires pour le patient • L'efficacité de l'activité physique adaptée a été démontrée dans le traitement de l'arthrose avec un excellent niveau de preuve • Dans la pratique clinique, la prescription de l'activité physique adaptée dans l'arthrose doit encore être encouragée L'activité physique est définie comme un mouvement du corps résultant d'une contraction musculaire et induisant une dépense énergétique. Elle peut être adaptée à l'état de santé des personnes et avoir pour objectif le maintien ou l'amélioration de l'état de santé. Le lien entre sédentarité et sévérité de la symptomatologie dans l'arthrose est maintenant bien établi, faisant de l'activité physique adaptée (APA) un traitement ciblé de 1re intention dans l'arthrose, afin de lutter contre les effets de la sédentarité, quels que soient le phénotype ou le stade évolutif de la maladie. Les dernières recommandations de l'EULAR, de l'ACR et de l'OARSI placent l'APA, sous la forme de programmes structurés d'exercices de renforcement musculaire, de mobilité articulaire, de proprioception et de travail aérobie, au centre du traitement des patients arthrosiques. L'intérêt de l'APA pour réduire la douleur et les limitations d'activité, à court, moyen et long termes, dans l'arthrose, notamment des membres inférieurs, a été démontré dans des essais cliniques et méta-analyses de haut niveau de preuve, avec des effets-taille comparables à ceux observés avec les traitements médicamenteux. Dans la pratique clinique, la prescription de l'APA dans l'arthrose doit encore être encouragée. Une attention particulière doit également être apportée à l'adhésion au traitement à long terme. Physical activity is defined as movement of the body resulting from muscle contraction and inducing energy expenditure. It can be adapted to a person's health status and have the objective of maintaining or improving health status. The link between sedentary lifestyle and the severity of symptoms in osteoarthritis is now well established, making adapted physical activity (APA) a first-line targeted treatment in osteoarthritis, in order to fight against the effects of a sedentary lifestyle, regardless of the phenotype or stage of the disease. The latest recommendations from EULAR, ACR and OARSI place APA, in the form of structured exercise programs for muscle strengthening, joint mobility, proprioception and aerobic work, as the core treatment for people with osteoarthritis. The benefits of APA in reducing pain and activity limitations, in the short, mid and long terms, in osteoarthritis, especially of the lower limbs, has been demonstrated in high-level clinical trials and meta-analyses, with effect-sizes comparable to those observed with pharmacological treatments. In clinical practice, the prescription of APA in people with osteoarthritis should still be encouraged. Particular attention should also be paid to patients' adherence at long term. [ABSTRACT FROM AUTHOR]

Malgré l'efficacité du traitement chirurgical pour diminuer les douleurs de la gonarthrose, on observe des déficits de force du quadriceps en postopératoire, même plusieurs années après l'opération. Il a été montré que la force préopératoire du quadriceps est un déterminant majeur prédictif des performances fonctionnelles en postopératoire. La rééducation préopératoire pourrait constituer un enjeu majeur du maintien de l'autonomie des patients. Actuellement, l'hétérogénéité des protocoles ne permet pas d'affirmer que cette rééducation est scientifiquement pertinente. Cependant, il est important d'analyser les protocoles les plus efficaces pour identifier les points clés à intégrer à la rééducation. Les effets positifs de ces protocoles sont présentés dans cet article : gain de force, réduction de la douleur, progrès fonctionnels. Despite efficacy of surgery to reduce osteoarthritis related pain, quadriceps weakness is observed following surgery, even after several months or years. It has been shown that preoperative quadriceps strength is a relevant predictor of functional postoperative performances. Thus, preoperative rehabilitation might be a major determinant for patient independence. Currently, protocols heterogeneity does not allow researchers to conclude that preoperative strength training physiotherapy is useful. However, it is important to differentiate the most efficient ones from others. Therefore, the best protocols are detailed and the effects on pain, strength and function are presented. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude était de proposer une prise en charge psychomotrice basée sur des mises en situation rythmique et de tester son impact sur les capacités attentionnelles et exécutives d'enfants TDA/H. Vingt-et-un enfants âgés de 8 à 13 ans (moyenne : 9,4 ans ± 1,8 ans ; 3 filles) diagnostiqués avec un TDA/H ont bénéficié d'une prise en charge psychomotrice (8 à 12 séances) axée sur des mises en situation rythmique (exercices de synchronisation à des rythmes externes de type métronome ou musiques). Un design test-retest a permis d'évaluer le niveau des fonctions attentionnelles et exécutives à l'aide de batteries d'évaluation neuropsychologiques avant et après l'intervention. Les performances attentionnelles et exécutives ont été améliorées après la mise en place du programme : capacités d'inhibition, maîtrise de l'impulsivité cognitive, et mémoire de travail visuo-spatiale. Le niveau de l'attention divisée s'est légèrement amélioré également, alors que l'attention soutenue auditive, l'attention sélective visuelle, et l'aversion au délai sont restées inchangées. Cette étude établit des liens entre un entraînement des capacités rythmiques et l'amélioration de plusieurs fonctions attentionnelles et exécutives chez des enfants TDA/H. Ce type d'intervention psychomotrice apparaît donc prometteur dans l'accompagnement thérapeutique des enfants souffrant de TDA/H, en complément ou alternativement à un traitement par méthylphénidate chez certains sujets. This study aimed at investigating the effects of a rhythm-based therapeutic program among ADHD children by assessing performance in attentional and executive domains. Twenty-one children (mean age: 9.1, SD: 1.8; 3 females) who previously received a diagnosis of ADHD benefited from a rhythm-based training program (8 to 12 training sessions) delivered during a psychomotor therapy. The program consisted of rhythmic perceptuo-motor exercises, including sensorimotor synchronization to external beats (metronome, music). Attentional and executive performances were assessed with a test-retest experimental design. Attentional and executive performance improved in different domains: inhibition, cognitive impulsiveness and visuo-spatial working memory. A slight improvement was visible for divided attention, whereas sustained auditory attention, selective visual attention and delay aversion did not change after intervention. These results are in favor of tight relations between a rhythmic training program and some attentional and executive functions among ADHD children, with beneficial effects of the training on a variety of cognitive performances. This study seems promising for the purpose of supplementing chemical treatments among a range of ADHD patients in cognitive domain. [ABSTRACT FROM AUTHOR]

L'arthro-distension est actuellement indiquée dans le traitement de la capsulite rétractile en phase raide et douloureuse, en cas d'insuffisance d'une à deux infiltrations intra articulaires gléno-humérales. Elle consiste en une injection intra articulaire gléno-humérale sous pression associée à un corticoïde, sous repérage clinique, échographique ou radioscopique. Elle doit être couplée à une mobilisation immédiate alors que l'épaule est encore sous l'effet de l'anesthésique. Une kinésithérapie régulière complète la séquence artho-distension-mobilisation. Cette modalité thérapeutique est utilisée en pratique pour accélérer la récupération algofonctionnelle. Joint distension is currently indicated in the treatment of adhesive capsulitis of the shoulder in the stiff and painful phase, in the event of insufficiency of one or two intra articular glenohumeral infiltrations. It consists of an intra articular glenohumeral injection under pressure associated with corticosteroid, under clinical, ultrasound or radioscopic guidance. It must be coupled with immediate mobilization while the shoulder is still under the effect of the anesthetic. Regular physiotherapy should follox the joint distension-mobilization sequence. This therapeutic modality is used in practice to accelerate algofunctional recovery. [ABSTRACT FROM AUTHOR]

Summary Our retrospective study of burn patients presents a three-step treatment of heterotopic ossification: excision surgery, early rehabilitation, and analgesia. We included patients admitted to the department for treatment of postburn heterotopic ossification between January 1, 1979, and September 30, 2015. The mean age at the time of the burn was 43.3 years. Men accounted for the majority of burn patients who developed an osteoma (70.8%). The mean total skin area burned was 38.4%. No osteoma justifying surgery was found for any patient with a total burned skin area less than 19%. The burned zones were related to the osteoma development in 94.3% of cases. On average, the surgery took place 10.8 months after the burn. The osteotomy was accompanied by surgical treatment of a contracture in 37.1% of patients. Most of the osteomata were found at the elbows (30), followed by the shoulders (3), and finally the knees (2). Rehabilitation began on D0 after the surgery, except if a flap or a thin-skin graft was used. Regarding analgesia, opiates were prescribed systematically during the immediate postoperative period. Elbow range of motion on flexion improved by a mean of 84.1°. During the postoperative period, we found 2 recurrences of osteoma and 1 elbow hematoma in two separate patients. There were no postoperative infections or neurological sequelae. Our retrospective French study confirmed results found in the international literature. The three-step treatment – excision surgery, early rehabilitation, and antalgia – seems to be the best means of treating osteoma with satisfactory results. Surgery is indicated only in the case of functional impairment and not simply based on imaging. [ABSTRACT FROM AUTHOR]

