23 results on '"L, Oujamaa"'
Search Results
2. Intérêt d’une rééducation précoce pour les patients neurologiques
- Author
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Dominic Pérennou, Jean-François Payen, L. Oujamaa, A. Marquer, P. Davoine, Gilles Francony, and A. Chrispin
- Subjects
medicine.medical_specialty ,Weakness ,Rehabilitation ,Activities of daily living ,business.industry ,Traumatic brain injury ,medicine.medical_treatment ,General Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,Critical illness ,medicine ,Physical therapy ,030212 general & internal medicine ,medicine.symptom ,business ,Stroke ,Early rehabilitation ,030217 neurology & neurosurgery ,Independent living - Abstract
Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients' impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
- Published
- 2012
3. Rehabilitation of arm function after stroke. Literature review
- Author
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Jérôme Froger, L. Oujamaa, J.-Y. Pelissier, Denis Mottet, and I. Relave
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medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Wrist ,Physical medicine and rehabilitation ,Meta-Analysis as Topic ,Neuroplasticity ,medicine ,Humans ,Orthopedics and Sports Medicine ,Stroke ,Physical Therapy Modalities ,Randomized Controlled Trials as Topic ,Rehabilitation ,Proprioception ,Stroke Rehabilitation ,Recovery of Function ,medicine.disease ,medicine.anatomical_structure ,Arm ,Physical therapy ,Upper limb ,Psychology ,Motor cortex - Abstract
In the recent literature we can find many articles dealing with upper extremity rehabilitation in stroke patients. New techniques, still under evaluation, are becoming the practical applications for the concept of post-stroke brain plasticity.This literature review focuses on controlled randomized studies, reviews and meta-analyses published in the English language from 2004 to 2008. The research was conducted in MEDLINE with the following keywords: "upper limb", "stroke", "rehabilitation".We reviewed 66 studies. The main therapeutic strategies are: activation of the ipsilesional motor cortex, inhibition of the contralesional motor cortex and modulation of the sensory afferents. Keeping a cortical representation of the upper limb distal extremity could prevent the learned non-use phenomenon. The modulation of sensory afferents is then proposed: distal cutaneous electrostimulation, anesthesia of the healthy limb, mirror therapy, virtual reality. Intensifying the rehabilitation care means increasing the total hours of rehabilitation dedicated to the paretic limb (proprioceptive stimulation and repetitive movements). This specific rehabilitation is facilitated by robot-aided therapy in the active-assisted mode, neuromuscular electrostimulation and bilateral task training. Intensifying the rehabilitation training program significantly improves the arm function outcome when performed during subacute stroke rehabilitation (six months). Ipsilesional neurostimulation as well as mental practice optimize the effect of repetitive gestures for slight motor impairments. Contralesional neurostimulation or anesthesia of the healthy hand both improve the paretic hand's dexterity via a decrease of the transcallosal inhibition. This pathophysiological mechanism could also explain the positive impact of constraint-induced movement therapy (CI therapy) in an environmental setting for chronic stroke patients.To ensure a positive functional outcome, stroke rehabilitation programs are based on task-oriented repetitive training. This literature review shows that exercising the hemiparetic hand and wrist is essential in all stages of a stroke rehabilitation program. New data stemming from neurosciences suggest that ipsilesional corticospinal excitability should be a priority.
- Published
- 2009
4. Influence de l'observance de la pratique des autosondages intermittents sur la fréquence des infections urinaires, la continence urinaire et les activités de vie quotidienne de patients neurologiques
- Author
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Pierre-Alain Joseph, M. de Sèze, L. Oujamaa, Jean-Michel Mazaux, E. Shao, and Michel Barat
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Gynecology ,medicine.medical_specialty ,Infection urinaire ,business.industry ,Obstetrics and Gynecology ,Medicine ,Neurology (clinical) ,business - Abstract
Decrire l'observance de la pratique des autosondages uretraux intermittents propres (ASIP) durant les quatre premieres annees suivant leur apprentissage et evaluer son influence sur l'incidence des infections urinaires, la continence urinaire et les activites de vie quotidienne. Etude retrospective par questionnaire medical aupres de patients anterieurement hospitalises en service de reeducation neurologique au CHU de Bordeaux pour apprentissage de la technique d’ASIP. Cinquante patients porteurs d’une neurovessie ont ete inclus et repartis en deux groupes selon la duree de pratique des ASIP: le groupe I (4 ans) etait constitue de 26 patients, le groupe II (2 ans) de 24. L'observance n'apparaissait pas correlee a la duree de pratique. Douze pour cent des patients avaient abandonne la technique d'ASIP, essentiellement du fait d'une mauvaise acceptation. Quatre-vingt-huit pour cent des patients se sondaient a une frequence moyenne de 4,5 ASIP/j. Le volume par sondage etait superieur a 400 cc dans la majorite des cas. La persistance ou l'augmentation de la frequence des infections urinaires sous ASIP apparaissait correlee a un volume moyen d'urine recueilli par sondage superieur a 400 cc (resultat non significatif, NS). Le nombre d'ASIP quotidien et l'observance stricte des regles d'hygiene ne semblaient pas correles a la frequence des infections urinaires (NS). La continence urinaire etait amelioree. Les activites de vie quotidienne etaient le plus souvent limitees par la presence de deficiences neuromotrices associees. L'observance de l'ASIP est satisfaisante apres 2 a 4 ans de pratique. L'augmentation de la frequence des infections urinaires apparait correlee au volume moyen de sondage, non a la frequence des ASIP ni au respect strict des regles d'hygiene.
