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BACKGROUND: Kinematic analysis and clinical outcome measures with established responsiveness contribute to the quantified assessment of post-stroke upper-limb function, the selection of interventions and the differentiation of motor recovery patterns.OBJECTIVE: This systematic review and meta-analysis aimed to report trends in use and compare the responsiveness of kinematic and clinical measures in studies measuring the effectiveness of constraint-induced movement, trunk restraint and bilateral arm therapies for upper-limb function after stroke.METHODS: In this systematic review, randomised controlled trials implementing kinematic analysis and clinical outcome measures to evaluate the effects of therapies in post-stroke adults were eligible. We searched 8 electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, CINAHL, CENTRAL, OTseeker and Pedro). Risk of bias was assessed according to the Cochrane Risk of Bias domains. A meta-analysis was conducted for repeated design measures of pre- and post-test data providing estimated standardised mean differences (SMDs).RESULTS: We included reports of 12 studies (191 participants) reporting kinematic smoothness, movement duration and efficiency, trunk and shoulder range of motion, control strategy and velocity variables in conjunction with assessment by Motor Activity Log, Fugl-Meyer Assessment and Wolf Motor Function Test. Responsiveness was higher (i.e., non-overlap of 95% confidence intervals [CIs]) for Motor Activity Log score (SMD for amount of use 1.0, 95% CI 0.75-1.25, pCONCLUSION: These results are consistent with current literature supporting the use of combined kinematic and clinical measures for comprehensive and accurate evaluation of post-stroke upper-limb function. Future research should include other design trials and rehabilitation types to confirm these findings, focusing on subgroup analysis of type of rehabilitation intervention and functional levels.

International audience; Background: Somatosensory impairment of the upper limb (UL) occurs in approximately 50% of adults post-stroke, associated with loss of hand motor function, activity and participation. Measurement of UL sensory impairment is a component of rehabilitation contributing to the selection of sensorimotor techniques optimizing recovery and providing a prognostic estimate of UL function. To date, no standardized official French version of a measure of somatosensory impairment has been established.Objective: To develop and validate a French version of the Erasmus modified Nottingham Sensory Assessment somatosensory (EmNSA-SS) and stereognosis (EmNSA-ST) component for evaluating the UL among adults with stroke.Methods: This study is a single-center observational cross-sectional study. A French version of the EmNSA for UL was developed by forward-backward translation and cross-cultural adaptation. Fifty stroke patients were recruited to establish concurrent-criterion-related validity, internal consistency, intra- and inter-rater reproducibility with intracorrelation coefficients (ICCs) for reliability and the minimal detectable change with 95% confidence interval (MDC95) for agreement, as well as ceiling and floor effects. Criterion validity was assessed against the Fugl-Meyer Assessment-Sensory (FMA-S) for the UL.Results: The median (range) EmNSA-SS score was 41.5 (1-44). The Spearman rank correlation coefficient between EmNSA-SS and FMA-S total scores was moderate (rho=0.74, P

Aims Urinary disorders (UD) secondary to multiple sclerosis (MS) are common and can be responsible for complications. Since 2004, we organized in our region their management through a neuro-urological activity and a care network that established and distributed an algorithm for screening and first line care. The objective was to assess the effects of this organization on the management of UD and its impact for patients. Methods Between January 2004 and December 2009, 328 patients were seen in neuro-urological consultation. The data of a group of 168 patients consulting during the deployment of our organization (before January 2007: group 1) were compared to those of 160 patients taken when the organization was well established (from January 2007: group 2). In parallel, the modification of the prescription rate of the first-line examination patients was evaluated. Results The two groups were significantly different concerning age, duration of MS, EDSS score (Group 1 vs. Group 2 respectively 51.6 ± 12.6 vs. 48 ± 11.8 years, P = 0.008; 19 ± 9.7 vs. 13.8 ± 10.5 years, P

