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The aim of this study was to identify specific cognitive patterns related to long-term vocational training outcome. Records of twenty-eight patients who had benefited from a professional rehabilitation program were retrospectively processed. Screening through machine learning algorithms of patients' neuropsychological scores identified cognitive patterns related to both vocational training outcomes: succeeded or failed. These patterns were based on cognitive performance intervals even if the cognitive ability was not impaired. The cognitive pattern related to a successful vocational training included performance intervals on measures underlying verbal memory consolidation, visual memory incidental recall, problem solving and planning abilities. The cognitive pattern explaining failure of vocational training included performance intervals on tasks involving planning and problem solving abilities. From a comprehensive neuropsychological battery, memory and executive measures appeared to be the best attributes related to the vocational training outcome in patients with brain injury. Even with a cognitive functioning above the pathological cutoff, patients suffering from a brain injury could fail a vocational training. The attributes related to the vocational training outcome would be more a specific level of cognitive functioning rather than an interpretation of neuropsychological scores only based on a normal versus pathological distinction.

Purpose: Individuals with traumatic brain injury (TBI) often present injury-related cognitive and behavioural sequelae hindering a successful professional outcome, even many years after injury. The aim of this study was to investigate cognitive and behavioural factors predicting vocational outcome in the post-acute stages (≥one year) of TBI.Methods: A systematic review of empirical research about vocational outcome of individuals with TBI was conducted. Studies published in PubMed and PsycINFO from 1 January 1998 to 31 May 2019 were screened. Only studies using the same injury severity criteria (the Glasgow Coma Scale score and/or the duration of post-traumatic amnesia) were selected.Results: We found that (1) self-reported symptoms, (2) Functional Independence Measure and Mayo-Portland Adaptability Inventory Scores, (3) alcohol abuse and mood disorders, and (4) Differentiated Outcome Scale Cognitive Scores in individuals with TBI were highly predictive of the vocational outcome.Conclusion: This systematic review emphasized the link between cognitive and behavioural functioning and vocational rehabilitation in individuals with TBI. However, scientific literature lacks cognitive and behavioural models predicting vocational outcome of these individuals, including academic or vocational training. Such models would allow clinicians to improve vocational guidance of these individuals.Implications for rehabilitationCognitive and behavioural assessment is highly important even many years after traumatic brain injury, especially in a social and professional rehabilitation context.Clinicians should integrate objective measures of cognition and behaviour in post-acute phases of traumatic brain injury.Identifying vocational outcome related cognitive and behavioural patterns of functioning would allow clinicians to improve vocational guidance of adults with traumatic brain injury.

To evaluate the objective and subjective functional effectiveness of tibial nerve neurotomy (TNN) in post-stroke spastic equinovarus foot (SEF).In an open study, 23 hemiplegic patients were assessed immediately before TNN and then 5months after TNN. The main outcome measure was the Lower Limb Function Assessment Scale (LL-FAS), which provided an ecologic assessment of impairments in standing and walking (i.e. kinematic abnormalities) and their impacts on activities of daily living. Patients were also assessed for global clinical impression of change, fear of falling, neuromotor impairments, spatiotemporal and video gait parameters and walking capacities.TNN had a very marked effect on the level of spasticity and the range of motion in dorsiflexion (p10(-3)). These changes resulted in better foot positioning when standing and walking (particularly in stance), which was perceived very favorably by the patients. There was a clear, patient-perceived improvement in activities performed when standing and walking (LL-FAS (p0.01)), the global clinical impression of change (p10(-3)) and the fear of falling (p=0.022) that was not revealed by conventional, objective measurements (New Functional Ambulation Classification, Rivermead Mobility Index).TNN is an effective treatment for post-stroke SEF; it is associated with a patient-reported improvement in standing and walking abilities during activities of daily living. Further research must now assess the long-term subjective efficacy of TNN.

Background Fatigue is a common symptom in patients with acquired brain injury (ABI) related disability while its multidimensionality has never been investigated, and specifically its relationship with patients’ cognitive functioning. Objective This study aimed to evaluate the validity of the Multidimensional Fatigue Inventory (MFI-20) in patients living with ABI-related disability. Methods Four hundred twenty-six participants divided in three different groups (ABI-related disability, physical-related disability without an ABI, and healthy volunteers with no disability) were administered the French version of the Multidimensional Fatigue Inventory. We investigated the link between these fatigue measures and neuropsychological assessment in patients with ABI. Performance on this tool was compared according to the group and we calculated normative data for the Multidimensional Fatigue Inventory based on healthy volunteers’ performance. Results In patients with ABI, fatigue measures significantly correlated with neuropsychological measures of attention, memory and executive functions. We found higher scores on Mental Fatigue and Reduced Activities dimensions in patients with ABI in comparison with the patients with physical disability (p Conclusions The Multidimensional Fatigue Inventory appeared to be a sensitive tool to detect ABI-related fatigue, fatigue levels being higher than in patients with physical disability and in healthy volunteers. As fatigue appeared to be related to memory, executive and attentional functioning of patients with ABI-related disability who often face unemployment, its impact on vocational outcome following ABI should be further investigated.

