[ contribution of the new scale for assessing disability]

The assessment of disability and its management is complex and problematic. With a view to ensuring equality of opportunity between disabled people and others, a new law adopted in August 2005 proposed a new method for assessing disability is applicable on a wider scale by GPs. Assessing the contribution of the new scale for assessing disability in patients suffering from debilitating diseases, to verify compliance in Tunisia. Cross- sectional study on 60 hemiplegic, paraplegic and post traumatic head injuries. The patients underwent clinical evaluation and a functional assessment. The assessment tools used were: the classification of the American Spinal Injury Association, the Barthel index, Glasgow Outcome Scale, Functional independence Measure, the Health Assessment Questionnaire and the Social Function-36. Patients were also evaluated with the new scale of disability. Concerning paraplegic patients, limitations of activity concerned mobility, maintenance staff, domestic life, social relationships, community life and major areas of life. On the hemiplegic, areas related to communication, mobility, maintenance staff, domestic life, social relationships, community life and major areas of life have been affected. We have noted a correlation between the new scale and the Barthel Index. Regarding traumatic brain injury, the areas most affected were those related to mobility, maintenance staff, domestic life and the major areas of life. A correlation was found between the new scale and the Functional Independence Measure in three populations, as well as the quality of life that has been correlated with disability. Disability was observed in 90% of paraplegics, 80% and 50% of hemiplegic patients with severe brain injury. The handicap was the heaviest seen in traumatic brain injury patients with a frequency of 20%. The new scale for assessing disability has reproduced disability and special needs of paraplegic patients, stroke patients and traumatic brain injury

[Functional impairment in patients with rheumatoid pelvispondilyte]

To assess functional impairment in patients with rheumatoid pelvispondylite. cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]. metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index [BASFI], and likert scale assessing social, economic arid physical disability. 30 patients [22 men], the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50%are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100: the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social economic and physical disability was felt among 67%of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index. This impact on the quality of life is increased by the low level of education and poor professional integration

[Necessity of physical activities restriction after lumbar discectomy]

Necessity of physical activities restriction after lumbar discectomy have been described in the literature. The aim of this study was to determine if early rehabilitation could favorably influence the prognosis of military patients who had undergone lumbar disk surgery. We performed a retrospective study involving patients who have had lumbar disk surgery, and had undergone physical rehabilitation program. A clinical evaluation, an assessment of pain and a functional assessment by the Arabic version amended self-questionnaire Oswestry have been made for these patients before and after a rehabilitation program started since the 40[th] postoperative day. We have collected 50 cases: 40 men and 10 women of average age 30 years. All these patients have been improved after surgery with no radiculalgies, but with persistence lumbar pain syndrome. After rehabilitation program, we noted a reduction of 42.85% of pain and functional improvement with a reduction in the average score of Oswestry index of 61.18%. The average work incapacity was 4 months. A workstation adaptation was indicated for all patients. Intensive rehabilitation program started early after lumbar disk surgery can improve the functionality of patients operated, and allows early return to professional activities with reduction of the healthcare cost

[Neurogenic bladder in diabetes mellitus]

Diabetic bladder dysfunction is among the most common complications of diabetes mellitus. It is principally caused by autonomic neuropathy defining diabetic cystopathy. Characterize the bladder dysfunction in patients with diabetes mellitus. The clinical and urodynamic records of patients with diabetes mellitus were reviewed. 40 patients with diabetes mellitus were included in the study mean aged 55 years. 32 patients had voiding dysfunction. Urinary frequency and difficulty emptying were the predominant symptoms that led to patient referral. 15 patients [31.25%] had decreased flow rates. 12 patients [37.5%] had diminished bladder sensation and/or impaired detrusor contractility. 10 patients [25%] had detrusor hyperreflexia. And 6 patients had impaired detrusor contractility with increased bladder sensation. Vescico-uretral dyssynergia was found in 2 patients [5%]. This study suggests that classical diabetic cystopathy is not the most common urodynamic findings in patients with diabetes mellitus and demonstrates the importance of urodynamic studies in diagnosing bladder dysfunction in diabetics before initiation of therapy

[Neurologic bladder in patients with spinal cord injury. Protocol of surveillance and managment]

Bladder dysfunction is constant in patients with spinal cord injury and this whatever is the injury level. They are characterized by a variable profile and changing in the course of the years. They constitute not only, an important cause of morbidity in this population but also mortality. The aim of this work is to emphasize the importance of the diagnosis and to study the bladder behaviour while clarifying the evolution of this type of bladder and to present a protocol of management of a neurogenic bladder. Retrospective study. 2 assessments in 6 months of interval were realized. The bladder evaluation consisted in a biological assessment, a urinary ultasound, a cystography and urodynamic investigations. The managment is initially realized there to hospital. Our study contains 62 persons with spinal cord injury of average age of 32, 4 years with post traumatic period average is of 41, 47 months. The various evaluations allowed us to conclude that there is a significant change of the neurological status as well as the urinary biological values with significant deterioration of the various ultrasound, cystography and urodynamic data. The diagnosis and the management of the neurological bladders of persons with spinal cord injury have to be besides the other deficiencies that these patients as well as neurological, orthopaedic, and cutaneous devices, because this is going to allow to improve their quality as well as their life expectation. Our results underline the importance and the necessity to establish a protocol of neurogenic bladder control rigorous and codified which remains to adapt according to every patient. This protocol is sometimes difficult to apply given the fact of the misunderstanding of this type of deficiency

[ contribution of home based exercise programme in case of osteoarthritis of the knee]

Knee Osteoarthritis is the most frequent articular disease. It may cause disability and handicap. To assess the effect of a home based exercice programme in a Tunisian population having knee osteoarthritis, associated with medical treatment and education. Prospective study during three months, including 34 Tunisian patients with knee osteoarthritis. A clinical and functional assessment of the patients was made using respectively the visual analogic scale for the pain, the Lequesne index, the Functional Independence Measure and the womac function score for the function, the HAQ and SF36 for the assessment of the quality of life. Visual analogic scores for pain were reduced in the exercise group. Lequesne index scores reduced significantly in the exercise group and were unchanged in the controls. Quality of life was greater in the exercise group compared with the controls. Home based exercise programme contributes to relieving pain, maintaining function and to ameliorate the quality of life of people having knee osteoarthritis