Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicentre controlled study. I. Clinical evaluation.

By means of a multicentric study in six rehabilitation centres, we assessed the RGO-II orthosis to restore functional gait in patients with spinal cord injuries. The 26 subjects participating in the study had spastic complete paraplegia. Twenty one had progressed to the training programme and 19 were able to stand up alone. The trained subject's walking distance ranged from 200 to 1400 m, while their walking speed ranged from 0.15 to 0.45 ms-1. A 2-month follow-up study revealed that, out of 15 patients using the hybrid orthosis, 11 were home users. Modalities and adverse effects of training are reported. The place of gait restoration with a hybrid orthosis in a rehabilitation programme is discussed.

Restoration of functional gait in paraplegic patients with the RGO-II hybrid orthosis. A multicenter controlled study. II: Physiological evaluation.

We have investigated physiological changes in 21 patients with a spinal cord injury who were fitted with the RGO-II hybrid orthosis. All parameters were measured before and after a training programme in order to evaluate the benefit of gait rehabilitation, cardiovascular adaptation, constipation, spasticity and osteoporosis. A tendency for the improvement in cardiovascular function was noticed, and a segmental decrease in right colonic transit time was observed. However there was no reproducible change in spasticity, and no gain in bone mineral density. These data suggest that the physiological benefits which occur when patients walk with the aid of a hybrid orthosis only correct the effects of immobility. In addition, we did not find any physiological improvement regarding the neurological lesion (spasticity or osteoporosis).

[Longitudinal division of the penis caused by an indwelling urinary catheter in a paraplegic patient]. / Section longitudinale du pénis secondaire au port de la sonde urinaire à demeure chez un paraplégique.

The authors report a rare case of longitudinal section of the penis, due to an urethral catheter. The patient was paraplegic and schizophrenic. They found only six such cases in the literature. They stress the risk of such complications in psychiatric patients.

[Value of voiding ultrasonography combined with urodynamic studies in the assessment of vesical sphincter dyssynergy]. / Intérêt de l'échographie mictionnelle couplée à l'urodynamique dans l'étude des dyssynergies vésico-sphinctériennes.

Fifteen paraplegic patients all presenting with vesico-sphincteric dyssynergia underwent, between January and September 1990, a urodynamic and electromyographic examination combined with pre-voiding or voiding transrectal ultrasonography. The ultrasound apparatus used was a Siemens Sonoline SL1 with a MHz linear intracavitary probe giving a strictly longitudinal plane of section. The urodynamic apparatus used was a Wiest 6000 with a Böhler 7 F urethral catheter and an electromyography needle-electrode implanted in the striated sphincter. This type of ultrasonography provided a precise and dynamic image of the bladder neck, prostatic urethra and external striated sphincter during the phases of filling and voiding. Spastic contractions of the striated sphincter during detrusor contraction were observed in 8 patients with an intermittent and jerky urinary stream. In 7 patients, the striated sphincter remained closed during detrusor contraction and only opened briefly as soon as detrusor contraction decreased, allowing only a weak and transient flow. By allowing the direct visualisation of the sphincteric obstruction during voiding, dynamic transrectal ultrasonography clearly confirmed the diagnosis of vesico-sphincteric dyssynergia. In contrast with classical voiding cystourethrography, this is a non-invasive, inexpensive and, most importantly, repeatable technique, as it does not require any irradiation. It is therefore suitable for drug evaluation trials, particularly of alpha-blockers and to assess one of the many treatments proposed in vesico-sphincteric dyssynergia.

[Arthritis of the hip in paraplegic patients. Apropos of 8 cases]. / L'arthrite de hanche chez le paraplégique. A propos de 8 cas.

Eight instances of septic arthritis of the hip were treated in 6 paraplegics. On each occasion the hip had been infected through a nearby ulcer. In 2 cases the diagnosis was only made at operation because signs of a severe infection are not obvious in paraplegics. The radiographs were often misleading, the joint space being either normal or narrowed even before the onset of sepsis. The treatment combined antibiotic therapy with resection of the head and neck stabilized by external fixation for 45 days. The procedure was only successful in 5 cases out of 8 as far as infection was concerned. The resection did not impair ability to sit in this type of patient.

[Orthostatic hypotension in tetraplegic patients (author's transl)]. / L'hypotension orthostatique au cours des tétraplégies par atteinte médullaire.

Blood pressure regulation was studied in nine patients with tetraplegia following total cervical section. Ten minutes after placing the patients in an inclined position at 30 degrees there was a marked reduction in blood pressure, an increase in heart rate, and absence of increased peripheral resistance. Valsalva's maneuver was pathological in all cases (lack of overshoot). Circulating catecholamines were measured in five cases and were low in decubitus and did not react to orthostatism. Plasma renin and aldosterone levels were at the upper limits of normal and reacted strongly to orthostatism. Marked hypersensitivity to exogenous angiotensin and noradrenaline was observed in all cases. These modifications result from section of the sympathetic efferent pathways. High plasma renin levels and their increase during orthostatism are not incompatible with these findings and probably result from intervention of renal baroreceptors. Whatever the mechanism involved, this increase in plasma renin activity could play an important role in the control of blood pressure in tetraplegic patients.

[Post-traumatic resorption of a vertebral body in a patient with spondylarthritis (author's transl)]. / Résorption post-traumatique d'un corps vertébral chez un spondylarthritique.

Rheumatoid pelvispondylitis in the lumbar spine can be the cause of a fracture of a vertebral body following usually minimal trauma. If no treatment is applied, a pseudo-arthrosis with severe bone resorption can occur. The whole vertebral body was affected in this way in the case reported.