The aim of this study was to propose new measures to evaluate memory processes in patients with severe traumatic brain injury (TBI). In this purpose, we analyzed learning and consolidation processes depending on own patient's performance during a memory test.One-week Free and Cued Selective Reminding Test - word version (1W-FCSRT-word), which special feature relies on a 30-min and a 1-week-delayed recall after encoding, was administered to a group of 43 patients with severe TBI (age range from 20 to 54 years) and a group of neurologically healthy volunteers matched for age and gender.Patients performed worse than healthy volunteers for the learning score. Their forgetting percentage was above healthy volunteers' performance and difference between the two groups increased with the delay from the learning phase.In patients with severe TBI, our results underlined an altered learning and an impairment of long-term consolidation. It is crucial to detect these deficits in the aim to highlight, with a better accuracy, these patients' memory complaints and to propose a better professional rehabilitation.

Introduction Comfort/discomfort (C/D) is an important factor of quality of life (QoL). Brain damage is a major source of discomfort. We developed a questionnaire for assessing C/D in daily living situations and for identifying the main causes of any discomfort and presented its pilot assessment in a population of stroke patients. Methods The scale is a questionnaire of the patient or caregiver that addresses (i) comfort/discomfort in 15 situations of daily living (including getting dressed, washing, lying in bed and sitting in a chair) and (ii) the roles of physical difficulties, psychological problems and a poorly adapted environment. We analysed its metrological qualities in a group of 62 stroke patients. Results For the patients, the most uncomfortable activities were eating, dressing the lower body, urine and faeces elimination and walking, and the most significant factors of discomfort were motor impairments, fatigue, limb stiffness, joint pain, depression and anxiety. The reliability was fair for the overall score and for each C/D item and moderate for the impact of impairments on comfort/discomfort. We also found fair internal consistency and convergent validity against measures of functional status, QoL and burden of care. Sensitivity to change over a 6-week period was modest. Conclusions The scale can help to define difficulties in daily living situations and identify opportunities for intervention in stroke patients.

Introduction/Background In 1998, a research on severe traumatic brain injury (STBI) patients 3 years after onset highlighted many difficulties regarding autonomy and quality of live (QOL). Lack of follow-up and specialized infrastructures was clear. Since then, the follow-up has been organized around the Brain injuries 59/62 regional network. We aimed at comparing the evolution of autonomy and QOL and their influencing factors (IF) between the two periods. Material and method All STBI people in the same area were evaluated 3 years after onset using the European Brain Injury Society document. Autonomy and QOL IF were analysed and compared between the two periods (end of the 1990s and 2010s). Results On the 23 and 24 evaluated patients respectively in 1998 and 2016, the overall autonomy (especially in elaborated activities) and scores of QOL tended to be higher in 2016. According to the family, the average QOF has significantly improved (P = 0.023). Changes in the role in the family (P = 0.007) and the need for respite (P Factors impacting negatively on the overall autonomy, respectively in 1998 and 2016, were: coma duration (P = 0.01/0.04), length of stay in acute care (P = 0.01/0.002), severity of physical deficiencies (P = 0.00/0.04) and several cognitive disorders. In 1998 as well as in 2016, the most dependent TBI people were having significantly more physiotherapy (P = 0.06/0.006) and speech therapy cares (P = 0.04/0.01). In 2016, patients were significantly more followed by the multidisciplinary team of the network (P = 0.029) and the socio-medical teams (P = 0.003). Concerning QOL, only cognitive and psycho-behavorial impairments were found in 1998 as well as in 2016. In 2016, we also found that severity of physical impairments negatively influenced the QOL (P = 0.029). Conclusion Better support for physical, cognitive and behavioral difficulties could lead to improved autonomy and QOL in TBI patients.