- Published
- 2006
5. « SIRPIDS » : un mode inattendu de réactivité EEG en réanimation
- Author
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L. Vercueil and L. Oujamaa
- Subjects
Neurology (clinical) - Abstract
Auteur correspondant : L. Oujamaa, service de reeducation postreanimation, hopital Michalon, BP 217, 38043 Grenoble cedex 09, France. Adresse e-mail : Un homme de 86 ans fut victime d'une chute accidentelle avec traumatisme crânien (TC) sans perte de connaissance le 15 juillet 2011. Le patient fut admis aux urgences du CHU de Grenoble. On nota dans ses antecedents une arythmie complete par fibrillation auriculaire pour laquelle il etait traite par aspirine. L'evolution clinique spontanee fut marquee par une somnolence dans les heures suivant le TC. Le scanner cerebral sans injection etait normal. De fait, le trouble de la vigilance s'amenda spontanement et le patient sortit apres 24 heures de surveillance. Il fut a nouveau admis, deux mois plus tard en raison d'une hemiparesie gauche d'installation progressive en quelques jours. Le scanner cerebral mis en evidence un hematome sous-dural droit responsable d'un effet de masse sur le ventricule lateral droit et d'une deviation de la ligne mediane (Fig. 1). L'evacuation chirurgicale de l'hematome fut realisee en urgence. La periode postoperatoire fut compliquee d'une crise tonico-clonique generalisee en phase d'eveil, conduisant a la realisation d'un controle scannographique qui retrouva un œdeme cerebral diffus. Le patient fut de ce fait maintenu sous anesthesie generale durant 48 heures. A l'arret de la sedation et sous traitement antiepileptique (levetiracetam), il persistait des troubles de la vigilance (score de Glasgow a 5). Le scanner cerebral ne retrouva pas d'anomalie. Devant le defaut de reveil, un EEG fut realise. L'EEG montra un trace de fond ralenti de maniere diffuse dans la bande theta. La stimulation douloureuse etait a l'origine de l'apparition d'ondes a front raide diffuses a 2 Hz, transitoires et asymptomatiques, realisant un aspect de « SIRPIDS » (stimulus-induced rythmic, periodic or ictal discharges, Fig. 2).
- Published
- 2013
6. [Early rehabilitation for neurologic patients]
- Author
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L, Oujamaa, A, Marquer, G, Francony, P, Davoine, A, Chrispin, J-F, Payen, D, Pérennou, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Pôle anesthésie-réanimation, CHU Grenoble, Santé, Plasticité, Motricité (TIMC-IMAG-SPM), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)
- Subjects
Heterotopic ossification ,Posture ,Spinal cord injury ,Guillain-Barre syndrome ,Neuropsychological Tests ,Respiratory failure ,Pressure ulcer ,Disability Evaluation ,Cognition ,Mechanical ventilation ,Weakness ,Traumatic brain injury ,Thromboembolism ,Activities of Daily Living ,Humans ,Early rehabilitation ,Mobility Limitation ,Thromboprophylaxis ,Neurologic Examination ,Disability ,Depression ,[SDV.NEU.SC]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Cognitive Sciences ,Dysphagia ,Prognosis ,Respiratory Function Tests ,Stroke ,Critical care ,Impairment ,Neuromyopathy ,Anoxic brain injury ,Independent Living ,Nervous System Diseases ,Critical illness ,Passive range of motion - Abstract
International audience; Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients' impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.