Résumé Actualisation des recommandations de la Société française de rhumatologie pour la prise en charge en pratique des patients atteints de spondyloarthrite (SpA). La SpA est prise en compte avec ses différentes expressions cliniques (axiale, périphérique, enthésitique) et ses manifestations associées et comprend le rhumatisme psoriasique. Procédures standardisées selon les recommandations EULAR pour l’élaboration des recommandations : analyse de la littérature depuis la version précédente (juin 2013), groupe de travail, élaboration de recommandations avec regroupement et synthèse, vote et niveau d’accord. Quatre principes généraux et 15 recommandations sont proposés. Les 4 premières recommandations concernent les objectifs du traitement et les considérations générales (outils d’évaluation, comorbidités). Les recommandations 5 et 6 s’intéressent aux moyens non pharmacologiques. La recommandation 7 concerne les AINS, base du traitement, et les items 8 à 10 l’utilisation des antalgiques, de la corticothérapie et des traitements d’action lente conventionnels. Les recommandations 11 à 14 s’intéressent à l’usage des biomédicaments, intégrant les nouvelles classes, dans leurs indications (maladie active malgré le traitement conventionnel, et pour les formes axiales non radiographiques, présence de signes objectifs d’inflammation) et suivi, leur gestion en cas d’échec ou en rémission. La recommandation 15 concerne le recours à la chirurgie. Cette actualisation, intégrant les données récentes, offre des recommandations en nombre plus réduit et de formulation plus simple, dans le but d’une utilisation plus facile pour guider la prise en charge en pratique des patients atteints de spondyloarthrite. [ABSTRACT FROM AUTHOR]

Résumé Le traitement de la capsulite rétractile dépend de la sévérité des symptômes, de sa phase d’évolution, de sa physiopathologie et de son type (idiopathique ou secondaire). À ce jour, le niveau de preuve d’efficacité des différentes thérapeutiques reste faible. À la phase initiale ou « phase douloureuse » ou phase « chaude », la plainte principale des patients est centrée sur la douleur. Il s’agit donc de soulager le patient et de prévenir la survenue de l’enraidissement. On prescrit en première intention des antalgiques de classe 1 et 2 associés ou non aux AINS. En cas d’échec, on propose des infiltrations intra-articulaires de corticoïdes qui ont une efficacité sur la douleur et la mobilité à court terme. En phase douloureuse et enraidie, les objectifs thérapeutiques sont centrés sur la récupération des mobilités en plus de la diminution des douleurs. Les infiltrations intra-articulaires gléno-humérales (IAGH) de corticoïdes seront proposées en 2 e intention, en l’absence de contre-indication, lorsque la douleur est invalidante et présente un caractère inflammatoire. Elles ont fait leur preuve d’efficacité à court terme sur la douleur et la mobilité et à moyen terme sur la mobilité par rapport aux traitements per os, à la rééducation et au placebo. La place des corticoïdes per os n’est pas justifiée, du fait de leur absence de supériorité et de leurs effets secondaires, excepté en cas de contre-indication aux infiltrations. Il reste à déterminer si la précocité du diagnostic, grâce notamment à l’IRM, ainsi que la précocité des infiltrations permet de limiter la durée d’évolution de la maladie. En cas d’échec des IAGH et lorsque l’enraidissement prédomine, une série d’arthrodistensions associée à une mobilisation intensive du membre supérieur peut être proposée. À tous ces stades, la place de la rééducation est primordiale pour récupérer les mobilités. Aucune étude n’a retrouvé d’effets délétères des exercices physiques adaptés dans la capsulite, quel que soit son stade. Enfin, de nouveaux traitements sont actuellement à l’étude et semblent prometteurs notamment comme alternative aux solutions chirurgicales en cas d’évolution vers une capsulite réfractaire telle que la radioembolisation artérielle et l’infiltration intra articulaire d’acide hyaluronique entre autres. Management of adhesive capsulitis of the shoulder depends on its severity, its stage, its physiopathology and its nature (idiopathic or secondary adhesive capsulitis). Today, there is no high level of evidence for its treatment's efficiency. During the first stage, called “freezing phase”, the main symptom is pain. The urgency is to relieve the pain and to prevent the shoulder from stiffness. The first treatment is painkiller with or without NSAID. If the patient is not enough relieved, we suggest intra-articular injection of corticosteroids which are efficient in reducing pain and gaining articular mobility in the short term. During stage two, called “frozen shoulder”, the objectives will be to improve articular mobility and to relieve pain. We suggest intra articular injection of corticosteroids in second line therapy, if there is no contraindication, when pain is intense and inflammatory. It showed to relieve pain and to improve mobility in the short term and to improve articular mobility in the mid term, in comparison to oral treatment, placebo and physical exercices. There is no place for oral corticosteroids, as it showed no superiority and they have many side effects, except in case of contra indication to intra-articular injections of corticosteroids. We still have to determinate if the earliness of diagnostic (thanks to the MRI) and the earliness of intra-articular injection could reduce the disease evolution. If the patient is not enough relieved and stiffness is important, we can propose capsular distension followed by intensive mobilization. At every stage, rehabilitation is very important in order to gain articular mobility. No study shows side effects of physical exercises. Several other treatments are under development and show promising results such as radio arterial embolization, intra-articular injection of hyaluronic acid, etc. These treatments could be really interesting in case of chronic stiff capsulitis as an alternative to surgery. [ABSTRACT FROM AUTHOR]

Introduction The purpose was to investigate the effect of vergence reeducation on postural control, in subjects with isolated vergence disorders. Material and methods We studied the dynamics of vergence in 19 subjects (20–44 years old) using video-oculography (Eye See Cam). On the basis of orthoptic and symptomatology assessments, ten of the subjects were diagnosed for vergence disorders then vergence eye movements were reeducated with the REMOBI method (US8851669, 5 weekly sessions lasting for 35 min). Postural control was measured before and after reeducation, postural recording was done in upright stance (Dynaport), with both eyes closed or open and looking a visual target located at 2 m distance. Results After reeducation with REMOBI, the visual symptomatology faded away and the stereoacuity improved at least for some subjects; the vergence latency decreased significantly and the vergence accuracy increased significantly. In terms of posture, the Mean Power Frequency (MPF) of the body sway decreased significantly in both eyes open and eyes closed conditions. Considering all subjects together (i.e. healthy subjects and subjects with vergence disorders before the reeducation), the antero-posterior body sway (Root Mean Square A/P) was positively correlated with the visual symptomatology: the higher the visual symptomatology, the higher was the body sway. Conclusion The results bring evidence for synergy between the quality of vergence and the quality of postural control. They open a new research line that bridges the gap between neuroscience, ophthalmology-orthoptics and posturology. [ABSTRACT FROM AUTHOR]

Résumé La capsulite rétractile de l’épaule est une pathologie fréquente dont l’évolution spontanée est favorable mais très prolongée. La récupération même si elle n’est pas totale est généralement fonctionnelle avec une raideur et/ou des douleurs minimes mais des séquelles peuvent persister. L’objectif du traitement est de diminuer les douleurs, importantes à la phase initiale, augmenter la mobilité articulaire et ainsi ralentir l’évolution de la maladie. Il n’existe pas de recommandations officielles concernant la prise en charge thérapeutique optimale. Le traitement médical (antalgiques, anti-inflammatoires, infiltrations de corticoïdes et rééducation) est indiqué en première intention. La capsulodistension plus mobilisation est envisagée en deuxième intention. La libération capsulaire arthroscopique et la mobilisation sous anesthésie sont d’indication exceptionnelle. La rééducation (techniques, durée et fréquence des séances, modalités de prise en charge) doit être adaptée aux déficiences et aux symptômes du patient et doit par ailleurs prendre en compte et traiter l’ensemble des dysfonctions du complexe de l’épaule. La participation du patient et sa compliance aux exercices d’auto-rééducation pluriquotidiens sont essentielles. Shoulder adhesive capsulitis is a common condition with favourable outcome but very long. Although full resolution of symptoms does not always occur, persistent symptoms are commonly mild with stiffness and/or minimal pain with possible persistent sequelae. Therapeutic interventions aim to reduce pain, which are important at the initial stage, and improve joint mobility thus shorten disability. There are no official guidelines for optimum therapeutic management. Conservative interventions including pain-killers, NSAIDs, corticosteroid infiltration and physical therapy are recommended at first. Shoulder capsular distension plus mobilisation is second line. Indications of arthroscopic capsular release or mobilisation under anesthesia are sparse. Physical therapy (techniques, duration and frequency of sessions, modality of management) need to be adapted to patient abilities and symptoms and must consider and treat the full shoulder complex dysfunction. Patient's involvement in rehabilitation and education to repeated home exercises is of paramount importance. [ABSTRACT FROM AUTHOR]