Pituitary deficiencies have been reported after traumatic brain injury (TBI) and may contribute to lasting cognitive disorders in this context. In a population of TBI patients with persistent cognitive and/or behavioral disorders, we sought to determine the prevalence of lasting pituitary deficiency and relationships with TBI severity, cognitive disorders, and impairments in activities of daily living (ADL). Fifty-five patients were included (mean age 36.1 years; 46 men) at least 1 year after TBI. They underwent a comprehensive evaluation of pituitary function (basic tests and stimulation), initial TBI severity, and long-term outcomes (cognitive performance, Glasgow Outcome Scale score, impact on ADL, and quality of life [QoL]). We used chi-squared and Mann-Whitney tests to probe for significant (p≤0.05) relationships between pituitary disorders and other parameters. Thirty-eight (69%) patients had at least one pituitary hormone deficiency. Growth hormone deficiency was more prevalent (severe: 40.0%; partial: 23.6%) than corticotropin (27.3%) or thyrotropin (21.8%) deficiencies. Other deficiencies were rare. Growth hormone deficiency was associated with attention and verbal memory disorders and reduced involvement in ADL. We did not find any relationship between pituitary deficiency and the TBI's initial severity. In a multivariate analysis, the TBI severity was introduced as a first factor, and pituitary deficits as a secondary factor for explaining the late outcome (ADL and QoL). In conclusion, TBI patients with cognitive sequelae must undergo pituitary screening because growth hormone, corticotropin, and thyrotropin deficits are particularly common and can adversely affect ADL and reduce QoL.

Introduction Les patients traumatises crâniens (TC) presentent souvent des troubles cognitifs et des troubles multimodaux de la posture et de la marche. L’objectif principal de ce travail etait de mesurer le cout de l’ajout de 3 types de tâches cognitives sur les parametres de marche. Patients et methode Les parametres spatiotemporels de marche ont ete evalues a l’aide d’un tapis Gaitrite chez 22 sujets victimes d’un traumatisme crânien modere a severe et 26 sujets controles apparies en âge. L’ajout des 3 tâches cognitives (back task, compte a rebours, parler en marchant) a ete mesure lors d’une tâche de marche sur terrain plat et de franchissement d’obstacle. Nous avons egalement mesure les liens entre le cout de la double tâche de locomotion et les performances dans un autre type de double tâche motrice (double tâche de Baddeley) et la confiance percus par le patient dans l’equilibre et la marche en vie quotidienne (ABCscale). Resultats Les resultats preliminaires montrent que le cout cognitif etait plus important dans le groupe TC pour la tâche de marche sur terrain plat et les tâches de comptage et de conversation avec l’examinateur. La reduction de la vitesse de marche portait a la fois sur la cadence et la longueur des pas. Par ailleurs, le cout de la double tâche de locomotion etait correle a celui de la double tâche de Baddeley (r = −0,420 ; p = 0,003), mais pas au score total de l’ABCscale. Discussion Le retentissement sur la marche de l’ajout d’une tâche cognitive intercurrente est facilement mesurable et pourrait sensibiliser l’analyse des consequences des troubles cognitifs dans la vie quotidienne. Cependant, la perception de la confiance dans les activites de marche semble impliquer d’autres facteurs.

Introduction/Background Patients suffering from traumatic brain injury (TBI) often present with cognitive but also posture and gait impairments. In this study, we aimed at evaluating the cost of the addition of 3 types of cognitive concurrent tasks on gait parameters, and studying the relationship between dual task cost and patient-reported perception of their confidence in balance and gait in daily living. Material and method Spatiotemporal gait parameters were assessed using a GAITRITE mat in 22 moderate-to-severe TBI patients and 26 age-matched healthy controls. The addition of 3 cognitive tasks (letter back-task, substractions by 3, talking when walking) was studied during unobstructed walking and stepping over an obstacle. We also evaluated the relationship between dual task cost during gait and (1) cost in another motor task (Baddeley) and (2) patient perceived confidence in dynamic balance and gait in daily living (ABC scale). Results Dual task cost during gait was higher in TBI patients compared to healthy controls when walking unobstructed and in the subtraction and talking concurrent tasks. Alteration of gait speed was primarily due to a decrease of step length more than of gait cadence. TBI patients tended to prioritize the cognitive task. Dual task cost during gait was correlated with the Baddeley dual task performance (r = −0.420; P = 0.003) but not with the ABC scale score. Conclusion TBI patients exhibit difficulties in dual task gait conditions, which can be easily assessed and should be addressed in rehabilitation. The dual task cost could be not specific to locomotor activities. Finally, other factors seem to explain the alteration in confidence in gait and balance in daily living.