Aims Lower urinary tract dysfunctions (LUTD) are very common in Multiple Sclerosis (MS), have a significant social impact, while the organic impact is discussed. We studied urinary complications and their risk factors in our cohort of MS patients, in order to improve the management of LUTD in MS. Methods Between 2004 and 2009, all patients affected by MS and managed for LUTD were included in a retrospective study. We studied the epidemiological data (age, gender), the clinical data (duration of MS, EDSS score, progression of MS) and the paraclinical data (urinary creatinine clearance, urine culture, urinary tract ultrasonography and in some cases urodynamic assessment and cystography). We then identified the urinary complications and their risk factors. Results Three hundred twenty eight patients, mean age 49.9 ± 12.3 years, with a MS for 14.3 ± 10 years on average and with a median EDSS score equal to 6 (1–9), were managed for LUTD. One hundred seventy eight (54%) patients developed one or more urinary complications. We identified duration of MS greater than 8.5 years and an EDSS above 7 as risk factors. Conclusion Urinary complications are common in symptomatic MS, these results imply screening and specialized care to limit the impact on the quality of life but also to prevent urinary complications. Neurourol. Urodynam. 34:32–36, 2015. © 2013 Wiley Periodicals, Inc.

Objective Neuropathic pain are frequent and often drug resistant in patients with lesion of central nervous system. It has an important impact on quality of life. The aim of this study was to assess the efficacy of rTMS protocol associated with an education to self-exercise of imagined movement or mirror therapy among patients with central neuropathic pain (CNP). Material/patients and methods Between December 2014 and August 2016, 39 patients with CNP were included in the study. Exclusion criteria were contraindication to rTMS: epileptic seizure or contraindication to magnetic field. We recorded age, gender, and disease and pain duration. A DN4 score (defining the CNP) and a BPI score (assessing pain and impact of pain on life activities) were performed at day 0, 48 hours after a first rTMS session, at the beginning and at the end of 5 days with a daily rTMS session, then one month (M1), three month (M3) and six month (M6) later. A first rTMS session was realized at day 0 for testing tolerance to magnetic stimulation. Then an rTMS session was performed each a day during 5 days, associated with an education to imagined movement or mirror therapy regarding the impairment of patients. Back home, patients were engaged to continue daily self-rehabilitation with imagined movement or mirror therapy. The primary outcome was a decreasing of the most intense pain of at least 2 points, defining well responders. Results Twenty-six male and 13 women, 56.5 years old, with CNP from 7.5 years on average, were included. Seventeen had a stroke, 16 were spinal cord injury, 6 had another central neuropathic disease. Twelve patients finished the all study. There was 30.6% of well responders at 48 hours, 35.5% at M1, 32% at M3 and 25% at M6. The distribution of the most intense pain was significantly shifted after five days of stimulation and during at least 3 months (Kruskal test, P 2 , P Discussion – conclusion This study show that rTMS associated with imagined movement or mirror therapy is a promising treatment to reduce CNP with an effect during at least 3 months.

Traumatic brain injury often results in cognitive impairments that limit recovery. The underlying pathophysiology of these impairments is uncertain, which restricts clinical assessment and management. Here, we use magnetic resonance imaging to test the hypotheses that: (i) traumatic brain injury results in abnormalities of functional connectivity within key cognitive networks; (ii) these changes are correlated with cognitive performance; and (iii) functional connectivity within these networks is influenced by underlying changes in structural connectivity produced by diffuse axonal injury. We studied 20 patients in the chronic phase after traumatic brain injury compared with age-matched controls. Network function was investigated in detail using functional magnetic resonance imaging to analyse both regional brain activation, and the interaction of brain regions within a network (functional connectivity). We studied patients during performance of a simple choice-reaction task and at 'rest'. Since functional connectivity reflects underlying structural connectivity, diffusion tensor imaging was used to quantify axonal injury, and test whether structural damage correlated with functional change. The patient group showed typical impairments in information processing and attention, when compared with age-matched controls. Patients were able to perform the task accurately, but showed slow and variable responses. Brain regions activated by the task were similar between the groups, but patients showed greater deactivation within the default mode network, in keeping with an increased cognitive load. A multivariate analysis of 'resting' state functional magnetic resonance imaging was then used to investigate whether changes in network function were present in the absence of explicit task performance. Overall, default mode network functional connectivity was increased in the patient group. Patients with the highest functional connectivity had the least cognitive impairment. In addition, functional connectivity at rest also predicted patterns of brain activation during later performance of the task. As expected, patients showed widespread white matter damage compared with controls. Lower default mode network functional connectivity was seen in those patients with more evidence of diffuse axonal injury within the adjacent corpus callosum. Taken together, our results demonstrate altered patterns of functional connectivity in cognitive networks following injury. The results support a direct relationship between white matter organization within the brain's structural core, functional connectivity within the default mode network and cognitive function following brain injury. They can be explained by two related changes: a compensatory increase in functional connectivity within the default mode network; and a variable degree of structural disconnection that modulates this change in network function. © 2011 The Author.