- Published
- 2012
7. Asymmetric standing posture after stroke is related to a biased egocentric coordinate system
- Author
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V. Chauvineau, Dominic Pérennou, L. Oujamaa, Patrice Rougier, Julien Barra, Bases Génétiques, Moléculaires et Cellulaires du Développement (BGMCD), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), Santé, Plasticité, Motricité (TIMC-IMAG-SPM), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)
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Male ,030506 rehabilitation ,Supine position ,MESH: Proprioception ,Somatosensory system ,Weight-Bearing ,MESH: Postural Balance ,0302 clinical medicine ,MESH: Rotation ,MESH: Aged, 80 and over ,Orientation (geometry) ,MESH: Weight-Bearing ,Postural Balance ,Stroke ,Aged, 80 and over ,MESH: Aged ,MESH: Muscle, Skeletal ,Movement Disorders ,MESH: Middle Aged ,Brain ,[SDV.NEU.SC]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Cognitive Sciences ,Hypoesthesia ,Middle Aged ,MESH: Leg ,MESH: Vision Disorders ,Female ,MESH: Somatosensory Disorders ,medicine.symptom ,0305 other medical science ,Psychology ,Adult ,medicine.medical_specialty ,Weakness ,Rotation ,MESH: Space Perception ,Vision Disorders ,MESH: Orientation ,MESH: Stroke ,Perceptual Disorders ,03 medical and health sciences ,MESH: Brain ,Physical medicine and rehabilitation ,Orientation ,medicine ,Humans ,Force platform ,Muscle, Skeletal ,MESH: Perceptual Disorders ,Aged ,Leg ,MESH: Humans ,MESH: Adult ,Proprioception ,medicine.disease ,MESH: Male ,Space Perception ,Coronal plane ,Somatosensory Disorders ,Neurology (clinical) ,Neuroscience ,MESH: Female ,030217 neurology & neurosurgery ,MESH: Movement Disorders - Abstract
International audience; BACKGROUND: Weakness and somatosensory deficits have long been known to be involved in the postural instability of subjects with stroke. Recently, it has been shown that impaired representations of the orientation of the longitudinal axis of the body (LBA, egocentric reference) and of verticality (allocentric reference) may also play a role. The objective of the present study was to determine whether these two references were independently linked to postural asymmetry in standing stroke patients. METHODS: Twenty-two subjects were tested after a first hemispheric stroke (13 +/- 7.5 weeks). The LBA perception was investigated in the supine position by adjusting the orientation of a luminous rod in the frontal plane to correspond to the subjective LBA. The subjective visual vertical (SVV) was assessed by adjusting the orientation of a luminous line in the frontal plane to correspond to the SVV in upright patients. Weight distribution was measured in the standing position for about 2 minutes and 45 seconds by two separate force platforms under the feet. RESULTS: LBA and SVV were strongly associated (r = 0.7; p < 0.001). The estimate of the LBA was a better predictor (r = -0.52: p < 0.02) of weight bearing asymmetry than was SVV (r = -0.41; p = 0.074) when adjusted for motor weakness and hypoesthesia. CONCLUSION: Contralesional rotation of the longitudinal axis of the body could lead to unequal distribution of loading on the feet. This novel interpretation of weight bearing asymmetry underlines the complexity of control of the erect stance following stroke and brings new perspectives for rehabilitation programs.
- Published
- 2009
8. Three weeks spent in an early rehabilitation and post-intensive care unit significantly reduce disability of severely brain-injured patients discharged from hospital
- Author
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L. Oujamaa
- Subjects
medicine.medical_specialty ,Rehabilitation ,business.industry ,Traumatic brain injury ,medicine.medical_treatment ,Neurointensive care ,Retrospective cohort study ,medicine.disease ,Intensive care unit ,law.invention ,Short stay ,law ,Intensive care ,Physical therapy ,Medicine ,Orthopedics and Sports Medicine ,business ,Stroke - Abstract
Introduction Brain plasticity is a time dependant variable for neurological recovery after acute brain injury. Objective To quantify functional benefit of a short stay in an early rehabilitation post-intensive care unit for severe brain injured patients. Method This retrospective cohort study took place in Early Rehabilitation Section (ERS) of Intensive Care Department of Grenoble University Hospital between 2011 and 2013. It focused on patients discharged from neurocritical care after acute brain injury. We have recorded Length of stay (LOS) and Functional Independence Measurement (FIM: total score = FIMc: cognitive and social score + FIMm: motor score), at admission and discharge from ERS. In ERS, rehabilitation took 2 hours per day, five days a week including speech language therapy, occupational therapy, physiotherapy and psychosocial support. Results One hundred and sixty-two patients were included, with median age 56, and ratio Female/Male 0.6. Seventy-nine had severe traumatic brain injury (TBI), thirty-one had subarachnoid haemorrhage, fifty-two had stroke. The median LOS was 28 days in intensive care, 22 days in ERS. The median FIM at admission in ERS: 22 points (FIMc 9, FIMm 13). The median FIM improvement at discharge from ERS: + 20 points (FIMc + 6 points, FIMm + 14). There was no statistical difference between traumatic and non-traumatic brain injured groups. Considering TBI patients: disorder of consciousness (DOC) was identified for 13, post-traumatic amnesia for 53. Considering vascular brain injured patients: 3 locked in syndrome, 16 akinetic mutisms, 32 severe dysexecutive disorder, and 17 were severe aphasia cases. If necessary, neurosurgical treatment was planned during ERS stay to accelerate functional recovery (cranioplasty, cerebrospinal fluid shunt). Amantadine was administered in case of DOC. Any medication which could reduce cognitive ability was avoided. Rehabilitation goal was focused on efficient communication, reduction of anxiety and sleep disorder, ability to swallow, wheelchair mobility and removal of all catheters. Conclusion Three weeks of early specialized rehabilitation promotes functional recovery for severe acute brain injured patients immediately after intensive care discharge. Patients are thereafter discharged to out-hospital rehabilitation centers with higher safety and lower dependency.
