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Persons with sacroiliac joint dysfunction exhibit altered electromyographic activity of the latissimus dorsi muscle when lifting a load
PERSONS WITH SACROILIAC JOINT DYSFUNCTION EXHIBIT ALTERED ELECTROMYOGRAPHIC ACTIVITY OF THE LATISSIMUS DORSI MUSCLE WHEN LIFTING A LOAD. ZRR Zully Rocío Rincón1 ABO Ana Beatríz Oliveira2 CRR Carolina Ramírez Ramírez3 1. Universidad de Santander, Colombia. 2. Universidade Federal de Sao Carlos, Brasil. 3. Universidad Industrial de Santander, Colombia. Brackground and aim: The interaction of the Latissimus Dorsi (LD) with the thoracolumbar fascia (TLF) is considered essential for the stability of the lumbo-pelvic region. Therefore, examining electromyographic (EMG) activity of the LD muscle when lifting a load in a standing position in people with and without Sacroiliac Joint Dysfunction (SIJD) may provide relevant information in the understanding of the SIJD. Methods: Cross-sectional analytical observational study with 114 subjects aged 18 and 40 years old (24.76 ± 8.06; men= 76; women= 38) distributed in three groups: Control, Low Back Pain (LBP) and SIJD. Diagnosis of SIJD was established through the multitest regimen. EMG activity of the LD was evaluated when lifting a load in a symmetrical bipedal position. The Root Mean Square (RMS) amplitude and latency of the right and left LD muscles were calculated. Kruskal-Wallis test and Dunn’s multiple comparisons test were conducted to compare RMS amplitude and latency of the LD muscle between groups. Results: A significant increase in RMS amplitude (p = 0.03) was found in the left LD and significant delay in the onset (p = 0.02) of the right LD in the SIJD group (Control: -1.88 msec [- 3.03, -1.14]; LBP: -1.49 msec (-1.88, -0.9), SIJD: -1.2 msec (-2.31, -0.91). Conclusion: Significant delays in the onset and the increase in the RMS amplitude of the LD muscle reveals a change in the pattern of EMG activity in subjects with SIJD. This suggests that the synergistic activity between the LD and the contralateral gluteus maximus may also be altered, affecting the force closure in the sacroiliac joint during load lifting, altering, in turn, the correct transfer of forces from and towards the lower limbs and trunk, thus potentially contributing to the perpetuation of symptoms. Keywords: sacroiliac dysfunction, pain, rehabilitation, motor control.
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Pain and disability in persons with sacroiliac joint dysfunction
PAIN AND DISABILITY IN PERSONS WITH SACROILIAC JOINT DYSFUNCTION (SIJD) BACKGROUND AND AIM: Sacroiliac joint dysfunction (SIJD) accounts for approximately 15% to 30% of cases of non-specific low back pain (LBP). SIJD can affect the ability to develop functional activities of daily life, however, it has not been described if there are differences in the pain and functional disability of people with LBP with and without SIJD. The purpose of this study was to analyze the pain intensity and disability in people with LBP with and without SIJD. METHODS: Forty-three men and 33 women between 18 and 40 years (Me 24 IQR 20-35) were included in two study groups: LBP (N=38) and LBP+SIJD (N = 38). The diagnosis of SIJD was established with 3 positive pain provocation tests. Functional disability was measuring using Oswestry Disability Index (ODI) and pain intensity using visual analogue scale. Chi-square and Kruskal Wallis test followed by the Dunn´s test were applied. RESULTS: Significant differences between groups were found, with a higher number of participants with pain at rest, on palpation and during the lifting of a load in the LBP+SIJD group (p<0.001). Likewise, moderate and severe disability were more prevalent in the LBP+SIJD group (p<0.03). CONCLUSION: Persons with LBP+SIJD had greater functional disability and pain. These results suggest that biomechanics alterations of the sacroiliac joint overloads the lumbopelvic area, thus increasing pain and disability in people with SIJD.
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Assessment of psychological impact in patients with stroke: about 71 cases
The Assessment of psychological impact in patients with stroke: about 71 cases M.Yazidi, A.kabil, R.Dades, N.Kyal, F.Lmidmani, A.El fatimi Department of Physical Medicine and Rehabilitation CHU Ibn Rochd Casablanca Background and aims : Psychological consequences following strokes include emotional, behavioural and cognitive impairments, they are frequently neglected, and yet have a major impact on quality of life. The aim of this study is to assess psychological impact in a group of patients followed for post-stroke rehabilitation. Methods : we conducted a prospective study over 2 years in the Department of Physical medicine and rehabilitation in Casablanca, including 71 patients. Were excluded patients with severe aphasia. Results : the average age was 56.2 years, the sex ratio was 1,29 all patients had ischemic stroke with variability of the localization and the severity.29,5% of patients had depression, 30.9% had anxiety, 18.3% had apathy. As for cognitive impairments: 37.6% had memory impairment, 25.3% had language difficulties, and visiospatial abilities were altered in 38% Conclusions : Post-stroke psychological impairments compromise the functional prognosis and are often a source of demotivation for patients especially for rehabilitation, it should be sought systematically and managed adequately in all hemiplegic, especially in the early phase.
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Management of vesicosphincteric disorders in patients with spina bifida
Management of vesicosphincteric disorders in patients with Spina Bifida M.Yazidi, R.Dades, A.Kabil, N.Kyal, F.Lmidmani, A.El fatimi Department of Physical Medicine and Rehabilitation CHU Ibn Rochd Casablanca Background and aims : Spina bifida is a birth defect in which the vertebral column is open, often with spinal cord involvement. Renal damage following vesicosphincteric disorders (VSD) is among the most serious complications of spina bifida. Methods : The aim of this study is to analyze the low urinary tract disorders leading to renal damage in a group of 35 children diagnosed earlier with Spina bifida Results : The average age was 9.6 ± 5.3 years. The mainVSD were pollakiuria in 63% , urinary incontinence 58%, urinary urgency in 81 % and dysuria in 78%. The urodynamic profile was marked by detrusor sphincter dysynergia in 27.8%, significant post void residual volume in 57.9%. Bladder compliance was decreased in 51.5% with phasic and terminal detrusor overactivity in 74.7% including 42.5% that are dangerous for the upper urinary tract. The management of VSD consisted in clean intermittent catheterization (CIC), oxybutynin, and perineal rehabilitation. Conclusions : Spina bifida’s incidence still ranges from 0.3–4.5 per 1,000 births, The objectives of care in physical medicine is to prevent uronephrological complications by early management of urinary disorders,to preserve renal function and improve the quality of life
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Anorectal disorders and management in spinal cord injured patients
ANORECTAL DISORDERS AND MANAGEMENT IN SPINAL CORD INJURED PATIENTS Dr Kyal. N, Dr Tahri. Z, Dr Boutalja. H , Pr Lmidmani. F, Pr El Fatimi. A Department of Physical Medicine and Rehabilitation of Ibn Rochd Hospital University, Casablanca, Morocco Background and aims : Anorectal disorders (ARD) in spinal cord injured (SCI) patients have major impacts on the quality of life of patients. Their evaluation and management must be systematic [1] The aim is to study the prevalence, the severity and the management of ARD in these patients. Methods : This is a descriptive and retrospective study of 46 SCI patients who were recruited in Physical Medicine and Rehabilitation department for rehabilitation care. The evaluation of ARD was done using the Neurogenic Bowel Dysfunction Score (NBD) questionnaire, and the functional independence measure (FIM). Results : The mean age was 43.6 with a male predominance. 73.9% were paraplegic. 41.3% had an ASIA B score and 26% an ASIA A score. The prevalences for constipation, dyschesia and fecal incontinence were 39.1%, 21.7% and 43.4% respectively. The NBD was 11.9±5.6 and the mean FIM 82.9. The management consisted of education and information of the patient, specific diet, oral bowel medications, enemas and pelvic floor therapy using biofeedback. Conclusion : The severity of ARD and therefore of the NBD score is correlated with the global motor deficit including the perineal region and with the ASIA score. The management of ARD involves a physical examination, imaging (MRI defecography) and anorectal manometry in order to propose the right therapy [2,3] References: [1] Qi, Z. Middleton, JW and Malcolm. A. Bowel dysfunction in Spinal Cord Injury. Current Gastroenterology Reports (2018) 20: 47. [2] Major. Y, Jones. M, Andrews. A, Kellow. JE and Malcolm. A. Anorectal biofeedback for neurogenic bowel dysfunctionin incomplete spinal cord injury. Spinal Cord (2016) 54,1132–1138. [3] Rodriguez, GM. Gater, DR. Neurogenic Bowel and Management after Spinal Cord Injury: a Narrative Review. J. Pers.Med.2022,12, 114.
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Clinical and functional aspects in patients with neuromeningeal tuberculosis: About 32 cases
Clinical and functional aspects in patients with neuromeningeal tuberculosis M.Yazidi, R.Dades, A.Kabil, N.Kyal, F.Lmidmani, A.El fatimi Department of Physical Medicine and Rehabilitation CHU Ibn Rochd Casablanca Background and aims : Tuberculosis of the central nervous system and is a major cause of morbidity and mortality in developing countries. Myelitis is the most frequent manifestation of spinal tuberculosis. Methods : We report the clinical and functional aspects in a group of patients with neuromeningeal tuberculosis (NMT) after functional rehabilitation. Over a period of 4 years, 32 cases of NMT were admitted for functional rehabilitation at the Physical Medicine and Rehabilitation Department at CHU ibn Rochd, neurological status was assessed according to ASIA, and disability by the MIF. Results : 87.5% of the patients were males, the average age of participants was 27.2 years (18-42), the average period of hospitalisation was 83.1 days (45-123), 63% of the patients had complete paraplegia according to the ASIA classification. 90% of the patients had bladder and bowel problems and required learning of self-catheterization. The average MIF scores at admission was 53.3 out of 126 (45-68) and 77.5 (69-98) at discharge with an average gain of 22 points. Conclusions : In Morocco, the average incidence of tuberculosis is 89 cases/100,000 inhabitants in 2015, extra-pulmonary tuberculosis represents 5 to 15%, of which only 1% affects the central nervous system, responsible of severe conditions that can be life-threatening and have functional repercussions, requiring early and multidisciplinary care. Tuberculosis is a real public health problem in Morocco. The main objective of rehabilitation of neuromeningial tuberculosis is to regain autonomy, reduce incapacity, and improve patients quality of life.
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Training as a strategy to improve care for patients with oropharyngeal dysphagia
Training as a strategy to improve care for patients with oropharyngeal dysphagia Nº48 Pages E MD, PhD1-2, Avellanet M MD, PhD1-2, Boada-Pladellorens A MD1-2, Ros M Speech Therapist1-2, Gea E Pharm, PhD1-3. 1Research Group in Health Sciences Universitat d’Andorra 2Rehabilitation Department – Hospital Nostra Sra. de Meritxell 3Pharmacy Department – Hospital Nostra Sra. de Meritxell Background Awareness of oropharyngeal dysphagia (OD) is crucial for early diagnosis, and to advance the prevention and treatment of swallowing disorders, enhancing professional consciousness is needed. The Health Sciences Research Group (Andorra University) that includes PMR doctors, pharmacist, speech therapist, has appointed in November 2021 an educational strategy for dysphagia, to raise awareness and training for health professionals related to OD: speech therapists, nurses and caregivers. Aim: The aim of the study is to evaluate participation in and benefit from training. Methods: Training was organized Training was organized in 3 levels (Level A: Basic 6 hours, Level B: Advanced 8 hours, Level C: Expert 8 hours) and the content was adapted to each level. Topics focused on 4 essential aspects that were combined with practical workshop: Anatomy-Physiology, Screening-Diagnosis, Therapeutic-nutritional interventions, Safety and efficient medication management. Participation and benefits were analyzed from November 2021 to December 2022. Participation was considered as an indicator of success. The attendees answered an evaluation survey measuring the content, methodology and organization. An open field was provided to indicate points/aspects for improvement. Photographies of the courses. Image – Evaluation survey for Level A – Results: A total of 124 places were offered for level A and 50 for level B. Attendance was 67% and 97% and overall rate, 4.46/5 and 4.55/5 for level A and level B respectively. The level C course was taken by 19 people out of those who took level 1 and overall rate was 8.9/10. Specific results on benefit were: Content 4.25/5, Teaching methodology 4.60/5, Training organization 4.53/5. The human resources of the workplace and the University email were the main means of communication to promote the level C course. Aspects to improve were increasing practical part, more real-life interventions, broader promotion of the training. Graphics for results : Attendance and overall rate. Specific results on benefit. How did you find about the program ? Conclusions Training evaluation was excellent both in participation and benefit for awareness in OD. A promotion strategy for basic level needs revision.
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Sexual dysfunction and quality of life in patients with spondyloarthritis in tunisian patients
SEXUAL DYSFUNCTION AND QUALITY OF LIFE IN PATIENTS WITH SPONDYLOARTHRITIS IN TUNISIAN PATIENTS Ramy Ben Tekaya, Jguirim Mahbouba, Saoussen Zrour, Ismail Bejia, Mongi Touzi, Naceur Bergaoui Hospital University Fattouma Bourguiba, Rheumatology Department, Monastir, Tunisia Introduction: The impact of Chronic disease is often multifactorial that affects physical, hormonal and psychological alterations, leading to problems of sexuality. Our study consists in evaluating the prevalence of fatigue and studying the quality of sleep and the sexual profile of patients with SPA. Methodology: It is a cross-sectional study including 28 patients with spondyloarthritis in the rheumatology department of the Fattouma Bourguiba University Hospital in Monastir. We used multidimensional fatigue inventory (MFI-20), Pittsburgh sleep quality index (PSQI), female sexual function index (FSFI), Sexual Health Inventory Results: The mean age was 53.7 years [25-64]. 82.1% of our patients were married. Fatigue, sleep quality and sexual profile were analyzed. Fatigue (via the MFI-20) was present in all patients. General fatigue and physical fatigue were the highest, with a mean of 12.98 and 12.81, respectively. Insomnia (PSQI> 5) was found in 65% of patients. Low sleep quality was found in 88.2% . Sleep latency > 31 minutes was found in 35.2%. Sleep duration <6 hours per night was found in 55.8% . Sleep disturbance >10 times in the last 4 weeks was found in 15% patients. Regular female sexual activity was found in 50%. Regular male sexual activity was found in 57.6% and mild erectile dysfunction (SHIM≤21) was noted in 65.3%. Conclusion: A multidimensional approach is needed to explore the different components of fatigue, sleep quality and sexual profile of SPA patients and its very diverse consequences. This should lead to an improvement in quality of life in current medical practice.
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Low-intensity extracorporeal shock wave therapy treatment of erectile dysfunction after robot-assisted radical prostatectomy
LOW-INTENSITY EXTRACORPOREAL SHOCK WAVE THERAPY TREATMENT OF ERECTILE DYSFUNCTION AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY M. Koleva¹, I. Takeva² Medical University – Pleven¹ Faculty of Medicine of Sofia University “St. Kliment Ohridski“², Bulgaria Background and aims Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been reported as an option in the treatment of patients with erectile dysfunction (ED). The algorithm of treatment is not clarified. The aim of the current study was to determine the efficacy and safety of Li-ESWT for early ED rehabilitation after robotic-assisted radical prostatectomy (RARP) for prostate cancer (PC) and whether more frequent administration of Li-ESWT has better therapeutic effect. Methods 68 men with prostate carcinoma underwent nerve-sparing robot-assisted radical prostatectomy from 2017 to 2022. 48 men underwent low-intensity extracorporeal shock wave therapy after robot-assisted radical prostatectomy for prostate carcinoma. • 26 men (group 1) were treated with low-intensity extracorporeal shock wave therapy once a week for a period of 6 weeks • 22 men (group 2) were treated with low-intensity extracorporeal shock wave therapy twice a week for a period of 6 weeks • 20 men (group 3) were not treated with low-intensity extracorporeal shock wave therapy There are many Li-ESWT devices worldwide. We used Chattanooga Intelect RPW Shockwave Therapy (Chattanooga Medical Supply Inc.), which operates with a pressure of 1.4 to 5 bar and a frequency of 0.5 to 21 Hz, applicator STORS Switzerland (Fig.1). Low-intensity extracorporeal shock wave therapy is administered. • after the 14th postoperative day • for a period of 6 weeks • at 5 positions of the penis: in the proximal, middle and distal part of the dorsal surface of the body of the penis, as well as on the left and right legs of the corpus cavernosum, with the penis in an extended position (Fig. 2) • 600 strokes were exposed at each point, for a total of 3000 strokes per procedure All procedures were performed without anesthesia in an outpatient setting. We used a standardized International Index of Erectile Function (IIEF-5) questionnaire to assess erectile function before, after Li-ESWT, and 1 month after therapy. Results The average age of the studied patients was 61.26±4.73. In the patients of groups 1 and 2, a significant improvement of the erectile function was achieved on the 1st month after the therapy compared to the initial values (Fig. 3). There was no significant difference between the results in the first two groups. The results were clinically significant difference in groups 1 and 2 compared to the control group. No cases of patients with side effects from Li-ESWT have been observed. Conclusions Early physical therapy may provide more effective penile blood flow during temporary cavernous neuropraxia occurring after radical prostatectomy. Considering the natural course of cavernous nerve recovery after radical prostatectomy, early physical therapy would be effective in improving the overall recovery of sexual function. Li-ESWT can be successfully applied to patients with ED after RARP. More frequent application does not lead to an increase in the effectiveness of the procedure. The method is efficient and safe. This study is financed by the European Union-NextGenerationEU, through the National Recovery and Resilience Plan of the Republic of Bulgaria, project № BG-RRP-2.004-0003-C01.
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Description of voice disorders in patients with amyotrophic lateral sclerosis (ALS) using biomechanical voice analysis
DESCRIPTION OF VOICE DISORDERS IN PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS (ALS) USING BIOMECHANICAL VOICE ANALYSIS (nº 81) Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects nerve cells in the brain and spinal cord, resulting in loss of muscle control at various levels. Dysarthria can occur in up to 80% of patients and is caused by weakness of the muscles of the mouth and face, among others. In the case of voice in ALS, there may be a mechanism of hyperabduction, or abduction observed depending on whether it is bulbar or corticobulbar predominant, respectively. The main aim of the study is to characterize the biomechanical voice alterations in ALS patients. Is a prospective descriptive observational study, in which a sample of patients with ALS is compared with a sample of patients without neurological voice pathology. Both patients underwent a biomechanical study of the voice using the mobile application Online Lab. The total sample was 86 patients (43 ALS patients and 43 control patients). No significant differences were observed in relation to voice sampling and time since ALS diagnosis. In the pairwise analysis using the OPLS- DA method, we observed with an R2 0.41 that patients with bulbar ALS compared to controls show impairment of Pr7, Pr10, Pr16 and Pr17, which informs us of an alteration in vocal fold closure with a decrease in the efficiency of glottal closure. By means of the biomechanical analysis of the voice in ALS with Voice Clinical System, we could obtain the characterization of the voice independently of the evolutionary moment of the ALS.
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Correlation between Outcomes of Rehabilitation Treatment in Fibromyalgia
Correlation between Outcomes of Rehabilitation Treatment in Fibromyalgia J. Getmansky, MD, E. Brav, L. Lutsky, MD, A. Friedman, MD, I. Treger, MD Background and aims Fibromyalgia (FM) is the most common cause of chronic widespread musculosceletal pain, often accompanied by fatigue, cognitive disturbance, psychiatric symptoms including sleep disturbance, and multiple somatic symptoms. Reduced functional capacity is a common characteristic of FM. The aim of this study is to examine the impact of FM on inpatient rehabilitation outcomes compared to patients without FM. Methods A retrospective cohort study was conducted based on electronic medical record data for Clalit Health Services (CHS) members. The study included all members of CHS aged ≥18 that were admitted to our department between 2015 and 2022, which were divided into 2 groups. Group 1 (n=43) consisted of patients who had a diagnosis of FM in their medical record and Group 2 (n=1,348) – these patients without FM. Tests assesing congnitive function (Montreal Cognitive Assessment [MoCA]), balance (Berg Balance Scale, Dynamic Gait Index [DGI]), and Functional Independence Measurement (FIM) – at admission and discharge, were extracted for each patient, as well as length of stay (LOS). Results No significant difference was found for MoCA, MMSE, Berg and DGI (p-value of 0.76, 0.76, 0.17, 0.24 respectively). Also, there was no significant difference in LOS, admission FIM and discharge FIM (p-value of 0.1, 0.23, 0.15 respectivly). Conclusions This study showed no diffrence in functional gain between patients with and without FM. Because the FM group was small relatively to the control group, there is a need for more research to avoid confounding factors that might have altered the true nature of the proposed objectives.
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Case report: anterior tarsal tunnel syndrome
CASE REPORT: ANTERIOR TARSAL TUNNEL SYNDROME Ioannis – Alexandros Tzanos1, Ioulia – Eleni Panagiotopoulou1, Nefeli – Anna Papageorgiou1, Georgia Mpaili2, Aikaterini Kotroni1 1. PRM Department, KAT General Hospital, Kifissia, Greece 2. Rheumatology Department, KAT General Hospital, Kifissia, Greece • Background and aims Τhe anterior tarsal tunnel syndrome is an entrapment neuropathy of the deep peroneal nerve, most commonly due to stretching of the nerve due to ankle instability or direct injury of the nerve at the ankle area. This case report study highlights the value of Electromyography (EMG) in conjunction with clinical information in the diagnosis of this relatively rare clinical entity. • Methods A 50-year-old woman was referred to our EMG Laboratory for an electrodiagnostic test of left lower limb. She reported a neglected, untreated fracture of her left ankle two years ago. Clinically, she presented with a varus deformity. During gait, she was loading the outer surface of the foot and the ankle with accompanying skin calluses. She reported mild pain and numbness in the dorsal area of her ankle and foot. Clinical examination showed impaired sensation in the distal dorsum of the left foot between hallux and 2nd toe in comparison with the left side. • Results The EMG examination showed a significant reduction in voluntary activity and a polyphasic form of motor units. In all the other muscles examined, the EMG test was normal. The nerve conduction studies were bilaterally normal except from the compound motor action potential of the left deep peroneal nerve that presented with low amplitude. Motor conduction velocity of the left deep peroneal nerve was also low, due to severe axonal damage. • Conclusions The combination of history, clinical examination and EMG findings in this patient support the diagnosis of anterior tarsal tunnel syndrome.
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Case report: electromyographic investigation of severe one-sided axonal sciatic nerve damage after ICU hospitalization due to severe Sars-Cov-2 infection
CASE REPORT: ELECTROMYOGRAPHIC INVESTIGATION OF SEVERE ONE-SIDED AXONAL SCIATIC NERVE DAMAGE AFTER ICU HOSPITALIZATION DUE TO SEVERE SARS-COV-2 INFECTION Ioannis – Alexandros Tzanos1, Antonios Gkountoulas1, Nefeli – Anna Papageorgiou1, Georgia Mpaili2, Michail Krikelis2, Kalirroi Antoniadi3, Aggelos Papakonstantinou3, Aikaterini Kotroni1 1. PRM Department, KAT General Hospital, Kifissia, Greece 2. Rheumatology Department, KAT General Hospital, Kifissia, Greece 3. General Hospital of Nea Ionia “Konstantopoulio” – Patision • Background and aims Severe SARS-CoV-2 infection is often accompanied by peripheral nerve damage. It is also known that patients often placed inappropriately in the ICU bed, which may lead to peripheral nerve entrapments. Our objective is to present a case of a patient with severe sciatic nerve damage after hospitalization in ICU due to severe SARS-CoV-2 infection. • Methods A 44-year-old woman came to our electromyography laboratory due to weakness and hypoesthesia of the left lower extremity (sciatic nerve distribution) for a month, at which time she was discharged from the ICU. He had remained in the ICU for 7 days due to severe respiratory failure due to SARS-CoV-2 infection. She was walking using an ankle foot orthosis. • Results Electromyographic testing revealed spontaneous activity at rest in the left hamstrings, tibialis anterior, gastrocnemius, abductor hallucis, and extensor digitorum brevis. No voluntary motor unit activity was found from the above muscles while no motor evoked potential was recorded from the left peroneal and tibial nerves. Sensory evoked potential from the left sural nerve was also not recorded, which support the diagnosis of postganglionic damage. • Conclusions Differential diagnosis of the cause of this sciatic nerve axonal injury between nerve entrapment due to prolonged misplacement and mononeuropathy due to Covid-19 in this case is difficult and requires more evidence from patient’s recent medical history.
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Electrodiagnostic challenges of amyatrophic lateral sclerosis: the experience of a complex case
ELECTRODIAGNOSTIC CHALLENGES OF AMYATROPHIC LATERAL SCLEROSIS: THE EXPERIENCE OF A COMPLEX CASE Ioannis – Alexandros Tzanos1, Antonios Gkountoulas1, Ioulia – Eleni Panagiotopoulou1, Aggeliki Emmanouil2, Gerasimos Evangelatos3, Nikolena Repousi4, Aikaterini Kotroni1 1. PRM Department, KAT General Hospital, Kifissia, Greece 2. Rheumatology Department, Evaggelismos General Hospital, Athens, Greece 3. First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Athens, Greece 4. Korgialeneio – Mpenakeio EES General Hospital, Athens, Greece • Background and aims Amyotrophic Lateral Sclerosis (ALS) is a degenerative, rapidly progressive disease of the motor neuron ganglia in the anterior horns of the spinal cord. It is also known that lymphomas are associated with the development of axonal/ demyelinating polyneuropathy. The purpose of this work is to present a case of a patient with history of lymphoma and coexisting clinical and electromyographic findings that raise the suspicion of ALS. • Methods A 55-year-old man with non-Hodgkin’s lymphoma reported cramps and fasciculations (mainly in lower limbs) starting three months before, as well as difficulty in carrying out some daily activities (eg clothing). His mother was diagnosed with ALS. The symptoms started after chemotherapy initiation. The clinical examination revealed normal muscle strength and sensation of the upper and lower extremities, increased patellar reflexes bilaterally, and left gastrocnemius fasciculations. • Results Electroneurography showed low sensory and motor conduction velocities in upper limbs. Electromyography showed fibrillation and positive sharp waves in right deltoid, extensor carpi longus, tibialis anterior, abductor halluces, and gastrocnemius, and also in left abductor hallucis and gastrocnemius. In some of these muscles, fasciculaton potentials were also recorded. During the examination, evidence of hypertonia of the lower extremities was also found. • Conclusions In this case, the ALS electromyographic criteria are met. However, the diagnosis of axonal/demyelinating polyneuropathy attributed to lymphoma or chemotherapy cannot be ruled out. The relatively symmetrical findings in the lower extremities and the slow conduction velocities in the upper extremities support the diagnosis of polyneuropathy, whereas fasciculations that of ALS.
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Training of general/family medicine residents in physical and rehabilitation medicine: expectations, reality, suggestions
TRAINING OF GENERAL/FAMILY MEDICINE RESIDENTS IN PHYSICAL AND REHABILITATION MEDICINE: EXPECTATIONS, REALITY, SUGGESTIONS Nikolena Repousi1, Ioannis – Alexandros Tzanos2, Sofia Sivetidou2, Aikaterini Kotroni2 1. Korgialeneio – Mpenakeio EES General Hospital, Athens, Greece 2. PRM Department, KAT General Hospital, Kifissia, Greece • Background and aims According to the new national legislation, General/Family Medicine residents in Greece may practice for 1 month in Physical and Rehabilitation Medicine (PRM). Our aim is to present the first conclusions from the implementation of this educational process. • Methods The initial goal of this rotation is to familiarize the General Practitioner (GP) with PRM, given the lack of relevant information. Furthermore, it targets on training in the diagnostic approach and the available conservative treatment options for diseases of the musculoskeletal and nervous system. • Results In the PRM Department, GPs are exposed to cases with musculoskeletal injuries, neurological conditions and chronic pain in whom physiatric assessment and rehabilitation are beneficial and thus understand its value. In this way, GPs can inform the patient about the possible need for rehabilitation. However, by attending the outpatient clinics of PRM, GPs can obtain useful knowledge for the provision of primary care and the practice of preventive medicine through ergonomic interventions. GPs also learn about the appropriate therapeutic interventions for these patients (eg modalities, medication, therapeutic exercise, orthoses) and thus can holistically approach them. In addition, by attending the electromyography laboratory, GPs can understand those cases in which there is a diagnostic value in performing this examination. • Conclusions For better contact of GPs with PRM, it is necessary to organize courses adapted to primary health care. More specifically, these courses should focus on the required knowledge for the proper guidance of patients with conditions related to PRM by the primary care physician.
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Electrodiagnostic approach of foot drop in a multitrauma patient with multiple operated pelvic fractures
ELECTRODIAGNOSTIC APPROACH OF FOOT DROP IN A MULTITRAUMA PATIENT WITH MULTIPLE OPERATED PELVIC FRACTURES Ioannis – Alexandros Tzanos1, Antonios Gkountoulas1, Dafni Sourelli2, Antonios Georgountzos3, Hrissoula Hatzara4, Eleftheria Veisaki,5 Sofia Sivetidou1, Aikaterini Kotroni1 1. PRM Department, KAT General Hospital 2. Korgialeneio – Mpenakeio EES General Hospital, Athens, Greece 3. Rheumatology Department, Evaggelismos General Hospital, Athens, Greece 4. Rheumatology Department, KAT General Hospital, Kifissia, Greece 5. Laiko General Hospital, Athens, Greece • Background and aims It is known that sciatic nerve lesions tend to affect more its peroneal division due to the peculiarity of the course of the peroneal nerve which makes this division more susceptible to injury and axonal damage. Therefore, the clinical findings of sciatic nerve injury usually resemble that of peroneal nerve damage. Distinguishing between these two entities requires electromyographic investigation of the short head of the biceps. • Methods A 32-year-old man was admitted to our Department to follow a rehabilitation program due to weakness and hypoesthesia of the right lower extremity (common peroneal nerve distribution). Symptoms started a month before, after being operated on for multiple fractures of the right pelvis due to car accident. • Results Electromyographic testing revealed rich spontaneous activity at rest in right tibialis anterior and less rich in right extensor digitorum brevis. No voluntary activity was recorded from right tibialis anterior while a pattern of reduced recruitment was recorded from right extensor digitorum brevis. No abnormal findings were found from right gastrocnemius, abductor hallucis, long and short head of biceps. The sensory evoked potential from right gastrocnemius nerve was normal while that of right superficial peroneal nerve was not recorded. • Conclusions Although data from medical history suggested sciatic nerve injury in the pelvic region as more likely, the absence of pathological findings from the biceps short head and the normal sensory evoked potential of gastrocnemius nerve argue in favor of peroneal nerve damage in the fibular head, possibly due to prolonged malpositioning during surgery.
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Ischiofemoral impingement syndrome: a rare diagnosis of buttock pain
ISCHIOFEMORAL IMPINGEMENT SYNDROME: A RARE DIAGNOSIS OF BUTTOCK PAIN Ioannis – Alexandros Tzanos1, Lamprini Drosou – Pappa2, Nikolaos Tsakalakis3, Aikaterini Kotroni1 1. PRM Department, KAT General Hospital, Kifissia, Greece 2. General Hospital of Arta 3. General Hospital of Nea Ionia “Konstantopoulio” – Patision • Background and aims Ischiofemoral impingement syndrome is a rare cause of hip pain and is defined as a narrowing of the space between the ischial tuberosity and the lesser trochanter (idiopathic, due to injury or due to abnormal morphology of the quadratus femoris muscle). Clinical symptoms vary, but usually consist of buttock and groin pain. Symptoms are reproduced by combined extension, adduction, and external rotation of the hip on physical examination and during walking with a long stride. On MRI, the signal of the quadratus femoris muscle is evaluated. • Methods A 39-year-old woman visited the outpatient clinic of our Department mentioning left gluteal pain during daily activities. She reported that the symptoms had ups and downs but worsened after a sudden movement while swimming two months ago. • Results Clinical examination revealed pain during testing of left hip extension, adduction, and external rotation. MRI of the left hip revealed swelling of the left quadratus femoris muscle. We recommended physical therapy sessions of strengthening and stretching of the quadratus femoris muscle and other hip external rotators, avoiding impinging movement. Nonsteroidal anti-inflammatory drugs were also prescribed for 10 days. Pain was significantly reduced and the ability to perform pain-free walking increased. • Conclusions In the case of this patient, the evidence from the medical history as well as the clinical and imaging findings favor the diagnosis of ischiofemoral impingement syndrome, which, although it is rare, must be included in the differential diagnosis in similar cases. Conservative treatment was sufficient for the remission of symptoms.