Objectives Neurogenic bladder dysfunction has a negative impact on the patient's quality of life (QoL). Cystectomy with ileal conduit urinary diversion is a treatment option in patients in failure after conservative management. The objective of this study was to evaluate the impact of ileal conduit urinary diversion on the QoL of patients with neurogenic bladder dysfunction. Materials and Methods From March 2004 to November 2010, 48 patients (36 women and 12 men with a mean age of 50.6 ± 11.8 years) treated by cystectomy with ileal conduit urinary diversion for neurogenic bladder dysfunction, prospectively completed, before and after surgery, two self-administered QoL questionnaires. Neurological diseases were multiple sclerosis in 38 cases, spinal cord injury in 7 cases, and other neurological disease in 3 cases. Cystectomy was performed by laparoscopy in all patients. QoL was measured by using two self-administered questionnaires, one questionnaire specific for urinary disorders validated in neurological patients, Qualiveen®, and the generic SF36-v2® questionnaire. Data were compared by Student's t test. Results Comparison of the Qualiveen® self-administered questionnaire scores and indices before and after surgery showed that, after surgery, patients presented a significant reduction of limitations (0.57 ± 0.64 vs. 1.55 ± 1.35, P

Purpose The efficacy of sacral neuromodulation for treating refractory idiopathic lower urinary tract dysfunction is now well established. Nevertheless, results of this technique in neurological patients are still controversial. The aim of this retrospective study was to assess the results of sacral neuromodulation in neurogenic bladder dysfunction. Materials and Methods Between 1998 and 2008, a percutaneous nerve evaluation or a two-stage technique was performed in 62 patients (mean age 50.5 ± 14.8 years) with neurogenic lower urinary tract dysfunction. Before and during the temporary stimulation, each patient had a urodynamic evaluation and performed a bladder diary. The test was considered positive if the clinical and urodynamic improvement was over 50% and if the symptoms reappeared after turning the stimulation off. Results Lower urinary tract dysfunction was detrusor overactivity in 34 cases and chronic urinary retention in 28 cases. A detrusor-sphincter dyssynergia (DSD) was associated in nine cases. Out of the 62 patients, 41 patients (66.1%) had more than 50% improvement on urodynamic evaluation and bladder diary and 37 were implanted. With a mean follow-up of 4.3 ± 3.7 years, results remained similar to the evaluation phase in 28 cases (75.7%), were partially altered in three cases (8.1%) and lost in six cases (16.2%). In these six cases, neuromodulation failed on average 12.0 ± 12.4 months after implantation. Conclusion Sacral neuromodulation seems to constitute a serious therapeutic option for patients with neurogenic lower urinary tract dysfunction. However, its results depend on the type of the underlying neurologic disease and in particular, whether it may progress or not. 30:547–550, 2011. © 2011 Wiley-Liss, Inc.