- Published
- 2015
9. Mars Airborne Canyon Explorer for Mars surface exploration
- Author
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J.W.G.P. Apeldoorn, J. Naber, W.A. Hageraats, L. Oujamaa, N.G. van Dael, A.T. de Jong, R.A. Raus, D.J.P. van Heerden, Q.P. Chu, D.C. Maessen, and G. Oldenziel
- Subjects
Canyon ,geography ,geography.geographical_feature_category ,Mars Exploration Program ,Mars surface ,Geology ,Astrobiology - Published
- 2006
10. [Cerebral vasculitis secondary to Toxocara canis and Fasciola hepatica co-infestation]
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L, Oujamaa, I, Sibon, A, Vital, and P, Ménégon
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Adult ,Male ,Vasculitis ,Fascioliasis ,Memory Disorders ,Toxocariasis ,Reflex, Abnormal ,Toxocara canis ,Fever of Unknown Origin ,Magnetic Resonance Imaging ,Eosinophilia ,Animals ,Humans ,Cognition Disorders ,Muscle, Skeletal ,Vasculitis, Central Nervous System - Abstract
Neurological complications of cosmopolitan parasitosis are rare. We report a case of a cerebral and systemic vasculitis secondary to a visceral larva migrans syndrome associated with a Toxocara canis and Fasciola hepatica co-infestation.
- Published
- 2003
11. Nerf pudendal et prothèse totale de hanche
- Author
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L. Oujamaa, G. Godlewski, Michel Prudhomme, and D. Pradat-Prat
- Subjects
Anatomy - Abstract
But de l’etude determiner chez des patients presentant une atteinte du nerf pudendal l’impact d’antecedents de mise en place d’une prothese totale de hanche (PTH). Ce type de complication est rarement decrit dans la litterature. Materiel et methodes etude retrospective de 30 patients qui presentaient une atteinte neurogene du nerf pudendal laquelle s’exprimait soit par une algie pelviperineale soit par des troubles genitosphincteriens. Les criteres d’evaluation etaient bases sur un questionnaire au cours d’un entretien medical pour preciser la chronologie des troubles et sur l’analyse des resultats electroneuromyographiques (latences distales des nerfs pudendaux, latence du reflexe sacre, electromyographie des muscles bulbocaverneux, potentiels evoques somesthesiques du nerf pudendal). Resultats nous avons constate une frequence non negligeable d’antecedent de pose de PTH parmi les patients porteurs d’une neuropathie pudendale. Le delai moyen d’apparition des symptomes etait de 2 ans (0,1 a 4 ans) apres chirurgie. Dans 68 % des cas il s’agissait d’algies pelviennes chroniques. Les explorations electrophysiologiques objectivaient une latence distale (LD) augmentee dans 18 cas, un retard du reflexe sacre (RS) sans allongement de la latence distale dans 12 cas. Ces deux anomalies etaient bilaterales chez 15 % des patients. Conclusion dans notre etude l’alteration du nerf pudendal est mise en evidence par l’exploration electrophysiologique a distance de la chirurgie (delai moyen de 2 ans). Les neuropathies pudendales pourraient constituer une complication tardive de la chirurgie de prothese totale de hanche. Les mecanismes en cause seraient etre d’ordre biomecanique : etirement ou compression chronique du nerf pudendal par desequilibre du bassin osseux apres chirurgie.
- Published
- 2006
12. Réflexe sacré et muscle Levator Ani
- Author
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D. Pradal-Prat, L. Oujamaa, P. Mares, Christophe Boulay, C. Gagnard, and G. Godlewski
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Anatomy - Abstract
But de l’etude cette etude electrophysiologique a pour but de determiner le reflexe sacre, il est habituellement recueilli dans les muscles du perinee superficiel, nous le detectons au niveau du faisceau pubo-rectal du muscle Levator Ani. Materiel et methode le reflexe sacre etait recherche au decours d’une exploration electrophysiologique chez 30 sujets dont le reflexe sacre recueilli dans le muscle bulbo-caverneux avait une latence normale ( Resultats la latence du reflexe sacre est obtenue avec une valeur comparable a celle du reflexe sacre classique ; elle est comparable a droite et a gauche, elle peut varier en fonction de l’âge. Conclusion ce reflexe n’explore pas le nerf pudendal et les segments medullaires dont il est issu mais permet d’explorer le nerf propre du Levator Ani et les segments dont il prend origine preferentiellement.
- Published
- 2006
13. Klippel Trenaunay et neuropathie pudendale
- Author
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Michel Prudhomme, D. Pradat-Prat, L. Oujamaa, and G. Godlewski
- Subjects
Anatomy - Abstract
But de l’etude presenter le cas d’une neuropathie pudendale associee a un syndrome de Klippel et Trenaunay (KT). Materiel et methodes patiente de 55 ans porteuse d’un syndrome angiodysplasique associant gigantisme monomelique, fistules arterioveineuses profondes et angiome cutane. Resultats cette patiente ne presentait pas d’antecedents obstetricaux. Elle etait atteinte d’un KT avec gigantisme monomelique du membre inferieur gauche. Elle consultait pour une incontinence urinaire d’effort moderee evoluant depuis la menopause. On notait un trouble de la statique pelvienne a l’examen gynecologique et l’electroneuromyographie perineale objectivait un allongement bilateral de la latence distale du nerf pudendal predominant a gauche. Les explorations urodynamiques etaient normales. Conclusion Le syndrome de Klippel Trenaunay est une affection rare dont le caractere hereditaire est actuellement debattu. Les neuropathies peripheriques associees au KT sont exceptionnellement decrites. A notre connaissance, il s’agit du 1er cas rapporte de neuropathie pudendale associee a un KT.
