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Resume But La lesion medullaire (LM) peut alterer a des degres variables la sexualite des patients. L’objectif de cette etude etait d’evaluer les dysfonctions sexuelles (DS) chez un echantillon de patients atteints de LM tunisiens et de determiner les facteurs associes a ces DS. Materiels et methodes Etude descriptive transversale realisee sur un echantillon de 30 patients atteints de LM. La sexualite a ete evaluee par : Male Sexual Quotient (MSQ) et Sexual Health Inventory for Men (SHIM). D’autres parametres ont ete collectes : sociodemographiques, cliniques, capacite fonctionnelle, profil psychologique, et qualite de vie (QDV) (Short-Form 36 : SF36). Resultats L’âge moyen etait de 41 ± 9,6 ans (23–56). La frequence des DS dans notre etude etait 69,2 %. Les items les plus touches du MSQ (76 %) etaient l’erection, l’orgasme, la seduction et la performance. Les DS etaient associees a une alteration des domaines de SF36. Nous avons note des correlations positives, d’une part entre le score MSQ et les sous scores limitations liees a l’etat physique (RP) et sante generale (GH) de SF36 et d’autre part entre le SHIM et les sous scores RP, la composante mentale (MCS) et physique (PCS). Le score MSQ etait correle negativement avec le score HAD. Aucune autre association n’a ete notee. Conclusion Notre etude a montre une frequence elevee de DS chez les patients atteints de lesions medullaires notamment tunisiens. Les DS etaient associees essentiellement a une degradation de la QDV et au profil anxio-depressif. L’absence d’autres associations pourrait etre expliquee par la particularite de notre culture qui considere encore la sexualite et les DS comme un sujet tabou et secondaire.

Background In European and North American countries, stunting and malnutrition are common in children with cerebral palsy (CP), especially those with multiple disabilities. The extent of this problem in children with CP in North African countries is still unknown. Aims To evaluate feeding problems and growth in a sample of North African multidisabled children with CP and to determine the factors associated with malnutrition in this population. Method We conducted a cross-sectional study including multidisabled children with severe CP. Anthropometric measurements (body weight, height, mid-upper arm circumference and triceps skinfold thickness) were performed. In addition, a thorough nutritional survey was conducted including feeding time and the presence of signs in favor of gastrointestinal problems. Results We included 40 children, mainly boys (60 %) with a mean age of 6.4 ± 3.7 (range 2–16 years). The nutritional survey had revealed the presence of dysphagia, constipation and gastroesophageal reflux in 55 %, 67.5 % and 70 % of cases, respectively. Sixty-five percent of children had a mealtime over 30 min. Based on World Health Organization (WHO) growth charts, 67.5 % of children were underweight. Forty percent of the children had their weight below the 20th percentile, 5 % and 7.5 % had their height and BMI below the 5th percentile according to CP specific growth charts. Triceps skinfold thickness and mid-upper arm circumference were below the 5th percentile in 50 % and 55 % of cases, respectively. Age (p = 0.047) and constipation (p = 0.003) were identified as predictors of malnutrition. Conclusions Growth parameters and nutritional status are significantly altered in in our sample of North African multidisabled children with CP with a high prevalence of feeding problems represented especially by dysphagia, constipation and GER. Among the studied factors age and constipation may predict the existence of undernutrition.

Introduction La douleur demeure l’une des principales causes qui alterent la qualite du sommeil (QDS) des patients diabetiques ou non. La neuropathie peripherique douloureuse est une complication qui touche plus 15 % des patients diabetiques. Objectifs L’objectif de cette etude etait de comparer la QDS chez une population de diabetiques de type 2 (DT2) souffrant ou non de douleur. Patients et methodes Etude transversale descriptive et analytique incluant 168 patients DT2 ayant donne leur consentement oral pour l’enquete. La QDSa ete evaluee par l’index de qualite du sommeil de Pittsburgh (PSQI). Le diagnostic de douleurs neuropathiques a ete realise a l’aide de l’echelle DN4. L’intensite de la douleur a ete evaluee par l’echelle visuelle analogique (EVA). Nous avons analyse la relation entre les scores de douleur et celui de la QDS. Resultats L’âge moyen etait de 56,2 ± 12,3 ans. La QDS etait mauvaise chez 74,4 % des DT2 selon le PSQI. Les scores EVA et DN4 etaient statistiquement plus eleves chez les patients souffrant d’une mauvaise QDS respectivement (p = 0,002 p = 0,008). Nous avons trouve une correlation lineaire entre le score DN4 et le score PSQI (r = 0,421, p Discussion La QDS etait plus mauvaise chez les patients douloureux. Une etude francaise realisee en 2013 par Bouhassira et al., a montre que les patients souffrant de douleur chronique avec des caracteristiques neuropathiques avaient une qualite de vie significativement inferieure, plus de problemes de sommeil que ceux avec une douleur chronique sans caracteristiques neuropathique. Conclusion Une prise en charge axee sur le depistage precoce et le traitement de ces douleurs se voit necessaire afin d’ameliorer la QDS de ces patients et par voie de consequence leur qualite de vie.