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Efficacy of rehabilitation in hospitalized patients with billateral Covid-19 pneumonia
EFFICACY OF REHABILITATION IN HOSPITALIZED PATIENTS WITH BILLATERAL COVID-19 PNEUMONIA Marina Vuković1, Nermin Abdić2, Vanja Vukićević3 1Romatem Montenegro, Center for physical therapy and rehabilitation, Podgorica, Montenegro 2Clinical Center of Montenegro,Clinic for orthopedics and traumatology Podgorica, Montenegro 3General Hospital Berane, Department for physical and rehabilitaion medicine, Berane, Montenegro Background and aims Rehabilitation is an integral part of the treatment of hospitalized patients with pulmonary insufficiency. We aimed to evaluate efficacy of early rehabilitation in patients with billateral covid pneumonia, the impact on functional disability caused by dyspnea and rating exertion and breathlessness during physical activity. Methods Hospitalized non-intubated patients with bilateral COVID 19 pneumonia included in a study. Patients had rehabilitation program twice a day (positioning, breathing exercises, airway clearance techniques, exercises for arms and legs, transfers, walk). The Modified Borg Scale (mBS), Modified Medical Research Council Dyspnea Scale (MMRCDS), assessment of walking ability, hand grip of the dominant hand using a dynamometer (HG) on the first (fdr) and last (ldr) day of rehabilitation, were measured. Results 54 patients average age 60±14.23 were included in the study. The average duration of rehabilitation is 9.81±5.33. 27 patients were on non-invasive ventilation, and 27 were on oxygen supplementation using oronasal mask. 41 patients were unable to walk on fdr, and on ldr four of them were unable to walk (X2 McNemar = 35.027, df=1, p< 0.001). Median value mBSfdr at rest (3.0; 0-5) and mBSldr (0.5; 0-3) (V=1029, p< 0.001). Median value mBSfdr after rehabilitation session (3.0; 0.5-7), and mBSldr (1; 0-4) ( V= 1252, p< 0.001). Median value MMRCDSfdr (4; 2-4) and MMRCDSldr (2; 0-4) ( V= 1275, p< 0.001). Median HGfdr (39.8; 0.5-110) and HGldr (49; 2-110) ( V= 59.5, p< 0.001). Conclusions Early rehabilitation helps improve functional performance, reduce dyspnea and improve strength in hospitalized covid patients.
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Musculoskeletal symptoms and related factors in postacute COVID-19 patients
Musculoskeletal Symptoms and Related Factors in Post Acute Covid-19 Patients Fulya Bakılan1, İsmail Güneş Gökmen2, Burcu Ortanca1, Anıl Uçan3, Şebnem Eker Güvenç4, Fezan Şahin Mutlu5, Hatice Merve Gökmen2, Ayşe Ekim6 1Eskisehir Osmangazi University, Department of Physical Medicine and Rehabilitation, Turkey 2Eskisehir City Hospital, Physical Medicine and Rehabilitation, Turkey 3Eskisehir City Hospital, Internal Medicine, Turkey 4Special Clinic in Eskisehir, Turkey 5Eskisehir Osmangazi University, Department of Biostatistics, Turkey 6Special Physical Medicine and Rehabilitation Clinic in Eskisehir, Turkey Introduction There is a lack of an overview of the factors associated with post-acute-COVID-19 musculoskeletal symptoms. The aims were:1-to evaluate the most frequent admission symptoms and the frequency of musculoskeletal symptoms in post-acute-COVID-19 patients; and 2-to determine the related factors with the post-acute-COVID-19 musculoskeletal symptoms. Methods A total of 280 post-acute-COVID-19 patients (183-females,97-males) who admitted to Physical Medicine and Rehabilitation, were enrolled and divided into two groups:1-patients whose musculoskeletal symptoms initiated with or were aggravated by COVID-19 (n=240); 2-patients whose musculoskeletal symptoms did not change with COVID-19 (n=40). The variables were demographic and treatment data, symptoms on admission, post-acute-COVID-19 symptoms, laboratory results (complete blood count, erythrocyte-sedimentation-rate, C-reactive-protein, ferritin, D-dimer), chest computed-tomography findings and symptoms during acute COVID-19. Results Most of the patients had fatigue (71.8%), spine-pain (70.7%) and myalgia (60.7%). The most common pain region was the back (30.4%). The frequency of dyspnea was 30%, of cough 18.5%, and of chest-pain 10.7%. Having any chronic disease (p=0.031), the duration of hospital stay (p=0.016), frequency of back-pain during acute COVID-19 (p=0.018), tomography findings and D-dimer (p=0.035) levels were significantly higher, and lymphocyte (p=0.024) levels were significantly lower in the patients whose symptoms began with or were aggravated by COVID-19. Conclusion This study described the factors associated with post acute COVID-19 musculoskeletal symptoms. The majority of post-acute COVID-19 patients had at least one symptom. Fatigue was the most common symptom in post acute COVID-19 patients, while the most frequent admission symptom to physical medicine and rehabilitation outpatient clinic was back pain. The presence of all these seem to contribute to post acute COVID-19 musculoskeletal symptoms : • Lower lymphocyte • Higher D-dimer levels • Presence of COVID-19 in chest computed tomography • Back pain during acute COVID-19 infection • Higher duration of hospital stay • Having chronic diseases References: • Bakılan F, Gökmen İG, Ortanca B, Uçan A, Eker Güvenç Ş, Şahin Mutlu F, et al. (2021). Musculoskeletal symptoms and related factors in postacute COVID‐19 patients. International journal of clinical practice, 75(11), e14734.
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Evaluation of spine and feet deformities in Belgrade children aged ten years old
EVALUATION OF SPINE AND FEET DEFORMITIES IN BELGRADE CHILDREN AGED TEN YEARS OLD Mirjana Grčki1, Aleksandar Radovanović2 1) Department of Physical Medicine and Rehabilitation, Health Center Euromedik, Belgrade, Serbia 2) Department of Physical Medicine and Rehabilitation, Health Center “Dr. Simo Milosevic” Cukarica, Belgrade, Serbia Background: The success of postural disorders and spinal deformities treatment is highly dependent on early detection and timely interventions1. In Serbia, one of the regular screenings of school-aged children is conducted at age ten, during the intensive growth period. Aim: To determine the incidence of idiopathic scoliosis (M41), postural disfunction (M40) and feet deformities (Q66) in school-going children aged ten in Belgrade municipality of Cukarica and to investigate the covariant influence of each of these deformities. Furthermore, we aimed to assess the gender differences and correlation among each of these deformities. Methods: During the regular screening 1103 school-going children (540 (49%) boys and 563 (51%) girls) were examined in the period of 4 weeks during Nov-Dec 2022. Following physical examination methods were used: Inspecting symmetry of the shoulders and scapulae, Adam’s forward bend test, observing longitudinal foot arch and plantography. Statistical analysis was performed using chi-squared test. Results: The incidences of deformities in the whole sample were M40 100 (9.1%); M41 135 (12.3%) and Q66 611 (55.4%). The statistical analysis showed that children diagnosed with Q66 have greater incidence of M41 (14.2% vs. 9.8% p=0.024). The analysis of differences between boys and girls revealed that M40 incidence was higher in boys comparing to girls (11.7% vs. 6.6%). Additionally, in the subset of boys, positive correlation was determined between M41 and Q66. 15.3 % boys with Q66 also had M41, while those without Q66 had M41 in 8.6% (p=0.019). Conclusion: Our results suggest that impaired static and postural stability due to feet deformities (flatfoot) can increase the risk of development of idiopathic scoliosis in school-aged boys. REFERENCES 1. Popova, Daniela, et al. Activities in Physical Education and Sport 5.1 (2015): 30-32.
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A randomized- controlled clinical trial comparing the effects of steroid phonophoresis and therapeutic ultrasound in carpal tunnel syndrome
EVALUATION OF THE EFFECTS OF STEROID PHONOPHORESIS AND THERAPEUTIC ULTRASOUND IN CARPAL TUNNEL SYNDROME

Burcu Ortanca 1, Onur ARMAGAN 1, Fulya BAKILAN 1, Merih OZGEN 1, Funda Berkan 1, Setenay ONER 2 

1 Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey 
2 Department of Biostatistics, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey Background and aims In this placebo-controlled, randomized, prospective study, the efficacy of ultrasonography (US) and steroid phonophoresis (PH) treatments was compared in patients with idiopathic carpal tunnel syndrome. Methods Twenty-seven patients (46 hands) were admitted in this study. Patients were randomly divided three groups. The first group was ultrasound group, the second group was PH group and the third group was placebo US group. Continuous ultrasound with a frequency of 1 MHz, an intensity of 1.0 W/cm2 was used in the US and the PH groups. PH group received 0,1% dexamethasone. Placebo group received a frequency of 0 MHz, an intensity of 0 W/cm² ultrasound. Treatments were administered for 5 days a week, a total of 10 sessions. All patients also wore night splints during treatment. Visual Analogue Scale (VAS), Boston Carpal Tunnel Questionnaire, grip strength and electroneurophysiological evaluations were compared before the treatment, after the treatment and three months later.  Results All clinical parameters improved in all groups after treatment and at 3 months, except grip strength (Table1). Recovery in the sensory nerve conduction velocity between palm and wrist was seen in ultrasound group at 3 months after the treatment; however recovery in the sensory nerve distal latency between 2nd finger and palm was seen in phonophoresis and placebo groups after treatment and at 3 months after the treatment (Table 2). Conclusion There is currently no agreement about treatment strategies for carpal tunnel syndrome. The merit of this study was that it compared the effectiveness of splint, US, and steroid phonophoresis in a randomized, placebo-controlled fashion. The results of this study suggest that splinting therapy combined with steroid phonophoresis, placebo or continuous ultrasound is effective for both clinical and electroneurophysiological improvement, however electroneurophysiological improvement is limited. Reference Ortanca B, Armağan O, Bakılan F, Özgen M, Berkan F, Öner S. A randomized-controlled clinical trial comparing the effects of steroid phonophoresis and therapeutic ultrasound in carpal tunnel syndrome. Arch Rheumatol. 2022 Jun 18;37(4):517-526.
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One-stage bilateral total hip arthroplasty: Case report and literature review
One-stage bilateral total hip arthroplasty: Case report and literature review Authors: José Pedro Pimenta¹; Tiago Barbosa¹; Ana Mafalda Cunha¹; Marco Silva¹; Vítor Sousa¹; Diogo Araújo¹; Joana Silva¹; Raquel Santos¹; Patrícia Cunha Vaz¹ ¹ Hospital da Senhora da Oliveira – Guimarães INTRODUCTION Total hip arthroplasty (THA) is a procedure in which the damaged bone and cartilage is removed and replaced with prosthetic components. It is considered one of the most cost-effective and successful orthopedic surgeries performed in the last 50 years, with good outcomes for patients suffering from advanced hip osteoarthritis, providing pain relief and improving general quality of life. However, in patients suffering from bilateral hip osteoarthritis, there is still controversies between conducting one or two-stage bilateral THA. CASE REPORT • Male, 43 years old. Autonomous in his activities of daily living (ADL). Working as a security for a company. • Personal history of pulmonary embolism, PESI score of 92 (intermediate risk). • Current medication: Apixaban 5mg twice daily. Patient stated bilateral hip pain started around 15 years ago. It got progressively worse with time, now affecting his professional activity. Patient has tried numerous non-surgical options prior, such as physical therapy, pain relief medication, or cortisone injections with little to no relief. He was proposed for a one-stage THA, which underwent smoothly. The patient was released with no complications, including DVT, and was well-adapted to the crutches, and was advised to continue with the physical therapy for strengthening and complete ROM. Three months after the surgery the patient was walking without any aid, showed a suboptimal ROM and the average pain levels were 0-1/10, without any discomfort at work. The patient was able to resume his life with a great improvement in quality of life. Fig.1: Preoperative hip X-Ray showing significant bilateral osteoarthritis of the hip. Fig.2: Postoperative hip X-Ray showing the correct alignment of the prothesis. DISCUSSION One-stage bilateral hip arthroplasty is a treatment option for patients suffering with bilateral hip osteoarthritis. By reviewing the literature we understand that one-stage bilateral hip arthroplasty was superior to two-stage bilateral hip arthroplasty in terms of systemic complication, such as DVP, and rehabilitation had better results. However, higher evidence level studies are necessary for further conclusions. REFERENCES • Hart, A. Khalil, N. N. Patel, et al., “One-stage versus two-stage bilateral hip arthroplasty: a systematic review and meta-analysis of comparative studies,” The Journal of Arthroplasty, vol. 33, no. 4, pp. 1269-1275.e1, 2018; • A. Matar, M. A. Mousa, and A. A. Elkousy, “One-stage versus two-stage bilateral total hip arthroplasty: a systematic review and meta-analysis,” The Journal of Arthroplasty, vol. 32, no. 9, pp. 2913-2919, 2017. • N. N. Patel, J. L. Yoon, A. M. Naziri, et al., “One-stage versus two-stage bilateral total hip arthroplasty: a comparison of complications and mortality,” The Journal of Arthroplasty, vol. 33, no. 1, pp. 142-147, 2018.
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Postural reconstruction in the treatment of complex regional pain syndrome of the manducator system
POSTURAL Reconstruction IN THE TREATMENT OF Complex regional pain syndrome OF THE MANDUCATOR SYSTEM Z.TAHRI H.BOURRA P.MADJIDANEM N.KYAL F.LMIDMANI A.ELFATIMI
Department of Physical Medicine and Rehabilitation, UHC Ibn Rochd- Casablanca-Morocco INTRODUCTION : The oral aperture in a well-balanced patient is artificially modified by a change in body posture. The imbalance of the mandible causes changes in the general posture of the body, corresponding to those that cause a deviation of the mandible when opening the mouth. The aim of this work is to demonstrate the efficacy of postural reconstruction in the treatment of Complex regional pain syndrome of the manducator system (CRPSMS) Materials and Methods:  Retrospective study of 12 cases with CRPSMS who benefited from rehabilitation sessions for 6 months at a rate of approximately one weekly postural reconstruction session. The physiotherapist will make the patient perform located voluntary contractions by movements with the greatest possible range of motion (the large amplitude movement relative, L.A.M.R), which induce remotely in the opposite block if possible, one or more evoked responses, that is, transient abnormal behaviors induced by hypertonic muscular chains. Evaluation methods : • Questioning in search of complicating factors of the disease or bad posture. • Joint, muscle, static and dynamic assessment from the beginning to the end of treatment RESULTS : There is a female predominance (11 women vs one man) with a mean age of 28 years old (19 -38 years old). Nine cases had a history of falls, three had complex psychological conditions. with regard to functional craniomandibular disorders and ENT-symptoms, the treatment modified them in nine cases (better posture placement of the head on the trunk) with improvement of pain in 11 cases (VAS went down from 6/10 to 2/10) DISCUSSION The CRPSMS includes all painful and non-painful disorders due to structural, biochemical or psychic dysfunction of the masticatory muscles and / or the temporomandibular joint. The therapeutic approach is conservative and cautious : Analgesics, anti-inflammatory or muscle relaxants. In postural reconstruction, there is an increase in tone obtained at a distance by the work of the lower block which is manifested on the upper cervical spine and on the temporo-mandibular region, by deviations of the jaw, or cervical dysmorphology interfering with swallowing. CONCLUSION Conventional rehabilitation alone does not cure or prevent relapses which are quite frequent, however, we are justified in saying that there is a high probability of a causal link between the work of postural reconstruction and the improvements observed in the cranio mandibular region. References 1- Georges W. manuel de posturologie : approche clinique et traitements des pathologies rachidiennes et céphalique. edition frisson-roche 2004 2- EMC de kinésithérapie 26-280-B-10 D collin : traitement du SADAM
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Biomechanical voice differences in patients with bulbar versus spinal ALS
BIOMECHANICAL VOICE DIFFERENCES IN PATIENTS WITH BULBAR VERSUS SPINAL ALS (nº 98) Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects motor neurons and causes muscle weakness and atrophy. ALS can be classified into bulbar ALS and spinal ALS. In bulbar ALS, speech and swallowing are initially affected, whereas in spinal ALS, the muscles of the limbs and trunk are usually affected. The biomechanical profile of voice in bulbar ALS patients is characterized by reduced speech intensity, reduced vocal range, and decreased speech rate. On the other hand, spinal ALS patients may experience reduced speech volume and decreased speech rate due to the weakness of the respiratory muscles, but they generally maintain their vocal range and articulation. The aim is describing the biomechanical differences of voice in bulbar versus spinal ALS. This is a prospective descriptive observational study, comparing biomechanical voice parameters in patients with bulbar versus spinal ALS. All patients underwent a biomechanical study of the voice using the mobile application Online Lab. The total sample was 43 patients (20 bulbar ALS and 23 spinal ALS). For the comparative model, using OPLS- DA analysis, of bulbar ALS with spinal ALS, we obtained significant alteration, with Q2 =0.0732 and R2=0.1747, of Pr5 and Pr18 in bulbar ALS, as well as a decreased Pr9 compared to spinal ALS. In conclusion, patients with bulbar ALS may have an increased time in the opening phase of the vocal cords (VC) as well as an increased mucosal wave of the VC during the opening phase and a decreased glottal closure force, compared to spinal ALS.
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Stromal vascular fraction treatment for knee osteoarthritis: preliminary results.
Stromal vascular fraction treatment for knee osteoarthritis: preliminary results. Nº107 Boada-Pladellorens A MD1,2, Avellanet M MD, PhD1,2, Veiga A, PhD3, Farras JA, MD4, Pages-Bolibar E MD, PhD1. 1Research Group in Health Sciences, Universitat d’Andorra 2Celular Clinic 3Barcelona Stem Cell Bank. Regenerative Medicine Programme. Institut d’Investigació Biomèdica de Bellvitge. IDIBELL. Barcelona 4Centre Radiològic Drs Farràs – Centre Mèdic d’Especialitats. Andorra Background and aims Knee osteoarthritis (KOA) is a chronic degenerative joint condition characterised by the progressive destruction of the articular cartilage. Treatment with stromal vascular fraction (SVF) contains adipose derived mesenchymal stem cells and is among the new strategies to treat KOA. SVF efficacy and safety has already been proven but the use of a standardised SVF product is needed to better analyse clinical and radiological improvements. Methods We present 6 cases of unilateral chronic KOA who underwent a standardised SVF treatment (CelStem). The treatment is made from the autologous adipose tissue acquired via liposuction and prepared by biotechnologists in a clean room manufacturing environment. Few hours after, the SVF treatment is injected intraarticularly in the affected knee. Magnetic resonance images (MRI) analysis through MOCART classification, pain, and functional outcomes (VAS and KOOS) are assessed before and 1-year after the treatment. Adverse effects are reported. Illustration of the components of lipoaspirate (a), adipose tissue (b) and SVF (c). Use with permission of Springer Nature. Results 4 men and 2 women, middle aged (mean age 54), mean body mass index 27.17, were treated with SVF: two left and four right knees. MOCART classification improved in all cases whereas VAS and KOOS did it in 4 patients (21.53, 4.1 and 14.62 points of average improvement, respectively). No adverse effects were reported. Characteristics of the patients VAS (a), KOOS score (b) and MOCART classification (c) differences between pre and post treatment Sagital knee MRI images pre (A) and post (B) SVF treatment showing improvement of femoropatellar cartilage lesion (red circles). Coronal knee MRI images pre (C) and post (D) SVF treatment showing greater thickness of femorotibial cartilage (red circles). Sagital knee MRI images pre (E) and post (F) SVF treatment showing improvement of focal cartilage lesion (red circles). Conclusions A manufacturing standardised SVF product is safe and seems to be effective for KOA with radiological evidence of cartilage regeneration. Boada-Pladellorens A, Avellanet M, Pages-Bolibar E, Veiga A. Stromal vascular fraction therapy for knee osteoarthritis: a systematic review. Ther Adv Musculoskelet Dis. 2022 Aug 16;14:1759720X221117879. doi: 10.1177/1759720X221117879. PMID: 35991523; PMCID: PMC9386815. Shanmugasundaram S, Vaish A, Chavada V, Murrell WD, Vaishya R. Assessment of safety and efficacy of intra-articular injection of stromal vascular fraction for the treatment of knee osteoarthritis-a systematic review. Int Orthop. 2021 Mar;45(3):615-625. doi: 10.1007/s00264-020-04926-x. Epub 2021 Jan 12. PMID: 33432400.
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Is stromal vascular fraction a treatment option for tendon injuries? A case report
Is Stromal Vascular Fraction a treatment option for tendon injuries? A case report Nº108 Boada-Pladellorens A MD, Avellanet M MD, PhD, Pages-Bolibar E MD, PhD. Research Group in Health Sciences, Universitat d’Andorra Celular Clinic Background and aims Current treatments available for tendinopathies and tendon injury, either conservative or surgical, are unable to restore the original tendon structure, functionality and biomechanical features. Although some preclinical studies have proven tendon healing with platelet-rich plasma (PRP), evidence in humans is still lacking. Therefore, biological treatments based on mesenchymal stem cells (MSC) are increasingly being used to improve tendon regeneration. Stromal vascular fraction (SVF), obtained from adipose tissue and made of large numbers of MSC, is feasible and safe and seems to improve tendon healing. Methods We present a clinical case of tendinopathy and tendon injury with previous poor outcome despite physiotherapy and PRP treatment. Results A 58-year-old man with chronic rotator cuff tendinopathies with partial tear in supraespinatus tendon of his right shoulder was firstly treated with physiotherapy without improvement. Afterwards, PRP treatment was applied on the partial tear. No changes, clinical nor radiological, were found. He finally underwent a unique intratendinous SVF injection resulting in no shoulder pain and radiological improvement at 6-months follow-up. Right shoulder coronal T2 MRI sequences: A: pre treatment; B: post treatment, after 6-months Right shoulder coronal T1 MRI sequences: C: pre treatment; D: post treatment, after 6-months. Red arrows: partial tear in supraespinatus tendon Red circles: signs of tendinosis without tears. Conclusions: The clinical application of SVF yield positive effects in the treatment of tendon injury and tendinopathy. A randomized clinical trial is needed to confirm the role of SVF for the treatment of tendon injury and tendinopathy compared to physiotherapy or other biological therapies. Zhang, J., Li, F., Augi, T., Williamson, K.M., Onishi, K., Hogan, M.V., Neal, M.D., Wang, J.H.-C., 2021. Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing. PLOS ONE 16, e0251166.. https://doi.org/10.1371/journal.pone.0251166 Chris H. Jo, Jee Won Chai, Eui Cheol Jeong, Sohee Oh, Paul S. Kim, Jeong Yong Yoon, Kang Sup Yoon, Intratendinous Injection of Autologous Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Rotator Cuff Disease: A First-In-Human Trial, Stem Cells, Volume 36, Issue 9, September 2018,1441–1450, https://doi.org/10.1002/stem.2855
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Gait analysis after acute achilles tendon rupture management: a systematic review
GAIT ANALYSIS AFTER ACUTE ACHILLES TENDON RUPTURE MANAGEMENT: A SYSTEMATIC REVIEW Petropoulos O1, Ntritsos G2, Varvarousis D1, Dimopoulos D1, Giannakeas N 2, Tzallas A2, Ploumis A1 1. Dpt. of Physical Medicine and Rehabilitation (PMR), Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece 2. Dpt. of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, Ioannina 45110, Greece Background and aims Gait analysis is a commonly used method for evaluating the biomechanics of walking. In the case of Achilles tendon rupture (ATR) management, gait analysis can be used to monitor recovery and identify any remaining deficits or abnormalities in the affected limb. A systematic review was conducted to investigate the effect of ATR treatment on gait. Methods A comprehensive search of the literature was performed according to the PRISMA criteria in the MEDLINE, Embase, Web of Science, and Google Scholar databases, including studies published up to January 2023. Data pertaining to temporal, spatial, and kinematic outcomes were extracted and assessed. Results In total, 28 articles were included in our review. Patients who underwent surgical repair showed a tendency for improved gait mechanics compared to those who received conservative treatment, although they required longer rehabilitation phases to restore their previous ankle mobility. Minimally invasive techniques had similar results without any additional complications. Treatment with sutures and platelet-rich fibrin (PRF) could exhibit additional significant functional improvements and an increase in the effectiveness of muscle work. Conclusions The findings from this study may be used to inform clinical decision-making for patients with Achilles tendon ruptures. It should be noted that the current evidence is of moderate to low quality, and more studies of greater quality with larger sample sizes and longer follow-up periods are required to investigate the long-term effects of surgical and non-surgical management on gait mechanics and patient outcomes. References • Tengman T, Riad J. Three-Dimensional Gait Analysis Following Achilles Tendon Rupture With Nonsurgical Treatment Reveals Long-Term Deficiencies in Muscle Strength and Function. Orthop J Sports Med. 2013 Sep 20;1(4):2325967113504734. doi: 10.1177/2325967113504734. PMID: 26535245; PMCID: PMC4555491. • Aufwerber S, Naili JE, Grävare Silbernagel K, Ackermann PW. No effects of early functional mobilization on gait patterns after acute Achilles tendon rupture repair. J Orthop Res. 2022 Aug;40(8):1932-1942. doi: 10.1002/jor.25199. Epub 2021 Oct 28. PMID: 34674300. • Agres AN, Duda GN, Gehlen TJ, Arampatzis A, Taylor WR, Manegold S. Increased unilateral tendon stiffness and its effect on gait 2-6 years after Achilles tendon rupture. Scand J Med Sci Sports. 2015 Dec;25(6):860-7. doi: 10.1111/sms.12456. Epub 2015 Apr 23. PMID: 25902929. Aknowledgements We acknowledge support of this work by the project “MEGATRON” (MIS 5047227) which is implemented under the Action “Reinforcement of the Research and Innovation Infrastructure”, funded by the Operational Program “’Competitiveness, Entrepreneurship and Innovation” (NSRF 2014-2020) and co-financed by Greece and the European Union (European Regional Development Fund).
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Gait analysis after acute achilles tendon rupture: a systematic review and meta-analysis
GAIT ANALYSIS AFTER ACUTE ACHILLES TENDON RUPTURE: A SYSTEMATIC REVIEW AND META-ANALYSIS Petropoulos O1, Ntritsos G2, Varvarousis D1, Dimopoulos D1, Giannakeas N2, Kefalas A1, Ploumis A1 1. Dpt. of Physical Medicine and Rehabilitation (PMR), Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece 2. Dpt. of Informatics and Telecommunications, School of Informatics and Telecommunications, University of Ioannina, Ioannina 45110, Greece Background and aims Achilles tendon rupture (ATR) can have a significant impact on gait, as it can cause problems with balance and stability. The purpose of this study is to document differences in gait assessment after the management of ATR in the literature. Methods A comprehensive literature review and meta-analysis were performed. Following the PRISMA guidelines, MEDLINE, Embase, Web of Science, and Google Scholar were searched to identify high-quality research articles. Search terms included “Achilles tendon rupture,” “Gait,” and “Gait analysis.” The full text of articles, including gait as a functional outcome measurement, was assessed. Meta-analysis was performed for the same outcomes measured in at least three studies. Results In total, 2339 articles were found on Achilles tendon rupture and gait analysis. 19 studies were included in our study. The meta-analysis showed that, overall, patients with an ATR displayed a statistically significant difference between limbs in ankle range of motion (mean difference -4.51, 95% CI -5.99 to -3.03), peak plantar flexion (mean difference -5.33, 95% CI -7.29 to -3.37), toe-off plantar flexion (mean difference -2.27, 95% CI -3.63 to -0.92), and initial contact dorsiflexion (mean difference 0.89, 95% CI 0.33 to 1.45). Conclusions This systematic review and meta-analysis suggests that gait analysis may have a role in the management of patients with ATR by providing objective evaluations of gait parameters and functional recovery. The analysis showed that ATR significantly affects the patients’ ankle range of motion, peak plantarflexion, toe-off plantarflexion, and initial contact dorsiflexion. References • Alviti F, Gurzì M, Santilli V, Paoloni M, Padua R, Bernetti A, Bernardi M, Mangone M. Achilles Tendon Open Surgical Treatment With Platelet-Rich Fibrin Matrix Augmentation: Biomechanical Evaluation. J Foot Ankle Surg. 2017 May-Jun;56(3):581-585. doi: 10.1053/j.jfas.2017.01.039. PMID: 28476390. • Zellers JA, Cortes DH, Pohlig RT, Silbernagel KG. Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes. Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):2831-2839. doi: 10.1007/s00167-018-5277-8. Epub 2018 Nov 10. PMID: 30415387; PMCID: PMC6510650. • Chan AP, Chan YY, Fong DT, Wong PY, Lam HY, Lo CK, Yung PS, Fung KY, Chan KM. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol. 2011 Dec 20;3(1):32. doi: 10.1186/1758-2555-3-32. PMID: 22185429; PMCID: PMC3259046. Aknowledgements We acknowledge support of this work by the project “MEGATRON” (MIS 5047227) which is implemented under the Action “Reinforcement of the Research and Innovation Infrastructure”, funded by the Operational Program “’Competitiveness, Entrepreneurship and Innovation” (NSRF 2014-2020) and co-financed by Greece and the European Union (European Regional Development Fund).
113
Quadruple fracture in a postmenopausal woman during prolonged bisphosphonate therapy – an instructive case – report
Quadruple fracture in postemenopausal woman during prolonged bisphosphonate therapy – an instructive case report Jelena Marunica Karšaj1, Danijela Klarić2, Simeon Grazio1 1 University Department of Rheumatology, Physical and Rehabilitation Medicine, University Hospital Center “Sestre milosrdnice”, Vinogradska cesta 29, 10 000 Zagreb, Croatia
2 St Cathrine Hospital, Ulica kneza Branimira 71E, 10 000 Zagreb, Croatia Introduction A 63-year-old Caucasian postmenopausal patient presented with a simultaneous bilateral radial fracture, right malleolar fracture and fracture of S4 due to fall from standing height. She has been treated by bisphosphonates during five years. Previously in 2016 she sustained fragility fracture of left malleolus, and at that time T-score was – 2.7. In between the prior single and current multiple low energy fractures she was treated with ibandronate with short periods of discontinuation (due to non-adherence) for in total five years while after couple of months of „drug holiday“ she continued antiresorptive therapy with risendronate, whom was faithfully compliant during two years, along with calcium and 25(OH)D supplementation. Methods and Results During the 24-month follow-up periods the results of DEXA and laboratory examination remained stationary. Regarding prevention of falls periodically she performed physical therapy under supervision. She did not have any preexisting medical conditions which are known secondary causes of bone loss. Her 25(OH)D was fluctuating between 65 and 93 nmol/L. According to FRAX calculation ten year probability for major osteoporotic fracture was 9.5% and for hip fracture 1.8%, which was not such a high susceptibility for multiple fragility fractures. After the recent fall resulting with multiple fragility fractures, we found suppressed bone turnover markers. Her serum osteocalcin level was 10.6 ng/mL; the refferal range (13.6-25.6 ng/mL); Beta-CrossLaps were 0.08 ng/mL; refferal range (0.104-1.008 ng/mL) for postemenopausal women probably due to prolonged exposure to bisphosphonates, while bone mineral density of the L1-L4 was 0.772 g/cm2 (T-score: − 2.5) and bone mineral density of hip region was 0.827 g/cm2 (T – score: -0.9). The concentrate of 25(OH)D showed gradual decline even though she was prescribed 25 000 IJ of cholecalciferol every second week. Conclusion In our case during the treatment with bisphosphonates, there were no significant changes including worsening of the T-score and BMD, BTM were suppressed and measurement could have helped in choosing the right therapy, which for this pateint in the first place should have been osteoanabolics. This case highlights the need to reassess the antiresorptive therapy duration, to stringent and extend surveillance in the prevention of fracture cascade, including BTM. Also, this case points out the importance of secure transition from long duration bisphosphonates to teriparatide eventually followed after 24 months with denosumab or zolendronic acid.
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Mulligan’s Mobilization with Movement: is there an interest after distal radius fractures ?
MULLIGAN’S MOBILIZATION WITH MOVEMENT : IS THERE AN INTEREST AFTER DISTAL RADIUS FRACTURES ? I.Loubiri, H.Abid, S.Laayouni, R.Moncer, S.Jomni Physical Medicine and rehabilitation department, Sahloul University Hospital, Sousse, Tunisia Background and aims Our objective was to study the effectiveness of a conventional rehabilitation program associated with the Mulligan’s Concept (MWM), on the reduction of pain, the improvement of joint mobility as well as on the reduction of the functional incapacity of patients with a Distal radius fracture. Methods A prospective comparative study was conducted including 6 patients followed for DRF treated by osteosynthesis. Patients were divided into 2 groups: group A (n=3) benefiting from a standard protocol of rehabilitation and group B (n=3) benefiting from the standard protocol associated with MWM (three sessions per week, total=15 sessions). The evaluation parameters were pain according to the Visual Analog Scale (VAS), hand and wrist range of motion (ROM) and function according to the Quick-Dash. Patients were evaluated at baseline and at the end of treatment. Results At the end of the treatment, a decrease in pain at rest and in activity and an improvement of ROM and function were obtained in all patients. However, improvement was greater in group B than in group A. Discussion In our study, functional improvement was greater in group B than in group A. According to Neto and Pitance, the MWM applied for DRF has shown its effectiveness by reporting an increase in grip strength without pain as well as an improvement in function. Brian Mulligan who taught the techniques of MWM, explains that informing the patient about what he must do and about the progress required from session to session is an essential element conditioning the success of this approach. Conclusions Combined to a standard protocol of rehabilitation, Mulligan’s MWM is effective in reducing pain and in increasing joint mobility and improving function in patients with DRF treated with osteosynthesis. More important, this combination allows a rapid functional improvement when compared to an isolated standard protocol of rehabilitation. These results need further studies to be confirmed. References 1.Paungmali A et al. Naloxone fails to antagonize initial hypoalgesic effect of a manual therapy treatment for lateral epicondylalgia. J Manipulative Physiol Ther. Neto F, 2.Neto F, Pitance L. L’approche du concept Mulligan dans la prise en charge des troubles musculosquelettiques. EMC – Kinesitherapie.  