- Published
- 2006
14. Factors Associated with Fatigue in COVID-19 ICU Survivors.
- Author
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Kennouche D, Foschia C, Brownstein CG, Lapole T, Rimaud D, Royer N, LE Mat F, Thiery G, Gauthier V, Giraux P, Oujamaa L, Sorg M, Verges S, Doutreleau S, Marillier M, Prudent M, Bitker L, Féasson L, Gergelé L, Stauffer E, Guichon C, Gondin J, Morel J, and Millet GY
- Subjects
- Humans, Middle Aged, Male, Female, Aged, Adult, SARS-CoV-2, Exercise Test, Vital Capacity, Surveys and Questionnaires, Respiration, Artificial, COVID-19 complications, COVID-19 physiopathology, Fatigue, Intensive Care Units, Survivors
- Abstract
Purpose: Approximately 30% of people infected with COVID-19 require hospitalization, and 20% of them are admitted to an intensive care unit (ICU). Most of these patients experience symptoms of fatigue weeks post-ICU, so understanding the factors associated with fatigue in this population is crucial., Methods: Fifty-nine patients (38-78 yr) hospitalized in ICU for COVID-19 infection for 32 (6-80) d, including 23 (3-57) d of mechanical ventilation, visited the laboratory on two separate occasions. The first visit occurred 52 ± 15 d after discharge and was dedicated to questionnaires, blood sampling, and cardiopulmonary exercise testing, whereas measurements of the knee extensors neuromuscular function and performance fatigability were performed in the second visit 7 ± 2 d later., Results: Using the FACIT-F questionnaire, 56% of patients were classified as fatigued. Fatigued patients had worse lung function score than non-fatigued (i.e., 2.9 ± 0.8 L vs 3.6 ± 0.8 L; 2.4 ± 0.7 L vs 3.0 ± 0.7 L for forced vital capacity and forced expiratory volume in 1 s, respectively), and forced vital capacity was identified as a predictor of being fatigued. Maximal voluntary activation was lower in fatigued patients than non-fatigued patients (82% ± 14% vs 91% ± 3%) and was the only neuromuscular variable that discriminated between fatigued and non-fatigued patients. Patient-reported outcomes also showed differences between fatigued and non-fatigued patients for sleep, physical activity, depression, and quality of life ( P < 0.05)., Conclusions: COVID-19 survivors showed altered respiratory function 4 to 8 wk after discharge, which was further deteriorated in fatigued patients. Fatigue was also associated with lower voluntary activation and patient-reported impairments (i.e., sleep satisfaction, quality of life, or depressive state). The present study reinforces the importance of exercise intervention and rehabilitation to counteract cardiorespiratory and neuromuscular impairments of COVID-19 patients admitted in ICU, especially individuals experiencing fatigue., (Copyright © 2024 by the American College of Sports Medicine.)
- Published
- 2024
- Full Text
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15. Functional hub disruption emphasizes consciousness recovery in severe traumatic brain injury.
- Author
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Oujamaa L, Delon-Martin C, Jaroszynski C, Termenon M, Silva S, Payen JF, and Achard S
- Abstract
Severe traumatic brain injury can lead to transient or even chronic disorder of consciousness. To increase diagnosis and prognosis accuracy of disorder of consciousness, functional neuroimaging is recommended 1 month post-injury. Here, we investigated brain networks remodelling on longitudinal data between 1 and 3 months post severe traumatic brain injury related to change of consciousness. Thirty-four severe traumatic brain-injured patients were included in a cross-sectional and longitudinal clinical study, and their MRI data were compared to those of 20 healthy subjects. Long duration resting-state functional MRI were acquired in minimally conscious and conscious patients at two time points after their brain injury. The first time corresponds to the exit from intensive care unit and the second one to the discharge from post-intensive care rehabilitation ward. Brain networks data were extracted using graph analysis and metrics at each node quantifying local (clustering) and global (degree) connectivity characteristics. Comparison with brain networks of healthy subjects revealed patterns of hyper- and hypo-connectivity that characterize brain networks reorganization through the hub disruption index, a value quantifying the functional disruption in each individual severe traumatic brain injury graph. At discharge from intensive care unit, 24 patients' graphs (9 minimally conscious and 15 conscious) were fully analysed and demonstrated significant network disruption. Clustering and degree nodal metrics, respectively, related to segregation and integration properties of the network, were relevant to distinguish minimally conscious and conscious groups. At discharge from post-intensive care rehabilitation unit, 15 patients' graphs (2 minimally conscious, 13 conscious) were fully analysed. The conscious group still presented a significant difference with healthy subjects. Using mixed effects models, we showed that consciousness state, rather than time, explained the hub disruption index differences between minimally conscious and conscious groups. While severe traumatic brain-injured patients recovered full consciousness, regional functional connectivity evolved towards a healthy pattern. More specifically, the restoration of a healthy brain functional segregation could be necessary for consciousness recovery after severe traumatic brain injury. For the first time, extracting the hub disruption index directly from each patient's graph, we were able to track the clinical alteration and subsequent recovery of consciousness during the first 3 months following a severe traumatic brain injury., Competing Interests: The authors report no competing interests., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)
