[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

[Evaluation of pain in patients with spinal cord injury]

The aim of this study is to evaluate the pain in patients with spinal cord injury and it recurrences on daily activities. We report a prospective study about 30 cases of patients hospitalized for a spinal cord injury between march and may 2002. Pain was evaluated regarding to the time of appearance, the duration, the frequency, the type based on the TASP, the intensity based on the visual analogic scale, the sleep and social repercussion and daily actvities consequences. We report a series of 14 women and 16 men with a mean age of 30,4 years. The mean time of spinal cord injury occurence was about 2, 9 years. Twenty four patients were suffering from pain [80%]. In 61%of cases, the pain was chronic evolving for at least three months. It was noxious in 45%of cases and neuropathic in 80%of them. There were sleeping disturbances in 66%of cases and social repercussions in 62, 5%of patients. A professional reintegration was acquired in onIy 33%of patients. Pain is a frequent symptom in spinal cord injury. The evaluation of the pain can improve the management of patients suffering from this pathology. The improvement of therapeutic results needs evaluating scales standardization

[Employment after spinal cord injury - about observations]

Spinal cord Injury management requires the collaboration of several structures of which the professional rehabilitation center located in La Manouba. This center contribute to the improvement of professional reintegration of spinal cord injured persons. to evaluate employment among spinal cord injured patients rebabilited in this center. a retrospective study of 34 patients with spinal cord injury [8 females and 26 males] mean aged 3005 years All patients had a professional training in the professional rehabilitation center after spinal cord injury 19 patients [55 8%] had a primary academic level and 14 patients [41 2%] had a secondary academic level. Before spinal cord injury, 27 patients [80%] were employed or had a school activity. Autonomy was satisfactory at 29 patients [88%]. After professional training, the rate of employment was 67.8%. Patients Aged> 30 years and those having a better functional autonomy had a better employment rate Sex, academic level and professional status before spinal cord injury have no influence on the employment rate. The rate of professional reintegration m spinal cord injured patients after professional rehabilitation is very satisfactory giving evidence of the efficiency of this rehabilitation It would be interesting to confirm this result by a prospective study

[Rehabilitation after conservative treatment of anterior shoulder dislocation]

The dysfunction of the internal rotator muscles in case of anterior shoulder dislocation and the risk of stiffness after immobilization explain the important place of the rehabilitation in this pathology. The purpose of this study is to clarify the contribution of the rehabilitation in conservative treatment of anterior dislocation of the shoulder. Materiel and Method: retrospective study including 20 patients with anterior shoulder dislocation who had an orthopedic treatment and rehabilitation. Evaluation before and after rehabilitation carried on: the intensity of pain, the range of motion, the muscular force of the internal rotator muscles and finally patient's satisfaction. Rehabilitation allowed painless in 80% of cases, an improvement of the range of motion and muscular force of the internal rotator muscles. 80% of patients were satisfied or very satisfied with obtained results. Rehabilitation after anterior shoulder dislocation is at present well codified and have an essential place in the conservative and surgical treatment after shoulder dislocation