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Anxiety and depression after stroke: about 43 cases
Anxiety and depression after stroke: about 43 cases Dr T.Zineddine, Dr K.Rsaissi, Dr Z.Tahri, Pr N.Kyal, Pr F.Lmidmani, Pr A.El Fatimi Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc Introduction: Depression is a common condition affecting a significant number of individuals following a stroke, with prevalence rates ranging from 30% to 60%.It can manifest shortly after the stroke event or even several years later. [1] Objectives: The objective of this study was to investigate the incidence of depression and anxiety in patients with post-stroke hemiplegia, following their stroke. Methods: This prospective study was conducted over a six-month period, from September 10th, 2022, to February 10th, 2023. It included all cases of stroke treated in the Physical and Rehabilitation Medicine (PRM) service during this period, with the exclusion of patients with severe aphasia. The Hospital Anxiety and Depression Scale (HADS) by Sigmond and Snaith was utilized for assessment. Results: Out of the 43 hemiplegic patients treated in our department, the mean age was 57.14 years (range: 17-87 years), and the male-to-female ratio was 1.1. All patients had experienced an ischemic stroke. Among the participants, 11 patients (25.6%) exhibited post-stroke depression, and 9 patients (20.9%) presented with anxiety. Additionally, 3 patients (6.9%) had uncertain depression symptoms, while 8 patients (18.6%) displayed definite depression symptoms. Furthermore, 5 patients (11.6%) exhibited doubtful anxiety, and 4 patients (9.3%) had clear symptoms of anxiety. Antidepressant treatment was initiated for the 9 patients who showed positive progress. Discussion: Our study revealed a relatively low frequency of post-stroke depression, which may be attributed to the limited sample size. However, it is crucial to address this condition, as it significantly impacts functional prognosis and can lead to patient demotivation, particularly during rehabilitation.[2] Post-stroke depression typically emerges early after the stroke event and exhibits a high incidence, with somatic and cognitive symptoms of depression being more prevalent, often associated with specific encephalic locations.[3] Conclusion: It is imperative to systematically assess post-stroke depression in all hemiplegic patients, particularly in the early phase, and through regular interviews involving family members. Appropriate antidepressant treatment should be implemented to achieve favorable outcomes. Référence : [1] Aslam, M., Numan, A., Arif, M., & Siddueiq, A. (2015). Frequency of depression in patients with stroke. Pakistan Journal of Neurological Sciences. [2] Bilge, C., Koçer, E., Kocer, A., & Börü, U. (2008). Depression and functional outcome after stroke: the effect of antidepressant therapy on functional recovery.. European journal of physical and rehabilitation medicine. [3] Nys, G., Zandvoort, M., Worp, H., Haan, E., Kort, P., & Kappelle, L. (2005). Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics. Journal of the Neurological Sciences.
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Nanomembrane based apheresis – simple and safe procedure for prevention cardiovascular complication in metabolic syndrome
NANOMEMBRANE BASED APHERESIS – SIMPLE AND SAFE PROCEDURE FOR PREVENTION CARDIOVASCULAR COMPLICATION IN METABOLIC SYNDROME Slavic V1,2, Randjelovic D1,2, Antunovic T3,2, Terzic N3,2, Boljevic J3,2 1Institute for Physical medicine, Rehabilitation and Rheumatology “Dr Simo Milosevic” Igalo, Montenegro 2 Centre of Excellence for Biomedical Research 3Clinical Center of Montenegro Corresponding author: drvjeroslavaslavic@gmail.com Background and aims Metabolic syndrome (MetS) includes physiological, biochemical, clinical, and metabolic abnormalities, unites in three pathologies – obesity, arterial hypertension and diabetes. Immediate treatment of the MetS is essential for prevention of life-threatening complication. Procedure of nanomebrane based Apheresis (NA) could be potent intervention as a part of preventive program for reduction cardiovascular complication in patients suffering MetS. The aim of this study was to present the effects of NA in patients who fulfill criteria for MetS. Methods This prospective study included 48 outdoor participants, 31.3% female and 68.7% male, average age of 50 years, underwent of four cycles of NA performed every other day, as safe and minimally invasive one needle procedure on Hemofenix device by using nanotech membrane PFM 500. Risks of allergic reactions and viral diseases transmission is excluded. During each cycle removed 30% of circulating plasma, which is replaced only with a saline solution. Blood samples for testing were obtained immediately before the first and after the forth cycle. Results Four cycles of NA significantly decreased systolic and diastolic blood pressure (p<0.001), sedimentation rate (p<0.0001), glucose (p<0.001), cholesterol (p<0.001), triglycerides (p<0.011), high-density lipoprotein cholesterol (p<0.006), fibrinogen (p<0.001), C reactive protein (CRP) (p<0.02) and high sensitive CRP (p<0.05). At the same time, there were no significant difference in the complete blood count. Conclusions NA should be powerful, but also simple and safe, technique for for removal proinflammatory and proatherogenic factors in order to slow down diseases course and prevent cardiovascular complication in patients suffering MetS.
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Impact of cardiovascular rehabilitation program on heart coherence
IMPACT OF CARDIOVASCULAR REHABILITATION PROGRAM ON HEART COHERENCE Slavic V, Vucic D, Randjelovic D, Markovic S Institute for Physical medicine, Rehabilitation and Rheumatology “Dr Simo Milosevic” Igalo, Montenegro Corresponding author: drvjeroslavaslavic@gmail.com Background and aims Heart Coherence is a state of high performance and healthy functioning that brings out the very best in us physically, emotionally, and mentally. Coherent heart rhythm pattern is validated method to establish autonomic nervous system (ANS) activity. The aim of this research is to assess the modifications of Heart coherence in a sample of cardiovascular patients during their rehabilitation. Methods This study included 40 cardiovascular patients referred to three weeks of rehabilitation at the Institute “Dr Simo Milosevic” Igalo, Montenegro, within 6 months of onset acute myocardial infarction. All patients received the standard cardio rehabilitation program lasted 18 therapeutic days, consisted of interval training on treadmill or bicycle, walking, swimming, muscle exercises monitored by purposely educated staff. Heart coherence measured by emWave Pro device before and after rehabilitation program as score (CS) and levels (CLs), before and after rehabilitation. The total CS ranged as follows: basic (0.5–1), good (1–2), very good (2–3) and excellent (+3). There were three CLs: low, medium, and high. Low level reflected the amount of time in which there was no wavelike activity, medium some wavelike activity, and high a considerable amount of wavelike activity in the heart rate variability (HRV) tracing. Results Rehabilitation program for cardiovascular patients significantly decreased heart rate (p<0.012) followed by significantly increased high CLs (p<0.043) in the HRV tracing. Conclusions The cardiovascular rehabilitation program significantly improved coherent heart rhythm pattern, and therefore ANS activity in patients suffered acute myocardial infarction within six months.
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The challenge of diagnosing chronic immune sensitive polyradiculopathy: a rare entity
Background and aims Chronic immune sensory polyradiculopathy (CISP) is a rare and underdiagnosed variant of chronic inflammatory demyelinating polyradiculoneuropathy. It is intended to portray the pathophysiology, clinical manifestations and treatment in the context of a clinical case of chronic immune sensitive polyradiculopathy resulting from radiotherapy treatment. Case Report A 68-year-old man, diagnosed with prostate cancer 15 years ago, who underwent radiotherapy and has been medicated with bicalutamide since then, was referred to our center. He had paresthesia with associated symmetrical “burning” pain in the leg and foot, which began 8 years ago. On physical examination, grade 2 was observed in right tibiotarsal dorsiflexion, abolished Achilles reflexes and tactile, painful and proprioceptive hypoesthesia in the leg and dorsum of the foot bilaterally, ataxic gait with steppage to the right and positive Romberg. The deficit in dorsiflexion started after prolonged hospitalization and after the remaining symptoms. No analytical changes. The electromyography showed neuropraxia of the right common peroneal nerve. Contrast-enhanced MRI showed roots with thickened fibers. A lumbar puncture was performed, which revealed albumin-cytological dissociation. The somatosensory evoked potentials of the lower limbs showed delayed responses, confirming an alteration between the sensory posterior ganglion and the cortex. A diagnosis of CISP and peripheral nerve injury was assumed. IV immunoglobulin was started, with significant improvement in sensory ataxia, gait pattern and recovery of Achilles reflexes. The patient will start a rehabilitation program aimed at the dorsiflexion deficit. Conclusion The description of this clinical case emphasizes the importance of a correct diagnosis in order to proceed with the correct treatment, with significant improvement in symptoms. In this particular case, the hypothesis that the cause of CISP is related to previous radiotherapy or continuous intake of bicalutamide cannot be ruled out. References 1. Koh JS, Tung JWM, Tan-Yu GLY, Umapathi T. Early Aggressive Immunotherapy Improves Functional Outcome in Chronic Immune Sensory Polyradiculopathy. Case Reports in Neurological Medicine. 2020;2020:6595086. 2. Ong S, Cassidy A. Chronic immune sensory polyradiculopathy (CISP). Practical neurology. 2022;22(1):57-59. 3. Sinnreich M, Klein CJ, Daube JR, Engelstad J, Spinner RJ, Dyck PJ. Chronic immune sensory polyradiculopathy: a possibly treatable sensory ataxia. Neurology. 2004;63(9):1662-1669.
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Conus demyelination syndrome in multiple sclerosis
“CONUS DEMYELINATION SYNDROME IN MULTIPLE SCLEROSIS” Galata A., Tsiamasfirou D., Manola M., Mitsostergiou P., Gklatzouni A., Petropoulou K. PRM specialist, 2nd PRM Department, National Rehabilitation Center, Athens ABSTRACT: Background and aims: Two female patients (39 and 41 years old) diagnosed with primary progressive multiple sclerosis (MS), 12 and 21 years ago respectively, were referred to our outpatient department in order to assess and manage symptoms due to lower urinary tract dysfunction (LUTD). Methods: By obtaining medical history, both patients mentioned that urinary urgency has been gradually replaced by hesitancy, straining and incomplete voiding. Evaluation was supplemented by clinical examination (sacral impaired sensation, absence of voluntary anal contraction), bladder diary, renal and bladder’s ultrasound (bladder thicken and trabeculation) and urodynamics studies (areflexia of detrusor). Results: Due to mixed symptoms and signs that were suggesting conus medullaris involvement, both patients were assessed by magnetic resonance of lumbar spine, confirming conus demyelination. Conclusions: Accurate diagnosis of neurogenic LUTD in MS is made based on a detailed assessment of information gathered from a full clinical evaluation including history and physical examination, combined with ultrasound images and urodynamics studies which are indicated to objectively study and demonstrate micturition dysfunction. BACKGROUND AND AIMS: Multiple sclerosis (MS) is a neurological disease with a great variety of clinical signs and symptoms that are time- and disease course-related. The prevalence of lower urinary tract symptoms (LUTS) in MS patients is very high (80-90%), with symptoms reflective of the overactive bladder (OAB) syndrome (ie, increased daytime frequency, urgency, urge urinary incontinence, and nocturia) being particularly common. MS plaque location (intracranial and/or spinal) is a key feature in the pathophysiology of neurogenic LUTS. Two female patients (39 and 41 years old) diagnosed with primary progressive MS, 12 and 21 years ago respectively, were referred to our outpatient department in order to assess and manage symptoms due to LUT dysfunction (LUTD). METHODS: According to international management guidelines for neurogenic LUTD (NLUTD) in general, the above-mentioned individuals were assessed with complete medical history, physical examination, bladder diary, urine analysis, kidneys’ and bladder ultrasound with post-void residual (PVR) measurements and urodynamics studies (UDS). Both patients mentioned that whereas storage symptoms were predominant at previous stages of their disease, over time, their LUTS profile has been changed, and gradually were replaced by voiding symptoms (hesitancy, straining to urinate, weak and interrupted stream double voiding and sensation of incomplete bladder emptying). Furthermore, the second patient had often episodes of urinary infections during the last year. Assessment of the two individuals was supplemented by clinical examination (sacral impaired sensation, absence of voluntary anal contraction), bladder diary, renal and bladder’s ultrasound (bladder thickening and trabeculation, plus increased PRV regarding the second patient) and UDS (areflexia of detrusor). RESULTS: Due to mixed symptoms and signs that were suggesting conus medullaris involvement, both patients were assessed by magnetic resonance imaging (MRI) of lumbar spine, confirming conus demyelination. CONCLUSIONS: Depending on the location of demyelination lesions, MS patients may present a broad spectrum of LUTS whose accurate diagnosis is made based on a detailed assessment of information gathered from a full clinical evaluation including history and physical examination, combined with ultrasound images and urodynamics studies which are indicated to objectively study and demonstrate micturition dysfunction. Demyelination plaques of the sacral cord are not uncommon and therefore, if clinical complaints may be interpreted by conus medullaris involvement, further MRI of lumbar-sacral spinal cord should be done. Due to the progressive nature of their disease, MS individuals should be well informed about the necessity of regular follow-up of their NLUTD. References: • Castel-Lacanal E, Gamé X, Clanet M, et al., 2015. Urinary complications and risk factors in symptomatic multiple sclerosis patients. Study of a cohort of 328 patients. Neurourol Urodyn, 34, 32-6. • Tracey JM, Stoffel JT, 2016. Secondary and tertiary treatments for multiple sclerosis patients with urinary symptoms. Investig Clin Urol., 57, 377–83. • Aharony SM, Lam O, Corcos J, 2017. Evaluation of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines. Can Urol Assoc J;11(1-2):61-4 • Fowler CJ, Panicker JN, Drake M, 2009. A UK consensus on the management of the bladder in multiple sclerosis. J Neurol Neurosurg Psychiatry, 80, 470–477. • Domurath B, Kurze I, Kirschner-Hermanns R et al., 2020. Neurourological assessment in people with multiple sclerosis (MS): a new evaluated algorithm. Multiple Sclerosis and Related Disorders 44,102248 • Abrams PCL, Khoury S, Wein A, 2013. Incontinence. 5th Edition. Arnhem: European association of urology. • Groen J, Pannek J, Castro Diaz D, et al, 2016. Summary of European Association of Urology (EAU) guidelines on neurourology. Eur Urol, 69, 324–33. • Trip SA, Miller DH, 2005. Imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry, 76 (Suppl III), iii11–iii18.
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Spinal stenosis: a differential diagnosis for post-polio syndrome?
Spinal stenosis: a differential diagnosis for post-polio syndrome? F D’Auria1; S Montrasio2; D Zelko2; D Bossi2; C Kiekens3 • Postgraduate School of Physical Therapy and Rehabilitative Medicine, University of Milan, Italy • San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy • IRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, Italy “Spinal stenosis in post-polio syndrome: two case reports” Background • Post-polio1 syndrome is a neurological condition characterized by neuromuscular and systemic symptoms such as progressive muscle weakness, osteo-articular pain, and abnormal fatigue. Methods • Including two male patients (59 and 73 years):
-Diagnosis of poliomyelitis in childhood
-Reduced functional autonomy for suspected post-polio syndrome
-Lumbo-sacral MRI: lumbar canal stenosis (L3-L4-L5)
 -Motor and sensory deficits in the four limbs
 -Lumbar decompression surgery
 -EMG/ENG: marked chronic neurogenic distress, with overlapping active denervation L4- L5(-S1) and signs of stenosis of the L4-L5 vertebral canal Results • Rehabilitation Project2 with interventions aimed at recovering muscle strength, proprioception and full autonomy in walking and ADL, training with virtual reality system for fine manual skills and psychological support interviews. • At discharge, patient 1 walked independently with a walker; patient 2 walked independently without the use of aids. Conclusions • Spinal stenosis can disguise itself as a post-poliomyelitis syndrome or as a progressive sensory-motor polyneuropathy3. • These patients presented radicular pain, recognized both by its somatic distribution and by the presence of associated dysesthesia in the dermatomeric distribution of the spinal roots involved. • These cases indicate that spinal stenosis may be more frequent than has been recognized so far. References • Lo JK, Robinson LR. Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations. Muscle Nerve 2018 Dec; 58(6):751-759. doi: 10.1002/mus.26168Epub 2018 Aug 22. PMID: 29752819. • Tiffreau V, Rapin A, Serafi R, Percebois-Macadré L, Supper C, Jolly D, Boyer FC. Post-polio syndrome and rehabilitation. Ann Phys Rehabil Med. 2010 Feb; 53(1):42-50. doi: 10.1016/j.rehab.2009.11.007. Epub 2009 Dec 30. PMID: 20044320. • Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis. Muscle Nerve. 2018 Dec; 58(6):760-769. doi: 10.1002/mus.26167. Epub 2018 Aug 23. PMID: 29752826.
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Grisel’s syndrome: a rare and potentially dangerous complication
Grisel’s syndrome: a rare and potentially dangerous complication F D’Auria1; S Montrasio2; GA Rispoli2; L Schisano3; C Kiekens4 • Postgraduate School of Physical Therapy and Rehabilitative Medicine, University of Milan, Italy • San Giuseppe Hospital, IRCCS MultiMedica Group, Milan, Italy • Policlinico of Milan, IRCCS Fondazione Cà Granda, Milan, Italy • IRCCS Ospedale Galeazzi-Sant’Ambrogio, Milan, Italy “Grisel’s syndrome after an adenotonsillectomy surgery: a case report” Background • Grisel’s syndrome (GS) is an atlanto-axial subluxation not associated with traumatic etiology or bone pathology, produced after an inflammatory, infectious or post-surgical process of the upper neck region1. • 8 years old girl, without any antecedents, who developed an anterior rotation to the right of the atlas with respect to the axis and subsequent stiff neck after an adenotonsillectomy. Treatment and Results • The clinical examination was suggestive for a post-surgical torticollis with tenacious contracture of the cervical, paravertebral and right trapezium muscles. The head was rotated to the right with the chin facing left, without eye deviations. No neurological deficits were detected. • Cervical CT: rotational subluxation type I of the atlas, according to the Fielding’s scale2 (simple rotational dislocation without anterior dislocation (or displacement) on the dens axis (type I) • Treatment: early treatment with non-steroidal anti-inflammatory drugs, reduced physical activity, muscle relaxation techniques and postural advice, led to a good result with restoration of correct cervical posture and the resolution of painful symptoms. Conclusions • Grisel’s syndrome is a rare but potentially dangerous complication. • With cervical CT-scan, it is possible to define the rotational degree of the atlas3. • The case described did not require surgical treatment but resolved with a conservative physical and rehabilitation medicine approach. References • Al-Driweesh T, Altheyab F, Alenezi M, Alanazy S, Aldrees T. Grisel’s syndrome post otolaryngology procedures: A systematic review. Int J Pediatr Otorhinolaryngol. 2020 Oct;137:110225. doi: 10.1016/j.ijporl.2020.110225. Epub 2020 Jun 27. PMID: 32658805. • Nakai A, Uehara M, Miyaoka Y, Oba H, Ikegami S, Takizawa T, Munakata R, Hatakenaka T, Kamanaka T, Kurogochi D, Fukuzawa T, Takahashi J. A case of adult-onset Grisel’s syndrome. Br J Neurosurg. 2022 Apr 8:1-3. doi: 10.1080/02688697.2022.2061420. Epub ahead of print. PMID: 35393919. • Fernandez Cornejo VJ, Martinez-Lage JF, Piqueras C, Gelabert A, Poza M. Inflammatory atlanto-axial subluxation (Grisel’s syndrome) in children: clinical diagnosis and management. Childs Nerv Syst 2003;19:342-7.
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EFFECT OF AQUATIC EXERCISES FOR PATIENTS AFTER A TOTAL HIP REPLACEMENT
EFFECT OF AQUATIC EXERCISES FOR PATIENTS AFTER A TOTAL HIP REPLACEMENT Loubiri . I , Layouni . S , Moncer .R , Gaddour .M , Jemni . S, Oannes .W Department of Physical Medecine and Rehabiliation, Sahloul Hospital, Tunisia Background and aims Recovery from a major surgery such as a hip replacement can be a long process. The benefits of aquatic therapy for recovery from hip replacement surgery have been clinically proven . Methods This is a prospective comparative study involving patients with hip arthroplasty. The were taken in charge over 6 weeks after surgery in a private center of physical rehabilitation.They were randomly divided into tow groups:groupe1 benefited from standar rehabilitation program and groupe 2 benefited from standar rehabilitation program associated with specific balneotherapy program.an evaluation of pain (VAS) ,joint mobility, muscle strength and functional abilities (Harris Hip Score) were performed at the beginning and the end of the rehabilitation protocol. Results Six patients were included with a mean age of 66 years. Most of the patients were male 83% The mean VAS decreased from 5.5 to 3 in groupe 1 and from 6 to 2 in groupe 2. Functional outcome scores improved : HHS increased for both groups of > 20 points . Conclusions This is a preliminary study on the effectiveness of thermal therapy for functional recovery after total hip replacement arthroplasty. Large randomized clinical trials are necessary to confirm that thermal hydrotherapy might become a useful strategy in the rehabilitation program of total hip replacement. References [1] Stefano Masieroet al. Does aquatic thermal therapy improve quality of life after total hip replacement? A retrospective preliminary pilot study. Janvier 2020 [2]   Miroljub Jakovljević, Renata Vauhnik. Aquatic exercises versus land based exercises for elderly patients after a total hip replacement. Zdrav Vestn.april 2011;240-5
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Effect of early management of Bell’s palsy in physical rehabilitation department
THE EFFECT OF MOTOR IMAGERY AND ACTION OBSERVATION TRAINING ON JOINT MOBILITY AFTER TOTAL HIP ARTHROPLASTY Loubiri . I , Moncer .R , Layouni . S , Gaddour . M , Jemni . S , Frigui .S Department of Physical Medecine and Rehabiliation, Sahloul Hospital,Sousse Tunisia Background and aims Motor Imagery and Action Observation Therapy are used in many fields such as neurology or sport. They are based on neurophysiological activations of brain structures similar to those implemented during a real movement. This study aimed at determining whether the combination of action observation and motor imagery (AO + MI) of locomotor tasks could positively affect rehabilitation outcome after hip replacement surgery. Methods A prospective comparative study including patients with total hip replacement managed for 3 weeks divided into tow groups.Groupe 1 received conventional rehabilitation associated with a mental imagery protocol and action observation therapy . Groupe 2 received conventional rehabilitation only. The evaluation parameters were pain (VAS) joint mobility,muscle strength and function (WOMAC index). Results 6 patients were included with a mean age of 47 years. The mean VAS for conventional groupe was 6 at baseline and decreased to 4 3 weeks later. The mean VAS for experimental groupe was 6.6 at baseline and decreased to 3.3 . Womac score decreased from 55 to 28 for groupe 1 and from 57 to 33 for groupe 2. All the evaluated parameters were improved for both groups with a superior result for interventional groupe . Conclusions The principal finding of the current study is that 3 weeks of additional nonphysical training resulted in better functional rehabilitation outcomes in patients with unilateral total hip replacement than with the standard rehabilitation program alone.Mental imagery(MI) in association with action observation (AO) therapy and conventional rehabilitation seems to be an effective approch in the postoprative recovery of patients with hip arthroplasty. It represent an affordable, safe, and not very time-consuming tool to optimize individual’s rehabilitation process. References [1] Villafañe JH, Pirali C, Isgrò M, Vanti C, Buraschi R, Negrini S. Effects of Action Observation Therapy in Patients Recovering From Total Hip Arthroplasty Arthroplasty: A Prospective Clinical Trial. J Chiropr Med 2016;15:229–34. [2] Marusic U et al. Motor Imagery during Action Observation of Locomotor Tasks Improves Rehabilitation Outcome in Older Adults after Total Hip Arthroplasty. Neural Plasticity Volume. 2018 ; 19;2018:5651391.
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Place of botulinum toxin in the management of spasticity and improvement of the quality of life of neurological patients
Place of botulinum toxin in the management of spasticity and improvement of the quality of life of neurological patients H.Idam ,S. hadir , P.Madjidanem , N.Kyal, F.Lmidmani, A.El Fatimi Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc Background and aims Spasticity is a frequent clinical sign in people with neurological disease, which have a significant effect on the individual’s functionality and quality of life.Botulinum toxin (BT) injection is the treatment of choice for local spasticity. The objective of our study is to recall the interest of botulinum toxin in improving the quality of life of patients. Methods This is a retrospective study concerning the treatment of spasticity by injection of botulinum toxin, an evaluation of the severity of the disorder by the Ashworth scale and an evaluation of the function and quality of life using generic scales (MIF and SF36). Results Fifty patients received a BT injection. The mean age was 25 years (5 -76 years). The etiologies were stroke (31%), cerebral palsy (25%), spinal cord injury (22%), head injury (13%), tuberculous myelitis (3%), hereditary spastic paraparesis (2%). The severity of the spasticity varied between 2 and 4 on the Ashworth scale, and the objectives set for the injection were variable: functional improvement of the limbs, control of joint deformities, hygiene and aesthetic concerns. The clinical and functional results were satisfactory with a reduction in spasticity and an improvement on the Ashworth scale of 1.5 points in average quality of life and function on the MIF and SF36 scales. Discussion Lower limb spasticity is a major problem in stroke, MS, spinal cord injury, and CP. Impairment of ambulation subjects the patients to problems related to inactivity, such as weight gain, impaired hygiene, deep venous thrombosis, and knee and hip joint issues. In small children, spasticity and increased tone in the muscles of the hip girdle often lead to hip dislocation. Botulinum toxin therapy is not yet approved by the FDA for the treatment of lower limb spasticity. There are several randomized, placebo-controlled, double-blind studies, however, that indicate reduction of muscle tone, and improved ambulation and quality of life after treatment of spastic lower limbs Conclusions The management of spasticity has changed considerably with the arrival of botulinum toxin. Several studies confirm the very satisfactory results and the notable improvement in the quality of life of patients and their functional recovery. Référence : Iman Moeini-Naghani, MD1 Taraneh Hashemi-Zonouz, MD2 Bahman Jabbari, MD1 Botulinum Toxin Treatment of Spasticity in Adults and Children , Semin Neurol 2016;36:64–72
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Challenges in management of frozen sholder in elderly patients with diabetes mellitus
CHALLENGES IN MANAGEMENT OF FROZEN SHOLDER IN ELDERLY PATIENTS WITH DIABETES MELLITUS Loubiri . I ,Trabelsi . E, Moncer .R , Gaddour . M , Toulgui .E, Jemni . S , Frigui .S Department of Physical Medecine and Rehabiliation, Sahloul Hospital,Sousse Tunisia Background and aims Frozen shoulder is a musculoskeletal disorder characterized by joint limitation that impairs the ability to perform activities of daily living. Its management can be difficult, particularly in elderly patients with diabetes mellitus. The objective of our study was to describe the modalities of the management of frozen shoulder in elderly diabetics in our physical medicine and rehabilitation (PMR) department. Methods We conducted a prospective cross-sectional study during the period between September 2021 and September 2022. All diabetic patients aged 65 and over consulting for painful shoulder in our PMR department were included. The data was collected using an individual data collection form. Results We collected 16 type 2 diabetic patients consulting for a painful shoulder. Five presented for a picture of adhesive capsulitis, three of which related to shoulder-hand syndrome secondary to vascular hemiplegia. Management included diabetes control and a switch to insulin before a series of three arthrodistensions with corticosteroids for all patients. We have associated a functional rehabilitation protocol aimed at gaining joint amplitude. Two of our patients required discontinuation of oral anticoagulants and substitution with low molecular weight heparin. The evolution was made towards functional improvement with an average gain in external rotation of 25 degrees and in abduction of 63 degrees. Conclusions Frozen shoulder in patients with diabetes is more likely to be a fibrosing syndrome as it is often associated with the presence of limited joint mobility and Dupuytren’s contracture. [1] Some patients with diabetes have a frozen shoulder with very little pain and more likely to be bilateral. Local corticosteroid injection, exercise and physical therapy is more appropriate in patients with diabetes and a frozen shoulder. Better control of the diabetes is primordial. References [1] Abate M, Schiavone C, Salini V, Andia I. Management of limited joint mobility in diabetic patients. Diabetes Metab Syndr Obes. 2013;6:197–207. [2] Merashli M, Chowdhury T, Jawad A S M. Musculoskeletal manifestations of diabetes mellitus. Quarterly Journal of Medicine 2015; 108; 853-7.