Study Type – Harm/Safety (case series) Level of Evidence 4 OBJECTIVE To determine if antibiotic prophylaxis is required for intradetrusor botulinum toxin A (BoNT-A) injections. PATIENTS AND METHODS This was a prospective non-randomized study. Inclusion criteria were adult patients with neurogenic detrusor overactivity who failed anticholinergic-based first-line treatment and had sterile urine culture 7 days before injections, a negative dipstick test on the day of the injections, and were performing clean intermittent self-catheterization. Injections were performed using a rigid cystoscope, under local anaesthetic. Patients received BoNT-A as either Botox® (Allergan Inc., Irvine, CA, USA) 300 U in 30 sites or Dysport® (Ipsen Ltd, Ipsen, Paris, France) 750 U in 20 sites. Urine culture was done 6 days and 6 weeks after the injections. If urinary tract infection (UTI) was suspected, a physician performed a complete physical examination. The primary outcome criterion was the occurrence of UTI during the first week after injections. RESULTS In all, 42 patients (22 women, 20 men) with a mean (sd) age 45.3 (16.4) years were included. A symptomatic UTI occurred during the first week after the injections in three patients (7.1%). The urinary colonization rate was 31% and 26% at 6 days and 6 weeks after injection, respectively. The most common bacterium was Escherichia coli (62.5%). There were no differences between 20 and 30 injection sites or between the sexes. CONCLUSION The rate of UTI after intradetrusor injections of BoNT-A was 7.1%. The most frequent bacterium involved was Escherichia coli. These results indicate that antibiotic prophylaxis for intradetrusor BoNT-A injections seems necessary.

Objectives To study the effect of botulinum toxin A (BoNTA) injections into the detrusor muscle on the incidence of symptomatic urinary infections in patients with neurogenic detrusor overactivity. Methods Between February 2004 and June 2005, 30 patients (18 men, 12 women), mean age 39.4±12.1 yr, with neurogenic detrusor overactivity received an injection of 300 U Botox ® (Allergan Inc., Irvine, CA, USA) into the detrusor. Fifteen patients had multiple sclerosis, 14 had spinal cord injury, and 1 had myelitis. Twenty-two patients had urinary incontinence. Patients were either resistant to anticholinergic medications, had discontinued treatment because of adverse effects, or had contraindications to anticholinergic drugs. Before and 6 wk after injection, each patient kept a bladder diary and underwent urodynamic investigation, retrograde and voiding cystourethrography, and urine culture. All symptomatic urinary infections (pyelonephritis, orchitis, prostatitis) occurring in the 6 mo before and the 6 mo after injection were recorded. Results Before injection, the mean number of symptomatic urinary infections over 6 mo was 1.75±1.87. After injection, the mean was 0.2±0.41 ( p =0.003), and only 3 patients presented symptomatic urinary infections. These patients were those who showed less improvement in their urodynamic parameters after injection (volume of the first uninhibited contraction, maximum bladder pressure, and maximum cystometric capacity, respectively; p =0.0037, p =0.0002, p =0.0027, ANOVA). Conclusions BoNTA injections into the detrusor muscle significantly decreased the incidence of symptomatic urinary infections. This effect seems to be related to improvement in urodynamic parameters, reflecting improved reservoir capacity at low pressure.

Resume Objectifs Evaluer la morbidite et la mortalite de la cystectomie laparoscopique associee a une ureterostomie transileale pour traiter les troubles vesico-sphincteriens d’origine neurologiques. Materiel Etude prospective realisee entre fevrier 2004 et avril 2006, aupres de 26 patients consecutifs, d’âge moyen 55,0 ± 12,7 ans, ayant beneficie d’une cystectomie laparoscopique pour des troubles vesicosphincteriens d’origine neurologique. La pathologie neurologique etait une Sclerose en Plaques (SEP) dans 20 cas, un traumatisme medullaire dans 4 cas et une myelite transverse dans 2 cas. Le score ASA median preoperatoire etait de 3 (2-3). Resultats Aucune conversion n’a ete necessaire. Une complication per-operatoire a ete notee (plaie vasculaire). Aucun deces peri-operatoire n’a ete constate. La sonde naso-gastrique a ete maintenue en post-operatoire en moyenne 8,69 ± 5,9 heures. Le delai moyen de reprise de boissons etait de 1,4 ± 0,7 jours et celui de reprise de l’alimentation de 2,6 ± 1,0 jours. Le delai moyen de reprise du transit etait de 3,8 ± 3,2 jours. La duree moyenne d’hospitalisation en unite de soins intensifs etait de 3,9 ± 1,1 jours. Deux complications postoperatoires ont ete notees chez le meme patient (un ileus et un encombrement bronchique). La prise post-operatoire de morphi-niques a ete necessaire dans 60% des cas. La duree moyenne d’hospitalisation etait de 10,3 ± 4,1 jours. Deux complications post-operatoires tardives ont ete notees chez la meme patiente (deux pyelonephrites). Conclusion La cystectomie laparoscopique chez les patients neurologiques est peu morbide, permettant une realimentation precoce des patients et une duree d’hospitalisation moderee.