Introduction/Background Seventy-five percent of people with an acquired brain injury are of working age, most of them are young adults who want to return-to-work or need to resume a vocational training. However, a failure in returning to work/vocational training is associated with depression and isolation. Our aim was to identify objective measures to allow clinicians to anticipate failure in resuming vocational training following a brain injury. Material and method Neuropsychological data from 343 patients with brain injury, who benefited from a vocational rehabilitation program (UEROS Lille, France) between 2002 and 2017, were retrospectively analyzed. After completing this program, 28 patients resumed a vocational training and we identified, trough machine learning algorithms, the neuropsychological measures predicting vocational outcome. Results Success in resuming vocational training after brain injury was predicted by mnemonic scores (verbal forgetting and visual retrieval). The scores obtained on the Tower of London test predicted both success and failure. Conclusion Our study highlighted that neuropsychological measures underlying planning abilities could help clinicians to anticipate a failure in resuming vocational training in patients with brain injury. Planning and memory abilities would predict an effective vocational outcome. These initial results, that need to be confirmed with larger samples of patients with brain injury who resumed vocational training, may have a relevant implication for neuropsychological practice, allowing a better vocational guidance of these patients.

Introduction/Background Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke especially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Material and method A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. Two hundred and twenty subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurrence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2 hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1 h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self-rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results Two hundred and eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not significantly different at day 30 nor any other secondary criteria except ARAT. Conclusion An additional time 1 h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study.

Objectives The goal of early supported discharge (ESD) is to reduce the duration of in-patient care in stroke units (SUs) and to optimize the management of pre- and post-discharge rehabilitation. Here, we report on and discuss ESD's effects on various outcome parameters in stroke patients. Methods Analysis of randomized, controlled studies and meta-analyses identified in the Medline and Cochrane databases. Results ESD interventions have been evaluated in more than 10 studies. Most of the included patients had suffered from mild or moderate strokes. Meta-analyses have shown that when compared with standard care, ESD has a positive effect on the risk of death or institutionalisation, death or dependence and participation in instrumental activities of daily living (iADL). In-patient hospitalization in the SU and the overall cost of care were significantly lower. Individual studies showed variability in the inclusion criteria, type of care, comparisons performed and conclusions drawn. ESD's superiority in terms of the risk of death or dependency was mainly reported in a Norwegian study and that in terms of iADL was reported in a Swedish study. There was no specific effect on functional impairment and personal ADL (pADL). Discussion This technique reduces the length of the in-patient stay and the overall cost of care while lowering the risk of death or institutionalisation and promoting participation in iADL. However, studies on this topic are heterogeneous.

Objective The aims of this study were to determine the prevalence of pituitary dysfunction in patients presenting with cognitive and/or mood complaints and/or fatigability late after a mild traumatic brain injury (TBI), and to analyse the relations of endocrine abnormalities with population characteristics, imagery and autonomy. Methods We studied 38 patients: 25 men, mean age 36 (range 21–60 years), at a mean of 23 months (range 9–40) post-event; 44.7% were GOS 1, 47.4% GOS 2 (moderate disability) and 7.9% GOS 3 (severe disability). 15 patients were active. For each patient, we collected data on initial CT scan, MRI lesions, late Glasgow Outcome Scale (GOS), autonomy (EBIS questionnaire) and pituitary functions (static and dynamic tests). Results No patient showed any posterior pituitary dysfunction. One (2.6%) showed a hyperprolactinemia, two (5.3%) a gonadotropin deficiency, seven (18.4%) a TSH deficiency. Nine patients (23.7%) had partial ACTH deficiency (diagnosed by ITT or metyrapone test). Severe GH deficiency (GHD) was diagnosed in nine patients (23.7%) (ITT or arginine + GHRH test) and was isolated in 39% of cases. Twenty-three patients (60.5%) showed at least one anterior pituitary deficiency requiring a substitutive treatment. Hypopituitarism was only related to age (positive correlation, P = 0.01) and the presence of a cerebral oedema on initial CT scan ( P = 0.044). We didn’t find any association with autonomy in activities, GOS score and MRI data. Conclusions In mild TBI patients with persistent cognitive disorders, fatigability or mood disorder, the risk of anterior pituitary deficiency is high and justifies a systematic pituitary assessment with specific reference tests.