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Postural and gait disorders related to cervical dystonia. About a case
ID : 158 Postural and gait disorders related to cervical dystonia Dr FADEL LABIBA ; Algiers hospital/Algeria Introduction : Dystonia is a muscle tone disorder induced by a dysfunction of the central nervous system resulting in involuntary and sustained contractions of a muscle or a muscle group,It is to be differentiated from spasticity which is a muscle tone disorder caused by an exaggerated contraction of a muscle in response to its stretchingCervical dystonia also called Spasmodic torticollis is the most common form of focal dystonia in adults.Spasmodic torticollis is localized in the muscles of the neck and shoulders. Symptoms can be intermittent or permanent.The etiology of spasmodic torticollis remains unknown at this time. Cervical dystonia and pain : Cervical dystonias are often associated with pain, especially in the neck or trapezius muscles.Patients with cervical dystonia may present with functional difficulties in daily activities such as driving which may become extremely difficult or even impossible.They may be hampered in professional activities which sometimes leads to job loss. Finally, postures, sometimes unsightly, can in turn compromise social life and lead to withdrawal. Evaluation of cervical dystonia : The Toronto Western Spasmodic Torticollis Rating Scale assesses the severity of dystonia, the degree of disability and the intensity of pain (1). Evolution: The course of spasmodic torticollis is variable.Symptoms may regress or even disappear. Spontaneous remission is observed in 15% of cases; it can last from a few months to a few years, before a recurrence in 60% of cases of spasmodic torticollis. Treatment in PRM : • Goals : – Decrease pain related to cervical dystonia – The aim of rehabilitation is postural correction in order to improve quality of life • Means: • Injection of botulinum toxin: this is the reference treatment for cervical dystonia Injections are renewed at regular intervals (2). • Functional rehabilitation targeted by physiotherapy and kinesitherapy (complements this treatment by strengthening antagonistic muscles and improving posture Patient’s informations and clinical funding : Mr. M.hamza, 31 years old, followed in MPR for 08 months for sustained cervical dystonia of acute installation, resistant to all usual drug treatments. The last clinical assessment in MPR dates back to February 2023 and notes: – an attitude in lateral rotation irreducible line of the head and neck – Nociceptive pain on mobilization of the neck rated 07/10 – Contracture of the neck muscles: left trapezium, left sternocleidomastoid and right splenus – Cervical spine stiffness -The patient’s neurological examination is unremarkable Postural and gait disorders : The patient walks without swinging of the right upper limb, head in right lateral rotation with asymmetry of the shoulders (it is noted that the right shoulder is in antepulsion, adduction and internal rotation) • The patient has the following deficiencies: Pain; cervical spine stiffness; postural and gait disorders • Responsible for the following disabilities: – An inability to drive a motor vehicle – An inability to practice sports – Inability to return to work • Leading to a situation of social and professional handicap with repercussions on the quality of life and work The management of : 1- The patient benefited from physiotherapy sessions consisting of: -Analgesic physiotherapy – Stretching of retracted muscles associated with muscle strengthening of antagonistic muscles – Posture correction work It should be noted that massage is contraindicated because it increases involuntary contractures 2- Ultrasound-guided injection of botulinum toxin type A The toxined muscles are: the right trapezius – the left trapeziusthe left sternocleidomastoid the right scalene – the left scalene – the right splenus Results: After two weeks of treatment with botulinum toxin type A, we note: • A decrease in pain that has become 04/10 • A decrease in the contracture of the injected muscles • Decreased neck rotation • An improvement in the amplitudes of the cervical spine • slight improvement in posture conclusion : AboBoNT-A may be an efficient choice for treating adult spasticity and cervical dystonia(3). Early prevention of the onset of posture and gait disorders is essential in the overall management of cervical dystonia. References : • Khashayar Dashtipour and al : Minimal clinically important change in patients with cervical dystonia: Results from the CD PROBE study Journal of the Neurological Sciences, 2019-10-15, Volume 405, Article 116413, Copyright © 2019 The Authors • Carlo Colosimoand al : Cumulative effects of long-term treatment with abobotulinumtoxinA in cervical dystonia: Findings from a prospective, observational study Journal of the Neurological Sciences, 2020-09-15, Volume 416, Article 117015, Copyright © 2020 The Authors • K. Johnston and al : Cervical Dystonia: Cost-Effectiveness Analysis and the Cost of Response in the United Kingdom Value in Health, 2021-06-01, Volume 24, Pages S161-S161, Copyright © 2021
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Fatigue during multiple sclerosis
15th Congress of the Mediterranean Forum of Physical Medicine and Rehabilitation Rome, July 6-8, 2023 Title: Fatigue during multiple sclerosis M.Kehli, Y.Kobci, D.M Mammeri, K.Layadi*. MPR service Regional university military hospital (HMRU) of Oran. *MPR department CHU of Oran kehlimouh@gmail.com Communication: e-poster • Introduction: Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease of the central nervous system, characterized by numerous symptoms during its evolution. Fatigue remains one of the most frequent and debilitating problems of MS patients. As its clinical presentation is highly variable, it seems likely that the same applies to its pathophysiology. Several factors could contribute to the development and/or exacerbation of fatigue in MS, this requires a fairly comprehensive assessment in order to properly manage MS patients. Objective: – Assess fatigue in patients with MS; – Identify its correlations with other clinical, functional and radiological signs. • Material and methods • Type of study This is a descriptive, bi-centric study of prospective collection, relating to patients with MS, carried out at the level of the Physical Medicine and Rehabilitation departments of the Center Hospitalo-Universitaire of Oran (CHUO) and the Hospital Military Regional University of Oran (HMRUO). • Study population All patients with MS referred to our level for rehabilitation care. • The inclusion criteria for this study – Patients with definite MS, diagnosed according to the Mac Donald 2005/2010 criteria. – Aged 18 and over. – Whatever the form, whatever the stage of the disease. • Non-inclusion criteria – A flare-up of the disease in the last 6 months. – A cognitive state incompatible with understanding the instructions. – The presence of a serious psychiatric pathology, an unstabilized or untreated inflammatory, infectious or cardiac disorder. – The presence of recent surgical history (less than six months). • Duration of the study It is two (02) years and 06 months, between January 2017 and June 2019. Univariate and multivariate analysis was performed using SPSS 20 software. For the main analysis of the evolution of MS, the residual disability levels of the EDSS scale (Expanded Disability Status Scale) at the last consultation were used. We used the visual analogue scale (EVA-fatigue) and the self-questionnaire “Fatigue Severity Scale” (FSS) French version to assess the severity of fatigue. • Results: • Age : The mean age of patients in our series was 41.57 ± 11.22 years with a minimum age of 19 years and a maximum age of 69 years, 56.3% of patients were over 40 years of age (Figure 1). Whereas the mean age of patients in our series at diagnosis was 35.23 ± 11.41 years, with a minimum age of 10 years (1 case) and a maximum age of 69 years (1 case), and the mean age of onset of symptoms was : 31.83 ± 11.52 years and ranged from 10 to 65 years. • Gender: Analysis of the results shows a predominance of females. Of the 103 patients, 71 were women (68.9%), while men accounted for 31.1% (32 patients). The female/male sex ratio was 2.21. • According to EDSS The mean EDSS scale in our series was 5.12 ± 1.97, with a minimum of 1 and a maximum of 9. The EDSS evaluation enabled us to classify our patients according to their current disability situation into four (4) levels (Table 2): Twenty-eight patients (27.2%) had minimal disability and no locomotion limitations, 21 patients (20.4%) had moderate disability with a progressive reduction in walking perimeter, while 35 (34.0%) had significant disability and relied on technical aids for ambulation, and 19 patients (18.4%) had lost all ability to walk outdoors and were variably confined to a wheelchair. • Assessment of fatigue. We were able to assess fatigue in 100 patients among our population by the Eva fatigue and only 77 patients by the FSS because of language problems (some of our patients do not speak French) Fatigue was found in 94 (91.2%) patients; it was of variable intensity and severity from one subject to another and reported at any time of the day. • According to EVA fatigue The mean VAS-fatigue scale of the 100 patients assessed was 4.93 ± 2.066 [min: 0 – max: 8] and 26% of patients had severe fatigue (VAS≥7) (Table 2). • According to the FSS The mean FSS of the 77 patients evaluated in our series was 4.17 ± 1.53 [min: 0 – max: 7]. We found that 53.2% had moderate fatigue and 15.6% had severe fatigue (Table 3). • Fatigue and disability We found no relationship between severity of disability and fatigue. We found no relationship between fatigue severity (p=0.159) and FSS (p=0.332) (Figure 2). • Fatigue and age Statistical analysis showed no significant relationship between age of MS onset and/or patients’ current age and fatigue severity (p = 0.302(Eva), p = 0.98(FSS)). (Tables 4 and 5) • Fatigue and duration of progression: We noted that there was a significant relationship between fatigue severity and duration of disease progression (p = 0.021), so 88.2% of the 34 patients who were diagnosed 10 years ago or more had moderate to severe fatigue (Table 5) • Fatigue and gender We found no correlation between fatigue severity and gender (EVA p = 0.44, FSS p = 0.11), but female MS patients in our series suffered more fatigue than males. We found that the F/H sex ratio for patients with “probable fatigue” according to FSS was 1.4, whereas it was 5 for those with “severe fatigue” (Table 5). • Fatigue and area of residence Overall, statistical analysis did not find a correlation between fatigue severity and place of birth and/or residence (p=0.06), but it should be noted that over 81% of patients who had lived in the littoral region had moderate to severe fatigue, compared with 65% in the highlands and only 40% in the south (Table 5). • Fatigue and form of MS Statistical analysis revealed a significant correlation between the severity of fatigue and the progressive form of MS (p = 0.02). Fatigue was lower in MS patients with relapsing-remitting (RR) MS than in those with progressive MS (primary progressive (PP), secondary progressive (SP)). • Fatigue and pain Statistical analysis showed no significant relationship between pain and fatigue severity (p = 0.153), but it was noted that 58.33% of patients with severe fatigue had neuropathic pain. (Table 5). • Fatigue and depressed mood Depression was diagnosed using DSM 4 (Diagnostic And Statistical Manual of Mental Disorders) criteria. We found that depression was present in 45 patients (43.7%). Depression was not correlated with fatigue severity (p = 0.073), but we did note that 09 out of 10 patients with severe fatigue had a depressed mood. • Fatigue and location of demyelinating plaques We found a significant relationship between the presence of cerebellar lesions and the severity of disability (p=0.008) (Table 5). • Discussion: There is no universally accepted definition of fatigue in MS. The Multiple Sclerosis Council for Clinical Practice Guidelines and the Paralyzed Veterans of America have adopted the following definition: “Fatigue is a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver as interfering with usual and desirable activities” (1). Unlike fatigue experienced in a healthy population, fatigue in MS is different: it is chronic, permanent, both physical and mental, and could prevent prolonged physical functioning, be aggravated by heat, and be responsible for significant impairment of quality of life (2, 3). Self-report scales are considered one of the best methods of gathering information on fatigue, as it is the respondent’s own report of his or her experiences. Fatigue in MS can have a variety of origins, but has been assessed in its entirety, partly due to the lack of locally translated rating scales. The MFIS and the MFI (Multidimensional Fatigue Inventory) are longer questionnaires, used less frequently in the MS literature (4). Thus, the FSS, developed for use in MS (5, 6), was used in our study. Long underestimated and neglected, fatigue is nevertheless extremely frequent in MS, according to studies; it occurs in 80 to 97% of cases, mainly in primary and secondary progressive forms (7,8), and our results are similar to those in the literature. Fatigue was reported in 94 patients (91.2%), varying in intensity and severity from one subject to another, with 26% of patients presenting with intense fatigue (VAS≥7). Fatigue is a predictive factor of work disability independently of other neurological deficits (2), and several studies have shown that motor disability is not related to fatigue level (9, 10). Our results concur with those of the literature, and there was no significant correlation between fatigue intensity and disability severity (VAS; p=0.159. FSS; p=0.332). However, we found that patients with MS for more than 10 years suffered more fatigue, irrespective of their disability severity as assessed by the EDSS. The study confirmed the absence of a link between fatigue and gender, confirming the findings of previous research which also showed no association of any kind (11, 12). However, our study showed that the prevalence of severe fatigue was higher in women. We did not find a relationship between pain and fatigue, which for some authors was consistently correlated at baseline and follow-up with pain intensity (13), but the presence of neuropathic pain was associated with severe fatigue. Our study did not reveal a significant correlation between FSS scores and the presence of depressed mood, which is in line with the opinion of Stroud et al (14), whereas the relationship between depression and fatigue in MS patients reported in previous studies was established (15). Radiologically, we found a significant correlation only with the presence of demyelinating lesions in the cerebellum (p= 0.008), something that is under-researched in the literature, and other volumetric parameters are interpreted such as the different volumes of the constituted grey nuclei and cortical thickness (16, 17). • Conclusion Fatigue is a frequent symptom in multiple sclerosis, aggravating patients’ disability. According to the results of our study, fatigue may be aggravated and become troublesome when it occurs in patients with a duration of disorders exceeding 10 years, or who present a progressive form of the disease, or demyelinating plaques in the cerebellum. Patients who are female, live on the coast (humidity) or have a depressive mood may suffer more severe fatigue than others. Appropriate management of fatigue in MS requires a good evaluation and semiological analysis. References: 1. Multiple Sclerosis Council for Clinical Practice Guidelines. “Washington, DC: Paralyzed Veterans of America; 1998.” Fatigue and multiple sclerosis: evidence-based management strategies for fatigue in multiple sclerosis 2. Béthoux, F. Fatigue et sclérose en plaques. In Annales de réadaptation et de médecine physique (Vol. 49, No. 6, pp. 265-271). Elsevier Masson. (2006, July). 3. Krupp LB, Alvarez LA, LaRocca NG, Scheinberg LC. Fatigue in Multiple Sclerosis. Archives of Neurology 45(4), 435-437. 1988. 4. Andreasen A, Stenager E, Dalgas U. The effect of exercise therapy on fatigue in multiple sclerosis. Multiple Sclerosis Journal. 2011;17(9):1041-54. 5. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of neurology. 1989;46(10):1121-3. 6. Krupp L, La Rocca N, Muir-Nash J, Steinberg A. fatigue severity scale (fss). 2015 7. Drenska K. Non-motor symptoms in multiple sclerosis. Varna: Varna Medical University Press; 2018. 8. Moreau T, Du Pasquier R. La sclérose en plaques: John Libbey Eurotext; 2017. 9. Hameau S, Zory R, Latrille C, Roche N, Bensmail D. Relationship between neuromuscular and perceived fatigue and locomotor performance in patients with multiple sclerosis. European journal of physical and rehabilitation medicine. 2017;53(6):833-40. 10. Garg H, Bush S, Gappmaier E. Associations Between Fatigue and Disability, Functional Mobility, Depression, and Quality of Life in People with Multiple Sclerosis. Int J MS Care. 2016;18(2):71-7. 11. Lerdal, A., Celius, E. G., Moum, T., et al. (2003). Fatigue and its association with sociodemographic variables among multiple sclerosis patients. Multiple Sclerosis, 9, 509–514. 12. Trojan, D. A., Arnold, D., Collet, J. P., et al. (2007). Fatigue in multiple sclerosis: Association with disease-related, behavioural and psychosocial factors. Multiple Sclerosis, 13, 985–995. 13. Patrick E, Christodoulou C, Krupp L. Corrélats longitudinaux de la fatigue dans la sclérose en plaques. Journal de la sclérose en plaques . 2009;15(2):258-261. doi : 10.1177/1352458508097466 14. Stroud, N. M., Minahan, C. L., et al. (2009). The impact of regular physical activity on fatigue, depression and quality of life in persons with multiple sclerosis. Health and Quality of Life Outcomes, 7, 68., 15. Feinstein, A., et al. (2011). Multiple sclerosis and depression. Multiple Sclerosis, 17, 1276–1281. 16. Dhia, Rihab Ben, et al. “Fatigue et sclérose en plaques: corrélations clinicoradiologiques.” Revue Neurologique 178 (2022): S120. 17. R. Patejdl et al. / Multiple sclerosis and fatigue: A review on the contribution of inflammation and immune-mediated neurodegeneration Autoimmunity Reviews 15 (2016) 210–220 © 2015 Published by Elsevier B.V.
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Effects of purposeful activity-based electrical stimulation therapy on brain function in individuals with chronic upper limb paralysis
Effects of purposeful activity-based electrical stimulation therapy on brain function in individuals with chronic upper limb paralysis Seigo Minami1, Ryuji Kobayashi2, Ken Kondo1, Takahiro Horaguchi1, Yoshihiro Fukumoto3, Hideaki Aoki4, Takuya Ishimori5, Tomoki Aoyama6 (Affiliations) 1 Faculty of Rehabilitation, Gunma Paz University, 2 Department of Rehabilitation Sciences, Hyogo Medical University, 3 Faculty of Rehabilitation, Kansai Medical University, 4 Graduate School of Medicine, Wakayama Medical University, 5 Department of Rehabilitation, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, 6 Graduate School of Medicine, Kyoto University Background and aims This study aimed to investigate the effects of purposeful activity-based electrical stimulation therapy (PA-EST) on brain function in individuals with moderate of hemiparetic upper limb in chronic stroke survivors, using functional near-infrared spectroscopy (fNIRS). Methods The study participant was a male in his 70s with right hemiplegia. The PA-EST program was performed for 3 months with fNIRS measurement before and after the intervention. Results The results showed improvements in upper limb motor function, quality of movement, and goal attainment scaling after PA-EST. The fNIRS data showed a significant decrease in oxy-Hb levels in the contralateral finger area during finger opening movements. Conclusions These findings suggest that PA-EST may have beneficial effects on brain function in individuals with chronic upper limb paralysis after stroke. However, further studies with a larger sample size are needed to confirm the results.
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Neurogenic bladder and intermittent catheterization: what difficulties are encountered?
Neurogenic bladder and intermittent catheterization: what difficulties are encountered? Jelassi Omaima1,3, Moncer Rihab2,3, Arfaoui Afifa2,3, Dhouibi Jaouher2,3, Ouanes Walid2,3, Jemni Sonia2,3 1. Physical medicine and rehabilitation department, M’saken Regional hospital, Sousse, Tunisia 2. Physical medicine and rehabilitation department, Sahloul university hospital, Sousse, Tunisia 3. Sousse University, Faculty of Medicine of Sousse, Tunisia Introduction Difficulties with intermittent catheterization (IC) are common and may lead to serious complications secondary to the neurogenic bladder. The aim of this study is to identify the factors that make the practice of IC difficult in neurological patients. Patients and Methods We conducted a descriptive cross-sectional study on patients practicing IC for neurogenic bladder, followed in our rehabilitation department. We used the “Intermittent Catheterization Difficulty Questionnaire” (ICDQ) in its Arabic version to evaluate the difficulties of IC (1). Results Our study population consisted of 15 patients, with a sex ratio equal to 0.5. The mean age was 38.5 years [26; 49]. The mean duration of IC practice was 9 years [3 months; 19 years]. The results of the ICDQ questionnaire showed that three patients had pain on introduction of the bladder catheter. A transient blocking sensation was described in five cases. One patient felt obliged to adopt a different position to allow catheter progression. One patient had spasms involving the muscles of the lower limbs concomitant with the practice of IC. Urethral bleeding was reported in one case. Changing position or using the fingers was necessary to ensure bladder emptying in one patient. A sensation of blockage on removal of the catheter was described in two patients. One patient reported urinary incontinence during IC. Residual pain after IC was reported in two patients. Conclusions Our study determined the causes that made IC difficult in neurological patients using a valid questionnaire. Any difficulty encountered during IC should be managed in order to resolve the causal problem. Reference • Ghroubi S, Chmak J, Borgi O, El Fani N, El Arem S, Elleuch MH. Translation and validation of the Intermittent Catheterisation Difficulty Questionnaire (ICDQ) in an Arabic population. Arab J Urol. 2020;18(1):226.
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Paraplegia secondary to aortic dissection: a case report
Paraplegia secondary to aortic dissection: a case report Jelassi Omaima1,3, Moncer Rihab2,3, Dhouibi Jaouher2,3, Rahmani Chiraz2,3, Ouanes Walid2,3, Jemni Sonia2,3 1. Physical medicine and rehabilitation department, M’saken Regional hospital, Sousse, Tunisia 2. Physical medicine and rehabilitation department, Sahloul university hospital, Sousse, Tunisia 3. Sousse University, Faculty of Medicine of Sousse, Tunisia Introduction Spinal cord infarctions (SCI) are uncommon and can vary in severity, outcome, and recovery. Aortic dissection (AD) is one of the most challenging etiologies of SCI, since it causes inadequate perfusion of segmental arteries that supplies the spinal cord. Rehabilitative management can be defiant because of secondary major disabilities. The aim of the study was to determine the clinical evolution and the functional outcome of a patient who had spinal cord infarction, addressed in our inpatient rehabilitation department. Observation We report a case of a 50-year-old male, known to be a heavy smoker, who underwent surgical repair of type A AD. He was then diagnosed for the first time with hypertension. The initial clinical presentation was made of acute interscapular tearing pain, rapidly followed by inability to walk because of weakness in both legs. One month after undergoing surgery, the patient was referred to our rehabilitation department. On examination, he presented with a flaccid paraplegia. Sensory modality of pin prick and temperature were impaired below the level of T10. Vibration, touch and proprioception assessment revealed no impairment. After digital rectal examination, neurological findings were consistent with anterior cord syndrome classified as ASIA impairment scale A. Motor and sensory recovery after rehabilitation were negligeable. At one month follow-up, the patient was on wheelchair and intermittent catheterization. Discussion and Conclusion Studies reported that anterior cord syndrome was on top of the clinical presentations, whether permanent or transient. Hypertension is the most common risk factor of AD. Severity of initial impairment is known to be associated with poor functional outcome. Early diagnosis and appropriate management can help regain a full neurological function (1, 2). References 1. Loeb T, Melki J, Pinsard M, Canonne M. Paraplégie après pontage aorto-bifémoral : des troubles neurovégétatifs systématisés doivent faire évoquer l’accident médullaire. Ann Fr Anesth Réanimation. 1 janv 1995;14(3):3002. 2. Gorecki JP, Ameli FM. Ischemic damage to the spinal cord following end-to-side aortobifemoral bypass. Ann Vasc Surg. nov 1993;7(6):56976.
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An exceptional presentation of a bilateral complex regional pain syndrome in a brain injured patient
An exceptional presentation of a bilateral complex regional pain syndrome in a brain injured patient Jelassi Omaima1,3, Layouni Saoussen2,3, Ghali Syrine2,3, Loubiri Ines2,3, Ouanes Walid2,3, Jemni Sonia2,3 • Physical medicine and rehabilitation department, M’saken Regional hospital, Sousse, Tunisia • Physical medicine and rehabilitation department, Sahloul university hospital, Sousse, Tunisia • Sousse University, Faculty of Medicine of Sousse, Tunisia Introduction Complex regional pain syndrome (CRPS) is a condition that can follow trauma or immobilization of an upper or lower extremity. Its pathophysiology remains controversial. Bilateral involvement remains exceptional. Observation We report the case of a 21-year-old patient, with no medical or surgical history, who had a severe brain injury following a road accident. He was hospitalized in our physical medicine and rehabilitation department five months after the trauma for spastic quadriplegia management. Examination of the knees revealed irreducible flessum on both sides, with limitation of flexion secondary to a neurogenic periarticular heterotopic ossification seen on standard radiographs. In addition, joint limitation with an irreducible 45° equinus of both ankles was noted without local inflammatory signs or vasomotor disorders. X-rays of the ankles were performed to objectivate heterotopic ossifications that could explain this joint limitation, especially in the immobilization context. We did find patchy osteoporosis in the talus and malleoli bilaterally, with respect for the joint spaces, confirming the appearance of a CRDS. Discussion CRDS can be secondary to simple immobilization. Some studies describe a vicious cycle of pain and immobilization in patients with CRPS. Simultaneous bilateral localization is rarely documented in the literature, which make this case exceptional (1, 2). Conclusions We reported a rare case of CRDS occurring in both ankles in a spastic quadriplegic patient secondary to brain injury. The only risk factor for CRDS was the prolonged immobilization. References 1. Dormohammadi Toosi T, Karimpour Reihan S, Afshari A, et al. Bilateral complex regional pain syndrome in a woman with major depressive disorder. Arch Iran Med. mars 2015;18(3):1968. 2. Fisher-Pipher S, Kenyon LK. Management of Bilateral Complex Regional Pain Syndrome in a Pediatric Patient. Pediatr Phys Ther. Winter 2015;27(4):44351.
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Myelite post Covid19 vaccination
MYELITE POST COVID19 VACCINATION MILOUDI D.R, BOUKHERS.O, DOUMI.R, Kehli.M, MAAMARI MD; MPR HMRU Oran/2RM • Introduction • Myelitis is an inflammation of the spinal cord, at a specific level. • This problem can affect both adults and children. • The signs develop either quite brutally and complete in a few hours, or more slowly in a few days or even weeks. • Myelitis is responsible for a sensory and sphincter deficit. • The disease usually takes 1 to 3 months. Beyond this period, the evolution is very variable in 2 to 12 weeks: either full recovery, partial recovery, or no recovery. • Myelitis may be observed in infectious diseases or following vaccination. • Clinical progression depends on early management. • Objectives:  To draw attention to this complication and show the interest of a neurological examination in post vaccination whose purpose is early management, to avoid the handicap of the patients. • Methods: This is the patient: 36-year-old male M.M with no particular history has spastic para paresis with bladder disorders, sudden installation. 15 days after vaccination with SINOVAC anti Sars-COVID19 treated with bolus corticosteroids and monthly endoxan cures. The clinical examination of the patient at 04 months post vaccination in the MPR department reveals a spastic para paresis of motor and sensory level T12 incomplete classified ASIA B, with orthopedic disorders of the 2 lower limbs. The rest of the clinical exam: • A pyramidal syndrome • Spasticity more marked with triceps and biceps (1+ according to Ashworth Scale). • Sensory level: Hypoesthesia from T12, Pre and endoanal hypoesthesia, Anal hypotonia • Sphincter vesico disorders: urinary incontinence • Results: Post-vaccination complications are multiple and possible with all vaccines, Myelitis linked to vaccination is rare, we report a case of paraparesis secondary to myelitis post vaccination by SINOVAC anti SARS Covid 19 , taken care of early at the level of the internal medicine department then, transferred to our level where an adapted rehabilitation has been done; • A complete clinical examination: general “looking for irritative thorns”; joint; muscular; neurological “spasticity assessment”; vesicosphincter; functional “disability assessment.” • Treatment of irritative spines (urinary tract infection) and spasticity • A pluridaily physiotherapy (based on stretching spastic muscles, gain of joint amplitude, muscle building, work of balance and walking) • Electrostimulation of the tibial nerve for urinary incontinence • A psychotherapy • The prescription of a walker then 2 canes and shoes with rising rod • The trend was marked by a satisfactory recovery after 05 months of support. With improvement of the BARTHEL index Index De BARTHEL Before TRT                                            After TRT 60                                           90 • Conclusion Early intensive and transdisciplinary management: neurologist, radiologist, MPR doctor with his team is necessary in the treatment of neurological disorders secondary to a vaccination against Covid-19. • Bibliographie • Article April2022: Myelitis with anti-MOG and anti-Covid vaccination: association.  About a case: Imene Fatima Bouakaz Mohamed Islam Kediha Abdelkrim Saadi Mahdia Hamalit Lamia Ali-Pacha Neurology, CHU Mustapha, Sidi M’Hamed, Algeria • Article November 2021: from the European Medicines Agency: EMA • Article January 2022: very rare cases of transverse myelitis possibly linked to ASTRAZENECA and JOHNSON vaccines.
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Pressure Ulcer Management In Patients With Impaired Mobility
Pressure Ulcer Management in Patients with Impaired Mobility Omaima Jelassi 1,3, Syrine Ghali 2,3, Bassem Tiss 2,3, Saoussen Layouni 2,3, Ines Loubiri 2,3, Rihab Moncer 2,3, Walid Ouanes 2,3, Khaled Maaref 2,3, Sinene Frigui 2,3, Sonia Jemni 2,3 1. Physical medicine and rehabilitation department, M’saken Regional hospital, Sousse, Tunisia 2. Physical medicine and rehabilitation department, Sahloul university hospital, Sousse, Tunisia 3. Sousse University, Faculty of Medicine of Sousse, Tunisia Introduction Pressure ulcers (PU) are described as localized damage to the skin over pressure points, which can extend to underlying muscles and bones. Susceptibility to PU increases in patients who are immobile for long periods, such as elderly persons, patients with severe acute illness and patients with neurological impairments such as spinal cord injuries. This study aims to describe the management of PU in rehabilitation field. Methods • We conducted a retrospective study in which we included patients with PU hospitalized in the physical medicine and rehabilitation department at Sahloul hospital, from 2020 to 2022 • We collected clinical data from patients medical files Results • Twenty-eight patients were included in the study. • Sex-ratio was 1,54. • Mean age was 40 years +/- 13,6. • The most frequent pathology that led to prolonged immobilization was spinal cord injury (n=9; 20%) (Fig.1). • PU developed mostly in sacral region (n=16, 57%) (Fig. 2), and in heels (n=12, 43%). • The majority of PU were classified as stage 2 (n= 18; 64,2%) (Fig. 3). • Six patients had a stage 4 PU. There was an osteitis in five patients (18%). • Eight patients (28,5%) had a depression. • Anxiety was identified in 12 patients (42,8%). • Treatment involved for all patients: • Relieving direct pressure • Modern dressings • Topic agents • Three patients (10,7%) were also treated with Vacuum Assisted Closure (VAC) therapy • Six patients having PU classified as stage 4 (21,4%) needed surgical excision. • Antidepressants were prescribed for patients with depression. Discussion Published evidence suggests that some of the benefits of modern dressings make them more cost-effective than traditional gauze dressings in PU management (1). VAC therapy significantly decreases the time to complete wound healing, hastens granulation tissue formation, and reduces the ulcer area compared to conventional dressing (2).It is actually a safe ,easy and effective therapy which can decrease the number of dressing changes and length of hospital stay(3). Conclusions PU impose a substantial financial burden. The main limit of our study is its retrospective nature which lead to missing details related to types of dressings and duration of treatment. Prevention has been a primary goal of PU research. References 1.       L San Miguel, J E Torra i Bou, J Verdú Soriano et al. Economics of pressure-ulcer care: review of the literature on modern versus traditional dressings.J Wound Care .2007 Jan;16(1):5-9. 2.     Sangma M D James, Sathasivam Sureshkumar, Thirthar P Elamurugan et al. Comparison of Vacuum-Assisted Closure Therapy and Conventional Dressing on Wound Healing in Patients with Diabetic Foot Ulcer: A Randomized Controlled Trial.Niger J Surg. 2019 Jan-Jun; 25(1): 14–20. 3.      Mustafa Citak , Manuel Backhaus, Renate Meindl, Gert Muhr et al. Rare complication after VAC-therapy in the treatment of deep sore ulcers in a paraplegic patient.2010 Dec;130(12):1511-4
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The outcome of targeted peri-neural corticosteroid installation for symptomatic neuroma, in limb amputation residuum
THE OUTCOME OF TARGETED PERI-NEURAL CORTICOSTEROID INSTALLATION FOR SYMPTOMATIC 
 NEUROMA, IN LIMB AMPUTATION RESIDUUM
 Zanaib Mahmud1, Bhaskar Basu1, Kath Crawford1,
 1Rehabilitation & Amputee Medicine, Manchester University NHS Foundation Trust INTRODUCTION Post amputation pain (PAP) is a disabling condition that has a significant impact on a person’s quality of life. Residuum neuromas are a common cause of PAP. Treatment of residuum neuromas is challenging, due to a lack of formal guidelines regarding their management. This pilot study was conducted at a sub-regional amputation centre, with an aim to determine the effectiveness of peri-neural corticosteroid injections for symptomatic neuromas in lower limb amputees. METHODS This was a retrospective study with data collated from February 2019 – January 2023. A total of 56 patients who met the inclusion criteria, received peri-neural injections in this period. 48 patients had neuromas confirmed on ultrasound. Data was recorded on an excel spreadsheet and included date(s) of injection(s), location of neuroma(s), pain scores pre/post injection. Pain scores were recorded using the Visual Analogue Scale (VAS). Pain scores were documented at the patient’s initial appointment and then two weeks post injection, via telephone or face to face follow up appointment. RESULTS & DISCUSSION A total of 76 peri-neural injections were carried out on 56 patients, as 18 patients had more than one neuroma diagnosed at presentation. The mean pre-injection VAS score was 8.2 The median pre injection VAS score was 8 The mean VAS score post-injection was 3.7, whilst the median was 4 9 out of 56 patients reported no change in their pain score post-injection. Twenty-nine patients required repeat corticosteroid injection to their residuum neuroma. 5 patients are currently awaiting surgery for stump neuroma excision CONCLUSION 70% of patients reported a reduction in their pain score post injection. 19.6% patients had no post injection VAS score documented but reported a significant improvement following peri neural injection. 16% patients unfortunately reported no effect post peri neural injection The study has highlighted areas for improvement in future assessment of the effectiveness of corticosteroid injections for residuum neuroma. Suggested areas for improvement include: • Introduction of a peri neural injection proforma to be completed at initial assessment and then 2-4 weeks post injection. • Ensuring that VAS scores are documented pre and post peri neural injection. • The use of other outcome measures to determine the effectiveness of peri neural injections. (functional grading systems etc.) Overall , the study has shown that peri neural corticosteroid injections may be an effective treatment method for relieving post REFERENCES [1] Mioton LM, Dumanian GA, Cheesborough J, et al. Targeted muscle reinnervation successfully treats neuroma pain and phantoms in major limb amputees: a randomized clinical trial. Neurosurgery. 2018;65(CN_suppl_1):86. doi:10.1093/neuros/nyy303.117. [2] National Institute for Health and Care Excellence (2013) Neuropathic pain in adults: pharmacological management in non-specialist settings. Clinical guidelines (CG173) [3] Stokvis A, van der Avoort DJC, van Neck JW et al. Surgical management of neuroma pain: a prospective follow-up study. Pain. 2010; 151:862-869 [4] Kesikburun S, Yasar E, Dede I et al. Ultrasound-guided steroid injection in the treatment of stump neuroma: pilot study. J Back Musculoskelet Rehabil. 2014; 27:275-279
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Association between strength of knee extensor and the grade of structural and functional damage in knee Osteoarthritis among postmenopausal women
ASSOCIATION BETWEEN STRENGTH OF KNEE EXTENSOR AND THE GRADE OF STRUCTURAL AND FUNCTIONAL DAMAGE IN KNEE OSTEOARTHRITIS AMONG POSTMENOPAUSAL WOMEN Background and aims Knee extensor weakness is traditionally considered to be a secondary phenomenon. Confirming musculus quadriceps (m. Qps) femoris strength as a potential predictor of osteoarthritis (OA) would contribute to a proactive approach in terms of preventing and slowing the progression of OA. This study aimed to assess the association between the strength of m. Qps femoris and the grade of structural and functional damage of the knee in postmenopausal women with knee OA. Methods This retrospective cross-sectional study included 142 postmenopausal women with knee pain ≥3 according to the numerical pain rating scale. They were all treated at the Special Hospital for Rheumatic Diseases Novi Sad, Serbia from February 2022 to March 2023. The experimental group (95) consisted of subjects with radiological damage II-IV grade according to Kellgren-Lawrence (KL) scale, while the control group (47) consisted of subjects without radiological damage on their knees (KL 0-I). The strength of m. Qps femoris was assessed by a manual muscle test, while the knee range of motion (ROM) was measured with a goniometer. All respondents completed the Lequesne index for the knee. Results The groups were equal in terms of average age (p=0.091) and body mass index (p=0.178). Most of the respondents of the experimental group (78.9%) had m. Qps femoris strength ≤3, while most of the respondents of the control group had m. Qps femoris strength (63.8%) >3. The difference was statistically significant (p<0.001). Тhe m. Qps femoris strength is not a statistically significant predictor of structural knee damage (p=0.482). The m. Qps femoris strength is a statistically significant predictor of the Lequesne score (Beta=-0.44, CI 95 [-5.58 – -2.75], p<0.001). Lower m. Qps femoris strength is a predictor of a higher Lequesne score. As m. Qps femoris strength increases the likelihood of functionally satisfactory knee ROM increases (Exp(B)=0.18, CI 95 [0.08 – 0.39], p<0.001). Тhe m. Qps femoris strength is a statistically significant predictor of knee ROM. Conclusions The greater strength of the m. Qps femoris is a predictor of a lower Lequesne score and functionally satisfactory knee ROM. The strength of the m. Qps femoris is a predictor of functional, but not structural knee impairment in knee OA. References [1] O'Neill TW, McCabe PS, McBeth J. Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol. 2018;32(2):312-326. [2] Berg B, Roos EM, Kise NJ, Engebretsen L, Holm I, Risberg MA. Muscle Strength and Osteoarthritis Progression After Surgery or Exercise for Degenerative Meniscal Tears: Secondary Analyses of a Randomized Trial. Arthritis Care Res (Hoboken). 2022;74(1):70-78.