Résumé La lombalgie commune est une affection chronique, incapacitante, récurrente, admettant de multiples facteurs de déclenchement, mécaniques le plus souvent, intriqués à de multiples facteurs psychologiques, environnementaux et génétiques. La lombalgie commune est une affection hétérogène. La rééducation comprend de multiples approches thérapeutiques : les unes sont passives, les autres sont actives. La multiplicité des méthodes rééducatives rend compte de multiples approches théoriques sous-jacentes. À ce jour, les exercices actifs et les étirements couplés à des activités aérobiques sont les plus utiles. Toutefois, ils nécessitent de la motivation et de la compliance. Les approches thérapeutiques rééducatives n’ont pas les mêmes finalités en fonction du stade aigu, subaigu ou chronique de la lombalgie. À la forme aiguë, la rééducation n’a pas d’intérêt excepté pour les manipulations ; dans la forme subaiguë, la rééducation a pour finalité de corriger les fonctions principalement musculaires qui ont été modifiées à la phase aiguë et qui perdurent ; dans la forme chronique, les approches thérapeutiques rééducatives sont plus complexes du fait des conséquences neurophysiologiques de la douleur chronique, de l’inactivité, de la peur de la douleur et du mouvement, et des conditions environnementales. Aujourd’hui, une approche scientifique des exercices de renforcement musculaire est nécessaire pour clarifier la place de la correction de la fonction de force musculaire dans le traitement de la lombalgie commune. The nonspecific low back pain is a chronical, recurrent, disabilitating condition that admits multiple trigger factors, mechanical most often, but entangled to multiple psychological, genetic, environmental factors. Nonspecific low back pain is a heterogeneous disorder. Physical therapy includes multiple treatments: some of them are passive and some of them are active. The multiplicity of the therapeutic approaches is related to many underlying theoretical concepts. Today, active exercises and stretching are the most useful physical therapies associated to aerobic activities. However, it necessitates motivation and compliance because they must repeat for long time. The therapeutic objectives are different between the acute, subacute and chronic features of the disorder. In the acute form, there is no place except for the manipulations. In the subacute form, the physical therapy had the objective of correcting mainly muscular functions that have been compromised at the acute phase and that remain. In the chronic phase, the therapeutic approaches are more complex, related to the neurophysiological consequences of the pain, the inactivity syndrome, the fear of pain and movement, and to the environmental factors. Today, a more scientific approach of the strengthening exercises is needed to clarify the place of the muscular strength function in the treatment of nonspecific low back pain. [ABSTRACT FROM AUTHOR]

Résumé Objectif Décrire et évaluer la place de l’appareillage et de la kinésithérapie dans la prise en charge des scolioses idiopathique et dégénérative de l’adulte. Méthodes Une revue de la littérature sans restriction de date ou de langue faite dans Medline a permis d’identifier quelques rares études de méthodologie correcte. Nous en avons rapporté les résultats en plus de notre expérience clinique. Résultats Chez l’adulte, l’objectif de ces traitements est avant tout de soulager les douleurs et améliorer la fonction. En cas de scoliose lombaire ou thoracolombaire évolutive (majoration de 5° entre deux radiographies), le port d’un corset orthopédique pourrait freiner l’évolution de la déformation s’il est porté 6 heures par jour. Si la scoliose n’est pas évolutive mais douloureuse, un corset de maintien lombaire sur mesure en coutil baleiné ou un corset rigide (plastique, résine ou plâtre) porté à la demande est suffisant. La kinésithérapie est indispensable si le patient est symptomatique. Elle repose sur un travail d’autocorrection (surtout dans le plan frontal et sagittal), de redressement actif, sur des exercices de renforcement musculaire des extenseurs du tronc, des étirements, sur la réalisation de tractions lombaires et s’associe à une rééducation fonctionnelle. Une activité physique aérobie est recommandée en complément. Conclusion L’appareillage et la kinésithérapie ont une place importante dans la prise en charge des scolioses de l’adulte, qu’elles soient idiopathiques ou dégénératives, évolutives ou non. Les modalités sont fixées après un examen clinique rigoureux et après évaluation des attentes des patients. Objective To describe and assess the place of brace and physical therapy in the treatment of idiopathic and degenerative adult scoliosis. Methods A literature review in Medline without blackout dates or language identified a few studies with a high level of evidence. We reported their results in addition to our clinical experience. Results In adults, the goal of these treatments is primarily to relieve pain and improve function. If lumbar and thoracolumbar scoliosis progress (increase of 5° between two X-rays), wearing a custom-molded rigid lumbar-sacral orthosis 6 hours per day may slow the progression rate. If scoliosis does not progress but is painful, customized lumbar support corset or rigid lumbar-sacral orthosis (plastic, resin or plaster) on demand should be sufficient. Physical therapy is essential if the patient is symptomatic. It is based on exercises to correct sagittal and coronal balance, including core strengthening, stretching, lumbar traction, and on functional rehabilitation. Aerobic physical activity is also recommended. Conclusion Bracing and physical therapy have an important place in the treatment of adult scoliosis, whether idiopathic or degenerative, progressive or not. They are determined after a thorough clinical examination and after evaluation of patient expectations. [ABSTRACT FROM AUTHOR]

Résumé La rééducation occupe une place essentielle dans la prise en charge des connectivites et des rhumatismes inflammatoires chroniques, quels que soient le stade, la sévérité ou l’activité de la maladie. Il n’existe pas de programmes standardisés « à taille unique » mais des programmes personnalisés, adaptés à chaque patient, dont l’élaboration repose sur le modèle conceptuel de la Classification internationale du fonctionnement, du handicap et de la santé (CIF). Nous proposons dans cette mise au point un rappel des principes de l’évaluation et de la décision thérapeutique en rééducation et réadaptation des pathologies inflammatoires de l’appareil locomoteur et une lecture critique de la littérature sur l’efficacité et la tolérance de la rééducation dans ces maladies. Rehabilitation is important in the management of autoimmune and inflammatory rheumatic diseases, whatever the disease stage, severity and activity. Rehabilitation programs are not “one-size-fits-all” and have to be tailored for each patient according to the conceptual frame of the International classification of functioning, disability and health (ICF). Herein, we review the principles of assessment and therapeutic decision in the rehabilitation of autoimmune and inflammatory rheumatic diseases and present the evidence of efficacy and safety of non-pharmacological interventions in these conditions. [ABSTRACT FROM AUTHOR]

Résumé Les déficits moteurs associés aux maladies neurologiques amènent les professionnels de santé à s’intéresser à un aspect de la prise en charge déjà bien connu dans le domaine cardiovasculaire, l’activité physique. Les bénéfices recherchés ne sont pas les mêmes selon la pathologie, ce qui sous-entend que la pratique doit être adaptée. Cependant, cette démarche répond à un objectif commun qui est d’empêcher l’altération de la qualité de vie. Summary Motor disorders associated with neurological diseases are leading health professionals to consider an aspect of health care which is commonly used in the cardiovascular field: physical activity. The benefits vary depending on the pathology, which means that the physical activity must be adapted. However, this approach is in line with a common objective which is to prevent a deterioration in the patient's quality of life. [ABSTRACT FROM AUTHOR]