Experience with pediatric home-based enteral nutrition (HEN), in particular series including children only, has been reported only rarely. We investigated the evolution of pediatric HEN activity during an 11-year period.All patients aged 17 years or younger who started HEN between January 1990 and December 2000 were included in this retrospective study.The annual number of patients treated with HEN increased dramatically from 16 in 1990 to 200 in 2000, with more than 65 new patients every year since 1999 (P0.0001). The mean age at the commencement of HEN decreased from 6.2 +/- 1.4 (SEM) to 4.8 +/- 0.7 years (P = 0.006). The use of nasogastric tubes decreased from 63% in 1990 to 35% in 1998 (P = 0.009), and the use of gastrostomy increased from 50% to 60% from 1994 onward. The proportion of patients with digestive diseases commencing HEN in each year decreased from more than 40% before 1996 to less than 32% in 2000 (P = 0.009). Commercially manufactured pediatric diets were used increasingly (P = 0.0006).The evolution of HEN was marked by changes in the population treated and the modes of treatment after the emergence of gastrostomy and commercial diets. This justified the creation of a multidisciplinary, pediatric artificial nutrition unit.

Summary Background & aims : We report our experience of paediatric home enteral nutrition, as there is little detailed evidence published. Methods : All patients younger than 18 years commencing treatment between January 1990 and December 2000 were included in this retrospective study. Results : The study covered 416 children and adolescents, corresponding to a total of 243,844 days of home enteral nutrition (HEN). The mean (±SD) age of patients commencing treatment was 5.4±5.3 years (range 0.1–17.8). Indications were digestive disorders in 35% of patients, neurological and muscular disorders in 35%, malignancy in 11%, failure to thrive in 8%, and miscellaneous ailments in 9%. Enteral feeding comprised commercially available paediatric industrial diets in 36%, adult-type diet in 35% and infant formulas in 29%. Children received enteral feeding by nasogastric tube (53%), or gastrostomy (41%). A mechanical pump was used in 98% of the patients. The mean duration of treatment was 595±719 days. Conclusions : HEN can be used while treating a large group of chronic diseases of children. It can be started very early in life and is often prolonged over several years.

Objective In the spectrum of spatial neglect, personal neglect (body neglect) plays an important role in the difficulties encountered by patients, but its assessment is often centered on the sphere of the face and/or involves tests that have no ecological value. The objective of this study was to develop an assessment tool adressing these two pitfalls. Material/Patients and methods The scale includes seven items assessing personal neglect on the entire body (face, but also upper and lower parts of the body). The ordinal rating (0-3) made by the examiner focuses on the patient's ability to explore and be aware of the contralesional body side when simulating activities of daily life. The validation study focused on inter- and intra-observer reliability, criterion validity (Fluff test, neuroanatomical correlates), construct validity (line bisection test, Catherine Bergego scale) and internal consistency. Results Twenty-three neglect patients (N + ) and 20 non-neglect patients (N-) have been included. The total score of the scale was correlated with the Fluff test score ( r = −0.566; P = 0.009), but not with assessments of the other features of neglect. Intraclass correlation coefficients (ICCintra = 0.924; ICCinter = 0.858) and the distribution on the Bland-Altman diagrams showed good reliability properties of the total score. Reliability of the items was moderate to good (kappa > 0.5) except for one item. Internal consistency of the tool was moderate (α = 0.56). The results concerning the neuroanatomical correlates are being processed. Discussion - Conclusion The assessment scale of personal neglect showed good psychometric properties. It allows the evaluation of personal neglect on the entire body with an ecological value. Future works are needed to precize validity of the scale and particularly its responsiveness.

Introduction La negligence personnelle (corporelle) tient un role important dans les difficultes rencontrees par les patients, mais son evaluation est souvent centree sur la sphere du visage et/ou releve de tests a faible dimension ecologique. L’objectif de cette etude etait de developper un outil d’evaluation repondant a ces deux ecueils. Patients et methode L’echelle comprend 7 items evaluant la negligence personnelle sur l’ensemble du corps (tete et parties superieure et inferieure du corps). L’evaluation ordinale (0–3) de l’examinateur porte sur les capacites du patient a explorer ou prendre conscience de l’hemicorps contralesionnel lors de simuli d’activites de la vie quotidienne. L’etude de validation a porte sur la reproductibilite inter et intra-observateur, la validite contre criteres (Fluff test, correlats neuroanatomiques), la validite du construit (test de bissection de lignes, echelle Catherine Bergego) et la coherence interne de l‘echelle. Resultats Vingt-trois patients negligents (N + ) et 20 patients non negligents (N − ) ont ete inclus. Le score total de l’echelle etait correle au score du Fluff test (r = −0,566 ; p = 0,009), pas aux evaluations des autres composantes de la negligence. Les indices de correlation intraclasse (ICCintra = 0,924 ; ICCinter = 0,858) et la repartition sur les les diagrammes de Bland-Altman temoignaient d’une bonne reproductibilite du score total. La reproductibilite des items etait moderee a bonne (kappa > 0,5) sauf pour un item. La coherence interne de l’outil etait moderee (= 0,56). Les resultats concernant les correlats neuroanatomiques sont en cours de traitement. Discussion L’echelle d’evaluation de la negligence personnelle a montre des premieres qualites psychometriques interessantes. Elle couvre l’evaluation de la negligence sur l’ensemble du corps avec une dimension ecologique. De futurs travaux restent necessaires pour approfondir la validation et en particulier determiner sa sensibilite au changement.

