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Introduction/Background Early mobilization (EM) in intensive care units is safe, feasible and beneficial for patients; however, little is known about the current practices of early mobilization for patients with brain injury in intensive care units (ICU) in France. Aim To evaluate the current mobilization practices and its barriers in ICUs for patients with acquired brain injury. Material and method A cross-sectional survey online was conducted with two questionnaires on early mobilization practices distributed to physicians and physiotherapists working in 130 ICUs across France. Results The survey was completed by 31 physiotherapists and 25 physicians in 24 different wards. Rehabilitation specialists were involved with care according to 88% of doctors. EM was most frequently started within 24–48 hours, according to 8 doctors and 15 physiotherapists. The majority of physiotherapists (84%) stated that 75%–100% of patients received positioning and passive range of motion therapy, alongside head of bed elevation (84% PTs). A lower proportion of patients received standing exercises (32% PTs reported 25–30% of patients), walking therapy (48% reported Conclusion Early mobilization in various forms is being practiced in the ICUs of France. Main results demonstrate a good willingness and enthusiasm amongst physicians and physiotherapists, but a lack of medical support and not enough personnel to attain early mobilization objectives. We suggest a need to have a standardize protocol to encourage early safe mobilization of neurological patients in intensive care. Further prospective research on safety and outcomes specific to neurological patients is needed.

Peripheral nerve blockade is one of the therapeutic possibilities to treat spasticity of various muscles. Percutaneous nerve stimulation allows accurate location of nerves and neurolysis can be performed using intraneural injection of 65% ethanol or 5 to 12% phenol. Spastic contraction of various muscle groups is a common source of pain and disability which prevents from having efficient rehabilitation. Test-blocks as well as neurolytic blocks are possible in most of motor nerves of the upper and lower limbs and main indications are spastic sequelae of stroke and spinal trauma but also of multiple sclerosis, cerebral palsy and chronic coma. The use of percutaneous nerve stimulation allows accurate location and four nerves are more frequently treated: pectoral nerve loop, median, obturator and tibial nerves. In patients with spasticity of the adductor thigh muscles, nerve blocks are performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. No complications occurred and minor side effects are transient painful phenomena during injection. These approaches proved to be accurate, fast, simple, highly successful and reproducible. Percutaneous neurolytic procedures should be done as early as possible, as soon as spasticity becomes painful and disabling in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neuron.

We have investigated with light and electron microscope immunocytochemistry the aminergic and peptidergic innervation of Onuf's nucleus in adult baboons. This nucleus, located in the ventrolateral part of the sacral spinal cord (S2 and S3), is considered to control urethral and anal sphincters and penile muscles. By comparison of intact and transected spinal cords, we have found that serotoninergic innervation has two origins: first, supraspinal, innervating the whole nucleus, with a possible predominance in the dorsal half; and second, intraspinal, corresponding to the ventral half of the nucleus. Thyrotropin-releasing hormone innervation appears largely coincident with serotonin, both in intact and transected spinal cords. Noradrenaline is exclusively of supraspinal origin, as attested by its disappearance below the level of the section. Substance P, calcitonin genex-related peptide, and Leux- and Metx-enkephalin, which profusely innervate Onuf's nucleus, are on the contrary not affected by the transection. They most likely originate from the cord itself or the dorsal root ganglia. Thus, Onuf's nucleus innervation in the baboon arises both from supraspinal and intraspinal sources. The present study provides an anatomical basis for both voluntary and reflex controls of excretory and sexual functions in a primate. The same neurotransmitter (serotonin) according to its cell origin and discrete topography could exert different influences upon the same effector system.

Fibularis lungus (FL) action and participation in gait disorders is often underestimated, although first description of the impact on gait of a FL “spasm” dates from 1872 [1] . Case history Thirty years aged men, with multiple sclerosis spastic tetraparesis, cerebellar hypotonia and ataxia. Functional exam: completely independent in everyday life activities, with difficulties to put on shoes, needing one croutch outside. Physical exam: paresthesia, thermoalgesic and proprioceptive hypoesthesia in both lower legs (LL), proximal weakness prevailing on the left, dystonia of extensor hallucis longus (Hallucis erectus) and clonus of soleus and gastrocnemius of both legs. Gait analysis FL is responsible for a left-hand side pattern prevailing on the left-hand side, associating “footdrop” and sole's eversion during swinging phase, valgus-valgus instability of the heel during stance and heel medial-lateral oscillations when standing tiptoe; [pre-injection video]. Treatement's history First, all three calf muscles of both legs have been injected (total of 300 UI Botox) but patient developed a botulism-like syndrome with; he had no profit of second injection with 25 units in both gastrocnemius and TP of each leg, rather it caused drastic weakening of propulsion. Treatment aims: improve control of inversion-eversion couple during terminal stance, without weakening propulsion strength or heel's medio-lateral stability during tiptoe stance. Treatment Injection of only left leg trigger muscles (FL and it's antagonists: TP, Extensor Hallucis Longus) with 50 UI each (total = 150) Post injection exam bilateral decrease of medial-lateral heel & leg-body oscillationsduring tiptoe stance, better leg shortenig during swing & no personal sensation of propulsion. Conclusion muscles actions must always be considered taking into account both proximal and distal fixed points. In case of proximal fixed point, LPL plantar flexes foot and reverse sole; when fixed point is distal, FL steadies leg (and body) upon the foot in frontal plane and draws leg's lateral side outwards.