Résumé La rééducation, longtemps déconseillée, semble aujourd’hui tenir une place prépondérante au sein de l’arsenal thérapeutique des myopathies inflammatoires. La difficulté de son évaluation réside, outre la faible prévalence de ces maladies, dans une triple hétérogénéité : celle, nosologique distinguant les différentes formes de myopathies inflammatoires et leur phase d’activité ; celle ayant trait au critère évalué pour affirmer l’efficacité ou au contraire la dangerosité de l’intervention proposée, et enfin celle concernant la diversité des modalités de la rééducation à entreprendre. Entre 1993 et 2016, on recense une trentaine d’études évaluant la rééducation au sein des myopathies inflammatoires parmi lesquelles on dénombre cinq essais thérapeutiques contrôlés et randomisés, quatre essais contrôlés non randomisés, 15 études de cohorte et sept études de cas. Toutes ces études concluent à la non-dangerosité de la rééducation et certaines montrent une amélioration significative de critères évaluant l’activité de la maladie (comme son retentissement fonctionnel ou sur la qualité de vie) et la fatigabilité. La rééducation, qu’elle soit aérobie, anaérobie ou mixte, nous semble aujourd’hui devoir systématiquement être associée au traitement médicamenteux proposé aux patients atteints de myopathies inflammatoires. D’autres études sont nécessaires pour optimiser les modalités de la rééducation à recommander, pour en comprendre le mode d’action, en quantifier l’impact et pour accroître le niveau de preuve encore trop faible conféré par les études existantes. Rehabilitation, for a long time not recommended, seems today to hold a prominent place within the therapeutic arsenal of inflammatory myopathies. The difficulty of its evaluation, apart from the low prevalence of these diseases, lies in a triple heterogeneity: first that distinguishing the different forms of inflammatory myopathies and the phase where they are active; second, that concerning the endpoint considered to assess the efficiency of the intervention; lastly, the diversity of the rehabilitation programs that can be undertaken. Between 1993 and 2016, about 30 studies estimating the rehabilitation of inflammatory myopathies have been published, among which five randomized controlled trials, four controlled trials, 15 open studies, and seven case reports. All these studies evidence the safety of rehabilitation and some show a significant improvement of the criteria estimating the activity of the disease, its functional impact or the impairment of quality of life and the limitation in daily life activities triggered by the disease. The rehabilitation, whether aerobic, anaerobic or mixed, must today systematically be associated with the pharmaceutic treatment proposed to patients affected by inflammatory myopathies. Other studies are necessary to optimize the rehabilitation methods, to understand their effects and action, and to quantify their impact and provide more trustworthy evidence. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Les neuroprothèses sont des dispositifs électroniques ou électromécaniques reliés au système nerveux permettant de remplacer un organe défectueux. Cet article a pour but de faire le point sur l’état actuel de ces dispositifs. Méthode Cet article aborde successivement différentes neuroprothèses. Si l’implant cochléaire existe maintenant depuis presque 60 ans, cette dernière décennie, les solutions technologiques pour restaurer d’autres sens comme la vue avec des rétines artificielles et le toucher avec des peaux artificielles ont fait d’importants progrès. De même, les myoprothèses, les interfaces cerveau-machine et les exosquelettes qui visent à restaurer le contrôle d’un membre occupent régulièrement l’actualité. Les myoprothèses sont destinées à pallier l’absence d’un membre supérieur suite à une amputation en enregistrant depuis la surface de la peau en amont l’influx nerveux transmis jusqu’aux muscles pour commander une prothèse de main. Les interfaces cerveau-machines enregistrent l’activité de neurones à l’intérieur du cortex moteur, plus rarement depuis la surface du scalp, pour décoder l’ordre moteur et le transmettre à un membre motorisé. Enfin, les exosquelettes sont des armatures mécaniques enveloppant tout ou une partie du corps pour l’animer. Résultats Les implants cochléaires et les myoprothèses sont maintenant régulièrement proposés respectivement aux personnes souffrant d’un déficit auditif sévère ou profond et aux personnes amputées au niveau de l’avant-bras. L’augmentation de la résolution des rétines artificielles devrait permettre à moyen terme de proposer aux personnes non aveugles de naissance mais atteintes de dégénérescence maculaire liée à l’âge une perception visuelle sommaire de leur environnement. Enfin, les neuroprothèses motrices non invasives commencent à être intégrées à des programmes de rééducation des accidents vasculaires cérébraux. Celles plus invasives permettant de décoder jusqu’à la direction du mouvement nécessiteront encore de nombreuses années de recherche, en particulier pour intégrer un retour sensitif. Discussion Ainsi, au-delà des effets d’annonce pour obtenir l’attention du public et des financeurs, et de l’enthousiasme des journalistes pour la nouveauté, qu’en est-il des attentes des potentiels utilisateurs, des désillusions et des satisfactions vécues par les patients, du nombre réel de personnes équipées, du prix et des possibilités d’utiliser de tels dispositifs en dehors des laboratoires ? Conclusions Cet article vise à positionner ces nouvelles technologies entre réalité et fiction, attentes des personnes soumises à un handicap, fantasmes de l’Homme augmenté et difficultés scientifiques. Introduction Neuroprostheses are electronic or electromechanical devices connected to the nervous system to replace a defective organ. This article aims to review the state of the art of these devices. Methods This article successively presents various neuroprostheses. While cochlear implants have existed now for almost 60 years, in the last decade, technological solutions to restore other senses, such as sight with artificial retinas, and touch with artificial skins, have made significant progress. Similarly, myoprostheses, brain-machine interfaces and exoskeletons, which aim to restore the control of a limb, often make headlines in the news. Myoprostheses are intended to compensate for the lack of an amputated upper limb by registering nerve impulses transmitted to the muscles from the skin surface to control a prosthetic hand. Brain-computer interfaces register neural activity within the motor cortex, or more rarely from the surface of the scalp, to decode the motor order and transmit it to a motorized limb. Finally, exoskeletons are mechanical structures enveloping all or part of the body to animate it. Results Cochlear implants and myoelectric prosthetics are now regularly offered for people with severe or profound hearing loss and for forearm amputees. Increasing the resolution of artificial retinas should help in the medium term to offer a basic visual perception of their environment, if not to people blind from birth, at least to macular degeneration sufferers. Finally, non-invasive motor neuroprostheses are now being included in rehabilitation programs for stroke. Invasive neuroprostheses actually able to decode the direction of movement will still require many years of research, in particular to integrate sensory feedback. Discussion Thus, beyond the spectacular aspect of communications on the subject to get the attention of the public and funders, and the enthusiasm for novelty of journalists, the real issues are the expectations of potential users, the disappointments and satisfactions of patients, the actual number of people equipped, and cost and scope for use of such devices outside the laboratories. Conclusion This article aims to position these new technologies in terms of reality and fiction, in terms of the expectations of people with a disability and fantasies of the augmented human, and in terms of the scientific difficulties encountered. [ABSTRACT FROM AUTHOR]

Résumé La pathologie fémoro-patellaire est un motif fréquent de consultation. Le diagnostic de syndrome douloureux fémoro-patellaire (FP) répond à certains critères. Son origine est multifactorielle. Tous les facteurs d’instabilité rotulienne peuvent entraîner des douleurs FP par augmentation des contraintes articulaires. Par ailleurs, le déséquilibre de la force musculaire aux dépens du vaste médial ou bien la raideur musculaire sont aussi des facteurs favorisants. Enfin les troubles statiques de la voûte plantaire, les troubles de torsion fémorale et/ou tibiale sont aussi fréquemment invoqués dans la littérature. Un bilan clinique complet est donc nécessaire, complété d’un bilan radiologique simple en cas de doute diagnostique ou d’échec thérapeutique. Le syndrome douloureux FP peut aussi avoir une origine secondaire notamment en cas de chondromalacie d’effort, voire de chondropathie ou d’arthrose FP isolée, ou de complication d’une chirurgie ligamentaire, méniscale. Le traitement, jamais chirurgical, sera basé sur de la rééducation à type d’étirement des chaînes musculaires et de renforcement global du membre et plus particulièrement du vaste médial. Lors de l’activité sportive, une genouillère ou un taping peut avoir un intérêt en recentrant la rotule. Enfin en cas de trouble de la statique du pied, une semelle pourra être mise en place. Une intervention chirurgicale ne sera réalisée qu’en cas d’instabilité rotulienne avérée avec au moins 2 épisodes de luxations et après une prise en charge rééducative bien conduite. La chirurgie réalisée sera à la carte en fonction des anomalies radiologiques : transposition de la tubérosité tibiale associée ou non à une ligamentoplastie du ligament fémoro-patellaire médial, voire un trochléoplastie en cas d’anomalies trochléennes majeures. La prise en charge de la pathologie de l’articulation fémoro-patellaire est donc multimodale, purement médicale en cas de syndrome douloureux fémoro-patellaire et médico-chirurgicale en cas d’instabilité rotulienne vraie. The patellofemoral pathology is a frequent cause of consultation. Criteria exist to diagnose the patellofemoral pain syndrome. His origin is multifactorial. The patellar instability may induce anterior knee pain in increasing patellofemoral forces. Imbalance between vastus medialis and the others chef of the quadriceps or muscular stiffness can also raise pain. Finally pathology of the plantar arch (pes planus), femoral or tibial torsional deformities are frequently involved in the literature. A thorough clinical exam is necessary. X-rays will be done in case of persistent pain despite a good therapeutic support or in case of a doubt in the diagnosis. Nevertheless, the pain origin can be due to chondromalacia, chondropathy or isolated patellofemoral arthritis, or as a complication of surgery (meniscectomy, ligament reconstruction). The treatment of anterior knee pain is based on physiotherapy including stretching and global muscular strengthening of the lower limb, with particular attention to the vastus medialis. During sports activities, a patellofemoral brace or a taping can be proposed to stabilize the patella. Pes planus have to be treated with a foot insole. Surgery is proposed in case of patellar instability with more than two dislocations and after physiotherapy. Choice of the surgery depends on radiological aspect: osteotomy of the anterior tibial tuberosity isolated or in association with medial patellofemoral reconstruction, or trochleoplasty in case of major trochlear dysplasia. Patellofemoral pathology is treated with a multimodal approach. Anterior knee pain will be treated medically. Surgery is proposed in case of recurrent patellar dislocation. [ABSTRACT FROM AUTHOR]