Objective The GAITRite® system, according to the published data, appears to be an easy to use and validated device for gait analysis. However, it only allows acquisitions on short distances in a nonecological environment. In addition to this device, it could be interesting to use new embarked evaluation tools. The main aim of this study was to examine the concurrent validity of temporal parameters recorded by the portable Zero Wire, AURION® footswitch system in comparison to the GAITRite® mat. Material/patients and methods In a single center prospective study, 40 healthy subjects were included. Each subject had to walk at three different speeds (slow, normal, max) and temporal gait parameters were recorded at the same time by each system. To measure the validity of the footswitch system, we calculated inter class correlation coefficient (ICC) for each temporal parameter (step and cycle time, cadence, % of stance, % of single support, % of swing). Results Gait parameters recorded at maximum gait velocity showed the best concordance between the two assessments, with a majority of parameters demonstrating a very good validity (ICC > 0.91). At slow speed, the analysis revealed excellent results for gait cadence and step and cycle times, whereas validity was good (ICC > 0.71) to moderate (ICC > 0.51) for the other parameters. The validity profile was a little worse at normal speed, especially for % of swing and % of stance. Discussion, conclusion The Zero Wire, AURION®, portable footswitch system, is a valid for temporal gait parameters assessment, particularly considering raw parameters. It provides the opportunity to assess gait parameters and variability in ecological conditions, particularly in dual-task gait protocols.

Objective In 1998, a research on severe traumatic brain injury (TBI) patients in Lille conurbation 3 years after TBI highlighted many difficulties regarding autonomy and quality of family, social and professional lives. Lack of follow-up and infrastructures was clear. Since then, follow-up has organized itself around the TBI and Stroke 59/62 network and several specialized structures were created. The goals of the study were to compare people, their outcome and the accompaniment path between 1998 and 2015. Material/patients and methods All TBI people in the same geographic area were evaluated 3 years after TBI with the EBIS (European Brain Injury Society) document. Old data were compared to latest. Results On the situations analyzed respectively (33/29 patients), we observed fewer accidents on public roads (20/9), more domestic accidents (6/15), a decline in deaths (10/5) especially after neurosurgery (5/1). In 1998 and 2015 respectively, on the 23/24 evaluated patients, the overall autonomy tends to be more importance in 2015. About the family, the average score of quality of life has significantly improved (P = 0.023). Changes in the role in the family (P = 0.007) and the need for respite (P Discussion – conclusion The evolution of hospital and post-hospital care has enabled a decrease in isolation, an improvement in autonomy and in family quality of life of persons with brain injury. However, some of them still escape from the follow-up. Unfortunately, follow-ups and resources remain unequal in France.

Objective Verbal memory impairment has been described in patients with traumatic brain injury (TBI) but the specific altered process, between encoding, consolidation and retrieval, is still discussed. The aim of this study was to use new measures to detect verbal memory impairment in TBI patients. In this purpose, we analyzed encoding and consolidation processes as a function of each patient's performance during a memory test. We calculated a learning score and a percentage of forgetfulness. Material/patients and methods One-week Free and Cued Selective Reminding Test (1W-FCSRT), which special feature relies on a 30-minutes and a one-week-delayed recall after encoding, was administered to 98 TBI patients (age range at the time of assessment from 20 to 56 years). Their performance was compared to performance of neurologically healthy volunteers matched for age, gender and socio-cultural level. Results A statistically significant difference was found between TBI patients and healthy volunteers for the learning score (W = 7640.5, P Discussion – conclusion Our results underlined an altered encoding and a long-term consolidation impairment in TBI patients. It is crucial to detect these deficits to propose a better professional rehabilitation.

