Risk of pressure ulcers in tetraplegic people: a French survey crossing regional experience with a long-term follow-up.

Background: Pressure ulcer risk assessment provides an indicator of quality of care in French health establishments. The reliability and validity of assessment tools have been shown to be lower for people with spinal cord injury (SCI). We hypothesized that skin complications would be less frequent in people with traumatic SCI and tetraplegia (TSCIt), who were initially managed in French regions with a high level of specialized SCI rehabilitation experience. Methods: First, we used the most recent French territorial survey about SCI to determine a 'Level of Regional Experience (LRE) in Specialized Physical Medicine and Rehabilitation'. We then studied the individual variables reported in the Tetrafigap survey (which compiled a cohort of TSCIts people to assess their trajectory and life conditions following their return to community life by questionnaires) using univariate analysis according to these LREs (chi2 test using a significance threshold of P < 0.05). Finally, we performed a series of logistic regressions to determine the link between LREs and pressure ulcers. Results: Management in high-LRE regions was linked with a lower declaration of pressure ulcers during early treatment and in the long term (on average, 8 years post-trauma). Conclusions: Using pressure ulcers as a marker, our study showed the protective element of regional experience in the early management of TSCIts patients. A dilution effect between SCI specialized units and more polyvalent physical medicine and rehabilitation departments should be prevented within each region within the scope of a regional organization that would link referral centres and local health care networks.

[Surgical rehabilitation of upper limb function by tendon transfer in tetraplegia]. / Les améliorations chirurgicales tardives de la fonction des membres supérieurs par transferts tendineux.

Patients with cervical spinal cord injury have partial paralysis of their upper limbs, depending on the precise level of the injury. Twenty years ago, attempts at surgical rehabilitation of upper limb function in such patients started with tendon transfers, along with tenodeses, and some arthrodeses. These procedures are performed at least one year post-trauma. Depending upon the level of the injury, they usually significantly improve the functional autonomy of these otherwise severely handicapped patients. It is estimated that 60-70% of all tetraplegic patients can benefit from this type of surgery.

[Surgical rehabilitation of the upper limbs after traumatic tetraplegia]. / Réanimation chirurgicale des membres supérieurs dans la tétraplégie traumatique.

Patients with a cervical spinal cord injury experience a complete paralysis of their lower limbs and a partial paralysis of their upper limbs associated with a dramatic decrease of upper limbs function. Twenty years ago, surgical rehabilitation of their upper limbs started to develop, based mainly on tendon transfer procedures. We report a consecutive series of 69 such patients operated in the past 12 years, amounting to 188 rehabilitation procedures on their upper limbs. Surgery was beneficial in all cases, there was no case of functional loss, and the patients were mostly satisfied with the procedures.

Effectiveness of femoral nerve selective block in patients with spasticity: preliminary results.

OBJECTIVES: To determine if the vastus intermedius nerve can be blocked by using surface coordinates and to measure the effects of selective nerve block on quadriceps spasticity and immediate gait. DESIGN: Case series. SETTING: Physical medicine and rehabilitation department of a university hospital. PARTICIPANTS: Twelve patients with hemiplegia disabled by quadriceps overactivity. INTERVENTION: Anesthesic block of the vastus intermedius by using surface coordinates, femoral nerve stimulation before and after block, and surface electrodes recording of the amplitude of the maximum direct motor response of each head of the quadriceps. MAIN OUTCOME MEASURES: Assessment of spasticity, voluntary knee extension velocity, speed of gait, and knee flexion when walking. RESULTS: To be effective, the puncture point (.29 of thigh length and 2cm lateral) had to be slightly modified to 1cm laterally from a point situated at 0.2 of the thigh length. A selective block of the vastus intermedius could not be achieved, but a block of the vastus lateralis was always achieved, twice associated with a block of the vastus intermedius, resulting in decreased quadriceps spasticity, no changes in gait parameters, no decrease in voluntary knee extension velocity, and subjective improvement in gait for 3 patients. CONCLUSION: Selective block of the vastus lateralis with or without the vastus intermedius can be achieved by using surface coordinates without any dramatic effect on knee extension velocity, and it could be useful for phenol or alcohol block or surgical neurotomy.