Résumé La prise en charge de la spondyloarthrite est difficile et a évolué en fonction des concepts et des nouveaux traitements. La SFR a émis récemment de nouvelles recommandations pour la prise en charge courante de cette pathologie. Il n’existe pas de texte simplifié récent reprenant ces recommandations à destination des patients. Réécrire les recommandations en langage compréhensible par la population générale pour la prise en charge en pratique de patients atteints de spondyloarthrite (incluant le rhumatisme psoriasique) ; réécriture s’appuyant sur le texte des recommandations de la Société française de rhumatologie publié en janvier 2014. Un groupe de travail formé de sept patients issus d’associations nationales de patients souffrant de spondyloarthrite (AFLAR et AFS) et de deux rhumatologues et un groupe de lecture de « patients » issus d’associations de patients (AFLAR, AFS et ACSAC centre et Normandie) ont été constitués. Le groupe de travail a réécrit « en langage patient » les recommandations de la SFR. Le texte a été revu via une enquête internet par le groupe de 204 lectures « patients », et gradé selon leur degré de compréhension, et d’acceptation du texte sur une échelle de 0 à 10, où 10 est l’accord maximal. Des recommandations sont proposées aux patients et au grand public pour mieux connaître la prise en charge de la spondyloarthrite. Après avoir rappelé les principes généraux et le cadre nosologique de la spondyloarthrite, il est proposé 28 recommandations. Le niveau de compréhension est en moyenne de 8,8 (± 0,4) et l’accord sur le fond des recommandations est en moyenne de 8,5 (± 0,3). Au total nous obtenons un taux de compréhension supérieur à 7/10 dans 88 % et un taux d’accord supérieur à 7/10 dans 81 % sur l’ensemble des 28 recommandations. Ces recommandations actualisées et livrées dans un langage compréhensible offrent aux patients et au grand public un aperçu global du guide de la prise en charge de la spondyloarthrite en pratique courante en France. Les recommandations ayant le niveau d’accord le plus faible portent sur la place des corticoïdes et des disease modifying antirheumatic drugs (DMARD) dans cette prise en charge. Un travail d’éducation thérapeutique important est à faire pour améliorer ce niveau d’accord. Ce projet est un témoin de l’intérêt qu’une société savante puisse travailler avec des associations de patients en France pour améliorer le niveau de connaissance des patients et donc leur prise en charge. [ABSTRACT FROM AUTHOR]

Summary Virtual reality (VR) is now commonly used in many domains because of its ability to provide a standardized, reproducible and controllable environment. In balance assessment, it can be used to control stimuli presented to patients and thus accurately evaluate their progression or compare them to different populations in standardized situations. In balance rehabilitation, VR allows the creation of new generation tools and at the same time the means to assess the efficiency of each parameter of these tools in order to optimize them. Moreover, with the development of low-cost devices, this rehabilitation can be continued at home, making access to these tools much easier, in addition to their entertaining and thus motivating properties. Nevertheless, and even more with low-cost systems, VR has limits that can alter the results of the studies that use it: the latency of the system (the delay cumulated on each step of the process from data acquisition on the patients to multimodal outputs); and distance perception, which tends to be underestimated in VR. After having described why VR is an essential tool for balance assessment and rehabilitation and illustrated this statement with a case study, this review discusses the previous works in the domain with regards to the technological limits of VR. [ABSTRACT FROM AUTHOR]

Summary Balance disorders related to disturbances in perception of spatial reference systems are common especially after right hemispheric stroke. Mental misrepresentation of bodily orientation in space is then often superimposed upon other factors affecting imbalance such as motor and sensory impairments. Traditional rehabilitation for balance recovery has not been specifically designed to improve balance disorders related to spatial cognition. The traditional approach, consisting of stimulating the conscious perception of body orientation in space, is demanding and laborious. The approach based on sensorial stimulation is completely different. The relevance of this method lies in the fact that, firstly it is specifically active in the cognitive component of balance disorders; and secondly, it can passively be applied with minimal patient participation, which is of particular importance for this patient group characterized by disorders of attention and concentration. These techniques, such as proprioceptive, visual or vestibular stimulation, have been found to correct spatial neglect but also postural bias. Clinical and data from functional neuro-imaging suggest a direct central action on cortical structures involved in the elaboration of spatial representation. These are promising techniques for the rehabilitation of postural disturbances related to spatial cognition disorders but are as yet at the stage of preliminary results. [ABSTRACT FROM AUTHOR]

Summary After stroke, the causes of balance disorders include motor disorders, sensory loss, perceptual deficits and altered spatial cognition. This review focuses on motor strategies for postural control after stroke. Weight-bearing asymmetry, smaller surface of stability, increased sway, body tilting and sometimes pushing syndrome are observed. Weakness and sensory impairments account only for some of these disturbances; altered postural reactions and anticipated postural adjustments as well as abnormal synergistic muscular activation play an important part. These disorders are often linked to cognitive impairments (visuospatial analysis, perception of verticality, use of sensory information, attention, etc.), which explain the preeminent disorders of postural control seen with right rather than left-hemisphere lesions. Most of the motor changes are due to an impaired central nervous system but some could be considered adaptive behaviors. These changes have consequences for rehabilitation and need further studies for building customized programs based on the motor comportment of a given patient. [ABSTRACT FROM AUTHOR]

Summary We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait. [ABSTRACT FROM AUTHOR]

Résumé La rééducation prend une part importante dans le traitement des paralysies faciales, en particulier lorsque celles-ci sont sévères. Elle a pour objectif de diriger la reprise de l’activité motrice et prévenir ou réduire les séquelles (syncinésies, spasmes, hypertonie). Il est préférable qu’elle soit proposée précocement afin de mettre en place un projet thérapeutique basé sur les résultats de l’évaluation couplés le cas échéant à ceux de l’ENMG. Lorsqu’il y a chirurgie, un travail préopératoire est préconisé, surtout dans les cas d’anastomose hypoglossofaciale et de myoplastie d’allongement du muscle temporal (MAT) où il y transfert de fonction. Nous proposons de présenter une technique originale visant à renforcer la boucle sensorimotrice et le contrôle cortical des mouvements, en particulier en cas d’utilisation de toxine botulique et après chirurgie. Summary Rehabilitation takes an important part in the treatment of facial paralysis, especially when these are severe. It aims to lead the recovery of motor activity and prevent or reduce sequelae like synkinesis or spasms. It is preferable that it be proposed early in order to set up a treatment plan based on the results of the assessment, sometimes coupled with an electromyography. In case of surgery, preoperative work is recommended, especially in case of hypoglossofacial anastomosis or lengthening temporalis myoplasty (LTM). Our proposal is to present an original technique to enhance the sensorimotor loop and the cortical control of movement, especially when using botulinum toxin and after surgery. [ABSTRACT FROM AUTHOR]