Background and Purpose— Very few neuroimaging studies have focused on follow-up of subcortical aphasia. Here, overt language production tasks were used to correlate regional cerebral blood flow (rCBF) changes and language performance in patients with vascular subcortical lesions. Methods— Seven aphasic patients were scanned twice with positron emission tomography (PET) at 1-year interval during a word-generation task. Using SPM2, Language-Rest contrast at PET1 was correlated to language performance and to time-lag from stroke. The same contrast was performed at PET2 and session effect (PET2–PET1) was correlated with performance improvement. Results— At PET1, correlation between rCBF and delay from stroke involved mainly ventral regions of the left temporal cortex and mesial frontal cortex. Correlations between rCBF and performance showed predominantly left dorsal regions in the frontal, temporal, and parietal lobes, but also the left ventral temporal cortex. One year apart, language performance improved and rCBF increased in perisylvian regions bilaterally. Best performers at PET2 showed an increase of activity in left ventral temporal cortex as well as in right middle temporal gyrus. Conclusions— On follow-up, expected language improvement and increase of activation in the classical language areas and their counterparts were observed. Moreover, all correlational analyses both at PET1 and on follow-up implicated the anterior part of the left inferior temporal gyrus, suggesting a disconnection between the superior and inferior parts of the left temporal cortex and a specific role for this region in lexical semantic processing.

Objective Lower urinary tract dysfunctions (LUTD) are very common in neurological diseases. TENS is a therapeutic alternative in the treatment of urinary and pelvic perineal symptoms, whose effectiveness has been proven in multiple sclerosis. Evaluate the benefits of treatment with TENS (U3 program) in clinical practice for neurological lower urinary tract dysfunctions (LUTD), incompletely controlled by the usual pharmacological treatment, on urinary symptoms and quality of life. Materials/patients and methods We performed a cohort, and prospective study, between June 2014 and September 2015 in the Physical Medicine and Rehabilitation Service in CHU Toulouse, Rangueil. We included patients with neurological LUTD, badly controlled by pharmacological treatments and with whom we prescribed TENS; they completed questionnaires of urinary symptoms (USP score) and of quality of life (Qualiveen) at baseline to 2 months and 6 months. Results Thirty-three patients were included (mean age 53.7 years, 70% women and 30% of patients with MS). Twenty-three patients were followed up at 2 months (M2) and 15 at 6 months (M6). TENS has been prescribed for purchase after 2 months of testing for 63.3% of patients (19 patients of the 30 who actually started the TENS). We find a statistically significant decrease in symptoms of over active bladder (OAB) (p = 0.0012) and dysuria (p = 0.0322) assessed by the USP score at M2. We find a statistically significant reduction of discomfort (p = 0.0305) associated with urinary disorders at M2. There is no significant difference in M6. The study of correlations shows that TENS improves very symptomatic patients (on OAB in M2 and M6) or very disabled in terms of quality of life (on total Qualiveen to M2 and on the lived symptoms to M2 and M6). Discussion/Conclusion TENS can be considered as a good symptomatic treatment for neurological LUTD in clinical practice.