Resume But Plusieurs composantes associees au syndrome metabolique (SM) peuvent favoriser le developpement de troubles vesicosphincteriens (TVS). L’objectif de cette etude etait d’analyser la prevalence des TVS dans une population de patients atteints de SM et d’etudier l’influence des differents parametres definissant ce syndrome. Patients Etude prospective realisee sur un groupe de 34 patients (dont 20 (58 %) femmes) ayant un SM selon les criteres de la NCEP ATP III. L’appreciation des symptomes urinaires a ete realisee a l’aide du score Urinary Symptom Profile (USP). Le poids, la taille, le tour de taille et l’indice de masse corporel (IMC) ont ete mesures et une recherche d’hypotension orthostatique a ete realisee. La glycemie a jeun et postprandiale, l’hemoglobine glyquee (HbA1c), cholesterol total, triglyceridemie, HDL-CT et LDL-CT ont ete doses. Resultats L’âge moyen etait de 56 ans (±9,2). Tous les patients etaient diabetiques et hypertendus. L’IMC moyen etait de 30,2 ± 4,8 et le tour de taille moyen de 107,8 ± 9,3 cm. Le score USP total etait de 8,3 ± 6. Vingt-neuf (85,2 %) patients avaient un syndrome clinique d’hyperactivite vesicale et 13 (38,2 %) patients avaient une incontinence urinaire d’effort. Le sous-score USP hyperactivite vesicale etait positivement correle a l’âge, la valeur de tour de taille, l’IMC et la glycemie postprandiale. Les autres parametres du SM n’etaient pas correles aux symptomes urinaires. Conclusion Les symptomes urinaires les plus frequemment rencontres au cours du SM etaient l’hyperactivite vesicale et l’incontinence urinaire a l’effort. Les parametres du SM qui influencaient le score USP etaient l’obesite abdominale et l’hyperglycemie.

KEYWORDSMusculoskeletal disorders;Hospital staff;Prevalence;Risk factorsAbstract Aim of the work: Musculoskeletal disorders (MSD) represent a significant occupationalproblem among hospital staff; however, data on musculoskeletal health of hospital staff are sparse.This study sought to determine the prevalence of MSD, their epidemiologic data and the associatedrisk factors.Methods: A previously self administered questionnaire sought information on demographics,prevalence and pattern of MSD, associated risk factors was employed as the survey instrument.A total of 520 questionnaires were distributed to hospital staff but only 433 questionnaires wasvalid. Eighty-seven of the returned questionnaires were excluded because of incomplete data.Results: The prevalence of MSD among hospital staff was 65.4%. Musculoskeletal disordersoccurred mostly in low back (74.5%), neck (38.1%), and knees (31.1%).Factors associated to MSD were age (P < 0.001), female gender (P < 0.001), years of service(P < 0.001) as well as prolonged standing or sitting (P = 0.016 and 0.023, respectively). No signif-icant association was found between repetitive movement, uncomfortable postures, heavy load han-dling, working on night shifts, stress and the presence of MSD.Conclusion: A high proportion of hospital staff reported MSD at some body site with the lowback being injured most often. Education programs on prevention and coping strategies for mus-culoskeletal disorders are recommended for hospital staff in order to reduce the rate of occupationalhazards and also promote efficiency in patient care. 2013 Egyptian Society for Joint Diseases and Arthritis. Production and hosting by Elsevier B.V.All rights reserved.

Resume La fasciite necrosante est une infection grave engageant le pronostic vital et necessitant un traitement urgent et adapte. Apres un traitement chirurgical, souvent agressif, des sequelles fonctionnelles importantes peuvent s’observer surtout au niveau du membre superieur. Nous rapportons le cas d’un patient presentant des sequelles fonctionnelles graves d’une fasciite necrosante du membre superieur et nous decrivons un protocole de traitement reeducatif multimodal en insistant sur sa place a moyen terme apres chirurgie.