Résumé Introduction La prise en charge chirurgicale des escarres périnéales fait appel à de nombreux lambeaux fascio-cutanés ou musculo-cutanés. Ils permettent d’assurer la couverture et le comblement de la grande majorité des escarres rencontrées chez le blessé médullaire. Dans de rares cas, ces solutions classiques sont dépassées : il est alors nécessaire de faire appel à des solutions chirurgicales sur mesure, adaptées au patient. Nous présentons ici un cas de lambeau sur mesure de membre inférieur en couverture d’escarres périnéales confluentes. Patient et méthode Notre patient, âgé de 49 ans, paraplégique depuis 21 ans, présentait des escarres ischiatiques et trochantériennes bilatérales (luxation tête-col), pubienne inférieure. La solution chirurgicale retenue a été la suivante : réalisation d’un lambeau total de cuisse droite pour la couverture et le comblement de l’hémi-bassin droit ; associé au prélèvement en îlot d’un lambeau musculo-cutané de face postérieure de jambe droite pour la couverture et le comblement de l’escarre trochantérienne gauche. Résultat L’intervention a duré 6 h 30 et a nécessité une transfusion massive (culots globulaires et plasma). L’antibiothérapie a été adaptée aux prélèvements. Les suites opératoires ont été simples, avec une cicatrisation stable obtenue en trois semaines. Discussion Le sacrifice d’un membre inférieur pour la couverture d’escarre géante périnéale est une solution chirurgicale extrême, à réserver pour des patients ayant parfaitement compris les enjeux de cette opération de la dernière chance. Une bonne connaissance de l’anatomie vasculaire est le pré-requis indispensable à sa réalisation, et permet de lever des lambeaux sur mesures. Le succès de cette intervention est étroitement lié à la collaboration avec l’équipe de rééducation (éducation thérapeutique adaptée [transferts et positionnement]). Summary Introduction Surgical treatment of perineal pressure sores could be done with various fascio-cutaneous or musculo-cutaneous flaps, which provide cover and filling of most of pressure sores after spinal cord injuries. In rare cases, classical solutions are overtaken, then it is necessary to use more complex techniques. We report a case of a made-to-measure lower limb flap for coverage of confluent perineal pressure sores. Patient and method A 49-year-old paraplegic patient developed multiple pressure sores on left and right ischial tuberosity, inferior pubic bone and bilateral trochanters with hips dislocation. Surgical treatment involved a whole right thigh flap to cover and fill right side lesions, associated to a posterior right leg musculo-cutaneous island flap to cover and fill the left tronchanteric pressure sore. Result The surgical procedure lasted 6.5 hours and required massive blood transfusion. Antibiotics were adapted to bacteriological samples. There were no postoperative complications; complete wound healing occurred after three weeks. Discussion A lower limb sacrifice for coverage of a giant perineal pressure sores is an extreme surgical solution, reserved to patients understanding the issues of this last chance procedure. A good knowledge of vascular anatomy is an essential prerequisite, and allows to shape made-to-measure flaps. The success of such a procedure is closely linked to the collaboration with the rehabilitation team (appropriate therapeutic education concerning transfers and positioning). [ABSTRACT FROM AUTHOR]

Objective To compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA). Methods Randomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12 months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint. Results Two hundred and forty patients were included (February–June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6 ± 15 at day 0 versus 46.5 ± 22.4 at 12 months, P < 0.001), but not in the non-thermal group (64.1 ± 15 at day 0 versus 62 ± 29 at 12 months, P = 0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS ( P = 0.08). However, at 12 months, the thermal cure group was significantly more improved ( P = 0.000). Conclusion In our study, crenobalneotherapy had resulted, at 12 months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation. [ABSTRACT FROM AUTHOR]

Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of post-stroke rehabilitation to stimulate recovery, but the concepts of empirical methods originally proposed by therapists to rehabilitate these patients have not withstood clinical analysis. Functional neuroimaging and animal models have unveiled the mechanisms underlying functional recovery and helped teams understand its limitations and improvement modalities. These neuroscience discoveries constitute the grounds needed to understand the emergence of new technologies: robotics and virtual reality. The objective of this review of the literature was to select key works in this field to better understand current therapeutic possibilities. [ABSTRACT FROM AUTHOR]

Innovative technologies for sensorimotor rehabilitation after stroke have dramatically increased these past 20 years. Based on a review of the literature on “Medline” and “Web of Science” between 1990 and 2013, we offer an overview of available tools and their current level of validation. Neuromuscular electric stimulation and/or functional electric stimulation are widely used and highly suspected of being effective in upper or lower limb stroke rehabilitation. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for the upper limb. Its effectiveness in gait training is more controversial. Virtual reality is widely used in the rehabilitation of cognitive and motor impairments, as well as posture, with admitted benefits. Non-invasive brain stimulation (rTMS and TDCS) are promising in this indication but clinical evidence of their effectiveness is still lacking. In the same manner, these past five years, neurofeedback techniques based on brain signal recordings have emerged with a special focus on their therapeutic relevance in rehabilitation. Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and “real use” of those devices is still an issue since most of them are not easily available in current practice. [ABSTRACT FROM AUTHOR]

Being able to predict an individual's potential for recovery of motor function after stroke may facilitate the use of more effective targeted rehabilitation strategies, and management of patient expectations and goals. This review summarises developments since 2010 of approaches based on clinical, neurophysiological and neuroimaging measures for predicting individual patients’ potential for upper limb recovery. Clinical assessments alone have low prognostic accuracy. Transcranial magnetic stimulation can be used to assess the functional integrity of the corticomotor pathway, and has some predictive value but is not superior when used in isolation due to its low negative predictive value. Neuroimaging measures can be used to assess the structural integrity of descending white matter tracts. Recent studies indicate that the integrity of corticospinal and alternate motor tracts in both hemispheres may be useful predictors of motor recovery after stroke. The PREP algorithm is currently the only sequential algorithm that combines clinical, neurophysiological and neuroimaging measures at the sub-acute stage to predict the potential for subsequent recovery of upper limb function. Future research could determine if a similar algorithmic approach may be useful for predicting the recovery of gait after stroke. [ABSTRACT FROM AUTHOR]

Objective This study aimed at testing the ability of the superimposed electrical stimulation technique to restore the mobility of pre-stiff thumbs after operative repair for rupture of the ulnar collateral ligament. Material and methods Eight patients demonstrating a pre-stiff metacarpophalangeal joint were involved in two rehabilitation sessions of a counterbalanced design. In the voluntary contraction session, they performed 20 min of repeated active flexions of the impaired metacarpophalangeal joint. In the superimposed electrical stimulation session, they performed 20 min of percutaneous neuromuscular electrical stimulations which were superimposed to voluntary flexion. Results Mean active range of motion improvement from pre- to post-session was significantly greater in the superimposed electrical stimulation condition compared to the voluntary contraction condition (11 ± 5 deg versus 3 ± 4 deg; P < 0.01). Conclusion Superimposing electrical stimulation to voluntary contractions is an efficient technique to improve active range of motion of the pre-stiff metacarpophalangeal joint of the thumb. [ABSTRACT FROM AUTHOR]

Objective To assess the relevance of the RAPT (Risk Assessment and Prediction Tool), among a cohort of patients undergoing total hip arthroplasty (THA). Method Prospective study of a cohort of patients evaluated before and after THA. The difference between the postoperative orientation predicted by the RAPT and the real one is assessed. Clinical, environmental and psychosocial criteria that could significantly change the orientation are discussed. Results One hundred and thirty-four patients (94 women and 40 men) were included. The average age was 71.6 (±10) years. Primary hip osteoarthritis was the indication for surgery in 78% of cases. The average length of stay in the surgery ward was 10 (±3) days. It was significantly higher for patients referred to a rehabilitation ward ( P < 0.0001). Sixty-six percent of patients were referred to a rehabilitation ward and 34% returned directly home. The average length of stay in rehabilitation ward was 27 (±13) days. The validity of the RAPT as a help decision tool has been confirmed. Thus, a low RAPT score was significantly associated with more frequent referral to a rehabilitation ward, conversely, a high RAPT score is significantly related to more frequent direct return to home. Conclusion This study confirmed the usefulness of the RAPT to help in patient orientation decision after total hip arthroplasty. The patient preference remains the main variable for orientation after THA. By the way, the patient preference must not be integrated into the RAPT, but need to be collected and be discussed with the patient. [ABSTRACT FROM AUTHOR]

Gait and balance disorders are often major causes of handicap in patients with cerebellar ataxia. Although it was thought that postural and balance disorders in cerebellar ataxia were not treatable, recent studies have demonstrated the beneficial effects of rehabilitation programs. This article is the first systematic review on the treatment of postural disorders in cerebellar ataxia. Nineteen articles were selected, of which three were randomized, controlled trials. Various aetiologies of cerebellar ataxia were studied: five studies assessed patients with multiple sclerosis, four assessed patients with degenerative ataxia, two assessed stroke patients and eight assessed patients with various aetiologies. Accurate assessment of postural disorders in cerebellar ataxia is very important in both clinical trials and clinical practice. The Scale for the Assessment and Rating of Ataxia (SARA) is a simple, validated measurement tool, for which 18 of the 40 points are related to postural disorders. This scale is useful for monitoring ataxic patients with postural disorders. There is now moderate level evidence that rehabilitation is efficient to improve postural capacities of patients with cerebellar ataxia – particularly in patients with degenerative ataxia or multiple sclerosis. Intensive rehabilitation programs with balance and coordination exercises are necessary. Although techniques such as virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting appear to be of value, their specific efficacy has to be further investigated. Drugs have only been studied in degenerative ataxia, and the level of evidence is low. There is now a need for large, randomized, controlled trials testing rehabilitation programs suited to postural and gait disorders of patients with cerebellar ataxia. [ABSTRACT FROM AUTHOR]