Objective Intermittent self-catheterization is the gold standard for patients with central neurologic bladder. It allows to reduce all urinary tract complications and to improve the quality of life. The factors of good compliance are continence and autonomy regarding the introduction of the catheter. Nevertheless, self-catheterization can be difficult because of the usual shortcomings associated with bladder and sphincter disorders (motor, sensory…). We found only one study about one adaptive equipment to facilitate the gesture for monoplegic patients. Observations This case report concerns a 53-years-old man, left brachial amputated in 1987 because of a motorbike accident associated with primitive progressive multiple sclerosis since 1996. He has an overactive bladder syndrome and dysuria because of a detrusor sphincter dyssynergia and overactive detrusor. Treatments by alpha bloquants then TENS on the tibial posterior nerve and finally neuromodulation of the posterior sacral roots did not succeed. The indication of self-catheterization was chosen and the patient's education was organized in Physical Medicine and Rehabilitation unit in University Hospital of Rangueil. The team of therapists has manufactured adaptive equipment to enable the learning of intermittent self-catheterization despite his amputation. It consists in the realization of a thermo-formed plastic penile support, with a central channel to support the penis and a curved base on both sides for holding the device between the thighs. It was a success and the patient was able to independently urinary catheterism with one hand while the device correctly maintained his penis. Discussion/Conclusion Three months later, he no longer needed this assistance. To conclude, it can be conclude that a multidisciplinary management allowed a monoplegic patient to acquire the self-catheterization technique, avoiding him to undergo surgical treatment.

Background and Purpose— Follow-up neuroimaging studies of aphasia never addressed a comparison between aphasic and healthy subjects. Investigation of changes over time in healthy subjects during language tasks seems a prerequisite before interpretation of longitudinal changes in aphasic patients. Methods— Six healthy subjects and 8 aphasic patients were PET scanned twice (PET1 and PET2) at a 1-year interval during a word generation task. Using SPM99, language-rest main effect was compared at PET1 and PET2 in each group, whereas group effect was assessed at each session. Correlations were analyzed in each group between performance indexes and changes in regional cerebral flood flow (rCBF) between the 2 sessions. Results— Language performances were improved in both groups. rCBF decreased from PET1 to PET2 in the healthy group and increased in the aphasic group in perisylvian regions bilaterally. Correlations between performance and rCBF changes across sessions were similar in the 2 groups; positive correlations involved superior temporal cortexes bilaterally, and negative correlations concerned superior frontal and medial temporal regions. Conclusions— Increased perisylvian activation over time probably reflects improved performance at the expenses of cognitive effort in aphasic patients. Decreased activation in different neural systems suggests a familiarization effect with reduced emotional load.

Objective Assessment of the metrological properties of the spatiotemporal gait parameters is a key point because they are used as a monitoring criterion of post-stroke recovery and as outcome in interventional studies. The objective of the study was to explore the relevance of gait assessment at maximal gait speed (MGS) rather than spontaneous gait speed (SGS) for post-stroke subjects through (1) the study of between and within-day reliability data of spatiotemporal gait parameters at SGS and MGS; and (2) a comparison of the direct measurement of velocity at MGS versus its estimate. It was also designed to (3) highlight the importance of considering the distribution of the random error to use an adequate expression of the measurement error (MErr). Material/patients and methods Spatiotemporal gait parameters – velocity, walk ratio, span acceleration, and spatiotemporal asymmetries indexes – from 30 post-stroke subjects (mean ± SD age, 51.6 ± 16.2 years; median [range] time since stroke, 4.4 [1 to 101] months; 60% of male; 70% using a walking assistive device) were collected using the Locometer (Satel, Blagnac, France) on three times, about 7 days (between-day) and 30 minutes (within-day) apart, at SGS and MGS. The minimal metrically detectable change with a 95% confidence interval was computed in original unit, or in percentage (MDCp) if the distribution of random error was heteroscedastic. Results Reliability was better at MGS than at SGS, and for within than for between-day test-retest. MDCp for velocity were equal to 36.2%/16.2% at SGS for between/within-day test–retest, and 21.2% at MGS for between-day test-retest. Gait velocity at MGS should be measured and not estimated because of unacceptable error of prediction in 70% of cases. An inappropriate expression of MErr without taking into account the random error distribution leads to over-/underestimate of the significant modifications of gait parameters. Discussion – conclusion Data from the present study allow for a suitable interpretation of spatiotemporal gait parameters modification for post-stroke subjects. We highlighted the necessary gait assessment at MGS, being the most likely to show differences related to therapeutic intervention for post-stroke subjects and showed that the velocity at MGS should be measured and not predicted.