- Published
- 2023
- Full Text
- View/download PDF
16. Cardiorespiratory Fitness and Neuromuscular Function of Mechanically Ventilated ICU COVID-19 Patients.
- Author
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Millet GY, Kennouche D, Foschia C, Brownstein CG, Gondin J, Lapole T, Rimaud D, Royer N, Thiery G, Gauthier V, Oujamaa L, Sorg M, Vergès S, Doutreleau S, Marillier M, Prudent M, Bitker L, Féasson L, Gergelé L, Stauffer E, Guichon C, and Morel J
- Subjects
- Aftercare, Humans, Intensive Care Units, Oxygen, Patient Discharge, Prospective Studies, Quality of Life, Respiration, Artificial, COVID-19 therapy, Cardiorespiratory Fitness
- Abstract
Objectives: The aim of the current study was to investigate the level of cardiorespiratory fitness and neuromuscular function of ICU survivors after COVID-19 and to examine whether these outcomes are related to ICU stay/mechanical ventilation duration., Design: Prospective nonrandomized study., Setting: Patients hospitalized in ICU for COVID-19 infection., Patients: Sixty patients hospitalized in ICU (mean duration: 31.9 ± 18.2 d) were recruited 4-8 weeks post discharge from ICU., Interventions: None., Measurements and Main Results: Patients visited the laboratory on two separate occasions. The first visit was dedicated to quality of life questionnaire, cardiopulmonary exercise testing, whereas measurements of the knee extensors neuromuscular function were performed in the second visit. Maximal oxygen uptake (V o2 max) was 18.3 ± 4.5 mL·min -1 ·kg -1 , representing 49% ± 12% of predicted value, and was significantly correlated with ICU stay/mechanical ventilation (MV) duration ( R = -0.337 to -0.446; p < 0.01 to 0.001), as were maximal voluntary contraction and electrically evoked peak twitch. V o2 max (either predicted or in mL· min -1 ·kg -1 ) was also significantly correlated with key indices of pulmonary function such as predicted forced vital capacity or predicted forced expiratory volume in 1 second ( R = 0.430-0.465; p ≤ 0.001) and neuromuscular function. Both cardiorespiratory fitness and neuromuscular function were correlated with self-reported physical functioning and general health status., Conclusions: V o2 max was on average only slightly above the 18 mL·min -1 ·kg -1 , that is, the cut-off value known to induce difficulty in performing daily tasks. Overall, although low physical capacities at admission in ICU COVID-19 patients cannot be ruled out to explain the association between V o2 max or neuromuscular function and ICU stay/MV duration, altered cardiorespiratory fitness and neuromuscular function observed in the present study may not be specific to COVID-19 disease but seem applicable to all ICU/MV patients of similar duration., Competing Interests: Dr. Millet’s institution received funding from Idex Lyon Fellowship and Idex Lyon COVID. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
- Published
- 2022
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17. Dynamics of clinical recovery during the early phase of rehabilitation in patients with severe traumatic and non-traumatic brain injury.
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Oujamaa L, Francony G, Boucheix P, Schilte C, Bouzat P, Perennou D, and Payen JF
- Subjects
- Adult, Aged, Cohort Studies, Disability Evaluation, Female, Glasgow Coma Scale, Humans, Intensive Care Units, Male, Middle Aged, Outcome Assessment, Health Care, Patient Discharge, Statistics, Nonparametric, Stroke physiopathology, Stroke Rehabilitation, Time Factors, Brain Injuries rehabilitation, Neurological Rehabilitation methods, Recovery of Function physiology, Treatment Outcome
- Abstract
Purpose: Our aim was to describe the changes in the functional outcome at the early phase of rehabilitation following severe brain injury and to identify the factors associated with faster recovery., Methods: This retrospective analysis included 182 patients who were transferred from the intensive care unit (ICU) to a post-ICU neurorehabilitation unit following traumatic brain injury (TBI) (n = 82) or cerebrovascular accident (CVA) (n = 100). Admission, discharge and changes in scores were calculated for the Functional Independent Measurement (FIM) and the Wessex Head Injury Matrix (WHIM). Patients with high dynamics of clinical recovery were defined by delta FIM scores ≥22., Results: Upon admission to the neurorehabilitation unit, 97% of patients had a FIM score <50 and 41% a WHIM score <32. Patients showed significantly improved FIM (+17 points; 7-37) and WHIM (+11 points; 3-19) scores with an over 22-day stay (14-38). Those with faster recovery (45%) were more likely those with high FIM and WHIM scores at admission. The nature and severity of the brain insult were not associated with the dynamics of recovery., Conclusions: Within a 2-6 week stay in a post-ICU neurorehabilitation unit, patients with severe disability could achieve partial functional independence and showed cognitive improvements.
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- 2017
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18. Transcranial Doppler to Predict Neurologic Outcome after Mild to Moderate Traumatic Brain Injury.
