Rehabilitation management of patients with spinal tuberculosis (Review).

Spinal tuberculosis (ST) is a serious condition and a global health concern, accounting for a significant portion of musculoskeletal tuberculosis cases. It can lead to sever spinal and neurological complications. The management of ST involves a multidisciplinary approach, including medical treatment, surgery and rehabilitation. Rehabilitation is crucial through the course of the disease's and is tailored for each stage according to the patients' complaints, and clinical and functional complications. In the case of neurological issues due to spinal compression, rehabilitation aims at overcoming bed confinement complications, involving mobilization techniques, strengthening exercises and related vesico-sphincter disorders (urodynamics, catheterizing). The role of rehabilitation for the management of pain in patients with ST is based on bracing (restricting movements and relieving the pressure on harmed structures), and analgesic physical means (electrical stimulation and massage techniques). Several rehabilitation options may be used to address musculoskeletal complications. Range of motion exercises, muscle strengthening, and posture and balance correction using sensory perception and proprioception techniques, are commonly involved. Cardiorespiratory reconditioning is required to improve respiratory function, walking ability and cardiovascular endurance. Ultimately, rehabilitation allows for the minimization of disability and the prevention of the loss of autonomy, particularly in elderly patients. The advantage of the rehabilitation approach is its multi-optional characteristics including physical therapy, occupational therapy, ergonomic advices and assistive equipment. Despite its crucial role, rehabilitation remains understudied in the management of ST. Thus, the present mini-review aimed to address the rehabilitation options for the clinical features and complications of ST, according to the course of the disease.

Feeding problems and malnutrition associated factors in a North African sample of multidisabled children with cerebral palsy.

BACKGROUND: In European and North American countries, stunting and malnutrition are common in children with cerebral palsy (CP), especially those with multiple disabilities. The extent of this problem in children with CP in North African countries is still unknown. AIMS: To evaluate feeding problems and growth in a sample of North African multidisabled children with CP and to determine the factors associated with malnutrition in this population. METHOD: We conducted a cross-sectional study including multidisabled children with severe CP. Anthropometric measurements (body weight, height, mid-upper arm circumference and triceps skinfold thickness) were performed. In addition, a thorough nutritional survey was conducted including feeding time and the presence of signs in favor of gastrointestinal problems. RESULTS: We included 40 children, mainly boys (60 %) with a mean age of 6.4 ± 3.7 (range 2-16 years). The nutritional survey had revealed the presence of dysphagia, constipation and gastroesophageal reflux in 55 %, 67.5 % and 70 % of cases, respectively. Sixty-five percent of children had a mealtime over 30 min. Based on World Health Organization (WHO) growth charts, 67.5 % of children were underweight. Forty percent of the children had their weight below the 20th percentile, 5 % and 7.5 % had their height and BMI below the 5th percentile according to CP specific growth charts. Triceps skinfold thickness and mid-upper arm circumference were below the 5th percentile in 50 % and 55 % of cases, respectively. Age (p = 0.047) and constipation (p = 0.003) were identified as predictors of malnutrition. CONCLUSIONS: Growth parameters and nutritional status are significantly altered in in our sample of North African multidisabled children with CP with a high prevalence of feeding problems represented especially by dysphagia, constipation and GER. Among the studied factors age and constipation may predict the existence of undernutrition.

Predictors of Quality of Life in Stroke Survivors: A 1-year Follow-Up Study of a Tunisian Sample.

BACKGROUND: Stroke survivors often have impaired quality of live (QOL). There is very little information about the determining factors of QOL of stroke survivors in developing countries managed in public health structures with limited access to state of the art treatments. OBJECTIVE: To identify the main determinants of QOL in Tunisian stroke survivors. METHODS: QOL was assessed at 3, 6 and 12 months after the stroke using the Tunisian version of the SF-36 questionnaire. Patients were evaluated using the National Institue of Health Stroke Scale, the motor index of Demeurisse, the Functional Independence Measure instrument, the Reintegration to Normal Living Index, the Mini-Mental State Examination and the Hospital Anxiety and Depression Scale. RESULTS: 65 stroke survivors were included (60% males; mean age 62.2±10.3 years). Eighty-sex percent of the patients had an ischemic infarction. Most of the stroke patients had minor or moderate stroke. All the QOL dimensions were altered at 3 months post stroke. Between the 3 and 6-months follow-ups, there were significant changes in the SF-36 scores and individual domains but QOL remained altered. Between 6 and 12 months, there were no significant changes in the majority of the SF-36 domains. Advanced age, neurologic impairment, depression and disability measured 1 month after stroke, the stroke side (left hemisphere), the life style, and higher education, were associated with worse QOL. CONCLUSIONS: Stroke severity, advanced age, post-stroke depression and disability seem to represent consistent determinants of QOL in Tunisian stroke patients.

Complex regional pain syndrome type I: incidence and risk factors in patients with fracture of the distal radius.

OBJECTIVE: To examine the incidence and predictors of complex regional pain syndrome type I (CRPS I) after fracture of the distal radius. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: A consecutive sample of patients (N=90) with fracture of the distal radius treated by closed reduction and casting. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Occurrence of CRPS I, occurrence of pain, wrist and hand range of motion, radiographic measures, Patient-Rated Wrist Evaluation, Hospital Anxiety and Depression Scale, and Medical Outcomes Study 36-Item Short-Form Health Survey at baseline and 1, 3, 6, and 9 months follow-up. RESULTS: CRPS I occurred in 29 patients (32.2%) with a mean delay ± SD of 21.7±23.7 days from cast removal. Univariate analyses found significant differences between patients with CRPS I and patients without CRPS I at baseline for sex (P=.021), socioeconomic level (P=.023), type of trauma (P=.05), pain at rest and activity (P=.006 and P<.001, respectively), wrist dorsiflexion and pronation (P=.002 and P=.001, respectively), finger flexion (P=.047), thumb opposition (P=.002), function of the hand (P<.001), and physical quality of life (QOL) (P=.013). Logistic regression showed that risk for CRPS I was higher in cases of women (odds ratio [OR]=5.774; 95% confidence interval [CI], 1.391-23.966), medium and low energy trauma patients (OR=7.718; 95% CI, 1.136-52.44), patients with a Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning score <40 (OR=4.931; 95% CI, 1.428-17.025), and patients with Patient-Rated Wrist Evaluation pain subscale score >16 (OR=12.192; 95% CI, 4.484-43.478). CONCLUSIONS: CRPS I occurs frequently during the third and fourth week after cast removal, especially in women who report severe pain and impairment of physical QOL. Additional prospective studies are required to verify these findings in comminuted and operated fractures of the distal radius.