Resume Objectif Etudier le profil anxio-depressif des patients pris en charge pour une fracture de l’extremite inferieure du radius et rechercher des correlations avec la survenue de l’algodystrophie. Patients et methodes Il s’agit d’une etude prospective (janvier 2008 a mars 2010) ayant inclus successivement 90 patients adresses pour reeducation apres une fracture de l’extremite inferieure du radius. Les criteres d’inclusion sont une fracture extra-articulaire traitee orthopediquement et vue dans la semaine suivant l’ablation du plâtre. L’evaluation du profil anxio-depressif est faite lors de la premiere consultation, a un mois, a trois mois, a six mois et a neuf mois grâce a la version arabe du score « Hospital Anxiety and Depression Scale » (HAD). Les signes cliniques de l’algodystrophie sont recherches systematiquement a chaque consultation. Le diagnostic est retenu selon les criteres de Veldman. Resultats Le score HAD depression parait etre plus eleve dans la population algodystrophique sans difference significative. Pour le score HAD anxiete, cette difference devenait statistiquement significative a partir du premier mois concomitant de la date moyenne de survenue de l’algodystrophie (20,7 jours). La population atteinte d’algodystrophie est restee significativement plus anxieuse jusqu’au sixieme mois (respectivement p = 0,007 a un mois, p = 0,018 a trois mois et p = 0,039 a six mois). L’amelioration du score HAD depression etait significativement superieure dans la population atteinte d’algodystrophie seulement au cours du premier mois. L’amelioration de l’anxiete (en termes de score HAD) etait comparable entre les deux populations tout au long du suivi, sauf au neuvieme mois ou elle devenait significativement plus marquee dans la population atteinte d’algodystrophie. Conclusion Notre etude n’a pas identifie la depression et l’anxiete comme facteurs predictifs de la survenue d’algodystrophie. Cependant, dans ce dernier cas, nous avons note une difference significative sur le plan de l’anxiete par rapport aux patients non atteints d’algodystrophie. En cas d’algodystrophie, les patients porteurs d’une fracture de l’extremite inferieure du radius gardent des troubles anxieux pendant six mois apres l’ablation du plâtre.

Subcutaneous rupture of the tibialis anterior tendon is rare. Diagnosis is usually clear. The essential clinical symptoms are progressively: footdrop gait, loss of ankle flexion strength, ankle foot pain and claw toes. But the occurrence of an asymptomatic time period between the injury and the onset of clinical signs can make the diagnosis more difficult. MRI is the gold standard examination for tendons injuries and associated bone and joints damages. Surgical exploration confirms MRI findings. It constitutes the treatment of choice for tibialis anterior tendon rupture. Surgical or functional techniques used have an impact on the design of the rehabilitation program, essential step in the care management of these injuries. It avoids postoperative tendon adhesions and their functional consequences. We report here a case of a man presenting with footdrop gait as the only clinical symptom.

Objective Many women experience pain in the lower back and gluteal region during pregnancy as the fetus develops and the uterus expands. Although rare, stress fractures of the sacrum and sscro-iliitis can occur during this period. They are most often ignored by practitioners and taken for sciatica in late pregnancy. Material/patients and methods We report a case of low back pain in a woman who delivered by caesarean that was considered to be caused by sacro-illitis and sacral fractures were not identified until after one year delivery. Results A 32-year-old nulliparous woman (height 164 cm, pre-pregnancy weight 48 kg, body mass index 17.8 kg/m2) reported lower back pain at 34 weeks of gestation and at 38 weeks, she had difficulty walking. She was delivered by cesarean and pain was spontaneously abated. Eleven months later, she had a second baby also by caesarean. She already walked with a Canadian cane at 37 week, for low back pain associated with buttock pain. The patient consulted for a left intense persistent buttock pain. Laboratory tests were normal, especially inflammatory and phosphocalcium balance, renal and thyroid tests. Bone density was normal. Pelvic computed tomography (CT) and magnetic resonance imaging performed showed sacro-illitis, with a longitudinal fracture on the left side of the sacrum. Treatment was conservative consisting of rest, discharge orthopedic footbed and analgesics. The outcome was favorable. Discussion – conclusion Sacro-illitis and sacrum during pregnancy or delivery are rare and most are diagnosed after delivery. Diagnosis of sacral fracture and Sacro-illitis that occur before delivery is difficult because symptoms can be nonspecific. There are individual differences in perception of pain but when pain is sufficiently intense to interfere with activities of daily living, as in our case, fractures should be suspected. The originality of this observation is based on the rare association of sacral location of the fracture with sacro-iliitis described rarely in the literature.