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Urodynamic Evaluation in Multiple System Atrophy
Urodynamic Evaluation in Multiple System Atrophy Tsiamasfirou D.1,, Galata A., Mitsostergiou P.1, Manola M.E.1, Glatzouni A., Domazou M. Petropoulou K1. 1 2nd Rehabilitation Department, National Rehabilitation Centre, Athens, Greece Background: Lower urinary tract (LUT) dysfunction in patients with multiple system atrophy (MSA), a rare neurodegenerative disorder, is a main feature of autonomic failure. Urodynamic examination (UDS) is crucial for defining the underlying pathophysiology. Aim: To study the effect of MSA on lower urinary tract and explore the different urodynamic patterns between MSA subtypes (MSA-P/MSA-C). Methods: Patients fulfilling criteria of possible or probable MSA, referred to Rehabilitation department, for evaluation of neurogenic bladder. Demographic data, medical history, type and frequency of LUT symptoms were recorded. Patients underwent Urinalysis, bladder ultrasound and UDS. Results: 10 patients (7 women and 3 men) with mean age 61,4 years, median disease duration 3,3 years and median symptoms’ duration 2,5 years were enrolled. Recorded symptoms included: incontinence (95%), urgency (70%), urinary frequency (70%) nocturia (30%) and incomplete bladder emptying sensation(60%). MSA-p was the most common type (70%) while detrusor hyperactivity was the main pattern (60%) with mean Maximum detrusor pressure (Pdetmax) 56,7cmΗ2Ο and mean Cystometric bladder capacity 240ml. Among MSA sub-types detrusor hyperactivity was dominant in MSA-p (66%). Micturition was achieved in 60% of patients. Bladder wall thickness (BWT) was detected in 66,6% of patients, indicating symptoms’ chronicity. 40% of patients experience constipation, indicative of neurogenic bowel dysfunction. Conclusions: Urodynamic examination can accurately detect neurogenic features of urological failure in MSA leading to timely management of LUT dysfunction and prevention of future complications. Claire Richard et al. Early bladder dysfunction in MSA: who seek shall find. Clinical Autonomic Research 2019;29:625–626
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Brain Plasticity: The Role of Rehabilitation in a Stroke Patient
BRAIN PLASTICITY: THE ROLE OF REHABILITATION IN A STROKE PATIENT BACKGROUND AND AIMS: Stroke is a devastating neurological condition and a leading cause of morbidity and mortality worldwide. Individuals recovery capacity is proportional to central nervous neuroplasticity, defined as a reconnection of the neural networks that were interrupted by the ischemic event. In the first days following a stroke, there is a period of heightened neuroplasticity and during this period behavioral interventions such as rehabilitation might be expected to be highly effective. Thus, the aim of this case report is to identify the impact of rehabilitation program (RP) on neuroplasticity in a patient with stroke sequelae. METHODS: A 53-year-old woman, with history of right hemisphere stroke several years ago, currently presenting decreased level of consciousness, motor and sensory defects and in need of ventilatory support and tracheostomy after suffering a Total Anterior Circulation Infarct (Figures 1,2,3,4) is displayed and the effect of the respective NRP is demonstrated. RESULTS: After an intensive rehabilitation period at a Intensive Care Unit and a Stroke Unit, the patient showed significant improvement in alertness, communication, logical reasoning, swallowing, muscle strength and ventilatory independence. Physical, occupational and speech therapy were provided 6 times a week. At hospital discharge on day 30, she was awake, decannulated, with no need of oxygen therapy or ventilatory support. She had regained understanding, but still had poor speech, some disorientation and mild dysarthria. She tolerated modified oral diet. Her muscle strength, sitting and standing trunk balance was improved, and she was walking with mild assistance. CONCLUSIONS: NRP after stroke intends to reduce disability by facilitating recovery of activity and daily routines. The brain plasticity can lead to an extreme degree of spontaneous recovery and rehabilitative training may modify and boost the neuronal plasticity processes, which is exposed by this clinical case.
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Interest of early mobilization in the rehabilitation of flexor tendon injuries of the hand in zone V
Introduction  the rehabilitation of hand tendon injuries has been totally evolved by the appearance of the concept of  “controlled early mobilization” limiting the risk of adhesions. Objective: In this work we evaluated the value of early mobilization in the management of flexor tendon injuries in zone V Methods It is a prospective comparative study, which included 6 patients( 18 fingers ) with a lesion of the flexor tendons of the hand in zone V, divided into two groups A and B. Both groups received the same rehabilitation protocol, except that the group A was treated early from the post-operative day and group B was treated a little later from the second month. The rehabilitation program included reducing trophic disorders and pain techniques. It included also relaxation and prevention of stiffness techniques The duration of the treatment was two months, at the rate of five sessions per week. Evaluation parameters were pain via VAS, oedema via girth measurement, joint mobility, muscle strength through analytic testing and hand function via DASH scale. Results the result obtained showed a more marked improvement in group A. At the end of the protocol, the edema presented a decrease varying between 1.1 and 2 cm for group A and 0.2 and 1 cm for group B. For the muscle strength, Group A patients had a gain average of 2.33 in FDS, Group B patients had a gain average of 1. Hand function of Group A presented a gain average of 48.8. While group B presented a gain average of 20.95. improvement in joint pain and amplitides is shown in Figures 3 and 4. Conclusion our results are similar to those of the literature. Earlier rehabilitation has been shown to be effective in improving the condition of patient with flexor tendon injuries of the hand. References 1-Dumitrache A, Sanchez K, Esnouf S, Roren A, Rannou F, Poiraudeau S, et al. rééducation de la main en pathologies médicale et chirurgicale: ergothérapie, orthèse et kinésithérapie. 2013;press med:163249. 2-A. Brunon-Martinez, M. Romain, J.-L. Roux. Rééducation des lésions tendineuses traumatiques de la main. Kinésithérapie-Médecine physique-Réadaptation.2006
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Impact of care burden on quality of sleep in mothers of children with cerebral palsy
Impact of care burden on quality of sleep in mothers of children with cerebral palsy Haddada I1, Belghith S1, Hadj Salah A1, El Arem S1, Moncer R2, Loubiri I2 , Zaafrane MH3, Sayhi T3, Fekih A4, Sghir M1, Kessomtini W1. • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital • Physical Medicine and Rehabilitation Department, Sahloul University Hospital • Department of Family Medicine, University of Monastir • Orthopedic Department, University Hospital of Monastir Background and aims Sleep disturbance may cause physical and psychological problems. The aim of this study was to evaluate the influence of care burden on quality of sleep among mothers of children with cerebral palsy (CP). Methods Mothers of children with established diagnosis of CP were recruited at the period from July to December 2021. The functional statuses of disabled children were graded according to the Gross Motor Function Classification System (GMFCS) scale. Care burden and quality of sleep were evaluated by the Zarit care burden scale (ZS) and The Pittsburgh Sleep Quality Index (PSQI), respectively. Results The study included 71 mothers, with mean age 38,77 ± 7, 27 years. The mean age of the children with CP was 7,7 ± 2,75 years. The most common clinical subtype of CP was spastic quadriplegia (47.9%). Thirty-eight children had the lowest level of functional status GMFCS (IV 18,3% and V 35,2%). Co-sleeping with children was found in 64.8% of cases. Regarding caregiver burden, 36.6% of cases had a higher burden level (ZS ≥ 41) with a mean ZS 36,44 ± 14. Concerning sleep quality, 74,6% had a pathological total score of sleep (PSQI ≥ 5) with a mean PSQI 7,62 ± 4,2 and 38% usually sleep less than six hours per day. Caregiving burden was significantly associated with sleep disturbance (p< 0,002). Discussion: Chronic illness of a child, in terms of quality of life, affects family and parents more than the child, because restrictions in the child’s independence cause greater burden on the parents. Mothers of children with CP report impaired sleep quality and fatigue, both of which are common as the disease progresses. Children with CP who have difficulty sleeping and require parental nighttime care are associated with poor maternal sleep quality which is important and can lead to higher failure rates and fatigue at home and work. There are many factors that can cause fatigue in mothers of children with disabilities, such as: insufficient physical activity, perceived lack of social support, and doctor's appointments and treatment. When the amount of the burden and difficulties of caregiving increases, mothers feel hopeless and as a result their QoL decreases significantly, especially with regard to vitality, social functioning and depressive emotions. Psychosocial support, strengthening the capacity of services which accommodate the needs of children and their mothers; and provision of assistive technology devices will be useful in reduction of fatigue levels of mothers. Fatigue may negatively affect the efficacy of rehabilitation programme which requires a multi-disciplinary approach involving all family members particularly mothers who play an essential role in the rehabilitation. Conclusions Sleep disturbance was common in mothers of children with CP, and our results demonstrated the relationship between sleep disturbance and caregiving burden. References: [1] Glinac A, Matović L, Delalić A, Mešalić L. Quality of Life in Mothers of Children with Cerebral Palsy. Acta Clin Croat. 2017 Jun;56(2):299-307. doi: 10.20471/acc.2017.56.02.14. PMID: 29485798. [2] Albayrak I, Biber A, Çalışkan A, Levendoglu F. Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy. J Child Health Care. 2019 Sep;23(3):483-494. doi: 10.1177/1367493519864751. Epub 2019 Jul 18. PMID: 31319696. [3] Garip Y, Ozel S, Tuncer OB, Kilinc G, Seckin F, Arasil T. Fatigue in the mothers of children with cerebral palsy. Disabil Rehabil. 2017 Apr;39(8):757-762. doi: 10.3109/09638288.2016.1161837. Epub 2016 Mar 25. PMID: 27015263. [4] Lang CP, Boucaut A, Guppy M, Johnston LM. Children with cerebral palsy: A cross-sectional study of their sleep and their caregiver's sleep quality, psychological health and well-being. Child Care Health Dev. 2021 Nov;47(6):859-868. doi: 10.1111/cch.12897. Epub 2021 Jul 26. PMID: 34265112.
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The role of mesotherapy in musculoskeletal pain: a review on the current evidence
The Role of Mesotherapy in Musculoskeletal Pain: a review on the current evidence Flávio Ribeiro¹, Joana Santos-Costa¹̕̕ ², Teresa Martins¹, Joana Martins¹


¹Physical and Rehabilitation Medicine Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
²Faculty of Medicine, University of Coimbra, Portugal Background and aims Mesotherapy (MST) consists in locoregional administration of intradermal microinjections containing different case specific drugs. It’s mainly used in PRM for musculoskeletal (MSK) pain relief. Our aim is to review the latest evidence about the role of mesotherapy in the treatment of musculoskeletal pain. Methods We conducted a search for studies that simultaneously included the MeSH terms [mesotherapy AND pain] and [mesotherapy AND musculoskeletal pain], in the last 10 years. The search was conducted using the following databases: Cochrane, Embase, PubMed and Google Scholar. Results We included a total of 7 studies in this review: 4 RCTs, 1 retrospective observational study and 2 systematic reviews. Mesotherapy with NSAIDs showed similar or better effectiveness and safety profiles in the relief of chronic and acute musculoskeletal pain and associated disability. In a recent study it was at least as effective in the treatment of MSK lumbar pain, when compared to epidural steroid injection. Conclusions MST is an effective and safe treatment modality for MSK pain, requiring lower total drug dosages, when compared to systemic NSAID therapy. However, there are very few recent RCTs on its usage and there is high inconsistency in the methodologies adopted between them. Being MSK pain the most prevalent of all painful conditions, efforts should be made to conduct RCTs using properly standardized protocols.
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Influence of care burden on mental disorders in mothers of children with cerebral palsy
Influence of care burden on mental disorders in mothers of children with cerebral palsy Haddada I1, Belghith S1, Hadj Salah A1, Krifa B1, Moncer R2, Loubiri I2, Zaafrane MH3, Sayhi T3, Fekih A4, Sghir M1, Kessomtini W1. • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital of Mahdia, Tunisia. • Physical Medicine and Rehabilitation Department, Sahloul University Hospital, Tunisia • Department of Family Medicine, University of Monastir, Tunisia • Orthopedic Department, University Hospital of Monastir, Tunisia Background and aims Mothers of children with cerebral palsy (CP) are highly vulnerable to mental disorders regarding the daily parenting stress. The aim of this study was to evaluate the influence of care burden on mental disorders among these mothers. Methods Mothers of children with established diagnosis of CP were recruited at the period from July to December 2021. The functional statuses of disabled children were graded according to the Gross Motor Function Classification System (GMFCS) scale. we used the Hospital Anxiety and Depression scale (HAD) to evaluate anxiety and depression among mothers. The level of care burden was measured using the Zarit scale (ZS). Results The study included 71 mothers, with mean age 38,77 ± 7, 27 years. The mean age of the children with CP was 7,7 ± 2,75 years. The most common clinical subtype of CP was spastic quadriplegia (47.9%). Thirty-eight children had the lowest level of functional status GMFCS (IV 18,3% and V 35,2%). Regarding caregiver burden, 36.6% of cases had a higher burden level (ZS ≥ 41) with a mean ZS 36,44 ± 14. High levels of depression and anxiety scores (HADS > 11) were observed in 63.4 % and 53.5 % of mothers respectively. Caregiving burden was significantly associated with anxiety and depression (p<0,001). The variables age or functional level of the child (GMFCS) and clinical subtype of CP had no significant association with mothers’ burden. Discussion: Most children with CP are cared for by their mothers at home, which presents several challenges. Often referred to as the care burden, these challenges affect the well-being of mothers and children. There is an increased incidence of depression among mothers of children with CP (Garip et al., 2017; Khanna et al., 2015). The study of Unsal-Delialioglu et al. (2009) found that the stress resulting from dealing with a chronic condition is a risk factor for the development of depression in the mothers. Also, Yilmaz et al. (2013) reported that disability in a child and accompanying challenges may negatively affect psychological health of mothers of children with CP. [1] Conflicting results about the relationship between GMFCS level and mothers’ pain severity, depression level, sleep quality, fatigue, and quality of life (QoL) have been reported by previous studies (Tuzun et al., 2010; Turkoglu et al., 2016). GMFCS level of the child was correlated with ZS scores, but gross motor function was not correlated with mothers’ pain severity, depression level, sleep quality, fatigue and QoL in the study of Albayrak and al., 2019. Another significant personal stressor is mothers' lack of knowledge about how best to care for their children. Lack of knowledge can lead to feelings of helplessness and hopelessness. Addressing this issue is important to improving the health and well-being of caregivers. When caregivers are supported with appropriate information, they can care for children effectively. This reduces stress levels for caregivers. Conclusions There is a need to reduce the care burden in mothers of children with CP by other family members and increase psychosocial support which can help improve the mother's mental health, and in turn can improve the psychosocial health of children with CP. References: [1] Albayrak I, Biber A, Çalışkan A, Levendoglu F. Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy. J Child Health Care. 2019 Sep;23(3):483-494. doi: 10.1177/1367493519864751. Epub 2019 Jul 18. PMID: 31319696. [2] Vadivelan K, Sekar P, Sruthi SS, Gopichandran V. Burden of caregivers of children with cerebral palsy: an intersectional analysis of gender, poverty, stigma, and public policy. BMC Public Health. 2020 May 8;20(1):645. doi: 10.1186/s12889-020-08808-0. PMID: 32384875; PMCID: PMC7206712.
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Total knee arthroplasty in rheumatoid arthritis functional results
Total knee arthroplasty in rheumatoid arthritis functional results Dr Z.TAHRI T,ZINEDDINE P.MADJIDANEM N.KYAL F.LMIDMANI A.ELFATIMI
Department of Physical Medicine and Rehabilitation, UHC Ibn Rochd- Casablanca-Morocco Background and aims Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects up to 1.5% of the worldwide population, women in particular.Total Knee Arthroplasty (TKA) has been described as an effective treatment for alleviation of pain and restoration of function in patients with RA.The aim of our study was to evaluate quality of life after Total Knee Arthroplasty in this population. Methods We reviewed the results of thirteen Total Knee Arthroplasty that had been performed to eight Rheumatoid arthritis patients in trauma and orthopaedic department of Ibn Rochd university hospital of Casablanca(IRUHC) who benefited from inpatient care in the physical and functional rehabilitation department of IRUHC between 2016 and 2022.We assessed the results using the Knee Society Score(KSS),visual analog scale and functional independance measure.. Results The mean KSS improved from 71.61±12.3 to 148± 19.7.Mean visual analog scale went from 5.9±0.9 to 2.3± 0.7 and functional independance measure went from 58 to 81/126. We found that 37.5% of the patients regained gait autonomy Conclusions These results show that a personalized rehabilitation program as a step of a multidisciplinary approach is key in optimising the results of Total Knee Arthroplasty in Rheumatoid arthritis patients and as result improving their quality of life. Future research could examine the implant survival rate in this population.
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Effect of electrostimulation of the intrinsic foot muscles on medial arch stability and postural balance in elderly
Effect of electrostimulation of the intrinsic foot muscles on medial arch stability and postural balance in elderly Haddada I, Belghith S, Hadj Salah A, Dorgham I, Sghir M, Kessomtini W. Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital of Mahdia, Tunisia. Background and aims Intrinsic foot muscle weakness is a major cause of balance impairment in older adults, resulting in limited range of motion due to fear of falling, which reduces quality of life. This prospective study aimed to investigate the effect of electrical stimulation of the medial arch of the foot on navicular height, balance, and fear of falling. Methods Twenty patients over the age of 65 were recruited for this study. Before and after 4 electrical stimulations of the medial arch of the foot at 85 Hz each for 20 minutes, navicular height of the dominant foot, balance on the Berg Balance Scale (BBS), Timed Up and Go test and single-foot posture and fear of falling through the Falls Efficacy Scale (FES) were measured. Results After 4 sessions of electrical stimulation, the height of the navicular increased significantly on average by 0.64 ± 0.24 cm (p = 0.004). FES scores and BBS scores improved significantly (p=0.003 and p=0.005, respectively). There were also significant improvements in the Timed Up and Go test (p=0.004) and the 30-second sit-to-stand test (p < 0.001). On the other hand, the single-foot support test showed no significant changes. Discussion: Previous studies have shown that a short period of electro-induced strengthening of the intrinsic muscles of the medial arch of the foot results in a significant reduction in navicular fall in the short to medium term. These results are of practical interest for injury prevention. Indeed, the role of the foot's intrinsic muscles in actively maintaining the medial arch has already been reported, suggesting that strengthening these muscles should be of interest in subjects with excessive pronation. [1,2] We hypothesized that balance ability improved due to increased force production of the hallux abductor muscle, which is consistent with the results of a previous study. They reported that strengthening the toe flexor muscles could increase static or dynamic balance ability in the elderly. [3,4] Enoka et al. found that increased sensory feedback induced by EMS produced clinically significant improvements in walking speed and endurance, and dynamic balance. Jang and Park also demonstrated that EMS produced a significant improvement in the TUG test after a 4-week intervention in elderly subjects. [5] This study has certain limitations. In fact, the training period was short. A longer training period should be implemented to better understand the long-term results. Conclusions In summary, the results of this study can be used in the context of muscle strengthening of the intrinsic muscles of the foot via electrostimulation of the medial arch to decrease the risk of falling or the fear of falling in elderly people. References: [1] Fourchet, F., Kilgallon, M., Loepelt, H., & Millet, G.-P. (2009). Électrostimulation des muscles plantaires et chute de l’os naviculaire. Science & Sports, 24(5), 262–264. doi:10.1016/j.scispo.2009.03.005 [2] Fiolkowski P, Brunt D, Bishop M, et al. Intrinsic pedal musculature support of the medial longitudinal arch: an electromyography study. J Foot Ankle Surg 2003;42(6): 327—33. [3] Namsawang, J.; Muanjai, P.; Luangpon, N.; Kiatkulanusorn, S. The Effects of Electrical Stimulation Program on Navicular Height, Balance, and Fear of Falling in Community-Dwelling Elderly. Int. J. Environ. Res. Public Health 2021, 18, 9351. https://doi.org/10.3390/ ijerph18179351 [4] Quinlan, S.; Fong Yan, A.; Sinclair, P.; Hunt, A. The evidence for improving balance by strengthening the toe flexor muscles: A systematic review. Gait Posture 2020, 81, 56–66. [5] Namsawang J, Muanjai P. Combined Use of Transcutaneous Electrical Nerve Stimulation and Short Foot Exercise Improves Navicular Height, Muscle Size, Function Mobility, and Risk of Falls in Healthy Older Adults. Int J Environ Res Public Health. 2022 Jun 11;19(12):7196. doi: 10.3390/ijerph19127196. PMID: 35742445; PMCID: PMC9223504.
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Radiofrequency Thermal Neuroablation of Genicular Nerves – an alternative pain management strategy of Pigmented Villonodular Synovitis in the knee
Radiofrequency Thermal Neuroablation of Genicular Nerves: an alternative pain management strategy for Pigmented Villonodular Synovitis (PVNS) in the knee José Inácio Menezes1, Miguel Correia1, Ana Sofia Meixedo1, Yuriy Mazin1, Ana Matos Gonçalves1, Tiago Rodrigues Lopes1 1 Physical Medicine and Rehabilitation, Centro Hospitalar Vila Nova de Gaia/Espinho – Centro de Reabilitação do Norte, Gaia, PRT. What is PVNS? Pigmented villonodular synovitis (PVNS), consists on a rare proliferative disorder characterized by the overgrowth of synovial tissue in the joints, bursae, and tendon sheaths, which can lead to the formation of focal or diffuse nodular thickening of the synovial membrane. The nodules or villi can be pigmented or non-pigmented. Symptoms PVNS can give rise to profound joint pain, rigidity, swelling, and restricted articular mobility, all of which can impose significant functional constraints upon the individuals afflicted by this condition. Treatment Surgical treatment is considered standard of care, especially if the disease has progressed to cause joint destruction. Open synovectomy and anterior arthroscopic resection are seen as validated treatment options. New targeted medical therapies have been developed in compliance with the new etiologic theories proposed for PVNS, whilst radiotherapy’s popularity has fallen majorly due to its higher toxicity when compared with these newer agents. Pain Management In managing PVNS, pain management is also a critical component of care. Patients with PVNS often experience chronic, persistent pain that can interfere with daily activities and reduce their quality of life. Pain can be managed through a variety of approaches, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and opioids. Additionally, physical therapy and occupational therapy can help improve joint function and reduce pain. Case Presentation A 67-year-old male diagnosed with PVNS involving the right knee joint, with 11 years of evolution and more recently exacerbated symptoms, referring diffuse inflammatory knee pain refractory to previous conservative analgesic strategies and to surgical treatment (anterior arthroscopic synovectomy) leading to significant functional limitation. Intervention: • Radiofrequency (RF) thermal neuroablation of the right superomedial, superolateral and inferomedial Genicular Nerves (GN) RF Parameters • Ultrasound-guided • 10cm injection electrode • Continuous application of 80ºC • Duration: 3 minutes Before Radiofrequency Pain Medication: • Pregabalin 150mg, • Buprenorphine 70mg, • Amitriptyline 25mg, • Tramadol + Paracetamol 75/650mg Visual Analogue Scale (VAS) • Average VAS: 6/10 • Maximum VAS: 9/10 At 1 Month Follow-up – Subjective 50% reduction on VAS – Decrease in reported rest pain Visual Analogue Scale (VAS) • Average VAS: 3/10 • Maximum VAS: 5/10 • Next evaluation at 3-month follow-up Conclusion Given the pronounced propensity for PVNS to manifest recurrently, these patients would most likely benefit from a comprehensive pain management strategy imbued with a multidisciplinary approach that could ensure them the best possible clinical outcomes and patient satisfaction. Radiofrequency thermal neuroablation, in this context, may be regarded as an effective approach to pain control in patients experiencing refractory symptoms associated with PVNS. Image Description Fig.1. Right Knee MRI compatible with the postulated PVNS diagnosis Fig.2 and Fig.3: Ultrasound-guided RF thermal neuroablation of the right knee superolateral GN
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Cervical and lumbar spine pain management with osteopathic manipulation combined with topical CFA application
P-206 Cervical and lumbar spine pain management with osteopathic manipulation combined with topical CFA application. Alessandro Zaccagna DO*, Leila Turki* * Studio Professionale Fisioterapico e Osteopatico Alessandro Zaccagna, Livorno – Italy Background and aim Cervical and lumbar spine pain were often treated with osteopathic normalization (ON) and, if necessary, oral or topical NSAIDs are used specially in the first days of treatment. Cetylated Fatty Acids (CFA), which are fatty acids esterified with cetyl alcohol, were demonstrated to be safe and useful to improve pain in sport athletes and in osteoarthritic subjects. The goal of this study is to demonstrate the opportunity to manage neck and back pain with ON combined with topical CFA-based cream and patch application. Methods Subjects with cervical and lumbar spine pain were treated with 10 ON combined with massotherapy, physiotherapy and kinesioterapy (MPKT), 2-3 times per week. 5 g CFA-based cream (Cetilar® Cream, Pharmanutra Spa) was applied during ON, manually massaged until completely absorbed, and one CFA-based patch (Cetilar® Patch, Pharmanutra Spa) was stick at home for the first 5 days of treatment. Pain and disability were assessed using numeric rating scale (NRS) and Oswestry Disability Index (ODI) respectively, at baseline (T0) and at the end of treatment (T1) after about 35 days. Use of NSAIDs were monitored during all treatment period. Results A total of 22 subjects were treated and 15 complete the treatment. 10 out of 15 subjects had neck pain and 5 out of 15 had back pain. A statistically significant reduction in pain on the NRS scale has been reported from T0 (7.6 1.5) to T1 (1.3 0.9) (Figure 1) and a significant reduction in ODI score has been reported from 23.7% 8.9% to 12.0% 2.4% (Figure 2), moving from a moderate disability to a minimum disability, according to the test interpretation ranges. None of the subjects treated used NSAIDs during the observation period. All 15 subjects used the patch regularly and none reported any tolerability problems. Conclusions With this observation we demonstrate that managing back and neck pain with osteopathic normalization combined with MPKT and topical CFA application allows to obtain a recovery of functionality and a reduction of pain in the long term and to avoid the use of NSAIDs. Further studies will be needed to better understand the synergy of these two treatments.
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The influence of yoga on individuals with knee osteoarthritis
Background and aims : Knee osteoarthritis (KOA) is a degenerative musculoskeletal disease prevalent in the elderly. Symptoms of KOA include leg pain and stiffness, muscle weakness, muscle atrophy, and abnormal gait, which limit patients’ participation in daily activities and further impair physical function. (1) KOA is the most common type of knee joint injury and is also a risk factor for several health problems. As a result, it occurs mainly in older women.(2) Yoga is consisting largely of postural exercises that are performed with the goal of developing strength, balance and flexibility. (3) The purpose of this study was to investigate the impact of yoga on osteoarthritis pain in the knee joints. Material and Method : A randomised controlled trial was conducted in physical medicine and rehabilitation department of Sahloul university Hospital in Sousse in a period of 3 months .Outpatients aged 50 and over with KOA were randomly devided into a two groups : a yoga group (G1) and a control group (G2). the participants of the group 1 were taught a modified yoga session of 30 minutes . It was repeated three times per week during 8 weeks. The yoga routine for G1 included 5 minutes warm-up, 20 minutes of suitable yoga asanas, and finally 5 minutes stretching. This modified yoga program was intended to improve mobility, fluidity of movement, strength of muscles especially to stabilize the joints of the ankle and knee, integration of left and right hemispheres of the brain and body awareness. (4) It was coached by experienced yoga instructor. While G2 was doing regular rehabilitation : physiotherapy, joint passive and active mobility , muscle strengthening , walking for 20 minutes Résultats : • We enrolled 10 patients in each group, mean age was 58,3 years ±6.3. Sex-ratio was 0.3. Compared to the baseline data, our results showed a decrease in means of VAS and WOMAC index for both groups (p<0.05 and p>0.05 in G1 and G2 respectively). Moreover, the yoga group had a significant improvement in KJM unlike the control group. However, our study did not find gain in the TUGT test in both groups. • Yoga may have potential to improve joint pain ,function, and stiffness in patients with knee osteoarthritis compared to controls with or without exercise. • Yoga may have potential to improve joint pain ,function, and stiffness in patients with knee osteoarthritis compared to controls with or without exercise. Table 1: Descriptive data for both groups. Notes: a) Data reported as mean standard deviation (SD). b) BMI refers to body mass index. c) There were no significant differences between groups(p > 0.1). Table 2: Anal tical data and results of the tests Yoga Control Combined value Age 58.1(6.5) 58.7 (6.1) 58,3 (6,3) 0.547 Gender (% male) 80 60 30 0.1600 BMI 30.9(5.3) 30.3(5.1) 30,6 (5.2) 0.486 Number of co- morbidities 3 (2) 3 (2) 3 (2) 0.3712 Number of drugs consumed 7(3) 7 (1) 7 (2) 0.5778 We included in our study People aged 60 years and over, able to stand without support, understand and follow simple instructions and demonstrations, and the absence of severe cognitive, hearing and visual impairment . The following outcomes were measured at baseline and the end of the 8-week yoga Intervention, by the same examiner: VAS for pain, WOMAC index , timed-up and go test (TUGT) and knee joint mobility (KJM). outcomes Yoga group G1 Control group G2 At Baseline At 8 weeks p- Value At Baseline At 8 weeks p- Value VAS pain 7.5 ± 2.88 5.33 ± 3.61 0.003 7.71 ±5.00 6.85 ±4.92 0.108 TUG (s) 6.18 ± 0.37 5.92 ± 0.4 0. 171 5.94 ± 0.71 5.85 ± 0.67 0.126 KMJ (°) 110 ± 10 120 ± 10 0.041 115 ± 10 120± 10 0.183 WOMAC index 86 ±3 80 ± 3 0.001 85 ± 3 82 ± 3 0.264 Figure 1 : yoga asanas done in the training routine for patients in the group 1 with the coach Conclusion:  The management of pain in physical medicine and rehabilitation department is a major concern with strategies for prevention and monitoring a focus in this setting. In addition to its meditation indication, Yoga have shown potential to improve KOA pain and function statue in geriatric population. Further studies with larger sample size are needed to compare the groups and confirm these results. The influence of yoga on individuals with knee osteoarthritis R.Moncer; H.Zakhama ;O.Jelassi ; I.Loubiri ; S.Frigui; W.wannes ; S.Jemni Physical medecine and rehabilitation departement –Sahloul hospital– Sousse – Tunisia
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Avascular necrosis of both knee joints after allogeneic hematopoietic stem cell transplantation – a case report
AVASCULAR NECROSIS OF BOTH KNEE JOINTS AFTER ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION – A CASE REPORT Tamara Vukic1, Lana Desnica2, Drazen Pulanic2,3, Radovan Vrhovac2,3, Neven Istvanovic1 1Department of Rehabilitation and Orthopaedic Aids, University Hospital Center Zagreb, Zagreb, Croatia 2Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia 3University of Zagreb School of Medicine, Zagreb, Croatia INTRODUCTION Avascular bone necrosis of symmetrical joints manifesting simultaneously although described in the literature is extremely rare and with this abstract we want to present a case of a young 36-year-old patient with bilateral avascular necrosis of both knee joints. CASE REPORT A 36-year-old male patient was referred to the physiatry outpatient clinic for a consultation by a hematologist in 2020. Patient complained of severe pain in both knee joints and had difficulty walking. Patient stated that symptoms appeared suddenly and were not provoked by any injury or trauma. A detailed medical history was taken and it was significant to notice that patient underwent allogeneic hematopoietic stem cell transplantation in 2018, after being diagnosed with myelodysplastic syndrome in 2017. After transplantation patient received high doses of immunosuppressive therapy for a period of six months. A detailed clinical examination was performed and in the clinical status, there was severe palpation tenderness of both knees, reduced range of motion and limping when walking. At the examination, patient presented with X-ray images of both knee joints which were taken in another institution. X-ray findings of both knee joints were normal, so a magnetic resonance imaging (MRI) was indicated. MRI scans presented with multiple irregular demarcated areas of both condyles of the femur and both patellas what is a typical sign for avascular necrosis of the bone. To relieve his symptoms patient was prescribed with physical therapy, painkillers and walking with crutches to reduce weight bearing. Patient was also referred to an orthopedic surgeon for a surgery consultation. Orthopedic surgeon examined the patient and indicated core decompression surgery of the affected bone. After three months patient went for the scheduled surgery on his left knee and had a good recovery afterwards. After the operation patient was under the constant supervision of a physiatrist and has completed a rehabilitation program. Patient is now waiting for a second operation, core decompression surgery on his right knee. CONCLUSIONS Bilateral avascular necrosis of symmetrical joints manifesting simultaneously is extremely rare and with this abstract we wanted to present a case of a young patient with bilateral avascular necrosis of both knee joints. If the patient’s medical history shows that he received immunosuppressive therapy, then avascular necrosis should be suspected. In the early stages of the disease this condition is often not visible on X-rays images, so a magnetic resonance imaging (MRI) should be taken. MRI is higly sensitive and specific imaging modality as MRI scans will show changes typical for avascular necrosis even in the early stages of the disease. It is important to detect avascular necrosis in the early stages of the disease as early detection results in better treatment options and consequently overall better treatment outcome for our patients. MeSH / Keywords: avascular necrosis, osteonecrosis, immunosuppressive therapy, hematopoetic allogeneic bone marrow transplantation, corticosteroid use
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Impact of smartphone addiction on neck pain and musculoskeletal disorders in physiotherapy students
Impact of smartphone addiction on neck pain and musculoskeletal disorders in physiotherapy students El Arem S, Belghith S, Haj Salah A, Haddada I, Sghir M, Kessomtini W Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital Background and aims: Smartphones have become an evident part of young adults’ life especially among students. Repetitive use of handheld electronic devices such as smartphones require special posture, placing stresses on the cervical spine and neck muscles which can lead, to neck pain or text neck syndrome. The aim of this study was to assess the impact of addiction to smartphone use on neck pain and musculoskeletal disorders (MSD) among physiotherapy students. Patients and methods: A cross sectional study was conducted including physiotherapy students of the city of Monastir. Students’ addiction to smartphones was assessed using the Smartphone Addiction Scale (SAS). Neck pain and disability were assessed using the Neck Disability Index (NDI) and MSD using the modified Nordic Musculoskeletal Questionnaire. Results: Thirty-six students with a mean age of 20.67 ± 1.26, participated in this study. with a sex ratio of 0.2. The average time spent using smartphone was estimated at 6.38 ± 2.14 hours per day. Mean SAS was 35.8±10.48 and NDI was 8.14 ± 4.8. most MSD reported in students were respectively neck pain (61 %), shoulders pain (33 %), wrists and hands pain (22 %) and upper back pain (17 %). The average VAS for neck pain was 3,65 ± 2,5. A significant correlation was found between SAS scores and VAS (p< 0,05, r= 0,162) , and NDI (p < 0.05, r= 0,35). Discussion: Excessive use of smartphones can lead to repetitive and continuous bending of the head and neck towards the screen throughout the day. These movements are associated with a high risk of chronic neck pain and may explain the strong association between SAS, VAS and NDI scores in the present study. An increase in the angle of head flexion requires greater contraction forces from the neck extensor muscles to support the head in a more flexed position, which has been identified as a risk factor for head and neck pain in tablet and smartphone users. In addition, looking down at your smartphone too often can lead to upper back pain, as well as shoulder pain and tension, ranging from chronic, stabbing pain to acute, severe muscle spasms. Sustained gripping and repetitive movements (particularly typing) with the thumb and fingers have all been identified as risk factors for disorders of the thumb and its musculature, leading to associated syndromes such as wrist tendonitis or De Quervain's disease. Conclusion: This study showed that excessive use of smartphones is correlated to neck pain and disability among students. Therefore, they should reduce the time spent on smartphone and maintain an appropriate posture during its use in order to prevent neck pain and other MSD. References: [1] Shah PP, Sheth MS. Correlation of smartphone use addiction with text neck syndrome and SMS thumb in physiotherapy students. Int J Community Med Public Health 2018;5:xxx-xx. [2] AlAbdulwahab SS, Kachanathu SJ, AlMotairi MS. Smartphone use addiction can cause neck disability. Musculoskeletal Care. 2017;15(1):10-2 [3] Neupane S, Ali U, Mathew A. Text Neck Syndrome - Systematic Review. Imperial J Interdiscipl Res. 2017;3(7):141-8. [4] Yanfei Xie, Grace P.Y. Szeto, Jie Dai & Pascal Madeleine (2015): A comparison of muscle activity in using touchscreen smartphone among young people with and without chronic neck–shoulder pain, Ergonomics, DOI: 10.1080/00140139.2015.1056237 [5]Szeto, G. P. Y., Tsang, S. M. H., Dai, J., & Madeleine, P. (2020). A field study on spinal postures and postural variations during smartphone use among university students. Applied Ergonomics, 88, 103183.
