[Necessity of physical activities restriction after lumbar diskectomy]. / Intérêt d'une approche active dans la prise en charge rééducative a la suite d'une première chirurgie rachidienne pour hernie discale.

BACKGROUND: Necessity of physical activities restriction after lumbar discectomy have been described in the literature. AIM: The aim of this study was to determine if early rehabilitation could favorably influence the prognosis of military patients who had undergone lumbar disk surgery. METHODS: We performed a retrospective study involving patients who have had lumbar disk surgery, and had undergone physical rehabilitation program. A clinical evaluation, an assessment of pain and a functional assessment by the Arabic version amended self-questionnaire Oswestry have been made for these patients before and after a rehabilitation program started since the 40th postoperative day. RESULTS: We have collected 50 cases: 40 men and 10 women of average age 30 years. All these patients have been improved after surgery with no radiculalgies, but with persistence lumbar pain syndrome. After rehabilitation program, we noted a reduction of 42.85% of pain and functional improvement with a reduction in the average score of Oswestry index of 61.18%. The average work incapacity was 4 months. A workstation adaptation was indicated for all patients. CONCLUSION: Intensive rehabilitation program started early after lumbar disk surgery can improve the functionality of patients operated, and allows early return to professional activities with reduction of the healthcare cost.

Total knee arthroplasty in a spinal cord-injured patient: a case report.

Patients with spinal cord injuries are prone to knee hydrarthrosis (also known as "water on the knee"), which can cause pain, functional impairment and the restriction of social activities. Total knee arthroplasty is a potentially appropriate treatment. Here, we report on a patient presenting partial T12 AIS grade C paraplegia who was able to walk with two forearm crutches, an ankle-foot orthosis on the right leg and a knee-ankle-foot orthosis on the left leg. Thirteen years after the spinal cord injury, the patient presented with septic arthritis of the right knee, complicated by recurrent hydrarthrosis during standing and walking. Arthroscopy revealed advanced osteoarthritis. Total knee arthroplasty was performed, with very good functional and social outcomes two and half years after surgery.

[Neurogenic urinary bladder in patients with spinal cord injury. Protocol of surveillance and management]. / La vessie neurologique du blessé médullaire: protocole de surveillance et de prise en charge.

BACKGROUND: 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. AIM: 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. METHODS: retrospective study. 2 assessments in 6 months of interval were realized. The bladder evaluation consisted in a biological assessment, a urinary ultrasound, a cystography and urodynamic investigations. The management is initially realized there to hospital. RESULTS: 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. CONCLUSION: 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.

[Study of the postural profile and spinal static for menopausal-women with chronic low back pain]. / Etude du profil postural et de la statique rachidienne chez les femmes postménopausées et lombalgiques chroniques.

OBJECTIVES: To study postural and spinal static modifications associated with chronic low back pain in menopausal women. METHODS: Clinical appreciation of static spinal profile in sagittal plane; postural evaluation on the Balance Master Neurocom force platform by the modified clinical test for the sensory interaction on balance (modified CTSIB test); Radiological evaluation of spinal and pelvic parameters as well as the sagittal profile according to the Roussouly classification. RESULTS: Spinal curves clinical measurement and the sway velocity of the pressure center on the Balance Master Neurocom do not show significant difference between the two groups. While the pressure center position in the anteroposterior axis shows significant difference between the two groups (p=0.02) with a more backwards projection found in chronic low back pain subjects. Radiological evaluation shows sagittal shelter significantly superior, sacral slope significantly lower and the type 1 of lumbar lordosis more frequent in chronic low back pain women compared to healthy women. DISCUSSION-CONCLUSION: In menopausal women, chronic low back pain seems to be associated with lower sacal slope, the type 1 of lumbar lordosis more frequent and behindly projection of pressure center.

[Impact of physical activity on the autonomy and the quality of life of patients with spinal cord injury]. / Impact de la pratique sportive sur l'autonomie et la qualité de vie du paraplégique.