Background Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions. Objective To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme. Methods This open-label observational study included eleven patients who had suffered a unilateral stroke or traumatic brain injury. All had impairment in the activities of daily living caused by severe hip and knee flexion. OnabotulinumtoxinA injections of 300-400U (total dose) were administered to the iliopsoas (iliacus) and knee flexors and, when necessary, to other muscles of the hip and knee. Evaluations were performed pre-treatment (weeks -4 to -8, and day 1) and post-treatment (week 10 and week 21): spasticity, range of motion, limb positioning, passive functions and pain. Results A modest improvement in hip and knee extension was observed, as evidenced by the Modified Ashworth Score and range of passive extension movements. Limb positioning was also improved. Clear benefits were found on passive functioning, including toileting, dressing and bed facilities, as well as pain levels. Active functions remained unchanged. More definite improvement was found in patients with severe difficulties. Conclusions OnabotulinumtoxinA injection can contribute to reducing the consequences of disabling lower limb flexion.

presentant une aphasie totale (score ASRS de Goodglass et Kaplan a 0) n’a pu passer l’entretien. Celui-ci a ete difficile chez 3 patients (deux ASRS 1, un ASRS 2), possible avec reformulations chez 16, et facile chez les 12 autres. Il existe des differences significatives avec les scores des temoins dans 5 des 6 categories CIF notamment pour les itemsRP entretien du linge, deplacements exterieurs, courses et achats, budget, relations avec des inconnus, loisirs de groupe, vie associative et demarches administratives. Parmi les facteurs d’environnement, le soutien social est juge satisfaisant dans 79,5%des situations. Les attitudes des autres sont jugees 3 a 4 fois plus souvent facilitatricesqu’obstacles. Le facteurSystemeset politiques est facilitateur pour Soins personnels, Vie domestique, Vie communautaire, mais plutot obstacle pour Relations et Loisirs. Discussion.– La GMAP est applicable a la plupart des personnes aphasiques, mais des versions multi-sources seront utiles chez ces patients. Le modele CIF parait pertinent pour comprendre leurs difficultes de participation. Reference [1] Belio C, Prouteau A, Koleck M, Saada Y, Merceron K, Destaillats JM, et al. Participation in patients with psychic and/or cognitive impairments. Annals PRM 2013 [in print]..

In patients with severe traumatic brain injury (TBI), a growth hormone deficiency (GHD) is frequent and may contribute to the cognitive sequelae and reduction in quality of life (QoL). Recent studies have suggested that GH replacement therapy (GHRT) can improve processing speed and memory. The aim of the study was to analyze the efficacy of GHRT on cognition, activities of daily living (ADL), and QoL and the factors that predicted and contributed to these effects. We included patients at least 1 year after their TBI and assessed pituitary functions (with stimulation tests), cognition (attention, memory, and executive function), participation in ADL and QoL. GHD was treated for at least 1 year in 23 patients, who were compared with 27 non-treated patients. Other deficiencies were also treated. Measurements were performed at baseline and 1 year later. An analysis of variance of the factors group and session (p ≤ 0.05) showed that most cognitive parameters had improved at 1 year (evidencing a session effect). A stronger effect of GHRT (i.e. a group x session interaction) was found for Rey Osterrieth complex figure recall and 2/6 domains in the QoL questionnaire ("personal" and "functional"). Trends (p ≤ 0.07) were also found for spatial orientation and immediate recall in the verbal memory test. Greatest improvements were associated with lower performance before treatment. The magnitude of the improvements in ADL and QoL was moderately correlated with the improvement in cognition. In conclusion, replacement therapy can improve cognition and QoL in patients with TBI who have GHD, especially in those with severe disabilities.