Resume Objectifs Recenser les pathologies douloureuses de l’epaule et decrire leurs caracteristiques epidemiologiques et evolutives dans une consultation de medecine physique polyvalente sur une periode de cinq ans. Patients et methodes Il s’agit d’une etude retrospective interessant les dossiers des patients suivis entre 2004 et 2008 pour epaule douloureuse a la consultation de medecine physique du CHU de Monastir (Tunisie). Les parametres etudies sont d’ordre epidemiologique et clinique. Resultats Parmi 5943 consultants, 2127 cas (35,8 %) de pathologies musculosquelettiques degeneratives ont ete notes. Parmi ces derniers, 453 cas (21,3 %) d’epaule douloureuse. L’âge moyen des patients de ce groupe etait de 51,43 ans ± 12,3 ans, avec une sex-ratio de 0,54. Les pathologies les plus frequentes etaient la tendinopathie de la coiffe des rotateurs et la capsulite retractile qui ont ete notees respectivement dans 346 cas (76,4 %) et 97 cas (21,4 %). Dans ces deux groupes, une predominance feminine a ete notee, avec des sex-ratios respectifs de 0,45 et 0,73. Le diabete a ete note dans respectivement 90 cas (26 %) et 51 cas (52,5 %). Les antalgiques sont prescrits dans 85 % des cas de tendinopathie de coiffe de rotateur et dans 81 % des cas de capsulite retractile. La difference entre la population de tendinopathie de coiffe des rotateurs et celle de capsulite retractile est significative en termes d’âge, de sexe, de nombre de seances de reeducation, d’antecedents et du nombre d’infiltrations realisees au cours de la reeducation.

Introduction/Background To evaluate the effect of hip external rotators and abductors strengthening in association with hip internal rotators stretching on pain and function in patients with Patellofemoral Pain Syndrome (PFPS). Material and method We conducted a cross-over randomized study including 109 patients with PFPS (75 females and 34 males aged of 31.6 ± 10.8 years). Patients were randomly assigned into first protocol A (G1, n = 67) of A-B arm with standard rehabilitation or protocol B (G2, n = 42) of B-A arm with standard rehabilitation associated to strengthening of hip external rotator and abductor musculature with stretching of hip internal rotators. Each protocol consisted of 3 sessions a week for 4 weeks. After a washout period corresponding to the recurrence of the same painful symptoms experienced by the patient rehabilitation programs were crossed-over. A visual analog scale (VAS) evaluating perceived pain, Functional Index Questionnaire (FIQ) and Kujala patellofemoral score were administered at baseline, at the end of each rehabilitation protocol and at 12 weeks after the completion of the second protocol for each group. Results Pain and function were significantly improved in both arms for the total population (P Conclusion Associating strengthening of hip abductors and external rotators and stretching of hip internal rotators provided better outcome in terms of pain and function in patients with PFPS which was maintained until the end of the study.

Resume Objectifs Presenter le resultat de la prise en charge des douleurs cervicoscapulaires compliquant un traitement carcinologique d’une neoplasie locoregionale et evaluer le role de la medecine physique et de readaptation d’apres une experience tunisienne. Patients et methodes Etude retrospective a propos de 19 patients pris en charge en ambulatoire (janvier 2001–janvier 2009) pour des douleurs cervicoscapulaires. Nous avons recueilli les parametres epidemiologiques et cliniques et avons evalue la douleur, les amplitudes articulaires de l’epaule, le lymphœdeme du membre superieur et le handicap ressenti avant et apres reeducation fonctionnelle. Resultats Il s’agit de 18 femmes et d’un homme, dont la moyenne d’âge etait de 48,8 ans (39 a 61 ans). Dans 19 cas, le traitement etait chirurgical, associe a une radiotherapie dans 12 cas. Il s’agit de cancer du sein chez 17 patientes et de cancer de la sphere otorhinolaryngologique chez deux patients. Le diagnostic etait une epaule douloureuse simple dans 15 cas, une capsulite retractile dans trois cas et une cervicalgie dans un cas. L’amelioration etait notable pour la douleur, les amplitudes articulaires et le lymphœdeme. Le handicap ressenti est reste important. Discussion et conclusion Les patients presentant des sequelles douloureuses cervicoscapulaires gardent un handicap important malgre une amelioration clinique objective. Les facteurs psychologiques en rapport avec la maladie neoplasique et son traitement lourd sont determinants. En plus de l’importance de la prise en charge reeducative, le suivi psychologique de ces patients est d’un grand interet dans les structures de medecine physique et de readaptation.