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The effects of extracorporeal shock wave therapy on pain, disability and life quality of chronic low back pain Patients: preliminary results
THE EFFECTS OF EXTRACORPOREAL SHOCK WAVE THERAPY ON PAIN, DISABILITY AND LIFE QUALITY OF CHRONIC LOW BACK PAIN PATIENTS: PRELIMINARY RESULTS Gaddour M ; Loubiri I ; Moncer R; Mrizek Z , Rahmeni C, Ouanes W, Jemni S INTRODUCTION The basic approach of choice for low back pain (LBP) therapy is still conservative management, which includes mainly pharmacotherapy, physiotherapeutic procedures and more recently, modern extracorporeal shock wave therapy (ESWT) have been also used. despite its high popularity and novelty, there is limited evidence concerning its effectiveness and safety of ESWT for patients with LBP. Thus, this study aims to investigate the effect of ESWT on pain, functional status, and quality of life in chronic LBP patients. METHODS : A prospective analytic study was occurred at the rehabilitation department .Patients with clinically diagnosed of LBP were included. The protocol consisted of two sessions of ESWT per week. All participants had ten sessions .The primary outcome included pain intensity which was assessed by the visual analogue scale (VAS). The secondary outcomes comprised functional status, quality of life, psychological outcomes, as well as the adverse events. The functional status was measured by the oswestry disabilities index in its Arabic version. The quality of life, and psychological outcomes were examined by the 36-Item SF and HAD score respectively. The data were obtained before treatment (t0), at one month (t1) and two months later (t2) RESULTS : We had the consent of sex women and for men patients to participate in the study. Epidemiologic characteristics are showed in table n 1 . Major pain relief was noticed at T1 and T2 compared with t0 . Overall, improvement in the parameters of disability, depression, anxiety, and quality of life in the patients with CLBP ( figure 1) . Statistical significance was found in pain reduction. Besides, a significant improvement of oswestry disabilities index was reported( 20.5 at t0 , 15 at t1 , 10.5 at t2 , P < .05). No adverse effect was noticed. CONCLUSION: Our preliminary results confirm the effectiveness and safety of ESWT for LBP. it allows pain relief, better functional status, quality of life, as well as the psychological outcomes of patients with LBP. Certainly Future comparative studies and clinical trials are needed to further investigate this issue
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Primary Raynaud’s phenomenon treated with high energy electromagnetic field stimulation: a case report
Primary Raynaud’s phenomenon treated with high energy electromagnetic field stimulation: a case report Ana Aljinović MD, PhD, Silvija Mahnik, MD, Department of Physical Medicine and Rehabilitation, Orthopaedic Surgery Clinic, Clinical Hospital Zagreb Primary Raynaud’s phenomenon (PRP) is often refractory to treatment. High energy electromagnetic field stimulation (HEMFS) is therapy used in rehabilitation to reduce pain, enhance circulation and tissue regeneration. In this case HEMFS was used to treat PRP. A 45 years old woman was tested with infrared thermography before and after the treatment (FLIR i60, FLIR® Systems AB, Sweden). At baseline After cold immersion After rewarming. The BTL Super Inductive System’s program for chronic circulation disordersl, 50% intensity, five times applied to the patient’s right hand. The patient with PRP treated with HEMFS had less pain in her right hand and thermography results show higher temperatures after treatment. This case shows that HEMFS could be beneficial treatment for the PRP.
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Effects of a reasonable accommodation on well-being for employee with disability: comparison of two cases using the Employment Passport
Effect of reasonable accommodation on the well-being of employees with disabilities: comparison of two cases using the Employment Passport UNO K1, KOBAYASHI R2, MAEBARA K3, MATSUI N4 1 Vocational Rehabilitation and Counseling Association,Tokyo, Japan 2 Department of Rehabilitation, Hyogo Medical University, Hyogo, Japan 3Department of Education and Human Studies, Akita University, Akita, Japan 4Vocational Rehabilitation and Counseling Association,Tokyo, Japan Background and purpose One of the important goals of vocational rehabilitation is not only to keep working but also to promote one’s well-being. Well-being is a positive state experienced by individuals and societies (WHO).The Employment Passport (Japanese Ministry, 2019) is an information-sharing tool that enhances the self-awareness of employees with disabilities, fills out their reasonable accommodation, and facilitates communication with their employers, thus promoting their well-being. This study aimed to clarfiy the effect of reasonable accommodation on the well-being of employees with disabilities and discuss the way of support for disabled employees. Methods This study included two employees with disabilities living in different places who used the Employment Passport as a negotiation tool for reasonable accommodation. There are differences in support and subjective well-being between the two employees. We used the well-being at work scale (WaW77; Persol Research and Consulting Co., Ltd & Takashi Maeno, Keio University, 2020) to measure subjective well-being. Results One employee without adequate support got a low score of “approval of others” and a high score of “overwork,” and his employer did not grasp his stress situation. Thus, mutual understanding between employers and employees is important for workers’ well-being.( Fig.1 ) Conclusion It is necessary for employees with disabilities to understand corporate culture, and employers should become more aware of their well-being too. Without a stereotypical view, we should support the sustainable work of employees with disabilities in terms of well-being. The Employment Passport as a negotiation tool (Japanese Ministry, 2019) 【contents】 Features of the disorder Appeal point Desired support Employer      Disabled person Fig.1 The well-being at work scale (WaW77; Persol Research and Consulting Co., Ltd & Takashi Maeno, Keio University, 2020)
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Assessment of management for adult constipation and improvement of laxative prescribing, in a rehabilitation inpatient setting
Assessment of management for adult constipation and improvement of laxative prescribing, in a rehabilitation inpatient setting Dr Ryan Fielder, Rehabilitation Medicine trainee (ST4), Mersey deanery, Broadgreen Hospital, Liverpool, England, UK Introduction • Constipation is a common issue within the adult inpatient population • This can be caused and/or worsened by immobility, acute illness, recent surgery, and medication side effects. All of these are colloquially known to be common to rehabilitation inpatients. • Constipation and its potential complications have the potential to inhibit rehabilitation and extend hospital stay, incurring a higher healthcare cost and poorer patient experience Aims • For 100% of patients on the ward to have evidence of regular review of bowel management, to include initiation of laxatives and reduction/stopping of laxatives according to recorded bowel charts • Promote adherence to national guidelines regarding laxative prescribing on an adult rehabilitation units • Implement a positive change to promote best practice Method • Collection of data from patients resident on the ward within specific dates period over 1 week • Data electronically recorded in Excel • Objectively categorise evidence of problems within current practice. (including: documentation of stool type and frequency, rationale for laxatives prescribed, appropriate type of laxative prescribed, review in response to change in bowel frequency/type)  • Creation of a ‘constipation review’ chart • Implementation of a weekly constipation review for patients to be undertaken by the medical team • Senior medical team members to lead this review • Data collection repeated to compare results to initial data Results • Guidelines not being fully adhered to, including poor documentation of bowel habits in patients, with the majority of patients being prescribed laxatives without documented review or a clear indication • Following implementation of the changes, documentation was clear and regular, the majority of patients had a predictable ‘normal’ bowel routine, and laxative prescriptions fell from 84% to 64% Conclusions • The project showed that good laxative prescribing may lead to predictable bowel regimens for patients with reduced laxative prescriptions overall • There is potential for reduced expenditure on laxative medications • A serendipitous observation was that the nurse’s records of bowel movements became more detailed (type and frequency) – with more information to interpret, changing laxatives appropriately became easier for the medical staff • The project opens up the possibility of further research into the greater benefits of this on hospital stay and patient experience References: NICE Clinical Knowledge Summary, Scenario: Constipation in adults (Last revised in January 2023), https://cks.nice.org.uk/topics/constipation/management/adults/ Mohammed MA, Moles RJ, Chen TFMedication-related burden and patients’ lived experience with medicine: a systematic review and metasynthesis of qualitative studiesBMJ Open 2016;6:e010035. doi: 10.1136/bmjopen-2015-010035
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The corrlation between rheumatoid arthritis activity and neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR)
Title : The corrlation between rheumatoid arthritis activity and neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) Autors : Ramy Ben Tekaya, Jguirim Mahbouba, Ghali Mourad, Saoussen Zrour, Ismail Bejia, Mongi Touzi, Sakly Nabil, Naceur Bergaoui Hospital University Fattouma Bourguiba, Rheumatology Department, Monastir, Tunisia Backgroud and aims Rheumatoid arthritis (RA) is characterized by synovial tissue (ST) inflammation leading to pain, joint destruction. Blood neutrophil to lymphocyte (N/L) ratio has been used as a simple marker of inflammation both in cardiac and non-cardiac disorders. In this study, we aimed to investigate the relation between neutrophil to lymphocyte ratio and RA. Methods We conducted a retrospective study including RA patients followed in university hospital Fattouma Bourguiba, Monastir. Results of blood tests (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], rheumatoid factor [RF], anti-citrullinated protein autoantibodies [ACPA], leukocyte formula ratios (NLR) and disease activity and function measures (disease activity score 28 [DAS28 -CPR], swollen and tender joint count [SJC, TJC], physician and patient visual analogical scale [VAS]) were collected. Results There were 74 participants (47,5%) in the RA patient group. 61 (82,4%) were in attack period and 13 of patients (17.5%) were in remission period. Median age at diagnosis was 53.3±4, and median follow-up was 12.6±8.8 years. 95,9% RF positive, 74,3% ACPA positive. General group comparisons revealed a statistically significant difference between groups (p<0.01), showed that the highest values of neutrophil/lymphocyte rates were found in the patients at attack period (3,2 vs 2,4). Patients in remission period had lower ratios than the patients did at attack period (p<0.001). Conclusion In this study our results shows that N/L ratio is higher in patients at attack period compared with RA patients at remission period. This suggests that these inexpensive, routinely performed blood tests may be a useful blood biomarker of synovial inflammation.
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Rehabilitation at home as bed substitution providing similar intensity of multidisciplinary and medical input to inpatient admission: a scoping review
REHABILITATION AT HOME AS BED SUBSTITUTION PROVIDING SIMILAR INTENSITY OF MULTIDISCIPLINARY AND MEDICAL INPUT TO INPATIENT ADMISSION: A SCOPING REVIEW Churilov I1,2, Churilov L3, Murphy D1 1Department of Rehabilitation, St Vincent’s Hospital Melbourne, Fitzroy, Australia; 2 Department of Medicine (SVHM), The University of Melbourne, Fitzroy, Australia; 3 Department of Medicine (RMH), The University of Melbourne, Parkville, Australia. Background There is growing world wide interest in rehabilitation at home bed substitution model of care. This model of care provides similar intensity of allied health, nursing and medical input to that received during an inpatient admission to patients who live at home but remain under the care of a hospital rehabilitation unit. Potential benefits of rehabilitation in patients’ own home environment include a reduction in hospital associated deconditioning, psychological benefits of being at home and reduced utilization of limited hospital resources. This approach to rehabilitation has not been extensively studied to date. Aim The aim of this scoping review was to systematically explore published literature on rehabilitation at home as a bed substitution model. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology to systematically search multiple databases. All papers that investigated the context of rehabilitation via bed substitution were included, without excluding any participant ages or diagnostic groups. Reference lists of relevant studies were checked for further studies. Results The PRISMA flow chart is shown in Figure 1. 8 papers were included. Study type, number of participants, features of rehabilitation bed substitution service, study population and outcomes are shown in Table 1. The main themes identified were: • Description of service and review of outcomes in participants from a wide range of ages and diagnostic groups; • Identification of patients potentially suitable for the service; • Participant experience with the service; • Clinician experience with the service. Discussion and Conclusions Rehabilitation at home as a bed substitution model is an area of growing interest. While there is strong support from participants and clinicians for this model of care, there is variability within each of the identified themes with different study designs and outcomes that are not standardized. Further research is needed into rehabilitation at home as bed substitution.
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Epidemiological profile of diabetic foot
Epidemiological Profile of Diabetic foot S. El Arem, M. Ben Khelifa, A. Haj Salah, B. Krifa, M. Sghir, W. Kessomtini PMR Department, Taher Sfar Hospital, Mahdia Introduction : Diabetic foot is a public health problem. It can cause serious complications leading to amputation. Diabetic neuropathy (DN) is the main factor of ulcerations. plantar hyperpressure is an aggravating factor. The aim of our study was to screen for various deformities of the diabetic foot through podoscopic evaluation. Patients and methods : We conducted a bicentric cross sectional study over a three month period including diabetic patients. Detail history including socio demographic data, characteristics of diabetes and the follow-up story were collected. podiatric examination was performed using a tangential lighting podoscope. Results : We included 150 patients. Their mean age was 56.91 ± 12.6 years with a range of 20 to 86 years. Half of patients were using oral medications, 28% were using insulin therapy and 21.3% were using both oral and insulin therapies. Diabetic neuropathy was found in 32.7% of the population. The podiatric examination revealed plantar hyperkeratosis in 84% of patients, dry skin in 46% and mycotic lesions in 27.3%. Plantar perforation was noted in 2 patients, and toe amputation in 4 patients. The main hyper pressure zone found was regarding the second metatarsal head (52%). Foot orthotics were prescribed in 18% of patients. Conclusion: Podiatric examination is essential to detect areas with hyper pressure at risk of hyperkerathosis and plantar perforation. It allows preventive measures, including devices to reduce hyperpressure and prevent complications.
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Is extracorporeal shock wave therapy effective for musculoskeletal pain ?
IS EXTRACORPOREAL SHOCK WAVE THERAPY EFFECTIVE FOR MUSCULOSKELETAL PAIN ? Loubiri . I , Gaddour. M,Layouni .S, Moncer .R , Toulgui .E,, Jemni . S ,Ouannes.W Physical Medicine and Rehabilitation Department , Sahloul Hospital Sousse, Tunisia Background and aims Extracorporeal shock wave therapy (ESWT) is a novel conservative treatment used commonly to treat pain with few known side effects. The aim of the study is to determine the clinical effectiveness of ESWT in various musculoskeletal conditions. Methods A prospective study was performed including patients diagnosed with musculoskeletal disorders from March 2022 to April 2023.The treatment consisted of six sessions of radial extracorporeal shockwave therapy (R-ESWT), one session per week. The main outcome measure to evaluate the treatment effect was pain, assessed by a visual analogue scale (VAS) at baseline, the end of treatment and three months later. Results One hundred twenty patients were included. Twelve patients had a history of diabetes mellitus type 2. Symptom duration mean was 86 days. The VAS mean at baseline was 8.7/10. Main pathologies treated were plantar fasciitis, Achilles Tendinopathy, shoulder tendinopathy and low back pain. The VAS was significantly decreased after ESWT sessions (mean difference = 2.2). Conclusions ESWT is a promising short term treatment for several chronic diseases when conventional treatments fail. Further studies should include longer follow-up periods. References [1] Extracorporeal shockwave therapy in musculoskeletal disorders Orthop Surg Res. 2012; 7: 11 [2] Effect of Shockwave Treatment for Management of Upper and Lower Extremity Musculoskeletal Conditions: A Narrative Review. PM R. 2018 Dec; 10(12):1385-1403.
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Is transcranial magnetic stimulation effective for chronic painful diabetic polyneuropathy?
Poster  227 Loubiri . I ,Layouni .S, Moncer .R , Toulgui .E,Gaddour. M, Jemni . S ,Ouannes.W Physical Medicine and Rehabilitation Department , Sahloul Hospital Sousse, Tunisia Background and aims Diabetic polyneuropathy is encountered in approximately one-third of people with diabetes. Unfortunately the management of painful diabetic polyneuropathy is still challenging. Repetitive transcranial magnetic stimulation has recently emerged as an alternative for the management of chronic pain. The aim of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation(rTMS) in improving resistant chronic diabetic neuropathic pain. Methods This prospective study is performed in the physical rehabilitation department . Patients with chronic diabetic polyneuropathic drug-resistant pain for at least 3 months with a VAS score of 5 or higher,were recruited. A high-frequency (10 Hz) rTMS stimulation protocol was applied for ten consecutive days over lower limbs motor cortex. Neuropathic pain was assessed by means of a DN4 questionnaire. The subjective intensity of pain was assessed using VAS. Psychological assessment was measured by the HAD scale at baseline ,end of treatment and three months later . Results A total of six participants was enrolled in our investigation with a mean age of 54 years. Four patients had type 2 diabetes with a mean duration of 17 years. They were on insulin therapy . The mean of glycated hemoglobin at baseline was 9.3%. The mean VAS score decreased from an initial 9 ± 0.5 at baseline to 5 ± 1.50 at the end of treatment. The mean DN4 questionnaire decreased from 6 to 3 an the end of study. Anxiety was found in 3 cases and tow patients had certain depression . All patients with definite depression decreased their depression score after the sessions.  The effect of rTMS on VAS scores was sustained up to 12 weeks. Conclusions Our current investigation was conducted to elucidate the potential therapeutic value of rTMS to manage painful peripheral neuropathy in diabetic patients. Our observations were consistent with previously conducted studies . High-frequency magnetic stimulation of the lower limb motor cortex can effectively reduce pain caused by chronic neuropathy in diabetics. This non invasive approach should be a part of multimodal management of painful diabetic polyneuropathy. References [1] Jean-Pascal Lefaucheur et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Volume 131, Issue 2, February 2020, Pages 474-528. [2] Seoyon Yang, MD, Sang Gyu Kwak et al. Short-term Effect of Repetitive Transcranial Magnetic Stimulation on Diabetic Peripheral Neuropathic Pain. Pain Physician 2022; 25:E203-E209. [3] Abdelkader AA, El Gohary AM, Mourad HS, El Salmawy DA (2019) Repetitive TMS in treatment of resistant diabetic neuropathic pain. Egypt J Neurol Psychiatry Neurosurg 55:30 .
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Alternative and complementary medicine in patients with osteoarthritis
Alternative and complementary medicine in patients with osteoarthritis S. El Arem, R. Ben Tekaya, A. Haj Salah, I. Haddada, M. Sghir, W. Kessomtini PMR Department, Taher Sfar Hospital, Mahdia Introduction: Complementary and alternative medicine (CAM) is an approach to health care based in treatments different from those of conventional medicine. The use of CAM has grown significantly in recent years. The aim of this study was to evaluate tendancy of use of alternative medicine and its effectiveness on pain, functional status on patients suffering from degenerative diseases (common low back pain, cervicarthrosis and gonarthrosis) Methods: This was a descriptive cross-sectional study including patients followed in our consultation for degenerative diseases (gonarthrosis, low back pain and cervicarthrosis). Patients were asked about the use of CAM, types of therapies used, the reasons for using these medicines and factors associated with their use. Results Thirty four patients were included in this study, 55.9% of them had used CAM at least once in their lives, 47.4% reported starting the use of CAM before the declaration of their illness. Sixty three percent of patients reported using CAM for pain relief, while 36.8% hoped for a cure. Regarding types of CAM, 52.6% of patients used cupping (El hijama), 47.4% used essential oils, 9% took herbal medicine and 5% opted for acupuncture. Not all patients informed their doctor about their use of CAM, 94.7% of the patients thought that CAM could not have any adverse effects and the majority thought that CAM was effective. Conclusion: In our study, the prevalence of CAM use remains high, with different types used, namely cupping and essential oil therapy.
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Peripheral nerve damage associated with complex regional pain syndrome: place of rTMS
Peripheral nerve damage associated with complex regional pain syndrome: place of rTMS S. Layouni, I. Loubiri, I,Dghim , R. Moncer, S. Frigui, W. Ouanes, S. Jemni Department of Physical and Rehabilitation Medicine, CHU Sahloul Sousse Introduction Peripheral nerve trauma frequently results in chronic disabling pain that is resistant to the usual treatments and impairs quality of life (1) Several studies have proven the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) on central neuropathic pain (2), while peripheral neuropathic pain is still an area of research. What can be said when it is complicated by complex regional pain syndrome (CRPS type I)? Observation We report the case of a 17 year old girl, hospitalized in our department for the management of post traumatic peripheral neuropathic pain in the territory of the left common fibular nerve ,complicated 2 months later by a complex regional pain syndrome type I (CRPS I)(3). The electroneuromyogram and ultrasound showed damage to the common fibular nerve. As the radicular and nociceptive pain did not improve under analgesia with pregabalin 300 mg/d and amitriptyline 50 mg/d, a high-frequency rTMS protocol (10Hz, 1500 pulses, 90% RMT) was attempted in the primary motor cortex (M1) contralateral to the lesion at a rate of 5/7, 10 sessions of 20 min per session. The evolution was marked by a decrease in pain with a VAS that went from 9/10 to 2/10 and a DN4 score from 9/10 to 1/10 at the end of the protocol, with a clear improvement on the psychological level with a HAD score that went from A/D: 12/11 to 4/5. Discussion In the last decade, a great amount studies around transcranial magnetic stimulation (TMS) have been carried out. These studies have shown the effectiveness of high frequency rTMS of M1 contralateral on the pain in CRPS type I (level C) and in central neuropathic pain (level A) (4). Conclusion rTMS seems to be a promising non-invasive therapeutic approach for the treatment of peripheral neuropathic pain, which remains to be approved by high-quality studies. Refrences 1. Complications with Peripheral Nerve Injury – Physiopedia [Internet]. [cité 31 mai 2023]. Disponible sur: https://www.physio-pedia.com/Complications_with_Peripheral_Nerve_Injury 2. Yılmaz B, Kesikburun S, Yaşar E, Tan AK. The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury. J Spinal Cord Med. juill 2014;37(4):397‑400. 3. Complex regional pain syndrome – Symptoms and causes [Internet]. Mayo Clinic. [cité 31 mai 2023]. Disponible sur: https://www.mayoclinic.org/diseases-conditions/crps-complex-regional-pain-syndrome/symptoms-causes/syc-20371151 4. Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence – PMC [Internet]. [cité 31 mai 2023]. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221422/
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Deep gluteal pain for a professional footballer, what do you consider ?
Deep gluteal pain for a professional footballer, what do you consider ? Saoussen Layouni, Imen Dghim, Emna Toulgui, , Loubiri Ines, Jemni Sonia, Walid Ouanes Physical Medicine and Rehabilitation Department, CHU Sahloul INTRODUCTION Muscle tears are a frequent occurrence in top-level sportsmen and women, particularly footballers (1). Muscle injuries frequently involve the hamstrings, quadriceps, adductors and medial gastrocnemius(2). Isolated tearing of the external obturator muscle has not been widely reported in the literature and underlies a specific injury mechanism. It occurs after a shortened warm-up for a rapid replacement. Sometimes, the diagnosis is less easy and the clinical examination less effective. In these cases, MRI is the ideal tool for an accurate initial assessment of the injury (3) and appropriate treatment. OBSERVATION We report the case of a 27-year-old professional footballer, right-handed midfielder, who presented deep right gluteal pain after a match with no particular mechanism of injury and no immediate cessation of activity, causing discomfort when running. On physical examination, the hip was moderately painful, particularly on full flexion and counter-rotation. Deep posterior palpation was painful. MRI revealed a stage 2 lesion of the right external obturator muscle, with oedema extending discreetly into the muscular head of the obturator. No other abnormalities were identified on this examination. The treatment consisted of active rest for three days and a rehabilitation program combining static work on the hip rotators with passive stretching of the various muscle groups in the pelvic region. As soon as the pain subsided, strengthening became dynamic, concentric then eccentric. Competition was resumed between days 15 and 20 without relapse. DISCUSSION Muscle tears are a frequent occurrence in footballers. Isolated tearing of the external obturator muscle has not been widely reported in the literature. In our case, the injury involved the external obturator muscle of the supporting limb. The traumatic mechanism is indirect. In the event of a muscular accident, the clinical examination and testing often enable a very precise diagnosis of the affected muscle and an assessment of the severity of the injury. MRI simply confirms the clinical diagnosis and contributes to grading the lesions, enabling the medical team to adapt treatment and predict the recovery time. Sometimes, the diagnosis is less easy and the clinical examination less effective, particularly in deep joints such as the hip, where musculotendinous lesions may be associated with osteochondral or labrum anomalies. In these cases, MRI is the ideal tool (3), providing an accurate initial assessment of the injury and enabling appropriate treatment to be given. This imaging test will also give an idea of how long it will take for the injury to heal, and is therefore an almost indispensable prognostic element for professional sportsmen and women eager to resume their activities. CONCLUSION To our knowledge, isolated tears of the obturator muscles have only been described in 3 cases in the literature. The mechanism of injury is poorly understood, with no cessation of physical activity. The first-line examination for the study of muscle masses has its limitations, particularly in the exploration of deep muscle masses. MRI is the technique of choice for assessing these lesions, due to its resolution and reproducibility. References : 1- Yard ED, Schroeder MJ, Fields SK, et al. The epidemiology of United States High School Soccer Injuries, 2005–2007. Am J Sports Med 2008;36:1930–7. 2- Agre JC. Hamstrings injuries: proposed aetiological factors, prevention, and treatment. Sports Med 1985;2:21–33. 3- Boutin RD, Fritz RC, Steinbach LS. Imaging of sports-related muscle injuries. Radiol Clin N Am 2002;40:333–62
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Relation between rheumatoid arthritis disease activity and neutrophil-lymphocyte ratio
Relation between rheumatoid arthritis disease activity and neutrophil-lymphocyte ratio Autors: Ramy Ben Tekaya1, Jguirim Mahbouba1, Ghali Mourad2, Saoussen Zrour1, Ismail Bejia1, Mongi Touzi1, Sakly Nabil2, Naceur Bergaoui1 1Hospital University Fattouma Bourguiba, Rheumatology Department, Monastir, Tunisia 2Hospital University Fattouma Bourguiba, Immunology Department, Monastir, Tunisia Background and aims Rheumatoid arthritis (RA) is characterized by synovial tissue (ST) inflammation leading to pain, joint destruction. It would be clinically useful to identify blood biomarkers of synovial inflammation. Neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) have been not only suggested as systemic inflammatory markers, but also associated with disease activity in some inflammatory diseases. The objective of this study was to to correlate NLR and PLR with inflammatory markers and disease activity measures in a tunisian sample of rheumatoid arthritis (RA) patients. Methods We conducted a retrospective study including 74 patients meeting ACR/EULAR 1987 and/or 2010 criteria followed at university hospital Fattouma Bourguiba. Results of blood tests (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], rheumatoid factor [RF], anti-citrullinated protein autoantibodies [ACPA], leukocyte formula ratios (NLR) and disease activity and function measures (disease activity score 28 [DAS28 -CPR], swollen and tender joint count [SJC, TJC], physician and patient visual analogical scale [VAS]) were collected. Results Of the 74 patients, 63 were female (85,1%). The average age of the onset of the disease was 53.3 years. The mean disease duration was 12.6±8.8 years. 95,9% RF positive, 74,3% ACPA positive. The mean values of PLR and NLR were 156.62 ± 86.59 and 3,05 ± 1.39. PLR showed a positive correlation with CRP (r=0.138; p=0.01) and DAS28(CRP) (r=0.126; p=0.05) Conclusions This study reinforced the suggested place of NLR and PLR as inflammatory markers and possible disease activity measures in RA.
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The management of Adhesive capsulitis following COVID 19 vaccination: A Case Report
Consequence or coincidence? Adhesive capsulitis following COVID19 vaccination: a case report SAAD Azza, LAYOUNI Saoussen, LOUBIRI Ines, FRIGUI Sinene, OUANNES Walid, JEMNI Sonia
Physical Medicine and Rehabilitation Department, University Hospital Sahloul- Sousse Tunisia Introduction In light of the recent pandemic, a plethora of vaccines were developed in an attempt to fight against the spread of the COVID-19 virus. Although used all over the world, their side effects are yet to be fully unveiled Patient Information and Clinical Findings A 68-year-old woman presented with left shoulder pain after receiving the second dose of the BNT162b2 vaccine. She had a medical history of a well-balanced hypothyroidism and no records of shoulder injuries. She developed pain in her shoulder that started on the same day of vaccination associated with body aches, asthenia and fever. These general signs were transient unlike the shoulder pain which lasted during three months after the injection. The pain was constant limiting her daily activities and disturbing her sleep the Visual Analogue Scales (VAS) was estimated at 9/10 The first investigations showed normal Thyroid Stimulating Hormone (TSH) and glycemia levels with no infectious context. When examining her shoulder, the active range of motion in abduction movement, forward elevation and external rotation were limited to 80°, 100°and 10° respectively, in addition to a limited internal rotation. The passive range of motion was limited in the abduction, forward elevation and external rotation to 90°, 110°and 40°respectively. The shoulder’s radiograph didn’t show any evidence of acute trauma, superior humeral head migration or osteoarthritis (figureA). An ultrasound of the shoulder showed no abnormalities (figure B). Conclusions Only six previous cases of shoulder injuries related to SARS-CoV-2 vaccines were published; half of which were related to mRNA vaccines1. In our study, we report a rare case of a healthy patient who developed adhesive capsulitis immediately after receiving the BNT162b2 vaccine that was treated by intra articular distension. What triggered this process of a post vaccination adhesive capsulitis is still unidentified. It might be due to an inflammatory or an autoimmune process as well as the presence of viral antigens and adjuvants. Références • Jonathan.S; Cecile.K. COVID-19 vaccine side effects:The positives about feeling bad.Sci Immunol 2021; 6(60) : eabj9256. • Chow JCK, Koles SL, Bois AJ. Shoulder injury related to SARS-CoV-2 vaccine administration. CMAJ 2022.194(2):E46-E49.