Objective Management of tracheotomy is a key point of the coma arousal phase. Tracheal lesions can interfere with the decannulation of the patient. The objectives of our study were to determine the incidence of post-tracheotomy tracheal lesions in patients with brain injury, identify their associated factors and to specify their impact on rehabilitation. Material/patients and methods We retrospectively included brain-injured patients hospitalized in the neurosurgical intensive care unit then in the coma arousal unit of the Lille university hospital between January 2012 and December 2014. All patients had a tracheotomy and benefited from an endoscopy prior and/or after decannulation. Data from intensive care unit and rehabilitation hospitalizations were collected to analyze factors associated with tracheal lesions and the impact on rehabilitation. Results Fifty-six patients were included. Thirty (53.6%) had a tracheal lesion, which was most of the time asymptomatic. The duration of stay in intensive care unit was significantly longer in the group with tracheal lesion (medians and interquartile ranges respectively: 54 [29] vs 42 [16] days, P = 0.012). Decannulation tended to take place later for patients presenting with a tracheal lesion (74 [60] vs 40 [69] days after the tracheotomy). The hospitalization in neurorehabilitation unit was also significantly longer for patients with tracheal lesion (181 [182] vs 149 [248] days). The refeeding process tended to start later in patients presenting with a tracheal lesion (71 [78.5] days) than in the group without tracheal lesion (61.5 [68]), but the return to a normal texture occurred at the same time. Discussion - conclusion Tracheal lesions after tracheotomy are common in patients at the coma arousal phase after an acquired brain lesion. They are often asymptomatic at this stage, and seem to delay decannulation and refeeding processes.

Objective The upper limb function of hemiplegic patients is currently evaluated using scales that assess physical capacity or daily activities under test conditions. The present scale, the Upper Limb Assessment in Daily Living (ULADL) Scale, was developed to explore the subjective and objective functional capacities of such patients in a proximal to distal sequence. Methods A group of experts constructed a scale addressing 17 upper limb functions (five active passive and 12 active) which could be explored by a questionnaire (Q) and a test (T). Reproducibility, internal consistency, concurrent validity (Rivermead Motor Assessment (RMA)) and learning effect were estimated in a multicentre study. Results 49 stroke patients were each rated three times within 7 days by a total of 21 physicians, yielding a total of 142 ratings. The ULADL took 16±8 min to complete compared with 9±5 min for the RMA. Cronbach9s alpha coefficient was 0.95 for Q and 0.97 for the practical tests (T). The global Q and T scores, and in particular the global Q score, were slightly higher at the second rating. The intra-rater intraclass correlation coefficient (ICC) was 0.65 (95% CI (0.44 to 0.79)) for Q and 0.97 (0.95 to 0.98) for T, and the inter-rater ICC was 0.95 for both Q and T. The Bland and Altman method showed good intra- and inter-rater reliability with no systematic trend. Correlation coefficients for ULADL versus RMA were >0.80 for both Q and T. Conclusions The ULADL Scale has good psychometric properties and can explore patients with different degrees of upper limb impairment.

article i nfo Objectives: We investigated the long-term effects and predictive indices of efficacy of tibial nerve neurotomy in a large series of patients with post-stroke hemiplegia. Methods: Fifty-one patients were prospectively included, who showed disabling lower limb deformity (equinus, varus, clawing toes). The motor branches of the tibial nerve were selected according to the type of deformity, and partially resected at the posterior part of the calf. Patients were regularly assessed, before surgery and from the third month to the second year post surgery, for spasticity (primary outcome measure), motor control, range of active and passive movements, balance, walk, gait parameters, Rivermead Motor Assessment (RMA), subjective improvement and satisfaction. Results: Neurotomy definitely reduced spasticity and improved motor control on antagonist muscles, while improving balance, walk, and the RMA. These effects were clearly perceived in daily living. A discrete decline was at times observed at 2 years. Functional improvement was greater in patients more severely impaired. Side effects, consisting in sensory disorders, were observed following neurotomy of the motor fascicles of the flexor digitorum longus. Conclusions: Tibial nerve neurotomy showed great and lasting effects, and can be proposed to improve walking and balance in stroke patients with disabling lower limb deformity.

Objectives (1) To examine communicative abilities, late after a mild traumatic Brain Injury (MTBI) and their consequences on social adaptation and quality of life; (2) To compare patients with and without complaints. Methods The following tests were presented to 31 adults who suffered from a MTBI: Test for subtle language (TLE), Lille communication test (TLC), participation in communication (QLPC), daily life problem solving (TRPVQ), quality of life (QOLIBRI) and social adaptation using the EBIS document. Results TLE, TLC and TRPVQ's scores were more often pathological than in the general population and especially for persons with complaints, anxiety and reductions in participation. For the 18 patients with complaints, pathological scores in TLE, QLPC and TRPVQ were correlated to participation in activity of daily life (especially elaborated ones), return to work difficulties and a bad feeling in social relations. For the 13 patients without complaint, language, communication and quality of life scores were worse when MTBI was recent, when return to work was difficult and when subjects had poor leisure participation. Conclusions Communication impairments can be seen after MTBI and must be evaluated and treated, particularly in people with complaints, in those presenting with a reduction in participation and who have difficulties in returning to work and participating in leisure.