Resume Objectif Analyser la qualite de vie des parents des enfants atteints d’une paralysie cerebrale. Methodes Quarante-neuf familles de 53 enfants atteints d’une paralysie cerebrale ont participe a cette etude. Un questionnaire a ete transmis aux parents afin d’evaluer les parametres suivants : la qualite de vie a l’aide d’un instrument generique : le SF12, la symptomatologie depressive et anxieuse a l’aide du hospital anxiety and depression scale (HAD) et l’impact du handicap sur la vie des parents en utilisant le family impact of childhood disability scale (FICD). Resultats L’analyse du score du FICD ne montre pas de difference significative entre les reponses de la mere et celles du pere. Le score moyen des items positifs etait de 15/20 pour les peres et de 12,2/20 pour les meres. Le score moyen des items negatifs etait de 31/40 pour les deux parents temoignant de l’importance de leur gene sociale et financiere. Environ 24,5 % des meres et 11,6 % des peres ont eu des scores superieurs au seuil limite de risque de depression avec une difference statistiquement significative ( p Conclusion La majorite des parents interroges vivent une epreuve difficile et negative sur le plan social et financier. Leur etat mental, physique et psychologique est affecte par la presence d’un enfant handicape dans la famille.

Objective The aim of this study was to estimate the prevalence and severity of feeding and nutritional problems in children with severe CP (with multiple disabilities), in addition to assessing the presence of predictors factors, associated with nutritional status. Patients and method This was a cross-sectional study of children with severe CP. Anthropometric measurements (body weight, knee height, mid-upper arm circumference, and triceps skin-fold thickness) were taken. Serum levels of ferritin, total proteins, albumin, lipid and vitamin D were measured. In addition, feeding times, the presence of gastrointestinal problems (drooling of saliva, vomiting, dysphagia, etc.). Results We evaluated 46 children with a mean age of 6.8 years. Sixteen children had seizures and 34 children had orthopedic problems. The presence of oromotor dysfunction were noted in 70% of cases. 65% were constipated, and 65% had drooling of saliva. The meal was given in the majority of cases by the mother and feeding mean times was 40 minutes. The majority of parents described feeding time as stressful and unenjoyable. The average value of triceps skin-fold was 7.6 mm and mid-upper arm circumference was 15 cm. 42 patients had low serum ferritin and vitamin D deficiency was noted in 43.4% of cases. Anthropometric and values of biochemical markers were significantly lower in patients with severe comorbidities and gastrointestinal problems. Discussion The results highlight that feeding problems, anthropometric, and biochemical markers of the nutritional status in children with severe cerebral palsy are common and severe. Many of these children would benefit from nutritional assessment and management as part of their overall care.

Aim The main objective of this study was to investigate the epidemiological characteristics, functional and socio-professional outcome of a population of individuals one year after a severe traumatic brain injury (TBI). Methods The following parameters were analysed: profession, mechanism of trauma, period of care in rehabilitation, initial GCS, imaging results, nature of neuro-orthopedic sequelae, cognitive disorders, and functional level assessed by the FIM (Functional Independence Measure). The handicap was evaluated by the Glasgow outcome scale (GOS). The socio-professional status after TBI (lifestyle, occupation and education) was also investigated. Results The average age of the 50 patients included in the study was 28.1 ± 15.3 years, mostly male (76%). Length of stay in functional rehabilitation averaged 8.7 ± 14.7 months. All patients included in this study were socially active before the accident and lived with their family. Only 7 patients had returned to work and only 8 patients had resumed their schooling. Problems with memory, executive functions and thinking were reported in 42% of cases. The behavioural troubles (frontal syndrome and emotional problem health) were noted in 40% of cases. The average value of the FIM was 84.1 ± 29. According to the GOS, 30% of patients had a good recovery, and 2 patients remained in persistent vegetative state. Discussion Our study population is relatively young and predominantly male. Rehabilitation management takes place very late and the rate of socio-professional reintegration is very low. These findings highlight the importance of providing coordinated medical rehabilitation and intensive care unit to promote social outcomes after severe TBI.

