Publications (98) View all
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Article: Clinical signs and radiographic evidence of esophageal perforation after tetraplegia.
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ABSTRACT: A diagnosis of esophageal perforation at some time after cervical spine surgery is difficult to establish since there exists no clinical picture specific to tetraplegic patients. We carried out a detailed retrospective study of revelatory clinical manifestations and conventional radiographic data in a series of 16 patients hospitalized at Hôpital Henry-Gabrielle (Lyon, France) for rehabilitation purposes between 1983 and 2010 and who presented this complication. The most frequent clinical picture associates cervical pain, fever and dysphagia. Simple front and side X-rays of the cervical spine led in 77% of the cases to a diagnosis of esophageal perforation. The most prevalent radiographic signs of the latter consist in osteosynthesis hardware or instrumentation failure, prevertebral free air next to the cervical esophagus and enlarged prevertebral space. Visualized esophageal X-rays, also known as series, highlight parenchymal opacity next to the posterior wall of the esophagus. A diagnosis of esophageal perforation needs to be carried out in order to facilitate suitable treatment and avoid the compromising of vital functions.Annals of physical and rehabilitation medicine 01/2013; -
Article: Kinematic characteristics of tenodesis grasp in C6 quadriplegia.
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ABSTRACT: Study design:Descriptive control case study.Objectives:To analyze the kinematics of tenodesis grasp in participants with C6 quadriplegia and healthy control participants in a pointing task and two daily life tasks involving a whole hand grip (apple) or a lateral grip (floppy disk).Setting:France.Methods:Four complete participants with C6 quadriplegia were age matched with four healthy control participants. All participants were right-handed. The measured kinematic parameters were the movement time (MT), the peak velocity (PV), the time of PV (TPV) and the wrist angle in the sagittal plane at movement onset, at the TPV and at the movement end point.Results:The participants with C6 quadriplegia had significantly longer MTs in both prehension tasks. No significant differences in TPV were found between the two groups. Unlike control participants, for both prehension tasks the wrist of participants with C6 quadriplegia was in a neutral position at movement onset, in flexion at the TPV, and in extension at the movement end point.Conclusion:Two main kinematic parameters characterize tenodesis grasp movements in C6 quadriplegics: wrist flexion during reaching and wrist extension during the grasping phase, and increased MT reflecting the time required to adjust the wrist's position to achieve the tenodesis grasp. These characteristics were observed for two different grips (whole hand and lateral grip). These results suggest sequential planning of reaching and tenodesis grasp, and should be taken into account for prehension rehabilitation in patients with quadriplegia.Spinal Cord advance online publication, 4 September 2012; doi:10.1038/sc.2012.101.Spinal Cord 09/2012; · 1.80 Impact Factor -
Article: [Transanal irrigation for bowel and anorectal management in spinal cord-injured patients].
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ABSTRACT: Bowel dysfunction and disordered defecation are very common after spinal cord injury (SCI) and can have a major impact on patients' social life and quality of life. The aim of this study was to assess the safety and efficacy of transanal irrigations (TAI) in the management of Bowel dysfunction in SCI patients. Forty-five consecutive SCI patients using TAI were retrospectively included. TAI efficacy was assessed through Neurogenic Bowel Dysfunction (NBD) score recorded before and after 8 weeks of regular use. Possible side effects were assessed with a semi-structured questionnaire. Patients who started TAI use at least 6 months previously were contacted to assess long-term compliance, efficacy and safety of TAI. After 8 weeks of regular use of TAI, the average NBD scores decreased by four points (P<0.0001) with a specific improvement in the items related to stool frequency (P: 0.036), occurrence of malaise, headache, or sweating during defecation (P: 0.043), use of drugs against constipation (P: 0.007) and frequency of fecal incontinence (P: 0.001). The main side effects were bleeding (10%) and abdominal pain (8%). At 6 months, 80% of the assessed patients had continued regular use of TAI with no particular problem. This study showed good medium and long-term efficacy and safety of TAI in the management of bowel dysfunction and defecation disorders in spinal cord-injured patients.Progrès en Urologie 07/2012; 22(8):467-74. · 0.58 Impact Factor -
Article: Could motor imagery be effective in upper limb rehabilitation of individuals with spinal cord injury? A case study.
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ABSTRACT: Study design:A case study.Objective:The aim was to investigate whether motor imagery (MI) could be successfully incorporated into conventional therapy among individuals with spinal cord injury (SCI) to improve upper limb (UL) function.Setting:The Physical Medicine and Rehabilitation Unit at the Henry Gabrielle Hospital in Lyon, France.Methods:The participant was an individual with a complete C6 SCI. MI content was focused on functional UL movements, to improve hand transport to reach out and grasp with tenodesis. The participant was tested before and after 15 MI training sessions (45 min each, three times a week during 5 consecutive weeks). MI ability and program compliance were used as indicators of feasibility. The Minnesota and Box and Blocks tests, as well as movement time and hand trajectory during targeted movements were the dependent variables, evaluating motor performance before and after MI training.Results:The participant's ability to generate MI was checked and compliance with the rehabilitation program was confirmed. The time needed to complete the Minnesota test decreased by 1 min 25 s. The Box and Blocks score was improved by three units after MI program. Decreased movement time and enhanced hand trajectory smoothness were still observed 3 months later, despite a slight decrease in performance.Conclusions:This study supports the feasibility for introducing MI in conventional therapy. Further studies should confirm the potential role of MI in motor recovery with a larger sample.Spinal Cord 04/2012; 50(10):766-71. · 1.80 Impact Factor -
Article: Bladder dysfunction in hereditary spastic paraplegia: a clinical and urodynamic evaluation.
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ABSTRACT: Hereditary spastic paraplegia (HSP) is a degenerative central nervous system disorder characterized by progressive spasticity and hyperreflexia of the lower limbs. Often, patients with HSP experience symptoms of voiding dysfunction. Urodynamic evaluations of these patients are rarely reported in the literature and the etiology of voiding dysfunction remains unclear. The present study characterizes lower urinary tract dysfunction in a large series of patients. The medical records of 29 HSP patients who underwent urodynamic evaluation were retrospectively analyzed. The history of lower urinary tract symptoms was noted and the urodynamic findings analyzed. Urgency was the most dominant complaint (72.4%), followed by frequency (65.5%), urinary incontinence (55.2%) and hesitancy (51.7%). The urodynamic findings showed signs of central neurogenic bladder in 24 patients (82.7%), with detrusor overactivity (DO) in 15 patients (51.7%) and detrusor sphincter dyssynergia (DSD) in 19 (65.5%). Post-void residual (PVR) of >10% of the voided volume was found in 12 patients (41.4%). There were significant relationships between detrusor overactivity and PVR (P=0.005), frequency (P=0.046) and nocturia (P=0.045). Ultrasound examination revealed no upper urinary tract complications. Despite the presence of DO and DSD, HSP patients do not seem to have a high risk of developing ultrasonographically-assessed upper urinary tract complications after a mean follow-up of 22 years, contrary to spinal cord injury population. These results may guide practitioners in their decision-making about the appropriate evaluation and treatment of bladder disturbances that accompany hereditary spastic paraplegia.Spinal Cord 01/2012; 50(7):558-62. · 1.80 Impact Factor