Résumé: Le cancer et ses traitements peuvent avoir des effets délétères sur les fonctions cognitives, ainsi qu’un impact négatif sur la qualité de vie des patients. Ce travail fait la revue de différentes études qui ont été mises en place pour traiter ou prévenir les troubles cognitifs de patients atteints de cancer. Deux approches dissociées mais complémentaires émergent dans la prise en charge des patients : une approche pharmacologique et une approche psychologique, sous la forme de rééducation cognitive. Malgré un intérêt grandissant des chercheurs pour cette thématique, nous notons que de nombreuses difficultés pratiques et méthodologiques persistent ; les résultats restent de ce fait difficilement généralisables. Nous espérons que nos réflexions sur la prise en charge des troubles cognitifs en cancérologie aideront au développement de nouvelles études dans ce domaine considéré comme très important par les patients. [Copyright &y& Elsevier]

Résumé: La prise en charge de la spondyloarthrite est difficile et a évolué en fonction des concepts et des nouveaux traitements. Objectif : élaborer des recommandations pour la prise en charge en pratique de patients atteints de spondyloarthrite (incluant le rhumatisme psoriasique), sous forme d’actualisation à partir des données récentes de la littérature des recommandations nationales et internationales préalables. Un groupe de travail et un groupe de lecture multidisciplinaire ont été constitués. Le groupe de travail a individualisé les questions en suspens. Partant des recommandations existantes et des données actualisées de la littérature, le groupe de travail a émis des recommandations, revues par le groupe de lecture, et gradées selon la grille AGREE. Des recommandations sont proposées pour la prise en charge de la spondyloarthrite. Après avoir rappelé les principes généraux du diagnostic, il est proposé cinq recommandations sur les principes généraux, quatre propositions sur la stratégie de prise en charge, cinq propositions sur la prise en charge non pharmacologique, sept recommandations sur la prise en charge par les moyens pharmacologiques conventionnels, six recommandations concernant les biomédicaments, et trois sur les moyens chirurgicaux et le suivi évolutif. Ces recommandations actualisées offrent au praticien un cadre global guidant la prise en charge de la spondyloarthrite en pratique courante. [ABSTRACT FROM AUTHOR]

Summary: About 80 papers dealing with verticality after stroke have been published in the last 20years. Here we reviewed the reasons and findings that explain why measuring verticality perception after stroke is interesting. Research on verticality perception after stroke has contributed to improve the knowledge on brain mechanisms, which build up and update a sense of verticality. Preliminary research using modern techniques of brain imaging has shown that the posterior lateral thalamus and the parietal insular cortex are areas of interest for this internal model of verticality. How they interact and are critical remains to be investigated. From a clinical standpoint, it has now been clearly established that biases in verticality perception are frequent after a stroke, causing postural disorders. Measuring the postural vertical with the wheel paradigm has allowed elucidating the mechanisms of lateropulsion, leading or not to a pushing. Schematically, patients with a hemispheric stroke align their erect posture with an erroneous reference of verticality, tilted to the side opposite the lesion. In patients with a brainstem stroke lateropulsion is usually ipsilesional, and results rather from a pathological asymmetry of tone, through vestibulo-spinal mechanisms. These evolutions of concepts and measurement standards of verticality representation should guide the emergence of rehabilitation programs specifically dedicated to the sense of verticality after stroke. Indeed, several pilot studies using appropriate somatosensory stimulation suggest the possibility to recalibrate the internal model of verticality biased by the stroke, and to improve uprightness. Vestibular stimulations seem to be less relevant and efficient. [ABSTRACT FROM AUTHOR]

Objective To analyse usefulness of the SPASE programme, a coordinated facility programme to assist traumatic brain injury (TBI) persons in returning to work and retaining their job in the ordinary work environment. Design A retrospective study including 100 subjects aged over 18 who had suffered traumatic brain injury (GOS 1 or 2). The criterion for return to work (RTW) success was the ability to return to the job he/she had before the accident or to a new professional activity. Results Factors associated with RTW success were at short-term (2–3 years): the presence of significant workplace support OR = 15.1 [3.7–61.7], the presence of physical disabilities OR = 0.32 [0.12–0.87] or serious traumatic brain injury OR = 0.22 [0.07–0.66]. At medium-term (over 3 years) these factors were: significant workplace support OR = 3.9 [1.3–11.3] and presence of mental illness OR = 0.15 [0.03–0.7]. Conclusion This study suggests that a case coordination vocational programme may facilitate the return and maintain to work of TBI persons. It reveals that the workplace support is a key factor for job retention in the medium-term. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the differences in gait characteristics and gait symmetry of post-polio syndrome (PPS) patients ambulating with or without shoes and between subgroups walking with different walking aids and orthoses, study the correlation of these data with personal data, illness condition, physical health, frequency of using aids and orthotics and frequency of falls, and derive recommendations for standardization of reporting these data. Method Twenty-six PPS subjects ambulated with their own walking devices. We calculated spatio-temporal parameters and symmetry indices (SI) of gait using a data acquired by a motion capture system. We compared inter-subject differences in gait pattern for PPS groups that differed by questionnaire-obtained data of demographics, physical activity, polio history, falls and walking aids. Additional inter-subject comparisons were performed between normal subjects ( n = 16), PPS patients walking with shoes with/without an ankle-foot-orthosis ( n = 11), PPS patients walking with knee-ankle-foot-orthosis ( n = 5), and PPS patients walking with a walker/crutches ( n = 10). We also compared intra-subject variability in PPS subjects who were able to repeat the trials barefoot. Results Our main results show that subjects who reported participating in physical activity twice a week or more had significantly better step time and double support symmetry. Subjects who use walking aids on a daily basis had significantly higher gait cadence and shorter stride time. Also, subjects that do not require knee-ankle-foot orthoses and/or walking aids walked with a smaller base width and better symmetry in stance and swing durations than PPS subjects who require these aids. Conclusions The gait pattern of PPS patients is related to numerous intrinsic and extrinsic factors. Standardization of the reporting protocol of gait-related data of PPS patients is crucial for patient evaluation and treatment design. [ABSTRACT FROM AUTHOR]

Aims To describe the rehabilitation of non-ambulatory children with cerebral palsy and to explore adjustability on their individual needs. Material and method Data described are extracted from an on-going national cohort study, following during 10 years 385 children with cerebral palsy, aged from 4 to 10, Gross Motor Function Classification System IV and V. We analysed data from the first 190 patients (mean age 6 years 10 months (SD 2.0), 111 boys), focusing on physiotherapy, ergotherapy, psychomotility and speech therapy in medico-social and liberal sectors. Results In medico-social sector, duration of paramedical care is significantly more important than in liberal sector (structure of care: median = 4.25 h/week, liberal sector: median = 2.00 h/week) ( P < 0.0001). More than 4 different types of care per week are given in medico-social sector, while in liberal sector children benefit from only 2 different types of care a week. In investigators opinion, rehabilitation in structures of care is 71.65% adapted as opposed to 18.75% in the liberal sector ( P < 0.001). Children level V have less time of rehabilitation than the others ( P = 0.0424). Interpretation Rehabilitation of children with cerebral palsy who are not able to walk, with an objective to improve quality of life, is truly multidisciplinary and suitable in medico-social sector. [ABSTRACT FROM AUTHOR]