Objective The seating intervention for wheelchair users intends to achieve a comfortable and functional position and to limit the risk of complications due to long sitting period (pain and discomfort, skin disorders, orthopedic, respiratory, digestive diseases). Few scientific papers about seating intervention in adults are published. The objective of the present study is to assess the objective and subjective effects of wheelchair seating intervention for patients at Toulouse University Hospital's WSC. Patients and methods A cohort study of patients cared at the Toulouse University Hospital's WSC between April 2014 and April 2016. The main criterion is the evaluation of patient's seating goal at 3 months of delivery of the equipment by the Goal Attainment Score (GAS). Other criterions are the evaluation of pain by visual analog scale (VAS), the comfort of the Assessment Tool Wheelchair Comfort (TAWC), the seating time (hours per day) and the sitting posture [Seated Postural Control Measure for Adults (SPCMA)]. Results Preliminary results show with 40 patients (mean 51 years ± 17): among them, 11 have spinal cord injury, 7 stroke. The most common deficiency is tetraplegia (20). Seventeen patients have cognitive impairment. Thirty-six patients have at least one complication of postural control disorder with 19 painful patients. Twenty-six patients completed the positioning care. GAS at 3 month improves: median +2 (min: 0/max: 3). The SPCMA improves: median +8/56 points (min: 0/max: 26). This improvement is statistically significant (Wilcoxon: P P = 0.005; TAWC Wilcoxon: P = 0.03). The sitting time is not modified. Discussion/Conclusion These preliminary results show the effectiveness of seating intervention on posture, pain and discomfort. Patient's goals are the most often reached. These preliminary results show the efficiency of WSC for patients, not only to improve posture.

Opinion/Feedback Surgical indication is recommended for specific locations (pelvic stage 3 and 4 pressure ulcers) and if medical treatment is impossible: – global patient assessment is recommended before surgical indication with benefits and risks analysis; – analysis is conducted on several stages; – risk factors analysis and control level; – efficiency analysis about medical and preventive coverage; – pressure ulcer origin analysis; – compliance patient assessment (care contract); – systematic pre operative procedure is recommended: – multi-disciplinary et pluriprofessionnal consultation; – psychological assessment and follow up; – radiological assessment (systematical, no systematical IRM except if osteitis, no TDM, no scintigraphy); – biological assessment (inflammatory nutritional, micro biological); – no pre-operative antibiotherapy; – specify definition of surgical type – realize pre-operative micro biological taking is recommended:(according to bone aspect): – enforce systematic post operative procedures is recommended: – plan patient installation: every patient must have a preventive mattress and book curative mattress for multiple scrap; – plan total immediate post operative dumped according to patient compliance in PRM ward (during at least 3 weeks, often 4); – organize seated station progressive recharging in PRM ward (during at least 3 weeks); – extend patient supervision and allow seated station; – plan further supervision.

Objective The shoulder is painful in 70% of post-stroke patients. Sling and shoulder orthosis are important for medical care. However, series slings have not proved efficiency to improve upper limb function. We realize (with OCTO31 company) a custom-made shoulder orthosis prototype (EO31) to set the upper limb in a posture with an elbow flexion, a forearm supination and, by the way, a finger extension. The objective is to facilitate the upper limb function and to decrease shoulder pain. Observations A 54-year-old female, 6-month post ischemic left stroke, with shoulder pain (diastasis) recovers a distal motor function with both pinch and grasp. She under-uses this recovery, due to proximal weakness with impossibility to obtain a functional position of the forearm. Patient has used the EO31 prototype daily for 30 days. Assessments are performed with prototype compared to standard shoulder orthosis (Ottobock ® Shoulder support 7126). Functional assessment (Wolf Motor Function Test and Chedoke Arm and Harm Activity Inventory) do not show significant difference (neither ability to perform tasks or speed) between the two orthosis. Quebec User Evaluation of Satisfaction with assistive Technology (QUEST) is a lot better with EO31 (31/35) compare to standard orthosis (14/35). Shoulder pain slightly decreases with EO31. Discussion/Conclusion This custom-made shoulder orthosis setting the upper limb in a functional posture improves comfort and patient's satisfaction. This improves significantly safety and observance. After a month of use, we were unable to prove the functional benefits of the prototype compare to a standard orthosis, probably due to functional improvement and motor recovery of the patient. This prototype will now be used with other patients, with early comparative assessment to confirm our results and better define functional benefits.

