SAS-PRP Study: A Real-Life Satisfaction Assessment in Patients with Cartilage Lesions of the Knee Treated by Platelet-Rich Plasma.

Platelet-rich plasma (PRP) is a rising therapy treating locomotor system lesions such as knee osteoarthritis. The objective of this study was to evaluate patients' satisfaction 6 to 12 months after a PRP injection for cartilage lesions of their knee under real-life conditions. Patients' satisfaction was assessed by a specific questionnaire named SATMED-Q©, which explores six different dimensions of a given treatment. In addition, pain and function were assessed thanks to VAS pain, WOMAC, and IKDC scores. Responders were identified through the OMERACT-OARSI criteria. We observed excellent satisfaction after a PRP injection with a SATMED-Q© score of 80.81% 6 to 12 months after the procedure. Even when there was no significant improvement in pain and function scores, 52% of the evaluated population fulfilled the OMERACT-OARSI criteria and were considered responders. According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren-Lawrence grades 1-2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee.

Sensory substitution of elbow proprioception to improve myoelectric control of upper limb prosthesis: experiment on healthy subjects and amputees.

BACKGROUND: Current myoelectric prostheses lack proprioceptive information and rely on vision for their control. Sensory substitution is increasingly developed with non-invasive vibrotactile or electrotactile feedback, but most systems are designed for grasping or object discriminations, and few were tested for online control in amputees. The objective of this work was evaluate the effect of a novel vibrotactile feedback on the accuracy of myoelectric control of a virtual elbow by healthy subjects and participants with an upper-limb amputation at humeral level. METHODS: Sixteen, healthy participants and 7 transhumeral amputees performed myoelectric control of a virtual arm under different feedback conditions: vision alone (VIS), vibration alone (VIB), vision plus vibration (VIS + VIB), or no feedback at all (NO). Reach accuracy was evaluated by angular errors during discrete as well as back and forth movements. Healthy participants' workloads were assessed with the NASA-TLX questionnaire, and feedback conditions were ranked according to preference at the end of the experiment. RESULTS: Reach errors were higher in NO than in VIB, indicating that our vibrotactile feedback improved performance as compared to no feedback. Conditions VIS and VIS+VIB display similar levels of performance and produced lower errors than in VIB. Vision remains therefore critical to maintain good performance, which is not ameliorated nor deteriorated by the addition of vibrotactile feedback. The workload associated with VIB was higher than for VIS and VIS+VIB, which did not differ from each other. 62.5% of healthy subjects preferred the VIS+VIB condition, and ranked VIS and VIB second and third, respectively. CONCLUSION: Our novel vibrotactile feedback improved myoelectric control of a virtual elbow as compared to no feedback. Although vision remained critical, the addition of vibrotactile feedback did not improve nor deteriorate the control and was preferred by participants. Longer training should improve performances with VIB alone and reduce the need of vision for close-loop prosthesis control.

Correction to: Effect of vibration characteristics and vibror arrangement on the tactile perception of the upper arm in healthy subjects and upper limb amputees.

The original article [1] contained an error whereby the captions to Fig. 3 and Fig. 8 were mistakenly interchanged.

Effect of vibration characteristics and vibror arrangement on the tactile perception of the upper arm in healthy subjects and upper limb amputees.

