Publications (2)4.37 Total impact
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Article: Metastatic paraplegia and functional outcomes: perspectives and limitations for rehabilitation care. Part 2.
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ABSTRACT: To identify functional outcomes that could justify the need for a rehabilitation care program for patients with metastatic epidural spinal cord compression (MESCC) and paraplegia. Publications from 1950 to January 2010 selected from 3 databases. Original articles dealing with outcome data for functional status, pain, and bladder dysfunction. Standardized reading grid. The data are dominated by retrospective studies for even functional-related data, and studies from rehabilitation teams are rare. They report a functional evolution similar to a population with traumatic spinal cord injury for the first 3 months. Patients who were ambulatory before treatment retained their ability to walk, and patients who were nonambulatory before treatment could regain gait abilities. Data also showed a positive impact on pain and bladder and/or bowel dysfunction. By restricting physical medicine and rehabilitation therapeutic care to a short time (1-2mo), the progression margin is possible in the short term and implies a voluntary and active therapeutic care approach for patients with paraplegia after MESCC on the basis of a codified and standardized program with clinical indicators, as well as patients' comfort indicators.Archives of physical medicine and rehabilitation 01/2011; 92(1):134-45. · 2.18 Impact Factor -
Article: Osteoporosis in persons with spinal cord injury: the need for a targeted therapeutic education.
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ABSTRACT: To identify circumstances surrounding the onset of fracture and common risk factors in persons with spinal cord injury (SCI) and to suggest an alternative or complement to the pharmacologic approach by evaluating the need for a prospective study based on the impact of a targeted therapeutic education on risk management of fractures in this population. Retrospective study. Hospital and Rehabilitation Center Setting. Women (n=7) and men (n=25; N=32; with ≥1 fracture after the initial SCI that occurred at home or in a hospital setting; mean ± SD age, 53±12y at the time of clinical review) with bone mineral density (BMD) measurements. Not applicable. Demographics, main circumstances of onset, and complications of fractures, as well as transversal bone mineral density evaluation. Nine patients had more than 1 fracture and 23 patients had only 1 fracture (total, 43 fractures; mean age at onset of fracture, 49±12y; median time since injury, 13.9y; mean delay in diagnosis, 6.5±15d). Fractures occurred mostly in the lower limbs. The circumstances of onset of these fractures were different and very stereotyped. In 3 cases, no trauma was reported. The most frequent mechanisms identified were forced maneuvers by the patient or a third party and falls. In 10 cases, the fracture occurred during a wheelchair transfer with forced maneuver or a fall from the wheelchair. Twenty-five patients were confined to bed after the fracture (mean duration of bed confinement, 18±28d; range, 0-120d). Postfracture follow-up showed that for 43 cases of fractures, 19 had at least 1 orthopedic complication, 15 had local complications, and 23 had general complications. Patients (23 of 32) benefited from dual-energy X-ray absorptiometry to assess BMD a few months or years after the fracture (mean femoral neck BMD, 0.574±0.197g/cm²; mean femoral neck T score, -3.8±1.5). With this retrospective analysis of common risk factors and circumstances of onset of secondary fractures, there is a clear future for a prospective study to evaluate the impact of targeted therapeutic education on risk factors for secondary fractures in patients with SCI.Archives of physical medicine and rehabilitation 01/2011; 92(1):59-67. · 2.18 Impact Factor