OBJECTIVE: To assess the effect of regular physical activity on the autonomy and the quality of life of Tunisian patients with spinal cord injury. METHODS: The study relates to 25 paraplegic divided into two groups: 10 paraplegic sportsmen and 15 sedentary paraplegics among whom we assess the degree of the autonomy with the Functional Independence Measure and the quality of life with the quality of life questionnaire SF36 in its Arabic version. RESULTS: The result analysis shows a significant difference of the total score of the Functional Independence Measure between the two groups, the sporting paraplegic having developed a better autonomy on the daily activities than the nonsporting paraplegics with a total average score of 115.10 against 93.87 (p<0.001). A significant difference is noted, mainly in the headings "personal care" and ',"mobility". Concerning the shutter "quality of life", the scores of various dimensions of scale SF36 were higher in the sporting paraplegic with significant difference in the headings bodily pain (p<0.01), vitality (p<0.04) and global physical score (p<0.008). CONCLUSION: This study enabled us to show that the regular physical activity as well had a positive effect on optimization of the functional capacities of paraplegic as on the improvement of its quality of life, thus, supporting a better socioprofessional reintegration.

[Role of the Neurocom Balance Master in assessment of gait problems and risk of falling in elderly people]. / Rôle du Neurocom Balance Master dans l'évaluation des troubles de l'équilibre et du risque de chute chez le sujet âgé.

INTRODUCTION: Falls in elderly people is currently a health service problem because of the multiple consequences. Numerous teams have been interested in predicting the risk of falling with clinical and instrumental tests. Our study investigated instrumental evaluation by use of the Neurocom Balance Master in the global assessment of gait problems and risk of falling in elderly people. PATIENTS AND METHODS: Transverse study concerning 60 subjects older than 65 years distributed in 2 groups of 30 subjects each according to the existence or not of falling incidents during the past year. Evaluation by the Balance Master involved the following items: 1) the modified Clinical Test for the Sensory Interaction on Balance (CTSIB), which estimates balance by measuring the speed of oscillation of the center of pressure (CP) with open then closed eyes and firm then mossy ground; 2) support monopodal 5" to the left then to the right, eyes open then closed in moderated speeds of oscillation of the CP; 3) passage from standing to sitting, in moderated speeds of oscillation of the CP; 4) limits of stability: the possibilities of moving the CP towards a predetermined target without moving the feet in moderated time and speed; 5) study of the step: determine length and width of the step as well as speed; 6) most about-turn: measure of speed of oscillation of the CP during the right then left about-turn; 7) clearing: the force of the impact and the oscillations of the CP during the clearing of an obstacle 10 cm high to measure leverage. RESULTS: The oscillation speed of the CP in the 2 groups during modified CTSIB, support monopodal 5", passage from standing to sitting, about-turn and clearing were significantly improved the group of the patients with falls (P < 0.05). The step, length and speed of these patients were significantly reduced, with no difference in width of the step between the 2 groups. In the evaluation of the limits of stability, only time necessary to reach the target was significantly increased in the group with falls. Finally, the indication of leverage and the force of impact on the ground measured by the test of clearing were more important in the group of fallers than in non-fallers. CONCLUSION: The Neurocom Balance Master estimates not only postural balance, but also the vestibulary system and reproduces the physiological conditions of daily life. It has a certain role in the early assessment of gait problems and the risk of falling. This system also allows for rehabilitation of the impaired balance and offers a profit with the biofeedback.

[Conservative management of full-thickness rotator cuff tears. A prospective study of 24 patients]. / Traitement conservateur des ruptures transfixiantes de la coiffe des rotateurs. Etude prospective ouverte. A propos de 24 patients.

OBJECTIVE: To evaluate the efficacy of conservative treatment of full-thickness rotator cuff tears. METHOD: A prospective open study of patients with full-thickness rotator cuff tears. The diagnosis was confirmed by ultrasonography examination. Therapeutic efficacy was evaluated before treatment, at the end of the treatment, and at 1, 3 and 6 months. Pain and handicap intensity were measured by a visual analogue scale, by the algo-functional Constant score, by articular mobility and, finally, by the resumption of daily and/or professional activities. Successful treatment was considered with a VAS pain scoreor=80. RESULTS: Twenty-four patients, mean age 59 years, with full-thickness rotator cuff tears for 9 months, on average, were included in the study. The parameters of pain function and handicap improved significantly since the end of treatment. The Constant score improved greatly, from 44.8 before treatment to 71.8 at the end of treatment and 74.2 at 6 months. This improvement continued until 3 months after treatment. The rate of success was 75% at 6 months. CONCLUSION: Despite the small sample size, our study confirm that rehabilitation should always be performed before a decision of surgical repair.