BACKGROUND: Vibrotactile stimulation is a promising venue in the field of prosthetics to retrain sensory feedback deficits following amputation. Discrimination is well established at the forearm level but not at the upper arm level. Moreover, the effects of combining vibration characteristics such as duration and intensity has never been investigated. METHOD: We conducted experiments on spatial discrimination (experiment 1) and tactile intensity perception (experiment 2), using 9 combinations of 3 intensities and 3 durations of vibror stimulations device. Those combinations were tested under 4 arrangements with an array of 6 vibrors. In both experiments, linear orientation aligned with the upper arm longitudinal axis were compared to circular orientation on the upper arm circumference. For both orientations, vibrors were placed either with 3cm space between the center of 2 vibrors or proportionally to the length or the circumference of the subject upper arm. Eleven heathy subjects underwent the 2 experiments and 7 amputees (humeral level) participated in the spatial discrimination task with the best arrangement found. RESULTS: Experiment 1 revealed that circular arrangements elicited better scores than the linear ones. Arrangements with vibrors spaced proportionally elicited better scores (up to 75% correct) than those with 3 cm spacing. Experiment 2, showed that the perceived intensity of the vibration increases with the intensity of the vibrors' activation, but also with their duration of activation. The 7 patients obtained high scores (up to 91.67% correct) with the circular proportional (CP) arrangement. DISCUSSION: These results highlight that discrete and short vibrations can be well discriminated by healthy subjects and people with an upper limb amputation. These new characteristics of vibrations have great potential for future sensory substitution application in closed-loop prosthetic control.

Quality of life assessment following amputation for septic shock: a long-term descriptive survey after symmetric peripheral gangrene.

PURPOSE: To assess health-related quality of life (HRQOL) following rehabilitation of amputees suffering symmetric peripheral gangrene (SPG) after septic shock. MATERIAL AND METHODS: A retrospective cohort study was conducted in nine French specialized rehabilitation centers. Thirty-two ICU adult patients hospitalized between 2005 and 2015 for septic shock who additionally presented with SPG resulting in at least two major amputations were enrolled. HRQOL was assessed by EQ-5D-3 L questionnaire. RESULTS: All patients (mean ICU length of stay 39 ±â€¯22d, SAPS II 58 ±â€¯18) had both lower limbs amputated and 84% were quadruple amputees. HRQOL, assessed 4.8 ±â€¯2.8 years after amputation, was inferior to the French reference. However, patients' self-rated health status was similar to the reference at the time of HRQOL assessment. The main factor of impaired HRQOL was intense phantom pain, not the mobility or self-care dimensions of EQ-5D. All patients except one preferred to be treated again for SPG despite disability. CONCLUSION: ICU survivors referred to rehabilitation centers after SPG-related amputations had impaired HRQOL. At the time of HRQOL assessment, they considered themselves in good health and preferred to be treated again despite disability. Appraisal of long-term functional outcome should not be used to guide end-of-life decision-making in this situation.

[Rehabilitation after a war injury]. / Des blessés jeunes et sportifs polytraumatisés « de la tête aux pieds ¼.

Rehabilitation after a war injury. Combat wounds can be the cause of serious physical and mental trauma. Injuries caused by the explosion of improvised devices are responsible for multiple penetrating injuries, limb amputations, brain or spinal-cord injuries, and sometimes severe burns. The performance of protective equipment and the effectiveness of the initial medical care allow those injured to survive, often at the cost of severely compromised functional prognoses. Following critical and surgical care, the multidisciplinary teams of Physical Medicine and Rehabilitation (PM et R) intervene with the wounded to initiate rehabilitation and assist with social and occupational reintegration. This support takes place in two steps: the primary phase of "acute rehabilitation" is aimed at preventing and treating complications and starting to relearn activities of daily living; the second phase of "rehabilitation-reintegration" encompasses both the medical and social fields. The implementation of individualized rehabilitation requires the collaboration of PM et R and psychiatric teams, along with various officials within the military institution. New processes specific to the military environment and adapted to the war wounded have been developed: the creation of the War Wounded Rehabilitation and Reintegration Unit (C2RBO: Cellule de Réadaptation et Réinsertion des Blessés en Opération); the use of new technologies and funding of bionic prostheses for amputees; the development of sports rehabilitation programs; the creation of tools to promote social and family reintegration; and the improved recognition of and compensation for injuries. In parallel, the care connection has been reorganized to create a "Defense Rehabilitation Pole" underpinned by a territorial network ensuring the implementation of a care course for every injured soldier, from the initial care in the Parisian military hospital complex to the military medical centers closer to the forces.