Objective Assess satisfaction of lower limb amputees towards their device. Patients and methods Prospective study of device-fitted lower limb amputees followed at the Physical Medicine and Rehabilitation department at the University Hospital of Monastir. Epidemiological and clinical parameters were assessed with evaluation of fitted patients’ satisfaction towards their prosthesis (survey on the satisfaction of patients with lower limb amputations towards their prosthesis) (SAT-PRO). Results We collected 74 lower limb amputees including 16 initially fitted and 58 who had their device during the study period. The average age of our patients was 62 years with a male predominance. The most frequent amputation level was transtibial (71%). The average delay of the device compared to the surgery was 10.08 months with extremes of 2–60 months. The age of the device for already fitted patients averaged 22.73 months with a range of 1–360 months. The calculated score of satisfaction towards the prosthesis (SAT-PRO) for fitted patients averaged 32.41 with extreme varying from 18 to 51. This assessment showed an improvement in the satisfaction of our prosthesis patients. SAT-PRO means within this group was increased from 32.77 to 38.31 (P = 0.002) with an average gain of 5.54 ± 5.38. Satisfaction towards the prosthesis was positively correlated with the urban origin, high socioeconomic level, the age less than 65 years, the absence of disease history, the traumatic etiology, the level of distal amputation, the age of the device, the quality of life and the functional outcome score (ICL). Discussion/Conclusion The level of satisfaction of lower limb amputees towards the prostheses depends on several factors. It is very important for its impact on the quality of life and autonomy.

Objective The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population. Material/patients and methods Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospital, assessments of the injury types, duration of coma, length of hospitalization in the Intensive Care Unit (ICU) and finally the discharge mode after the ICU stay (transfer to neurosurgery ward, to rehabilitation unit, or home discharged). Results This study highlights the following results: – the predominance of young patients (76.9% under 35 years old); – the male dominance was clear (80%); – road traffic accidents are the main etiology of STBI with a frequency of 61.5% and the transport to the hospital was provided by emergency medical service in only 8 cases; – the predominance of STBI in the months of May and September; – the traumatic brain injury types are dominated by cerebral contusions (42.3%) and intracerebral hemorrhage (46.2%); – two patients remained in a vegetative state and 3 in pauci-relational condition. After an average ICU hospitalization of 10.5 ± 12 days [1–45], no patient was admitted into a rehabilitation unit, only 7 patients were addressed to physical medicine and rehabilitation consultation and 18 patients were transferred to neurosurgery. Discussion–conclusion The management of patients with STBI is complex to organize and must be performed by multidisciplinary teams. We should note the acute shortage in physical medicine and functional rehabilitation and waking units in the hospital structures of our healthcare system. So in order to create a better management strategy, the first aspect to be taken into consideration, is to develop the bonds between the medical structures and professionals dealing with head injuries in our hospitals and possibly the creation of mobile consultation units made of volunteers in PMR, reanimation, neurosurgery, psychiatry, psychology, physical therapy, nursing and social assistance.

Objective Winging of the scapula has a variety of causes and a variable prognosis. It contributes to a disruption of the scapulohumeral rhythm with a decreased flexion and abduction of the upper extremity and a source of a considerable pain. This condition can affect the ability to perform activities of daily living. The most common cause of scapula winging is serratus anterior paralysis resulting from a lesion of the long thoracic nerve. The rupture of the muscle itself remains uncommon. Observations Six patients presented to the department of Physical Medicine and Rehabilitation complaining of shoulder pain and great difficulties performing activities of daily living. Five women and a man, with a mean age of 44 years (14 to 58). Physical examination found drooping and a moderate decrease of range of motion of the shoulder. A winged scapula was seen in all cases. A soft mass was palpable at the level of the lower half of the vertebral border of the left scapula in a woman. In this case, US and CT were performed, they showed a rupture of the serratus anterior along the vertebral border of the left scapula with a fatty degeneration of the muscle. In the other cases, ENMG was performed, showing partial denervation of the long thoracic nerve. Discussion–conclusion Although rare, a good number of cases of paralysis of the long thoracic nerve are reported in the literature, but only a few concerning the muscle injury. The early differentiation between a nerve injury and a muscle injury is important. In most cases, nerve paralysis was due to traction of the nerve. Isolated serratus anterior rupture is a rare condition that is secondary to direct trauma or overuse. In all cases, the most common symptoms reported by patients are inability to elevate the arm above the level of the shoulder, pain about the shoulder and varying degrees of stiffness of the shoulder. The most striking thing noted on physical examination was the winged scapula. Rehabilitative treatment with specific exercises allows reducing the scapula winging, decreasing pain, consistent with a good functional improvement.