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Does ICF linking identify properly outcome measures in lower limb musculoskeletal conditions?
Does ICF linking identify properly outcome measures in lower limb musculoskeletal conditions? Nº239 Pages E MD, PhD1, Avellanet M MD, PhD1, Boada-Pladellorens A MD1, Chaler J, MD, PhD2, Anasetti F Biomed Eng2, Arienti C, PhD, MSc, DO3, Kiekens C MD, PhD3. 1Research Group in Health Sciences . Universitat d’Andorra 2PM&R department. Hospital Egarsat. Terrassa (Barcelona) Spain 3Cochrane Rehabilitation, Milan, Italy. Background Lower limb musculoskeletal conditions (LLMC) are one of the main causes of morbidity and disability worldwide. The International Classification of Functioning, Disability and Health (ICF) provides, through categories and core sets, a multi-dimensional approach to describing human functioning and disability. As it’s been adopted by WHO, ICF constitutes the reference framework to assure information comparability. The ICF allows to link the concept of functioning with tools that can be assessed and reported in a standardized manner To attain such objective, linking outcome measures (namely, health-status measures, but also clinical measures and interventions) and ICF is essential. However, at this moment, a clear map of LLMC patient outcome measurements linked to ICF is not available.  Illustration of ICF components ICF linking Linking rules allow clinicians and researchers to link and compare meaningful concepts related to functioning and a specific pathological condition. The most appropriate outcome measures are selected and linked to ICF, usually using ICF core sets. Those are shortlists of ICF categories selected from the whole classification for specific health conditions and contexts. Illustration of ICF linking. Prodinger B, Ballert CS, Cieza A. Setting up a cohort study of functioning: From classification to measurement. J Rehabil Med. 2016;48(2):131-40. Cieza A, Fayed N, Bickenbach J, Prodinger B. Refinements of the ICF Linking Rules to strengthen their potential for establishing comparability of health information. Disabil Rehabil. 2019 Mar;41(5):574-583. Objective: The objective of this protocol is to understand the extent and type of evidence in relation to LLMC assessment methods linking to ICF categories included in validated core sets.    Methods  Under the guidance of Cochrane Rehabilitation, we propose a protocol for a scoping review of LLMC outcome measures and ICF linking (registered at Open Science Framework). Target population: LLMC patients. Concept of interest: ICF linking to assessment methods. Context: importance to adopt a common language through ICF to assess LLMC patient functioning. Search: Embase, CENTRAL, CINAHL and PubMed databases. Search terms: ICF; core sets, linking, hip fractures, hip osteoarthritis, hip replacement, knee osteoarthritis, knee replacement, knee injuries, lower limb fractures, ankle injuries, ankle fractures, low back pain, osteoarthritis, musculoskeletal diseases.     Expected Results   Exact mapping of published studies on linking LLMC functional assessment methods to the ICF. Identification of main research gaps regarding ICF linking to assessment methods in LLMC patients. The main findings will summarize linking and facilitate clinicians’ effective use of them. 
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The Overlooked Etiology of Neuropathic Upper Limb Pain
The Overlooked Etiology of Neuropathic Upper Limb Pain SAAD Azza, LAYOUNI Saoussen, LOUBIRI Ines, FRIGUI Sinene, JEMNI Sonia, OUANNES Walid Physical Medicine and Rehabilitation Department, University Hospital Sahloul- Sousse Tunisia Introduction Neuropathic upper limb pain is frequent and typically has an orthopedic or rheumatological etiology. Nonetheless, it may be the presenting symptom of a serious underlying condition, such as lung cancer. the clinician should not overlook a sometimes-serious secondary etiology. Patient Information and Clinical Findings  We report a case of a 66-year-old man with a 100 pack-year history of smoking suffering from pain in his right upper limb. The pain gradually worsened over the past two months and was described as neuropathic residing in multiple territories of the brachial plexus. The Visual Analogue Scale (VAS) was estimated at 5/10. Associated symptoms included muscle weaknesses in the affected limb and chronic productive cough. The examination of his cervical spine revealed no abnormalities. The mobility of the different joints of the upper limb were preserved. During the inspection, he had a facial edema, a supraclavicular swelling (figure1), an amyotrophy of the supra and infra spinatus muscles, an amyotrophy of the thenar and hypothenar eminences(figure2)and a clubbing of the fingernails(figure3). The neurological examination concluded a motor deficit in the different muscles of the concerned limb (global assessment of 3 according to the medical research council (MRC)) an abolition of the deep tendon reflexes and sensory deficits. A shoulder X-ray revealed opacity in the right apical zone. A chest X-ray showed an opacity in the apex of the right lung(figure4). After a thorough investigation, the patient was found to have lung cancer with local invasion. Conclusions Our case shows that common symptoms such as upper limb pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with upper limb pain
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Prevalence and risk factors of anxiety and depression among mothers of children with cerebral palsy
PREVALENCE AND RISK FACTORS OF ANXIETY AND DEPRESSION AMONG MOTHERS OF CHILDREN WITH CEREBRAL PALSY Haddada I 1 , Dorgham I 1 , Hadj Salah A 1 , Ben Fredj M 2 , Moncer R 3 , Loubiri I 3 , Zaafrane MH 4 , Sayhi T 4 , Turki R 4 , Sghir M 1 , Kessomtini W 1 1. Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital 2. Department of Epidemiology and Preventive Medicine, University Hospital of Monastir 3. Physical Medicine and Rehabilitation Department, Sahloul University Hospital 4. Department of Family Medicine, University of Monastir Background and aims: Caring for a child with a disability can have psychological impact on parents as the primary caregivers. The present study aimed to evaluate anxiety and depression levels in mothers of children with cerebral palsy (CP) and to determine the associated factors. Methods: Mothers of children with established diagnosis of CP were recruited at the period from July to December 2021. The functional status of disabled children was graded according to the Gross Motor Function Classification System (GMFCS) scale. The Hospital Anxiety and Depression Scale was used to evaluate mood disorders among mothers. Results: The study included 71 mothers, with mean age of 38,77 ± 7, 27 years. The average age of children was 7,7 years [2-12 years]. The most common clinical subtype of CP was spastic quadriplegia (56.3 %). Thirty-eight children were classified GMFCS IV (18,3%) and V (35,2%). Mothers had a normal anxiety score in 24%, a borderline score in 22.5% and an abnormal score in 53.5%. Regarding depression, normal score was found in 15.5%, borderline score in 21.1% and abnormal score in 63.4%. Anxiety was significantly associated with mother’s depression (p=0.001). Depression was significantly associated with low-income household (p=0.047) and mother’s anxiety (p<0.001). No association were found between HADS and clinical parameters of children with CP including age, type of CP and functionnal impairement (p>0.05). Discussion: The task of caring for disabled children may have a stressful impact on the caregivers which may contribute to psychiatric morbidity [1]. Child behaviour and cognitive problems, low caregiver self-efficacy and low social support were identified as factors that are consistently related with higher levels of stress and depression [2]. Conclusion: Mothers of children with CP should be given a regular psychological support to reduce emotional distress and increase self-efficacy. References: • Amosun SL, Ikuesan BA, Oloyede IJ. Rehabilitation of the handicapped child–what about the caregiver? P N G Med J. 1995 Sep;38(3):208-14. PMID: 9522860. • Pousada, M., Guillamón, N., Hernández-Encuentra, E. et al. Impact of Caring for a Child with Cerebral Palsy on the Quality of Life of Parents: A Systematic Review of the Literature. J Dev Phys Disabil 25, 545–577 (2013).
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Post-mastectomy pain syndrome: assessment and management in physical medicine and rehabilitation
POSTMASTECTOMY PAIN SYNDROME: ASSESSMENT AND MANAGEMENT IN PHYSICAL MEDICINE AND REHABILITATION K. DAMOUCHE, S .AGGOUNE, M. TAIR Department of physical medicine and rehabilitation, Specialized University Military Hospital Orthopedics, Rehabilitation, Equipment. Algiers, Algeria. Introduction Post-mastectomy pain syndrome (PMPS) is a chronic pain, beginning immediately or early after a mastectomy or a lumpectomy that affects the anterior chest, the armpit, and/or the arm in its upper half. [1] Frequently reported risk factors are: young age of the patient, increased body mass index, intercostobrachial nerve damage during surgery, lymph node dissection, additional treatment with radiotherapy or therapy; insufficient or non-existent postoperative pain management as well as psychological morbidity. [2] Diagnosis is based on clinical examination. The diagnostic criteria were described in 1989 by Watson. [3] The PMPS is characterized by neuropathic pain, most often treated with medication (analgesics, corticosteroids). Sometimes these pains are debilitating, constant and difficult to manage. The significance and severity of PMDS range from simple discomfort to major disability with significant retention on quality of life. [4] Objectives Our objectives are: – Evaluate the functional impact of post-mastectomy pain syndrome and its impact on quality of life; – Support in physical medicine and rehabilitation. Methods A case report of PMPS; ranked intense 34/39 according to the score of Labrèze and al [5]: a 42-year-old right-handed woman operated for breast cancer by right mastectomy with lymph node dissection; marked post-op by the onset of neuropathic pain, which worsened after the chemotherapy sessions, with onset of stiffness in the right shoulder leading to incapacity and restrictions and deterioration in quality of life, preventing radiotherapy sessions from taking place. These pains were not relieved by analgesic drug treatments and corticosteroid injections. The clinical examination found: – BMI at 25 – Scar from surgery on the anterolateral face of the right hemithorax, anfractuous and adherent – Contracture of the periarticular muscles of the shoulder, with retraction of the right pectoralis major – Stiffness of the right shoulder with pain on mobilization AVS: 08/10. Passive limitation: anterior elevation at 55°, abduction at 40°, external rotation at 0° – Neuropathic pain DN4 to 06/10 – The other joints are free and mobile, no muscle deficit – Radiological assessment of the right shoulder: absence of metastases To assess the impact of PMPS we used: QUICK DASH questionnaire (Disabilities of the Arm, Shoulder and Hand) and the score was 6, 82 We proposed a treatment protocol that required 3 months of care in the physical medicine and rehabilitation department: – Antiepileptic drug treatment (TEGRETOL LP 400 mg) – Physiotherapy, kinesitherapy and occupational therapy sessions; – Mesotherapy sessions; – Psychological support Results – A significant reduction of the VAS pain: 02/10 – Supple surgical intervention scar with reduced contractures of the peri-articular muscles – Improvement of the articular amplitudes of the right shoulder: 140° anterior rise, 120° abduction, 55° external rotation.These amplitudes allowed him above all to do his radiotherapy sessions – Improved PMPS intensity tracking score of Labrèze and al, which became light 10/39 – Increased QUICKDASH score to 95, 45. Conclusion Post-Mastectomy Pain Syndrome is one of the most feared sequelae of surgical treatment of breast cancer, due to its considerable impact on quality of life and its slow and difficult resolution. It is important to provide comprehensive and global interdisciplinary care as soon as the illness of patients at risk is announced, in order to prevent the occurrence of a major disability. Keywords: postmastectomy pain syndrome, stiffness, disability, physical medicine and rehabilitation References [1] International Association for the Study of Pain (IASP). Washington : IASP ; 2011. [mis à jour 2022] Visceral and other syndromes of the trunk apart from spinal and radicular pain, [2], Wallace MS, Wallace AM, Lee J, Dobke MK. Pain after breast surgery : a survey of 282 women. Pain 1996; 66: 195-205 [3] Watson CPN, Evans RA, Watt VR. The post-mastectomy pain syndrome and the effect of topical capsaicin. Pain 1989 ; 38 : 177-87 [4] Audrey Pourtales. Le bloc paravertébral curatif des syndromes douloureux post mastectomie : mythe ou réalité ? Une analyse observationnelle prospective de l’efficacité du BPV sur la douleur et la qualité de vie de patientes souffrant de SDPM réfractaires. Médecine humaine et pathologie. 2017. dumas-01636637. [5] Laurent Labrèze and al, Un nouveau score de suivi de l’intensité des syndromes douloureux post-mastectomie (SDPM). DOULEURS Vol 11 – N° 4 – septembre 2010 Page: 158-164© Elsevier Masson SAS Corresponding author: E-mail address: damouchekarima@gmail.com
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Sleep quality in caregivers of children with cerebral palsy and its relationship to quality of life
Sleep quality in caregivers of children with cerebral palsy and its relationship to quality of life Haddada I1, Dorgham I1, Hadj Salah A1, Ben Fredj M2, Moncer R3, Loubiri I3, Sayhi T4, Zaafrane MH4, Turki R4, Sghir M1, Kessomtini W1. • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital • Department of Epidemiology and Preventive Medicine, University Hospital of Monastir • Physical Medicine and Rehabilitation Department, Sahloul University Hospital • Department of Family Medicine, University of Monastir. Background and aims : Sleep disorders (SDs) may have deterious effects on health. This study aimed to assess sleep quality and its impact on health-related quality of life (QoL) in mothers of children with cerebral palsy (CP). Methods : Mothers of children with established diagnosis of CP were recruited at the period from July to December 2021. The functional statuses of disabled children were graded according to the Gross Motor Function Classification System (GMFCS) scale. we used the Pittsburgh Sleep Quality Index (PSQI) and the SF-36 to measure SDs and QoL respectively in mothers. Results : The study involved 71 mothers with an overage age of 38,77 ± 7, 27 years. The mean age of children was 7,7 years. Thirty-eight children had the lowest level of functional status (GMFCS IV and V). Associated impairments such as epilepsy was noted in 47.9% of children. Co-sleeping with children was found in 64.8% of cases. Fifty-three mothers (74,6%) had a pathological total score of sleep (PSQI ≥ 5) and 38% usually sleep less than six hours per day. Forty-sex mothers (64,8%) had impaired QOL (SF-36 <66.7%). The SF-36 physical and mental component scores were 44,27±11,4% and 38,02±9,3%, respectively. On statistical analysis, SDs were significantly associated with epilepsy in children (p=0.012), mother’s anxiety (p=0.001) or depression (p=0.008), and impaired QoL (p=0.008). Discussion: Poor sleep quality is associated with poorer psychological health and well-being for caregivers. This was reported by 71% of caregivers [1]. Significant association was found between SD in caregivers and bed-sharing [2]. Conclusion : Poor sleep quality can be physically and psychologically destructive in the long term for mothers who are providing care. Our results showed that SDs should be routinely assessed in this population. References : • Lang, C. P., Boucaut, A., Guppy, M., & Johnston, L. M. (2021). Children with cerebral palsy: A cross‐sectional study of their sleep and their caregiver's sleep quality, psychological health and well‐being. Child: Care, Health and Development, 47(6), 859-868. • Adiga D, Gupta A, Khanna M, Taly AB, Thennarasu K. Sleep disorders in children with cerebral palsy and its correlation with sleep disturbance in primary caregivers and other associated factors. Ann Indian Acad Neurol. 2014 Oct;17(4):473-6. doi: 10.4103/0972-2327.144044. PMID: 25506179; PMCID: PMC4251031.
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The impact of emotional distress on quality of life in caregivers of children with cerebral palsy
THE IMPACT OF EMOTIONAL DISTRESS ON QUALITY OF LIFE IN CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY Haddada I1, Dorgham I1, Hadj Salah A1, Ben Fredj M2, Moncer R3, Loubiri I3, Sayhi T4, Zaafrane MH4, Turki R4, Sghir M1, Kessomtini W1. • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital • Department of Epidemiology and Preventive Medicine, University Hospital of Monastir. • Physical Medicine and Rehabilitation Department, Sahloul University Hospital • Department of Family Medicine, University of Monastir. Background and aims : Disability in a child affects not only the child’s life but also the family’s life. The aim of this study was to evaluate the impact of emotional distress on health related quality of life (QoL) in mothers who look after children with cerebral palsy (CP). Methods : Mothers of children with established diagnosis of CP were recruited at the period from July to December 2021. The functional statuses of disabled children were graded according to the Gross Motor Function Classification System (GMFCS) scale. The SF-36 and the Hospital Anxiety and Depression Scale (HADS) in their arabic version were used to mesure QoL and mood disorders among mothers ;  respectively. Results : The study included 71 mothers, with mean age 38,77 ± 7, 27 years. The mean age of the children with CP was 7,7 ± 2,75 years. The most common clinical subtype of CP was spastic quadriplegia (47.9%). Thirty-eight children had the lowest level of functional status GMFCS (IV 18,3% and V 35,2%). High levels of depression and anxiety scores (HADS > 11) were observed in 63.4 % and 53.5 % of mothers respectively. Forty-sex mothers (64,8%) had a poor QOL (SF-36 <66.7%). This include physical component score (44,27±11,4%) and mental component score (38,02±9,3%). The QoL scores were significantly associated with mood disorders (p<0.001). Discussion : A review shows that caregivers of children with CP tend to have high levels of stress and depression and lower quality of life than parents of healthy children [1]. The QoL determinants of caregivers of children with CP are multidimensional, including child characteristics, caregiver characteristics, and environmental factors [2]. Conclusion : Our study has showed prevalent depression and affected QoL in mothers of children with CP. Targeted interventions may be needed to ameliorate both mental health and QoL. References : • Pousada, M., Guillamón, N., Hernández-Encuentra, E. et al. Impact of Caring for a Child with Cerebral Palsy on the Quality of Life of Parents: A Systematic Review of the Literature. J Dev Phys Disabil 25, 545–577 (2013). • Mei-Hui Tseng, Kuan-Lin Chen, Jeng-Yi Shieh, Lu Lu, Chien-Yu Huang & Rune J. Simeonsson (2016) Child characteristics, caregiver characteristics, and environmental factors affecting the quality of life of caregivers of children with cerebral palsy, Disability and Rehabilitation, 38:24, 2374-2382.
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Botulinum toxin injection effects in children with spastic cerebral palsy
BOTULINUM TOXIN INJECTION EFFECTS IN CHILDREN WITH SPASTIC CEREBRAL PALSY Background and aims: Spastic cerebral palsy (CP) is the most diagnosed disorder among children with CP. Spasticity can prevent or hamper function, cause pain and disturb sleep. Botulinum toxin (BT) injection is now an established first-line treatment for focal spasticity. Our objective was to evaluate the effects of botulinum toxin injections (BTX-A) on spasticity and quality of life in children with CP. Methods A retrospective study of 41 pediatric patients with spastic CP treated with BTX-A intramuscular injection at our department.Spasticity was evaluated using: modified Ashworth scale (MAS) and quality of life was evaluated using The Cerebral Palsy Quality of Life primary giver questionnaire (CP QOL-Child). Evaluation was done before treatment and 4 weeks post injection. Results Mean age was 8,2 years (5-12) and 59,1% were male.79% had lower limb spasticity with gastrocnemius muscles and hip adductors being mostly affected (80,2%) and 87,5% had equinovarus foot. According to the Gross Motor Function Classification System (GMFCS) 89,3% of children were in level 4 before injection.72% had a MAS superior to 3 before injection and 39,7% maintained this score after 4 weeks, mean CP QOL before injection was at 27,5(21-31) and at 36,2 at 4 weeks. Conclusions BTX-A intramuscular injection in cerebral palsy children does improve spasticity and quality of life.Further studies focusing on the impact of BTX-A on pain component are needed.
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The transversal role of Physical and Rehabilitation Medicine compared to medical and surgical specializations
THE TRANSVERSAL ROLE OF PHYSICAL AND REHABILITATION MEDICINE COMPARED TO MEDICAL AND SURGICALSPECIALIZATIONS Vita G1, FotiC2 1 Physical and Rehabilitation Medicine residency program, University of Rome Tor Vergata, Rome, Italy; 2Physical and Rehabilitation Medicine, University of Rome Tor Vergata, Rome, Italy. Background and aims Physical and Rehabilitation Medicine (PRM) is an independent specialty aiming at disability prevention and treatment. Its main goal is to improve the functioning of the systems and organs of the human body. The objective of this study is to better clarify the evolution across the centuries of MFR, and Physiatrists, MFR physicians, and its role within European Health System (EHS). Methods A narrative review was designed to describe the evolution of clinical care across human development and the rising importance of PRM in the contemporary care setting and its role in the EHS. Results Since the birth of ancient medicine, a dichotomous division between medical clinic (MC) medical and surgical clinic (SC) specialties were introduced. For instance, in 13th century in Sicily medical figures were divided between the “Plague Doctor” (surgeon) and the “Urine Doctor” (clinician). In the XX century, improvement of organ pathophysiology knowledge, medical technological innovation led to apparatus or organ-driven specialization of different specialties. However, after World War I, an increasing number of veterans and their unmet need for their disabilities emerged because both CM and CC were not enough to meet the patient’s care and improve their quality of life and PRM was introduced and developed. Conclusions Nowadays, the Rehabilitation Care (RC) has gone beyond the limits of mere physical rehabilitation and has risen as a third part of the EHS aiming at the patients’ holistic and functional recovery as a single scientific nucleus with all its sub-specializations of apparatus and function.
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Musculoskeletal complications in patients with diabetes mellitus; experience of a rehabilitation department
Musculoskeletal complications in patients with diabetes mellitus; experience of rehabilitation department Gaddour M ; Loubiri I ; Mrizek Z, Moncer R; Arfaoui A, Toulgui E, Jemni S Introduction The complications arising from longstanding type 2 diabetes mellitus (T2DM) can affect almost all systems of the human body and preferentially affect the kidneys, heart, eyes, nerves, and musculoskeletal (MSK) system. MSK complications are seldom considered life threatening, they can cause significant disability and affect the quality of life (1). The objective of the study was to investigate the MSK complications of T2DM among outpatients in a rehabilitation department. Methods : A cross-sectional study was carried out in a tertiary care hospital for one year period. Diabetic patients referred to physical medicine and rehabilitation outpatient were included. For all patients included in the study, we recorded the following demographic features including age, gender, and body mass index (BMI). We obtained the following clinical information including type and duration of diabetes (in years), antidiabetic treatments, the hemoglobin A1C (HbA1c) levels of the patients. Diabetes was considered controlled if HbA1c level was < 7%. We collected MSK complications diagnosed using a targeted medical history, standardized physical examination, and investigations if needed. Results : We screened a total of 340 patients. Forty patients were having the duration of diabetes for <1 year. A majority of the participants were having uncontrolled diabetes. The mean BMI was 26.4. descriptive characteristics of the study population are showed in table n 1. MSK complications were found in 340 patients. Low back pain (LBP) was the most frequent reported symptom (n = 84;24.7%). Other complications in descending order of the prevalence were knee pain , shoulder pain, neck pain, , hand and wrist complications ( table 2) Conclusion: Musculoskeletal complications of T2DM are common and can result in significant disability in this population. Optimal care of diabetics should include prevention and management of such complications.
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Non pharmacological management of low back pain, experience of rehabilitation department in Sousse, Tunisia
Non pharmacological  management of low back pain , experience of rehabilitation department of Sahloul, Sousse Gaddour M, Loubiri I, Layouni S, Moncer R, Toulgui E, Dghim I, Jemni S Physical medicine and rehabilitation department, university hospital Sahloul, Sousse, Tunisia INTRODUCTION low back pain (LBP) has been a major public health challenge in the world .To treat LBP, numerous approaches have been explored. Pharmacological treatment remains a mainstream therapy for LBP but it is still not satisfactory, considering the potential harms caused by medication. Clinicians have been seeking for beneficial non-drug therapies to manage LBP. this study aimed to report the experience of rehabilitation department and list the non pharmacological tools used to treat LBP. METHODS A prospective descriptive study was conducted in the physical medicine and rehabilitation department of university hospital sahloul, sousse . patients with LBP were included . all patients had physiotherapy exercises. New non pharmacological interventions were practiced. The primary outcome was the reduction in pain intensity using the VAS. RESULTS : Eight patients included received radial extracorporeal shockwave therapy( RESWT). After determining the regions of low back pain through physical examinations, the shockwave energy was delivered.The chief complaint of the patients with chronic low back pain was pain in the buttock and lumbosacral region of the spine. Therefore, the treated regions were mainly the quadratus lumborum muscle, the gluteus maximus muscle and the piriform muscle. No adverse effect was noticed and mean VAS passed from 7.3 to 3.5 /10. Mesotherapy, a well-tolerated treatment, was prescribed to sex patients complaining of LBP. systematized point mesotherapy and intra-epidermal techniques were used. Xylocaine, anti inflammatory and myorelaxant used had a good effect to reduce pain Mean VAS passed from 6.9 to 2.9 after 5 sessions of mesotherapy. Three patients received Dry needling (DN). DN is as a relatively new treatment modality practiced. It involves a minimally invasive procedure in which an acupuncture needle is inserted directly into myofascial trigger points. Among three patients receiving DN, two patients reported significant pain relief. CONCLUSION : A variety of non-pharmacological interventions have been tested to treat LBP and showed efficacy. Future comparative studies are needed to confirm this efficacy
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Spondylo-epiphysary dysplasia tarda complicated with spastic tetraparesia with vesico-sphincterial and ano-rectal disorders. Which approach for PRM?
CODE N°254 LATE SPONDYLO-EPIPHYSARY DYSPLASIA (LSED) COMPLICATED WITH SPASTIC TETRAPARESIA WITH VESICO-SPHINCTERIAL AND ANO-RECTAL DISORDERS. WHICH APPROACH FOR PRM ? Introduction : LSED, rare genotypic chondrodysplasia. The form linked to the X chromosome is the most common and is often complicated by spinal cord damage with neuromotor consequences, hence the interest of PRM follow-up. Observation : We report the case of a 47year-old patient, followed in rheumatology and referred for a urodynamic assessment (UDA), with a history of repeated urinary tract infections, LSED diagnosed in 2008 complicated by polyarthrosis, cauda equina syndrome, Protects Total Hip (PTH) and Bilateral knee in 2011 and 2012, notion of similar case in the family (sister). She presented with Bladder-Sphincter Disorders after these PTH operations. She had developed during her hospitalization in rheumatology, a bladder globe without sensation of need, the cauda equina syndrome was placed and the patient placed under a permanent catheter. The CT scan reveals global dorsolumbar disc bulges staged on advanced osteoarthritis and secondary canal stenosis. The physical examination is very disturbed on the neuro-orthopedic level subject to retractions and pain in the proximal but null in the distal. We find a small patient with 153cm, confined to a wheelchair, impossible to walk, transfers possible with human assistance, holds the seated position with posterior support, the standing position impossible because of statistical disorders. Discussion : The patient had not benefited from follow-up in PRM for neuro-orthopedic management and improvement of the functional assessment would be very beneficial in the prevention of these spinal complications. Multidisciplinary management would be beneficial for such a clinical picture. Conclusion : LSED is a very disabling pathology that would not require multidisciplinary followup including PRM in order to prevent complications, improve functional prognosis and quality of life. Keys work : Chondrodysplasia, LSED, genotypic
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Achilles or not Achilles – A case of a functional re-rupture
Achilles or not Achilles – A case of functional re-rupture INTRODUCTION Achilles tendon rupture corresponds to 20% of all tendon ruptures and its annual incidence is around 11-37 cases/100,000 inhabitants . It has a bimodal distribution, affecting mainly athletes between 30 and 40 years of age or the population over 60 years of age, in this case more frequently due to low-energy injuries in degenerated tendons. One of the main complications during rehabilitation is re-rupture. CLINICAL CASE DESCRIPTION We present the case of a 61 years-old female diagnosed with rheumatoid arthritis, taking corticosteroids for the last 17 years. Fell on the sidewalk and was unable to get up afterwards. Went to the ER 1 month after due to a change in gait pattern and swelling of the right leg. Presented with heel pain, palpable gap, positive Thompson test, inability to plantar flex. TESTS AND PROCEDURES Ultrasound confirmed complete rupture of Achilles tendon 1.7 cm from distal insertion and 1.4cm gap. Underwent tenorrhaphy of Achilles tendon using Speedbridge technique and direct anchorage of the proximal stump on the calcaneus. Completed 24 sessions of physiotherapy as an outpatient. In the 12th postoperative week, patient presented again a palpable gap, without palpable tendon, positive Thompson test and increased range of dorsiflexion. Unexpectedly, patient had active plantar flexion with grade 4 muscle strength. Walking was possible, without aids, but unable to heel off in the gait stance phase. The ultrasound confirmed re-rupture of the Achilles tendon 1.7 cm from its distal insertion in the calcaneus with a tendon gap of 5.2 cm. CONCLUSIONS After discussing the case with the Orthopedics team, the hypothesis raised was that of re-rupture with maintenance of function through the still intact suture threads. Right now, is waiting for an MRI to confirm the hypothesis. The purpose of this case is to draw attention to an atypical presentation of a surgically treated Achilles tendon rupture which, even after re-rupture, maintained its function.
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Target group survey on rehabilitation service utilization and needs among patients with rheumatic conditions
Target group survey on rehabilitation service utilisation and needs among patients with rheumatic conditions. Authors Varje-Riin Tuulik ¹ ² Eve Sooba ³ 1 The Centre of Excellence in Health Promotion and Rehabilitation, Lihula mnt 12/1, 90507 Haapsalu, Estonia 2 West Tallinn Central Hospital, Paldiski mnt 68, 10617 Tallinn, Estonia 3 East Tallinn Central Hospital, Pärnu mnt 104, Tallinn , Estonia Correspondence: v_riinu@hotmail.com Introduction The aim of the study was to understand the needs for rehabilitation of patients with rheumatic diseases to prepare to draft the guidelines of social rehabilitation. Methodology This study was an electronic survey distributed through patient`s organisation. Results/ Findings Four men and 57 women filled in the questionnaire. Majority (35) of the respondents belonged to the age group 40-64 years. About half (31) of the participants had history of rheumatic disease over 10 years. Fourty-four respondents worked full- or part-time, only four reported inability to work due to health problems. More than a third (21) of the respondents had no experience with any type of rehabilitation service, 26 had utilised the services provided by social support structures and 34 were treated as in- and/or outpatients in physical and rehabilitation medicine facilities. Nineteen participants found that they had the opportunity to choose the most suitable rehabilitation service for them. Coping with ADL as a desired goal for the rehabilitation was set by the vast majority (58) of the respondents. The other often named goals were better work performance and engaging in hobbies. Ten participants would prefer rehabilitation in group, the rest would rather use individual services. The preferred duration of a rehabilitation program was three (20 respondents) or 12 months (19), 51 respondents preferred rehabilitation sessions with a frequency of one to three times a week. Physiotherapy was the most desired service (58 participants) followed by physical and rehabilitation medicine doctor’s consultation (43). Most of respondents (35) preferred the complex rehabilitation service in medical spa. Conclusion Distributed through a patients’ organisation, an electronic survey can give valuable information to plan patient centered rehabilitation service for patients with rheumatic conditions. The patients have a clear vision of their needs and are ready to share it in order to jointly design the rehabilitation services. Code: 259
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Cerebral palsy in children: challenges and management of musculoskeletal disorders A Cases Series.
e-poster 260 Cerebral palsy in children: challenges and management of musculoskeletal disorders A Cases Series. K. EL Youbi, S. Karkouri. Department of Physical Medicine and Rehabilitation, University Hospital ibn Sina, Rabat, Morocco. Background and aims: Managing cerebral palsy (CP) in children are complex. It involves a range of musculoskeletal disorders like spasticity, weakness, and deformity. Orthopaedic treatment is challenging and requires a multidisciplinary approach. The aim of this study is to describe our experience in managing musculoskeletal disorders in children with CP. Methods:  A retrospective study from October 2019 to July 2022 investigated the various musculoskeletal disorders and their management in children with CP. Results: Twenty patient records were chosen. The median age was nine years with a male predominance (12/8). A clinical spine and musculoskeletal exam, along with radiological assessment, were done upon admission. Scoliosis, pelvic obliquity and/or joint deformities involving ankles, knees, hips and wrists are the main problems found. An experienced team of orthotists assisted in the treatment of these orthopaedic disorders. The type of scoliosis brace used was determined by the severity of the curves. Orthotic devices are used to limit the progression of deformities, particularly in the hip, ankle, and knee joints. Following the presentation of pain and significant deformities, five patients were referred for surgery. Physiotherapy and occupational therapy are prescribed and performed, with adapted exercises for each case. Botulinum toxin injections were given to nine patients with significant spasticity. These measures enable our patients’ osteoarticular function to be stabilized or even improved particularly in cases handled early. Discussion: As children with CP grow, the effects of brain injury extend to most parts of the musculoskeletal system. Biomechanical and biological pathways of musculoskeletal deformities include inhibition of longitudinal growth of muscle-tendon units and long bones, muscle imbalance and hypertonia, impaired gait biomechanics, and weakness leading to reduced activity. These stiffnesses may respond to nonsurgical management, including a cast and brace, stretching, or intramuscular injections of BoNT-A. In young children, rehabilitative management can offer a wide variety of possibilities to improve functional status and promote children’s motor skills, including fitting with the various orthoses available, physiotherapy and occupational therapy, BoNT-A injections, and robotic devices. All of these weapons help broaden the horizons and opportunities for people with CP and reduce or delay surgical indications. Due to the variety of clinical presentations as well as the quality and speed of the management of these patients, the results of similar studies in the literature are variable, so in our experience, an adapted and early rehabilitative management allows patients to maintain as much orthopaedic function as possible while delaying surgery in cases with profound motor function deficits. Conclusions: Many musculoskeletal disorders caused by CP require a narrower multidisciplinary approach, where early rehabilitative treatment from diagnosis is critical to improving their prognosis.