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Bouzat P, Almeras L, Manhes P, Sanders L, Levrat A, David JS, Cinotti R, Chabanne R, Gloaguen A, Bobbia X, Thoret S, Oujamaa L, Bosson JL, Payen JF, Asehnoune K, Pes P, Lefrant JY, Mirek S, Albasini F, Scrimgeour C, Thouret JM, Chartier F, and Ginet M
- Subjects
- Adult, Cerebrovascular Circulation, Endpoint Determination, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Tomography, X-Ray Computed, Treatment Outcome, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic diagnostic imaging, Nervous System Diseases diagnostic imaging, Nervous System Diseases etiology, Ultrasonography, Doppler, Transcranial methods
- Abstract
Background: To assess the performance of transcranial Doppler (TCD) in predicting neurologic worsening after mild to moderate traumatic brain injury., Methods: The authors conducted a prospective observational study across 17 sites. TCD was performed upon admission in 356 patients (Glasgow Coma Score [GCS], 9 to 15) with mild lesions on cerebral computed tomography scan. Normal TCD was defined as a pulsatility index of less than 1.25 and diastolic blood flow velocity higher than 25 cm/s in the two middle cerebral arteries. The primary endpoint was secondary neurologic deterioration on day 7., Results: Twenty patients (6%) developed secondary neurologic deterioration within the first posttraumatic week. TCD thresholds had 80% sensitivity (95% CI, 56 to 94%) and 79% specificity (95% CI, 74 to 83%) to predict neurologic worsening. The negative predictive values and positive predictive values of TCD were 98% (95% CI, 96 to 100%) and 18% (95% CI, 11to 28%), respectively. In patients with minor traumatic brain injury (GCS, 14 to 15), the sensitivity and specificity of TCD were 91% (95% CI, 59 to 100%) and 80% (95% CI, 75 to 85%), respectively. The area under the receiver operating characteristic curve of a multivariate predictive model including age and GCS was significantly improved with the adjunction of TCD. Patients with abnormal TCD on admission (n = 86 patients) showed a more altered score for the disability rating scale on day 28 compared to those with normal TCD (n = 257 patients)., Conclusions: TCD measurements upon admission may provide additional information about neurologic outcome after mild to moderate traumatic brain injury. This technique could be useful for in-hospital triage in this context. (Anesthesiology 2016; 125:346-54).
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- 2016
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19. [Early rehabilitation for neurologic patients].
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Oujamaa L, Marquer A, Francony G, Davoine P, Chrispin A, Payen JF, and Pérennou D
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- Activities of Daily Living, Cognition physiology, Critical Care, Depression diagnosis, Depression etiology, Depression psychology, Disability Evaluation, Humans, Independent Living, Mobility Limitation, Nervous System Diseases complications, Nervous System Diseases psychology, Neurologic Examination, Neuropsychological Tests, Posture physiology, Prognosis, Respiratory Function Tests, Thromboembolism complications, Nervous System Diseases rehabilitation
- Abstract
Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients' impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be., (Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)
- Published
- 2012
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20. An atypical ballistic traumatic cauda equina syndrome with a positive outcome. Focus on prognostic factors.
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Galano E, Gélis A, Oujamaa L, Dutray A, Pelissier J, and Dupeyron A
- Subjects
- Adult, Electromyography, Forensic Ballistics, Fractures, Bone diagnosis, Fractures, Bone etiology, Fractures, Bone rehabilitation, Humans, Magnetic Resonance Imaging, Male, Polyradiculopathy diagnosis, Polyradiculopathy epidemiology, Prognosis, Rare Diseases, Recovery of Function, Suicide, Attempted, Tomography, X-Ray Computed, Treatment Outcome, Walking, Lumbar Vertebrae injuries, Polyradiculopathy etiology, Polyradiculopathy rehabilitation, Wounds, Gunshot complications
- Abstract
Introduction: Traumatic cauda equina syndromes due to projectile wounds often have a poor prognosis. We report on an unusual ballistic cauda equina traumatism with a good functional outcome., Clinical Case: A 44-year-old man was admitted to emergency room for an incomplete cauda equina syndrome after trying to kill himself by means of a pneumatic nail gun. The nail had gone right through the third lumbar vertebra. Because of the stability of the fracture, orthopaedic surgery was not indicated. Neurological recovery was progressive. At 6 months, there was still a partial L5-S1 motor deficit on the left side but the patient could walk without crutches, and within an unlimited walking distance., Discussion: Initial imaging displayed a projectile trajectory focused on the spinal canal on level L3, which could have been considered as bad prognosis. The positive analytic and functional outcome correlates with the limited neurological tissue damage, probably explained by the ballistic properties of the projectile., Conclusion: Apart from the influence of a possible surgical act, the neurological and functional prognosis of a traumatic cauda equina syndrome caused by a projectile also depends on its physical characteristics.
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- 2009
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21. Asymmetric standing posture after stroke is related to a biased egocentric coordinate system.