Objective The aim of our study was to evaluate the role of the visual biofeedback in balance disorders in lower limb amputees. Material/Patients and methods A prospective study performed in lower limb amputees followed at the Physical Medicine and Rehabilitation department of the University Hospital of Monastir. The first group received visual biofeedback on the balance platform combined with conventional rehabilitation of balance disorders. The second group of patients was treated only by conventional rehabilitation. Patients were evaluated clinically before and after each program. The total duration of the protocol was 24 sessions. Results Ten patients participated in our study. Five patients received only conventional rehabilitation and the five others were treated also using visual biofeedback. Both groups were clinically improved. Patients benefiting from visual biofeedback rehabilitation had a statistically greater improvement in the gain on the functional scores (L Test, monopodal support) as well as an improvement in the area and length of the center of pressure in the stabilogram with closed eyes. Discussion/Conclusion Visual biofeedback rehabilitation seems to improve the integration of proprioceptive information with a functional gain.

Objective To evaluate the impact of simulation-based learning according to the Kirkpatrick model (degree of satisfaction, skills acquisition and change of practices) in physical medicine and rehabilitation (PMR) residents. Material/patients and methods This is a prospective study as part of a simulation training project for residents in PMR. Over a period of 5 months, we have organized, in collaboration with Educational Simulation Center of Faculty of Medicine of Monastir (CeSimFMM), three practical training workshops to all PMR residents being validated specialty in Tunisia. The proposed simulation workshops had the following themes: botulinum toxin (BT) injections in the lower limbs, BT injections to the upper limbs and peripheral motor blocks in PMR. The collection of evaluation data was based on an anonymous questionnaire that assessed: degree of satisfaction, knowledge/performance and change in professional practices. Results Twenty residents were able to participate in these three workshops. The mean age of participants was 29.6 ± 3.6 years and 12 were female. The anonymous self-questionnaire distributed to learners at the end of this simulation-based learning cycle had revealed a 100% satisfaction level, ninety percent of the learners had agreed that the simulation-based learning allowed them to acquire skills and after a decline of five months 95% agreed on the fact that the simulation allowed them a change in their professional practices (only 5% did not agree). Discussion – conclusion The findings of the current study suggest that simulation-based learning in PMR residents might have a positive impact on self-efficacy and learning motivation that affects knowledge and clinical skill acquisition. Therefore, these findings demonstrate that, if integrated appropriately, simulation educational approach can be used in academic settings as an active learning methodology.

Objective To determine factors influencing long-term functional and professional outcomes in patients post severe traumatic brain injury (STBI). Material/patients and methods A descriptive analytical transversal and cross-sectional study involving patients with STBI dated more than 1 year and managed in rehabilitation department on an outpatient basis. Described parameters were: coma duration, post-traumatic amnesia duration (PTA), duration of hospitalization in intensive care unit, rehabilitation delay management, brain imaging findings, motor impairment, neuropsychological impairment assessed with Neurobehavioral Rating Scale-Revised (NRS-R), functional outcomes assessed with Functional Independence Measure (FIM) and disability assessed with Glasgow Outcome Scale (GOS). Results Three years post-STBI, motor impairment was severe in 34% of cases. Neuropsychological impairments were common: memory disorders (89.6%), attention-deficit disorder (81.2%), irritability (64.6%). Dependency in activities of daily living according to FIM was severe and total in 44% of cases and disability was severe in 44% of cases according to GOS. Factors significantly associated with bad functional outcomes (FIM and GOS) were: coma duration ( P : 0.014), PTA ( P P Discussion–conclusion It is important to determine and to understand factors influencing patient's prognosis after severe traumatic brain injury allowing us to improve functional and professional outcomes of this population. The current study confirmed the impact of APT and coma duration on functional recovery and professional activities resumption.