Rééducation et réadaptation après une blessure de guerre. Le blessé de guerre est un traumatisé grave à la fois physique et psychique. Les blessures sont souvent provoquées par l'explosion d'engins improvisés responsables de lésions multiples et pénétrantes, d'amputations de membre, de traumatismes crâniens ou vertébro-médullaires et parfois de brûlures graves. La performance des équipements de protection et l'efficacité de la prise en charge médicale initiale permettent à ces blessés de survivre, souvent au prix d'un pronostic fonctionnel sévèrement engagé. Après la prise en charge critique réanimatoire et chirurgicale, les équipes pluridisciplinaires de médecine physique et de réadaptation (MPR) interviennent auprès des blessés pour initier la rééducation et les accompagner jusqu'à la réinsertion socio-professionnelle. Cette prise en charge se déroule en deux temps : les phases primaires de « rééducation initiale ¼ visent à prévenir et traiter les complications médico-chirurgicales et à débuter les actions d'autonomisation du blessé dans les activités quotidiennes ; les phases secondaires dites de réadaptation-réinsertion entrent dans le champ du médico-social. La mise en oeuvre des projets de réadaptation personnalisés nécessite la collaboration des équipes de MPR et de psychiatrie avec les différents acteurs sociaux de l'institution militaire. De nouveaux processus spécifiques au milieu militaire et adaptés au blessé de guerre ont été développés : la création de la Cellule de réadaptation et réinsertion des blessés en opération dite C2RBO, le recours aux nouvelles technologies et le financement des prothèses bioniques chez l'amputé, le développement de la réinsertion par le sport, la création d'outils favorisant la réinsertion socio-familiale et l'amélioration des processus de reconnaissance et de réparation du préjudice. En parallèle, le réseau de soins est réorganisé pour créer à terme un véritable « Pôle de réhabilitation de la défense ¼ sous-tendu par un maillage territorial garantissant la mise en oeuvre d'un parcours de soins adapté à chaque blessé, depuis sa prise en charge initiale sur l'ensemble hospitalier militaire parisien, jusqu'au plus près des forces, dans les centres médicaux des armées.

Occurrence of adverse events in long-term intrathecal baclofen infusion: a 1-year follow-up study of 158 adults.

OBJECTIVE: To assess the frequency and types of adverse events (AEs) related to intrathecal baclofen (ITB) therapy in adults, and associated risk factors. DESIGN: A prospective, observational cohort study of adults followed up from January 1 to December 31, 2010. SETTING: A neurologic rehabilitation department in a university hospital. PARTICIPANTS: All consecutive adult subjects (N=158) receiving ITB via a pump, either implanted or followed up during the study period. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Frequency and type of AEs. RESULTS: In 2010, 158 subjects were followed up for ITB therapy, of whom 128 were implanted before 2010 (nonsurgical subjects), and 30 underwent implantation in 2010 (surgical subjects). Of these 30 subjects, 20 were "newly implanted" and 10 were "replacements." The most frequent pathologic disorders were spinal cord injury (42%) and multiple sclerosis (28%). Twenty-eight subjects (18%) experienced a total of 38 AEs. The rate of AEs was .023 per month of ITB treatment. AEs were related to the surgical procedure in 53% of cases, to the device in 29% (predominantly catheter dysfunctions), and to adverse effects of baclofen in 18%. AEs related to the surgical incision (scar complications and collections) were more frequent in replacement than newly implanted subjects (P=.009). No significant association between occurrence of an AE and subject characteristics (age, gait capacity, spinal vs cerebral spasticity, duration of ITB therapy follow-up) was found. Nearly half of the AEs were serious, extending admission time by a mean of 16 days. No AE induced long-term morbidity or death. CONCLUSIONS: The AE rate was relatively low in this cohort. This has to be balanced against the clinical, functional, and quality-of-life improvements, which are expected from ITB therapy.