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Barra J, Oujamaa L, Chauvineau V, Rougier P, and Pérennou D
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- Adult, Aged, Aged, 80 and over, Brain blood supply, Brain pathology, Brain physiopathology, Female, Humans, Leg physiopathology, Male, Middle Aged, Movement Disorders diagnosis, Movement Disorders etiology, Muscle, Skeletal innervation, Muscle, Skeletal physiopathology, Perceptual Disorders diagnosis, Perceptual Disorders etiology, Proprioception physiology, Rotation adverse effects, Somatosensory Disorders diagnosis, Somatosensory Disorders etiology, Somatosensory Disorders physiopathology, Vision Disorders diagnosis, Vision Disorders etiology, Vision Disorders physiopathology, Weight-Bearing physiology, Movement Disorders physiopathology, Orientation physiology, Perceptual Disorders physiopathology, Postural Balance physiology, Space Perception physiology, Stroke complications
- Abstract
Background: Weakness and somatosensory deficits have long been known to be involved in the postural instability of subjects with stroke. Recently, it has been shown that impaired representations of the orientation of the longitudinal axis of the body (LBA, egocentric reference) and of verticality (allocentric reference) may also play a role. The objective of the present study was to determine whether these two references were independently linked to postural asymmetry in standing stroke patients., Methods: Twenty-two subjects were tested after a first hemispheric stroke (13 +/- 7.5 weeks). The LBA perception was investigated in the supine position by adjusting the orientation of a luminous rod in the frontal plane to correspond to the subjective LBA. The subjective visual vertical (SVV) was assessed by adjusting the orientation of a luminous line in the frontal plane to correspond to the SVV in upright patients. Weight distribution was measured in the standing position for about 2 minutes and 45 seconds by two separate force platforms under the feet., Results: LBA and SVV were strongly associated (r = 0.7; p < 0.001). The estimate of the LBA was a better predictor (r = -0.52: p < 0.02) of weight bearing asymmetry than was SVV (r = -0.41; p = 0.074) when adjusted for motor weakness and hypoesthesia., Conclusion: Contralesional rotation of the longitudinal axis of the body could lead to unequal distribution of loading on the feet. This novel interpretation of weight bearing asymmetry underlines the complexity of control of the erect stance following stroke and brings new perspectives for rehabilitation programs.
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- 2009
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22. Rehabilitation of arm function after stroke. Literature review.
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Oujamaa L, Relave I, Froger J, Mottet D, and Pelissier JY
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- Humans, Meta-Analysis as Topic, Physical Therapy Modalities, Randomized Controlled Trials as Topic, Recovery of Function, Arm physiopathology, Stroke physiopathology, Stroke Rehabilitation
- Abstract
Introduction: In the recent literature we can find many articles dealing with upper extremity rehabilitation in stroke patients. New techniques, still under evaluation, are becoming the practical applications for the concept of post-stroke brain plasticity., Methods: This literature review focuses on controlled randomized studies, reviews and meta-analyses published in the English language from 2004 to 2008. The research was conducted in MEDLINE with the following keywords: "upper limb", "stroke", "rehabilitation"., Results: We reviewed 66 studies. The main therapeutic strategies are: activation of the ipsilesional motor cortex, inhibition of the contralesional motor cortex and modulation of the sensory afferents. Keeping a cortical representation of the upper limb distal extremity could prevent the learned non-use phenomenon. The modulation of sensory afferents is then proposed: distal cutaneous electrostimulation, anesthesia of the healthy limb, mirror therapy, virtual reality. Intensifying the rehabilitation care means increasing the total hours of rehabilitation dedicated to the paretic limb (proprioceptive stimulation and repetitive movements). This specific rehabilitation is facilitated by robot-aided therapy in the active-assisted mode, neuromuscular electrostimulation and bilateral task training. Intensifying the rehabilitation training program significantly improves the arm function outcome when performed during subacute stroke rehabilitation (< six months). Ipsilesional neurostimulation as well as mental practice optimize the effect of repetitive gestures for slight motor impairments. Contralesional neurostimulation or anesthesia of the healthy hand both improve the paretic hand's dexterity via a decrease of the transcallosal inhibition. This pathophysiological mechanism could also explain the positive impact of constraint-induced movement therapy (CI therapy) in an environmental setting for chronic stroke patients., Conclusion: To ensure a positive functional outcome, stroke rehabilitation programs are based on task-oriented repetitive training. This literature review shows that exercising the hemiparetic hand and wrist is essential in all stages of a stroke rehabilitation program. New data stemming from neurosciences suggest that ipsilesional corticospinal excitability should be a priority.
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- 2009
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23. [Cerebral vasculitis secondary to Toxocara canis and Fasciola hepatica co-infestation].
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Oujamaa L, Sibon I, Vital A, and Ménégon P
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- Adult, Animals, Cognition Disorders etiology, Eosinophilia etiology, Fever of Unknown Origin etiology, Humans, Magnetic Resonance Imaging, Male, Memory Disorders etiology, Muscle, Skeletal blood supply, Reflex, Abnormal, Vasculitis etiology, Vasculitis parasitology, Fascioliasis complications, Toxocara canis isolation & purification, Toxocariasis complications, Vasculitis, Central Nervous System etiology
- Abstract
Neurological complications of cosmopolitan parasitosis are rare. We report a case of a cerebral and systemic vasculitis secondary to a visceral larva migrans syndrome associated with a Toxocara canis and Fasciola hepatica co-infestation.
- Published
- 2003
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