Objective Central neuropathic pain is common among neurological patients. Drug therapy has high pharmacoresistance and some GABAergic agents can be detrimental to the recovery process. Alternative therapies include neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and motor imagery techniques with mirror therapy. The objective of this study was to evaluate their effectiveness in clinical practice on central neuropathic pain. Material/Patients and methods Thirty-two patients followed in the Physical Medicine and Rehabilitation department of Rangueil University Hospital were included. Subjects with central neurological disease (from stroke, spinal cord injury, etc.) failed drug therapy with DN4 ≥ 4. They received a first session of rTMS of 20 minutes (10 Hz frequency and intensity of 90% of the motor threshold) over the controlateral pain motor cortex then daily rTMS sessions were conducted over 5 days with motor imagery exercises and mirror therapy twice daily. Effectiveness was assessed by changes in the BPI score at 2 days, 1 month, 3 months and 6 months. Results At 2 days (31 patients), scores of BPI3, 5, 9 and BPI severity decreased significantly (of respectively 12.6%, P = 0.001; 10.4%, P = 0.025; 28.2%, P = 0.000 and 8.6%, P = 0.001). At 1 month (20 patients), scores of BPI 3, 5, 6, 9 and BPI severity decreased significantly (of respectively 20,8%, P = 0.011; 26.1%, P = 0.005; 26%, P = 0.045; 32.5%, P = 0.009 et 24.5%, P = 0.022). At 2 days, pain ≤ 2 years was associated with better response to treatment (responders: lower BPI severity score ≥ 2 points) (Chi 2 test, P = 0.04). The positive response found at 2 days is also correlated to a positive response at 1 month (Chi 2 test, P = 0.011). Discussion/Conclusion The preliminary results of this study show a significant decrease in pain at 48 hours and 1 month intervals. A positive response at 48 hours indicates a good predictor of response to therapeutic treatment.

Objective Post intensive care rehabilitation is a relatively new concept that aims to admit in rehabilitation unit patients just after intensive care to deliver appropriate rehabilitation treatment while ensuring monitoring of heavy medical conditions. Aims Assess activity of post intensive care rehabilitation service in Toulouse University Hospital from 2008 + (year of creation) to 2015 and compare it to the work of other French post intensive care rehabilitation. Material/patients and methods Epidemiological study, observational, descriptive, retrospective-based patient files maintained by physicians of the service, the data PMSI, medical file. We asked by email to other referring French physicians in a rehabilitation post intensive service some information about their activity. Results Between August 2008 and August 2015, 241 patients were admitted on 6 beds of rehabilitation after intensive care in CHU de Toulouse, or 5.7 patients per year per bed The average duration of stay is 63.3 days, with wide variability between patients (with duration of stay from 2 to 505 days). The original service is neurology in 25% of cases, neurosurgery in 22% of cases, an intensive care unit or intensive care in 35.6%. The disease is mainly represented by stroke in 32% of cases; SCI about 24% of patients. Approximately 50% of patients were weaned from their respiratory technical assistance. The main downstream service is traditional hospitalization neurological MPR service (39% of cases). Eleven percent of patients had to be re hospitalized in MCO service. Only 2 patients (0.84%) died during their stay in SRPR. Since 2008, 140 patients (59%) went back home and 36 patients died (15%). Discussion - conclusion Our unit accommodates many patients. Some care pathways should be further improved.

Pharmacotherapy of aphasia had been discussed for the last twenty years with first bromocriptine and amphetamine and then serotoninergic, GABAergic and cholinergic agents. Here, we reviewed the MEDLINE available reports of drug therapy for aphasia. So far, proofs of efficiency were found indubitable for none of the studied molecules. However, some of them showed limited efficiency (piracetam and amphetamine). Moreover, drug therapies for aphasia were less efficient alone than when they were associated with speech therapy.