Objective To assess the prevalence of sleep disorders (SD) in ischemic stroke (IS) patients followed in physical medicine and rehabilitation (PMR) and to compare this prevalence to that found in a control population. Material/Patients and methods A cross-sectional study was conducted over a period of 8 months. We enrolled IS patients and case controls matched for age and sex and who met the inclusion criteria. The data studied were epidemiological and clinical. The evaluation of SD was achieved according to the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index (PSQI). Statistical analysis was made by appropriate tests using SPSS 20 software for windows. Results The studied population included 50 patients (IS-P), and 50 controls (control-P) with a median age of 58 years. The sex-ratio M/F in both populations was 1.5. The median age was 60 for women and 56.5 years for men. IS-P had more cardiovascular risk factors (hypertension, dyslipidemia) and cardiovascular complications (atrial fibrillation, carotid stenosis..) than control-P (P According to the Epworth sleepiness scale, IS-P had a worse sleep quality than control-P: (greater daytime sleepiness and sleep apnea syndrome [SAS]). The prevalence of SD was 42% in IS-P and 18% in control-P (P = 0.012). Sleep quality as it was assessed by the PSQI was worse in IS-P than in control-P. The prevalence of poor sleep quality was 46% in IS-P and 30% in control-P (P = 0.152). Discussion - Conclusion Our results suggest that the prevalence of SD was higher in IS-P than in control-P. Hemiplegic patients developed more daytime sleepiness with a higher probability of SAS. Screening for SD according to questionnaires such as the Epworth Sleepiness Scale and the PSQI should be part of the assessment of any IS patient in PMR.

Objective Evaluate the quality of life and psychological state of the lower limb amputees. Patients and methods Prospective study on the lower limb amputees followed at the Physical Medicine and Rehabilitation department of the University Hospital of Monastir. The variables analyzed were epidemiological, clinical with an assessment of the patients quality of life using the quality score of life “Short form 36” (SF_36) and a psychological evaluation by the score “Hospital Anxiety and Depression scale” (HAD). Results Our population consisted of 101 patients, including 16 (15.8%) initially device-fitted and 58 (57.4) who had their devices during the study period. The mean age was 61.3 years with a male predominance (75.2%). The vascular etiology of amputation was the most frequent (37.6%). The most represented level of amputation was transtibial (73.3%). The SF36 physical component score was initially more affected than the mental component with an average score of 32.53 PCS and MCS average 36.84. These scores were significantly higher among patients initially fitted. For 74 device-fitted patients, we observed a statistically significant improvement after device MCS scores (P = 0.001) and PCS (P = 0.002), as well as all the elementary scores of the Sf-36 score. This improvement was slightly higher for the mental component. The HAD-A score was 9.28 with the presence of anxiety symptoms in 47 patients (46.6%). The HAD-D score was 10.26. Forty-five patients (44.5%) had depressive symptoms. For the fitted patients there was a statistically significant difference between the HAD-A scores (P = 0.002) and HAD-D (P Discussion/Conclusion The impairment of quality of life, anxiety and depression are very common among amputees. The device allows a statistically significant improvement of the HAD and the physical and mental components of the SF 36.

Introduction Restoration of muscle function and orthopedic state is a crucial step in the course of treated foot deformities in infants including talipes equinovarus. Some steps of the treatment cannot be done in cases of paralysis of leg muscles. Observation It's a case of an infant that was sent us in the 16th day of life to take care of a deformation of the right foot. On examination, we found a talipes equinovarus with an amyotrophy of the muscles of the posterior compartment of the leg, the rest of the examination was without abnormalities. Ultrasound concluded to posterior, anterior and lateral leg muscle hypoplasia. Electromyographic examination performed at 4 months of age showed an absent electromyogram trace on medial femoral nerve and common fibular nerve. Ponseti method was used, followed by a specific rehabilitation program (mobilization + active rehabilitation) with a posture equipment (derotation brace). The orthopedic outcome was satisfying. He acquired walking at the age of 14 months with a stepping and internal rotation of the tibial segment, which was stabilized by a walking brace. Ultrasound monitoring performed monthly showed a gradual improvement in muscle atrophy of the leg, but without a motor recovery. Discussion The particularity of our clinical case is a complete agenesis of the leg muscles with a nerve agenesis. Nevertheless we used the Ponseti method followed by active rehabilitation. Orthopedic and functional result was satisfying. Cases reported in the literature of paralytic congenital talipes equinovarus were treated with tendon transfer, and in our case this indication was difficult.

Revue du rhumatisme - In Press.Proof corrected by the author Available online since mercredi 28 janvier 2015