To assess the impact of rehabilitation on healing and recurrence rate of ankle sprain, 1 year apart, 111 patients, who suffered an ankle sprain (67 men and 44 women; 17 mild sprains, 67 medium and 27 severe), were included by emergency physicians of four emergency rooms (ER) of Finistère. The physician was free to prescribe, or not, further investigations. He prescribed systematically to patients RICE (rest, ice, compression, elevation) protocol, put an ankle brace, and gave a prescription of standardized rehabilitation. The prescription was the same for the four ER. All patients were recalled to 1 year. Of the 111 patients initially included, 21 patients were excluded for lack of response after three phone calls. In the end, 90 patients were assessable (56 men and 34 women), mean age 31.4 ± 12.6 years (range 15–55) at the time of initial trauma. Emergency physicians had diagnosed, initially, 16 mild sprains (17.8%), 56 medium sprains (62.2%) and 18 severe sprains (20%). Of the 90 patients, 73 patients have been rehabilitated (81.1%). Of the 44 accidents of everyday life, 31 were rehabilitated (70.5%). Of the 27 sports accidents, 25 were rehabilitated (92.6%). Of the 19 work-related injuries, 17 were rehabilitated (89.5%). There is no significant relationship between rehabilitation and no recurrence ( P = 0.45) nor between rehabilitation and full recovery of the ankle ( P = 0.59). Conclusion: We find no association between rehabilitation and prevention of recurrence, nor between rehabilitation and healing of patients. However, our study is limited by the small size of the non-rehabilitated group. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To quantify with a force platform the support of the operated leg through table tennis practice and to study the effect of this physical activity on the early support of the knee recovery after knee anterior cruciate ligament (ACL) reconstruction. Equipment and method: The movements of the pressure center on 40 subjects of the right (n =20) or left (n =20) knee surgery were assessed during table tennis practice. The average position (x, y), the lengths and the surface covered by the center of pressure were compared with a controlled group of 20 non-operated individuals to quantify support. The subjects were then randomized to surgery according to a table tennis controlled practice or not (10 sessions of 15minutes during 5 days) to study the support resumption of the operated side. Results: Operated knee subjects show a lack of support on the operated side compared to non-operated subjects during the table tennis practice. Table tennis training during one week improves the operated limb support and the lateral and total movements of subjects. This activity can be associated with the accelerated rehabilitation protocol proposed after ACL reconstruction. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Testing the new hip joint Helix3D efficiency through clinical data and walking parameters. Method: Three young hip-disarticulated patients (P1, P2 and P3) were assessed both with their previous prosthesis at first day, then four days and six months after being trained with a new prosthesis equipped with the Helix3D hip joint. Assessments comprised a satisfaction questionnaire, a two-minute walk test and a recording of main spatiotemporal gait parameters Results: After four days with the Helix3D, the satisfaction for the prosthesis was improved for P1, unchanged for P2 and reduced for P3. Distance walked during two minutes increased for P1, unchanged for P2 and slightly improved for P3. Gait pattern was improved in P1, only. P1 abandoned the Helix3D at six months due to an ischiatic wound. P2 and P3 chose not to use the Helix at the end of the four days training period because they could not adapt to the Helix3D characteristics (hydraulic control of hip extension and assistance to hip flexion) and because they did not gain enough benefits. Despite much effort to adjust the prosthesis, the three patients definitively abandoned the Helix3D because of comfort problems, and decided to walk with their previous prosthesis equipped with a monocentric hip joint or even with crutches only. Conclusion: The Helix3D hip joint may need further developments to get clinically relevant for hip-disarticulated amputees who may also need a long training period to adapt to its technical characteristics. [Copyright &y& Elsevier]

Abstract: Aim: To describe the amount of medical and paramedical involvement in a sample of Breton children with cerebral palsy as a function of the Gross Motor Function Classification System (GMFCS). Materials and methods: This is a transversal descriptive study. All children with cerebral palsy in Brittany were eligible. Parents who accepted to participate were asked to fill in a questionnaire regarding medical and paramedical involvement with their child. Results: One hundred and thirty-three parents participated. 40.6% of the children were level I on the GMFCS, 20.3% II, 12.03% III, 13.53% IV and 13.53% were level V. Thirty-nine percent of the children took at least one medication (of which 43% were antiepileptic drugs). 33.1% of the children had received at least one injection of botulinum toxin within the year. Forty-four percent used a mobility aid. Eighty-five percent of the children had at least one orthotic device, most often a night ankle-foot orthosis. The median number of rehabilitation sessions per week was 3.85 [0.5–11.5]. The frequency and type of sessions were mostly related to the GMFCS level. Conclusion: This study reports high levels of medical and paramedical involvement. Studies must attempt to define optimal practice. [Copyright &y& Elsevier]

Abstract: Goal Attainment Scaling (GAS) is a method for quantifying progress on personal goals. Turner-Stokes's guide to GAS is a method for quantifying progress towards personal goals. Turner-Stokes's guide and the use of Kiresuk's T-score are the most widely used GAS-based approaches in rehabilitation. However, the literature describes a number of other approaches and emphasizes the need for caution when using the T-score. This article presents the literature debates on GAS, variations of GAS (in terms of the score level assigned to the patient's initial status and description of the scale's different levels), the precautions to be taken to produce valid GAS scales and the various ways of analyzing GAS results. Our objective is to (i) provide clinical teams with a critical view of GAS (the application of which is not limited to a single research group's practices) and (ii) present the most useful resources and guidelines on writing GAS scales. According to the literature, it appears to be preferable to set the patient's initial level to –2 (even when worsening is a possible outcome) and to describe all five GAS levels in detail. The use of medians and rank tests appears to be appropriate, given the ordinal nature of GAS. [Copyright &y& Elsevier]

Abstract: Numerous studies have recently been published on improving upper-limb motor function after stroke. There has been a particular interest in brain stimulation techniques, which could promote brain plasticity. In this review, transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS) are presented as techniques that could be relevant in Physical Medicine and Rehabilitation (PM&R) centers in the future. We are presenting a comprehensive literature review on the studies using tDCS or rTMS for upper-limb rehabilitation after a stroke. Both techniques have shown their ability to modify cortical excitability and to transitorily improve upper-limb function after one single stimulation session. The first placebo-controlled, blinded therapeutic trials, which included repeated daily sessions, seem quite promising, and deserve to be validated by further trials. [Copyright &y& Elsevier]

Abstract: Objective: Decades after an acute poliomyelitis infection many persons experience new symptoms or impairments which may affect their life satisfaction. The objective of this study was to investigate the association between life satisfaction and self-reported impairments in persons with late effects of polio. Material and methods: One hundred and sixty-nine persons (104women and 65men) with prior polio responded on admission to rehabilitation to the Life Satisfaction Questionnaire (LiSat-11) assessing satisfaction with life as a whole and 10 domains of life satisfaction and to a 13-item questionnaire assessing self-reported impairments related to late effects of polio. Results: A majority was to some degree satisfied with life as a whole and with all 10 domains of life satisfaction in LiSat-11, but less than 20% was very satisfied or satisfied with their somatic health. Muscle fatigue, muscle weakness, general fatigue, muscle and/or joint pain during physical activity and cold intolerance were the most frequently reported impairments. Overall, those who rated themselves as not satisfied (according to LiSat-11) reported significantly higher degrees of impairment than those who were satisfied. The relationships between the items of life satisfaction in LiSat-11 and the items in the self-report questionnaire varied from −0.01 to −0.64. Conclusion: Satisfaction with life as a whole, and different domains of life satisfaction are low to moderately associated with self-reported impairments. This implies that rehabilitation interventions must address not only self-reported impairments but also activity limitations and participation restrictions in order to enhance life satisfaction in people with late effects of polio. [Copyright &y& Elsevier]

Abstract: In rheumatoid arthritis (RA), wrist and hand involvement is very frequent and occurs very early. Despite heterogeneity of onset modalities, some clinical features are suggestive but not specific of the disease. These include at the initial stage, the combination of synovitis and tenosynovitis in several sites. When the disease does not include the presence of autoantibodies (50 %) and/or erosive lesoins (90 %), new imaging tools applied to those sites are of diagnosis and prognosis values (active synovitis in power doppler ultrasound ; bone oedema in MRI). New imaging modalities are emerging and those allowing quantitative evaluation of periarticular bone loss from hand joints are promising for assessment of early arthritis. Medical treatment is in accordance with recommendations for RA management. Potential impact of TNF-antagonists on tenosynovitis refractory to conventionnal DMARDs has been suggested. Radiation synovectomy for mono- or olgo-articular disease appears as helpful. Surgical steps are often required during the course of RA. Nevertheless, in the last ten years, an important decrease of surgical procedures was observed. Reaxation and stabilisation of the damaged joints or tendons are the main objectives of these interventions. The hand surgeon has numerous surgical procedure available: synovectomies, flexor or extensor tendon reconstructions, arthroplasties, arthrodeses, capsuloplasties. These techniques are described in this chapter, with their indications, limits, and complications. At the wrist level, stability and axis restoration are the main objectives. The long finger surgery must restore an efficient grasp and pinch. The rheumatoid thumb surgery is based on stability restoration that is crucial for pinch. [Copyright &y& Elsevier]

Abstract: Background: Evaluate the functional outcome of a specific program of rehabilitation during conservative treatment of fracture of the greater tuberosity. Methods: We retrospectively studied the records of 22 patients, with minimally displaced greater tuberosity fracture, according to inclusion criteria. All patients have received an early (one week after the injury) rehabilitation program based on physical analgesic therapy means, techniques for recovering range of motion, strengthening exercises, proprioceptive stabilization exercises and usability advices. The evaluation was done at baseline, one, two and three months of the end of physical treatment. Results: Pain, perceived disability and range of motion were improved significantly since the end of rehabilitation. The improvement of function (Constant score) was significant at different evaluation times. The functional result seems to be poor when patients are aged and pain is severe at baseline. Conclusion: During conservative treatment of fracture of the greater tuberosity, earlier rehabilitation allows rapid range of motion and functional recovery limiting care duration. After fracture healing, the rehabilitation program becomes similar to that advocated in rotator cuff disease. Whatever the initial treatment choice, rehabilitation must be considered at the waning of the first week. [Copyright &y& Elsevier]