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Hand early-applied prosthetics in children: evaluation protocol from Italy
HAND EARLY-APPLIED PROSTHETICS IN CHILDREN: EVALUATION PROTOCOL FROM ITALY Authors: Gaudenzi M1, Della Bella G2, D’Urzo R2, Tofani M2,3, Luttazi P2, Pochiero L2, Denza G4, Zenardi D4, Castelli E2, Affiliations: 1School of specialization in Physical and Rehabilitation medicine, clinical sciences and translational medicine department, university of Tor Vergata, Rome, Italy 2Operative Unit of Neurorehabilitation children’s Hospital Bambino Gesù, Rome, Italy 3Department of Human Neurosciences, Sapienza University of Rome, Italy. 4ITOP SpA Officine Ortopediche, Via Prenestina Nuova 307/A, 00036 Palestrina, Rome, Italy Background and aims There are currently few studies analysing the use of prostheses and rehabilitation in children with upper limb amputation or agenesis, with important consequences on the timing prescription of prosthetics and the start of an occupational therapy. According to current literature, first passive prosthetis is usually prescribed at six months, when the child has learned how to manage the sitting posture alone (“fit to sit”). Furthermore, the rapid somatic growth of the child, together with manufacturing challenges and costs did not lead a massive use of prosthetics device in children. On the other hand, following the Neuronal Group Selection Theory (NGTS) developed by Edelman in 1989, recent hypotheses suggest that the first prosthesis should be prescribed as early as possible, giving the child the opportunity to develop an extended motor repertoire with and without a prosthesis. Another fundamental aspect is that upper limb deficiency needs a total care for the family, and the psychological impact, both on child and parents, plays a non-marginal role in the process of condition acceptance and better adherence to the rehabilitation pathway. Our study wants to propose a specific pilot protocol for the evaluation and prescription of hand-early applied prosthetics in children. Methods 53 children (25 girls and 28 boys) with upper limb unilateral congenital agenesis or amputation were enrolled. They underwent evaluation using the following scales: the Pediatric Evaluation of Disability Inventory (PEDI), the Unilateral Below Elbow Test (UBET), the AbilHand Kids and lastly the Child Amputee Prothetics Project – Prothesis Satisfaction Inventory (CAPP-PSI), with the support of video recordings. According to children functioning profile and tools characteristics, the evaluation protocol was divided as follow: 0-2 years, 2.1 – 5 years and more than 5 years. At the time of the first evaluation 42 patients had never used prostheses, 9 were already prosthetised and 2 had orthesis. Of 42 patients without prostheses, 17 were successively prescribed and delivered an aesthetic prosthesis while a myoelectric prosthesis was delevered to 2 patients. Of 9 patients who already used aestethetic prostheses at the time of first evaluation, 5 were prescribed and delivered a myoelectric prosthesis. Furthermore, participants older than 18 months and their parents completed a semi-structured interview and questionnaires (PSI SF, PedsQL CBCL) to investigate stress levels, quality of life and behavioral correlates, pre and after prosthesis delivery. Results From a first qualitative analisys, rehabilitation professionals have underlined some common characteristics in these children: poor shared attention, difficulty in motor planning, underdevelopment of reaching, gripping and manipulation skills and postural asymmetry. Furthermore, psychologists observed that mothers perceived higher level of stress than fathers and obtained lower scores in quality of life tests. Children didn’t seem to show emotional and behavioral correlates and quality of life seemed improved after prosthesis delivery. Conclusions Our pilot protocol showes preliminary evidences for the evaluation of hand early-applied prosthetics in children with both upper limb agenesis or amputation. Although data are still collecting, we can confirm that rehabilitation team should be composed by medical doctors, physiotherapists, occupational therapists and psychologist, in order to offer a comprehensive care taking to both children and their families. Futher investigations will explore the role of time in prescribing prosthetis, rehabilitation and psychological therapies, for the purpose of extablishing shared standardized pathways of care.
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Evaluation of the quality of life and the functional impact in patients with Guillain Barré
Evaluation of the quality of life and the functional impact in patients with Guillain Barré M.Yazidi, A.Kabil, R.Dades, N.Kyal, F.Lmidmani, A.El fatimi Department of Physical Medicine and Rehabilitation CHU Ibn Rochd Casablanca Background and aims Guillain-Barré syndrome (GBS) is a primary acute inflammatory polyradiculoneuritis of autoimmune origin. The vital and functional prognosis may be compromised in the short and medium term. Methods Retrospective study including 27 patients with GBS, who were treated in the Physical Medicine department at the Ibn Rochd University Hospital. Results The average age was 32.7 years. The majority of patients were females. All patients had a tetraparesis on admission.7 patients required assisted ventilation, 17 patients had early axonal damage on ENMG. The evolution was favorable in the majority of cases at 1 year. The average MIF score increased from 65.8 to 107.3/126. 9 patients regained their professional activities, one patient was able to benefit from a professional reclassification. The SF-36 score was improved in all dimensions in all patients. Conclusions GBS is the most frequent form of acute polyradiculoneuritis, initially life-threatening and secondarily compromising the functional prognosis, with residual functional sequences that can sometimes persist and affect the patient’s daily and professional activities, thus the need for an early multidisciplinary care.
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Internet delivered cognitive rehabilitation for patients affected by post COVID-19 condition, a feasibility study.
Internet delivered cognitive rehabilitation after COVID-19 M Gewers1,2, A Bartfai1,2, K Borg1,2 ,U Fors3, S Koch4, M Möller1,2 1 Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden 2 Division of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden 3 Department of Computer and Systems Sciences (DSV), Stockholm University, Stockholm, Sweden4 Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden Conclusions Internet delivered cognitive rehabilitation has been considered a promising intervention for patients with post COVID-19 condition (PCC). Preliminary results do not support the practical feasibility of a model analogous to internet delivered psychological therapy due to large drop out and low engagement. Qualitative analysis will be carried out to investigate the reason for the dropouts. Introduction Cognitive difficulties frequently form part of residual effects after COVID-19 infection. Internet-delivered interventions appear as an appropriate rehabilitation solution saving time and energy. Therefore, we have adapted an internet-based program, eRehabCog originally developed for patients with mild to moderate acquired cognitive impairment, for patients with PCC. eRehabCog is an interactive psychoeducative program consisting of 10 modules with information about cognitive symptoms, how to manage them and home assignments.  Aim The objective of the study is to assess the feasibility of the eRehabCog for patients with PCC. Results Engagement thus far has been markedly low. The proportion of patients discontinuing is considerably higher than for brain injury patients according to our experience. Patients that completed the program took more time than recommended, which defies expectations of a well-educated patient group. Future studies are needed to explore the experiences of rehabilitation of patients with PCC. Karolinska institutet Mikael Gewers, Phd Student Department of clinical sciences Mikael.gewers@ki.se Danderyd Hospital 182 88 Stockholm +46 (0)8 123 55 000 Danderyd Hospital Mikael Gewers, Lic. Psychologist Department of rehabilitation medicine Mikael.gewers@ki.se Danderyd Hospital 182 88 Stockholm +46 (0)8 123 55 000
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When rehabilitation is not enough – the suspicious case
When rehabilitation is not enough – the suspicious case Background and aims Arthroscopy is a minimally invasive surgery involving examination of a joint with an arthroscope to diagnose or treat joint conditions. Compared to open surgery, it is associated with less scarring, decreased risk of infection, reduced postoperative pain and swelling and faster return to work and sports. Nevertheless, it is crucial to undergo a proper aftercare to avoid complications, with initiation of passive range of motion (PROM) exercises as soon as it is safe to minimize potential joint stiffness. Heterotopic ossification is the formation of mature bone in the extra skeletal soft tissue. It is a frequent complication in the rehabilitation setting, mostly following trauma. Methods 57-year-old-man | Former volleyball player | Without relevant antecedents Presented following an arthroscopy of the right shoulder and elbow, due to rotator cuff tear and loose bodies in the elbow. In the first appointment after surgery, it was prescribed treatment with: • Non- steroidal anti-inflammatory – etoricoxib • Course of preconized rehabilitation: • Assisted passive/active ROM • Electric stimulation, Massage, Acupuncture Results After 20 weeks of treatments: • Elbow with edema, rigidity and functional limitation with pain • Passive ROM: 90º flexion with shoulder compensation | -20º extension | 70º supination • MRI with high-volume heterotopic calcification in the proximal anterior extremity of the radius bone. To prevent ankylosing of joints, it was suggested additional mobilization with ROM exercises and posterior surgical resection of mature bone, made after 8 months of the original intervention. Conclusions The aim of this work is to emphasize the crucial role of rehabilitation programmes in the post-surgery setting. Besides restoration of functionality, it should be used to objectively measure recovery and recognize complications to treat.
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A human with a tail? A case of closed spinal dysraphism
A human with a tail? A case of closed spinal dysraphism Gonçalo Martins e Pereira1, Margarida Mota Freitas1, David Cordeiro1, João Francisco Luís1, Fernanda Pinheiro1, Sara Antunes1, Andreia Amorim2, Susana Almeida Farinha1 1Physical and Rehabilitation Medicine Department – Hospital Garcia de Orta; 2Neurosurgery Department – Hospital Garcia de Orta No. 274 Background & Aims Spinal dysraphism is a congenital malformation of the spine which may affect the bone structure, the meninges, the spinal cord, and the nerve roots. It is a type of neural tube defect (NTD). The presentation, severity, treatment, morbidity and prognosis are extremely variable. The incidence of all forms of this rare condition is 0.5 to 8 cases per 1,000 live births.1 The aim of this case report is to raise awareness to spinal abnormalities, its variable forms, and the importance of specialized teams in the management of spinal dysraphism. Case Report We report a case of a girl with a malformation in the sacral region with a “vestigial tail” (fig.1). The pregnancy was routinely monitored, without any abnormality in ultrasound study and with normal development. The mother took supplementation with iron and folic acid. It was an eutocic delivery. The MRI detected a spinal dysraphism with a tethered spinal cord, without Arnold Chiari syndrome or hydrocephalus. Surgery was performed at 3,5 years old. Caudal Appendix + Intracanal Lipoma removal: • Section of caudal appendix • Partial Laminectomy of L5 • Excision of subcutaneous lipoma contiguous to the spinal cone • Section of adherences for tethered cord correction Neuro-monitorization during the whole surgery. No major complications were reported. At the present, the patient is 5 years old. She has a normal development (motor and cognitive), without any signs of neurologic deficits, achieving sphincters’ continence, and without psychological impact. She is closely followed-up by a multidisciplinary team of Physiatrists, Pediatricians, and Neurosurgeons. Discussion & Conclusions Spinal dysraphism needs individual evaluation, treatment, and close follow-up by multidisciplinary teams.1-2 Closed spinal dysraphism is a subtype of NTD, a disorder of secondary neurulation. Often, the distal spinal cord is tethered to surrounding tissues. There is a striking association with intradural lipoma, which is not well explained yet.2 In cases of tethered spinal cord, it is essential to make an early diagnosis for surgical correction to ensure the prevention of focal neurological deficits.3 In all cases of dysraphism, there is a risk of progressive motor or sensory impairment, neurogenic bladder and bowel. Close medical monitoring is essential during growth.1-3 This successful case demonstrates the benign course that may occur in such a rare pathology, bearing the early detection and strict follow-up before and after treatment during growth to better outcomes.2 References: • Holmes LC, Li V. Occult Spinal Dysraphism. Pediatr Rev. 2019 Dec;40(12):650-652. doi: 10.1542/pir.2018-0155. PMID: 31792051. • Copp AJ, Adzick NS, Chitty LS, Fletcher JM, Holmbeck GN, Shaw GM. Spina bifida. Nat Rev Dis Primers. 2015 Apr 30;1:15007. doi: 10.1038/nrdp.2015.7. PMID: 27189655; PMCID: PMC4898641. • Pierre-Kahn A, Zerah M, Renier D, Cinalli G, Sainte-Rose C, Lellouch-Tubiana A, Brunelle F, Le Merrer M, Giudicelli Y, Pichon J, Kleinknecht B, Nataf F. Congenital lumbosacral lipomas. Childs Nerv Syst. 1997 Jun;13(6):298-334; discussion 335. doi: 10.1007/s003810050090. PMID: 9272285.
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Functional assessment in military tibial amputees
Functional assessment in military transtibial amputees Wechtati Ghada, Mouhli Najla, Hfaidh Mèriam, Ksibi Imène, Rahali Hajer, Maaoui Rim Physical medecine and rehabilitation departement of military hospital of Tunis Introduction A transtibial amputation(TTA) is a burden for society through its cost and for the individual, responsible for changes in body image, musculoskeletal sequelae, and functional impairment [1]. The objective of our study was to assess functional and gait abilities in this population. Methods This was a descriptive cross-sectional study of military transtibial amputee patients followed in the physical medicine department of the Military Hospital of Tunis, over a period of 6 months between December 2021 and May 2022. Sociodemographic and patient habits were collected. We proceeded to the stump examination, joint examination, muscle assessment and pain assessment. A functional evaluation was carried out by evaluating monopodal support, walking speed, and the 2-minute walk test. An evaluation of the postural balance was made using the timed up and go test and using validated scales : the berg balance scale and the ABC Scale. Results Forty patients were included. The average age was 30.15 ± 7 with male exclusivity. The practice of sports activities and the resumption of professional activity were respectively 28% and 55%. All patients were independent. The average length of amputation in months was 45.15±18. The average daily use of the prosthesis in hours was 11.83±1.5. The mean BMI was 23.3 kg/m²±2.8. The amputation was on the right side in 56% of cases. The level of amputation was the middle third in 60% of cases. The stump was conical in shape in 85% of cases with an average length of 16.3 cm±3.4. Muscle testing did not reveal motor deficit, however, all patients presented with amyotrophy of the thigh. Pain assessment revealed 4 patients with nociceptive pain and 19 patients (48%) with neuropathic pain. Functional evaluation showed stable monopod support without support for more than 10 seconds in 100% of cases, a mean walking speed of 1.37m/s±0.267, a mean 2 min test value of 161m±24.6, Romberg’s test was normal in all patients. The average TUGT was 11.76±2.5, the BBS was 54.65±2, and the ABCS was 39.70±5.9. Discussion Limb amputation is known to cause several functional limitations that decrease the ability of TTAs to function adequately and independently in society. These functional limitations are mostly undetectable on traditional clinical examination. Successful prosthetic rehabilitation in traumatic trans-tibial amputees improves their functional abilities. Unlike vascular patients, traumatic amputees are often young and in good health, and optimal prosthetic adaptation is possible and allows them an excellent functional result[2]. Conclusion These clinical assessments are essential in the examination of any patient presenting with a lower limb amputation whatever its etiology. A complement by instrumental evaluation of postural balance by force platform and muscle strength by a force dynamometer seems interesting. References [1] Hewson A, Dent S, Sawers A. Strength deficits in lower limb prosthesis users: A scoping review. Prosthet Orthot Int. 2020;44:323-40. [2] Isakov, H. Burger, J. Krajnik, M. G E. knee muscle activity during ambulation of trans-tibial amputees. J Rehabil Med 2001;33:196-9.
280
Ischemic stroke and covid 19: impact of mobilization start time on functional outcomes
Ischemic Stroke And Covid 19: Impact Of Mobilization Start Time On Functional Outcomes Vesna Bokan-Mirković, MD,PhD, Center for Physical Medicine and Rehabilitation, Clinical Centre of Montenegro Background Ischemic stroke is a known complication of COVID-19. During the period of the COVID-19 pandemic early rehabilitation of stroke patients was carried out in the Clinical Centre of Montenegro (CCM) while following the recommended epidemiological measures. Standard Early mobilization (EM) was carried out within the framework of a multidisciplinary stroke unit team according to the recommendations of the application of an individual approach and when patient’s clinical condition permits. The aim of this study was to investigate the optimum mobilization start timing treatment in patients with ischemic stroke associated with prior COVID-19. Methods The study included all patients with ischemic stroke (IS), hospitalized in the period from January 2021 to December 2021, older than 18 years. From total of 248 patients with IS, 30 patients were treated of COVID-19 in the period prior to the onset of stroke. Only data (using Heliant health information system) for those patients who were discharged alive was included in the analysis. Correlations were made using the mobilization start day after hospital admission. Results Table 1. Starting mobilization stroke patients who were COVID 19 recovered Table 2. Correlation of IV day and mRS values at discharge Analysis of the first mobilization showed a good distribution of activities, the largest number of patients had some of their first activities on the fourth day of hospitalization, such as sitting in bed and sitting with legs down, transfer to chair and walking. Activity on the fourth day correlated with mRS values at discharge, Pearson -.571, p = 0.05; mRS at discharge 2.94 ± 1.652 / mRS after 6 months 2.47 ± 1.457, p < 0.05. Conlusion This trial shows that early mobilization was delayed> 72 h in the majority stroke patients with previous infection with COVID 19.
285
The impact of pain on sexual satisfaction among patients with chronic low back pain
The impact of Pain on sexual satisfaction among patients with chronic low back pain Hachfi H.1, Haddada I.2, Dorgham I.2, Brahem M.1, Abdellatif S.1, Kessomtini W.2, Younes M1. • Rheumatology, Taher Sfar University Hospital, Mahdia • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital, Mahdia Background and aims : Chronic low back pain (CLBP) as other musculoskeletal diseases may affect all aspects of life including sexual function. The aim of this study was to assess the impact of CLBP on sexual satisfaction and to identify the associated factors. Methods : This was a cross-sectional study conducted on patients with CLBP. We measured sexual satisfaction using the male and female Sexual Quotient questinonnaires (SQ). We used the Quebec back pain disability scale (QBPDS) to assess LBP-related functional disability. Results : 152 patients with CLBP (93 females and 59 males, mean age: 53.7 ± 11.3 years [23 to 79]) were included. The CLBP average duration was 6.4 ± 5.1 years. The pain intensity was meanly 46.5 ± 50 mm on the Visual Analogical Scale. Functional impairment (QBPDS<50) was found in 60.5 % of patients. The SQ was meanly 39,2 ± 33,6 [0 to 100]. In this study, 37.4% of patients didn’t have any sexual activity, 2% had a catastrophic sexual life, 8.6% had a disappointing sexual life, 19.1% had an average sexual life, 19.1% had a satisfying sexual life, while only 13.8% had a very fulfilling sexual life. Sexual dissatisfaction was significantly associated with age (p= 0,035) and gender (p= 0,038). However, we didn’t found a significant correlation with the duration of the disease, the mean visual analogue scale for pain and the functional scores of Quebec. Discussion : Sexual difficulties in CLBP are frequent and ranging from 50% to 78% [1]. The effect of pain on the patient’s capacity for sexual intercourse is negative and may lead to disinterest and avoidance of any sexual activity [1]. The quality of sexual life was more disrupted in older patients. But it’s commonly admitted that older patients are less sexually active than younger persons [2]. Sexual quality of life was more disturbed in patients with worst functional status. Prolonged disability may change patients’ feelings of sexual effectiveness and attractiveness to his or her partner, which may lead to a deficiency or a lack of sexual desire or activity independently of pain intensity and disease duration [3]. Conclusion : Sexuality is negatively affected in patients with CLBP. Therefore, sexual consulting must be included in CLBP management. References : • Ambler N, Williams AC, Colline P, R Gunary, Cratchley G. troubles sexuels de patients souffrant de douleur chronique. Clin J Pain. 2001. • Enzlin P, Mathieu C, Van den Bruel A, Bosteels J, Vanderschueren D, Demyttenaere K. Ladysfonction sexuelle chez les femmes atteintes de diabète de type 1: une étude contrôlée. Diabetes Care. 2002. • Rosenbaum TY. Douleur musculo - squelettique et la fonction sexuelle chez les femmes. J Sex Med. 2010.
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The influence of pain and disability on the quality of life in patients with chronic low back pain
The influence of Pain and Disability on the quality of life in patients with chronic low back pain Hachfi H.1, Haddada I.2, Dorgham I.2, Brahem M.1, Abdellatif S.1, Kessomtini W.2, Younes M1. • Rheumatology, Taher Sfar University Hospital, Mahdia • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital, Mahdia Background and aims : Chronic low back pain (CLBP) is one of the most frequent musculoskeletal disorders in daily practice. This study aimed to investigate disability in patients with CLBP and its impact on their quality of life (QoL). Methods : It was a cross-sectional study condected on 152 patients suffering from CLBP during a period of nine month. We used the Quebec back pain disability scale (QBPDS) and the Dallas Pain Questionnaire (DPQ) to assess LBP-related functional disability. We have specifically studied the impact of CLBP on patients’ QoL using the Short Form-36 Health Survey (SF-36).  Results : The average age of our patients was 53.7years [22–78 years], with a female predominance in 67% of cases. The mean visual analogue scale for pain was 4.62mm [1–9]. The mean duration of pain was 6.4 ± 5.1 years. The average score of QBPDS was 45,2 ± 19,5 [2-92]. 60,5% of cases were severely disabiled (QBPDS>50). Concerning the mean Dallas score, the segmental results were as follows: 52.8% of impact on daily activities, 47.9% of impact on work/leisure ratio, 44.7% of impact on anxiety/depression ratio and 33.8% of impact on sociability. Regarding the QOL: the mean SF-36 scale was 41,3 ± 16,4 and a poor QOL (SF-36 < 66,7) was noted in 90,8 % of cases. In this study, a poor QoL was significantly associated with pain intensity (p<0.001) and functional disability (QBPDS) (p<0.001). Discussion : Chronic low back pain can be the cause of greater disability and lower quality of life, especially in patients with somatic and mental co-morbidities, in female patients and in patients with higher levels of chronic pain [1]. A strong association was observed between disability and the physical quality of life domain, indicating that disability negatively affects and strongly influences physical quality of life in these patients with chronic low back pain [2]. Conclusion : Functional disability is common in patients with CLBP and affects negatively their well-being. References : • Ketiš, Z. K. (2011). Predictors of health-related quality of life and disability in patients with chronic nonspecific low back pain. Slovenian Medical Journal, 80(5). • Stefane, T., Santos, A. M. D., Marinovic, A., & Hortense, P. (2013). Chronic low back pain: pain intensity, disability and quality of life. Acta Paulista de Enfermagem, 26, 14-20.
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Sleep disturbance in patients with chronic low back pain
Sleep disturbance in patients with chronic low back pain Hachfi H.1, Haddada I.2, Dorgham I.2, Abdellatif S.1, Brahem M.1, , Kessomtini W.2, Younes M1. • Rheumatology, Taher Sfar University Hospital, Mahdia • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital, Mahdia Background and aims: Chronic Low back pain (CLBP) is a common health condition that may affect the quality of life of patients including their sleep quality. The aim of this study was to assess sleep disorders (SDs) among patients suffering from CLBP and determine its associated factors. Methods: This was a cross-sectional study conducted on patients with CLBP. Pain intensity was assessed by the visual analog scale (VAS). We used the Quebec back pain disability scale (QBPDS) to assess CLBP-related functional disability. Sleep disorders were evaluated with Pittsburgh Sleep Quality Index (PSQI) and The Epworth slippiness scale (ESS). Results: A total of 152 patients were included with a mean age of 53.7± 11.3 years [23-79]. The average duration of pain was 6.4± 5.1 years [2-24 years]. Pain was mild to moderate in 70,4% of cases with a mean VAS of 46,5 ± 50 mm [1 and 9]. The average score of QBPDS was 45,2 ± 19,5 [5-92]. The average score of ESS was 8,3 ± 4,6 [0 -21] and SDs (ESS> 9) were noted in 42,8 % of cases. Concerning the PSQI, the mean scale was 6,9 ± 4,3 [0-19]. Sleep disturbance and duration, Sleep quality and Sleep efficiency were the most affected sleep components. Statistical analysis showed a significant association between SDs (ESS) and pain as well as with functional disability (p<0,001). Discussion : Consistent evidence found that CLBP was associated with greater sleep disturbance; reduced sleep duration and sleep quality; increased time taken to fall asleep; poor day-time function; and greater sleep dissatisfaction and distress [1]. The estimated prevalence of sleep disturbance was 58.7% (95% CI 56.4–60.7%) [2]. In this study the intensity of back pain was only weakly associated with sleep disturbance, suggesting that other factors contribute to sleep problems for LBP patients [2]. Conclusion : Our study showed that the sleep disruption wasn’t rare in patients with CLBP. This can be related to the disability and pain caused by this disease. References : • Kelly, Gráinne A. MSc, BSc*; Blake, Catherine PhD, MSc, BSc*; Power, Camillus K. MD†; O'Keeffe, Declan MD‡; Fullen, Brona M. PhD, BSc*. The Association Between Chronic Low Back Pain and Sleep: A Systematic Review. The Clinical Journal of Pain 27(2):p 169-181, February 2011. • Alsaadi, S.M., McAuley, J.H., Hush, J.M. et al. Prevalence of sleep disturbance in patients with low back pain. Eur Spine J 20, 737–743 (2011). 
291
Epilepsy of infancy with migrating focal seizures. When should we think about genetic origin? About a case
EPILEPSY OF INFANCY WITH MIGRATING FOCAL SEIZURES. WHEN SHOULD WE THINK ABOUT GENETIC ORIGIN? ABOUT A CASE. K. DAMOCHE, S. AGGOUNE, M. TAIR Department of physical medicine and rehabilitation, Specialized University Military Hospital Orthopedics, Rehabilitation, Equipment. Algiers, Algeria. Introduction: Epilepsy of infancy with migrating focal seizures (EIMFS) is an early infantile epileptic encephalopathy (EIEE) characterized by resistant focal seizures that migrate from one hemisphere to the other, delayed psychomotor development and acquired microcephaly. [1][2] It is a very rare disease (1case per 1million) caused by a de novo mutation of the voltage-gated potassium channel subunit KCNT1 gene. [3] Seizures often begin before 6 months of age and increase in frequency and severity, adversely affecting neurological development and often leading to regression of mental abilities and severe developmental impairment. [4] Seizure drug resistance is high. Neurological status progressively deteriorates with worsening seizures and arrest or regression of psychomotor development. [5] Diagnosis of KCNT1-related epilepsy is made based on clinical symptoms and identification of a heterozygous pathogenic variant. [1][4] Objectives : Due to the rarity of this disease, a limited number of cases of KCNT1-related epilepsy have been reported in the literature [4][6]. Our objective is to determine that in the face of EIEE with episodes of regression, the genetic origin must be sought. Methods: We report the case: a six-month-old infant D.A.B referred for care in the physical medicine and rehabilitation (PMR) department. He presented with developmental delay and acquired microcephaly, initially diagnosed with West syndrome. The child was normal until the age of 3 months; he had onset of drug-resistant tonic-clonic seizures which worsened over time. EEG showed multifocal epileptiform discharges and MRI was unremarkable. The evolution was marked by a regression of psychomotor acquisitions, hence the questioning of the initial diagnosis. We referred the child to pediatrics for genetic testing. Results The genetic study carried out at the age of 18 months, at the level of the Timone Hospital Marseille France medical genetics service, revealed the presence of the heterozygous variant in the DNA sample analyzed: KNCT1. Conclusions The genetic origin should be suspected in infants presenting EIEE, often in the context of an uneventful perinatal history and without underlying cerebral abnormalities accompanied by regression of psychomotor acquisitions. Genetic diagnosis can lead to early therapeutic intervention using new and/or reoriented therapies. [7] Keywords: Early infantile epileptic encephalopathy, regression of psychomotor acquisitions, genetic study, KNCT1. References [1] Rikke S. Møller and al, «Incidence of Aicardi-Goutieres syndrome and KCNT1-related epilepsy in Denmark » Molecular Genetics and Metabolism Reports 33, 2022 [2] Joe James and al, Epilepsy of infancy with migrating focal seizures due to a novel homozygous mutation in KCNT1 gene: A case report Seizure: European Journal of Epilepsy 106 (2023) 36–38 [3] R.Burgess, the Genetic Landscape of Epilepsy of Infancy with Migrating Focal Seizures. Ann Neurol. 2019 Dec; 86(6): 821–831 [4] C.X. Lim, M.G. Ricos, L.M. Dibbens and al., KCNT1 mutations in seizure disorders: the phenotypic spectrum and functional effects, J. Med. Genet. 53 (2016) 217–225,   [5] Sameer M. Zuberi and al, ILAE classification and definition of epilepsy syndromes with onset in neonates and infants: Position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia. 2022; 63:1349–1397. [6] A. McTague, U. Nair, S. Malhotra and al., Clinical and molecular characterization of KCNT1 -related severe early-onset epilepsy, Neurology 90 (2018) e55–e66, [7] Judith Kröll, Nouvelles Thérapies D’épilepsies de l’enfant, PAEDIATRICA Vol. 32 | 3-2021. Corresponding author: E-mail address: damouchekarima@gmail.com
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Quality of Life and Patient Satisfaction:an 18-months-Follow-up of CARDIO-RESPIRATORY REHABILITATION PROGRAM
Quality of Life and Patient Satisfaction : An 18-months-Follow-up Of CARDIO-RESPIRATORY REHABILITATION PROGRAM  C. Rahmani1,E.Toulgui1,W.Benzarti2,I.Ghannouchi3,W.Ouanes1,S.Jemni1,H.Ben Saad3 Introduction : The measure of patient satisfaction and willingness to continue the treatement is very important in health care. In this study we aim to determine perceived effectiveness and satisfaction of patients who completed the first trial of cardio-respiratory rehabilitation program CRRP post COVID-19 in Tunisia. Methods: The study participants were those ,who had agreed to participate to the CRRP in the outpatient physical medicine department ,sahloul hospital from February 2nd, 2021 to August 26th, 2021 A telephone questionnaire was used .the satisfaction of the patients was assessed by a commonly used 5 point Likert scale Quality of life was assessed by the SF-12, which is a self-assessment scale of quality of life that is a shortened version of the SF-36.Anxiety and depression were assesed by HAD questionnaire Dyspnea , the disability caused by breathlessness on daily activities, was assessed using the mMRC Results : Fourteen male patients aged 50 to 70 years were initialy included in the CRRP Duration between the end of the CRRP and this study 13 patients were included ,only one patient coudn’t be reached. All patients agreed that CRRP was effective. The median of perceived effectiveness was 70 . High satisfaction ratings were found :10 patients were very satisfied and 3 were satisfied For dyspnea,the median mMRC dyspnea scale was 1 (0–2).In fact after the CRRP dyspnea was significantly improved by two points Finally the median score of depression and anxiety among study participant was respectively 5 and 7 The quality of life assessed by the physical (PCS12) and mental (MCS12) components of the SF12 was significantly associated with the perceived effectiveness and the satisfacting rating. Discussion: Patients were highly satisfied with post-COVID-19 CRRP.It was effective in the long term on quality of life,anxiety and depression. A recent study published in the Journal of Cardiopulmonary Rehabilitation and Prevention evaluated the long-term outcomes of a cardiac rehabilitation program one year after completion. Sethi A et al found that patients who completed the program had significant improvements in physical function, quality of life, and healthcare utilization one year after the program. Conclusion: The patient’s progress should be monitored to ensure that the improvements achieved during the rehabilitation program are sustained. References: [1] Impact of cardiorespiratory rehabilitation program on submaximal exercise capacity of Tunisian male patients with post-COVID19: A pilot study ,frontiers in physiology [2] One-year follow-up of a prospective, randomized controlled trial. J Cardiopulm Rehabil Prev. 2021 May 1;41(3):165-170
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Thoracic meningioma revealed in the aftermath of surgery for a lumbar herniated disc
Thoracic meningioma revealed in the aftermath of surgery for lumbar herniated disc S. Aggoune, K. Damouche, K. Talbine, M. Tair Service de MPR, Hopital Militaire Universitaire Spécialisé orthopédie, Rééducation, Appareillage Algiers Algéria Introduction Spinal meningiomas are typically slow-growing benign tumors(1), predominantly affecting females. They are most commonly located in the thoracic region, accounting for 70% of cases (2). Patients often have a prolonged clinical history before the meningioma is diagnosed. The duration of symptoms before their appearance ranges from 1 to 2 years and varies based on the size and location of the tumor (3). Symptoms can range from simple radicular pain to a combination of medullary compression syndrome and spinal syndrome. MRI is the most reliable examination for tumor localization and treatment decision-making (4). Total surgical resection is the preferred treatment option (1), and prognosis is generally favorable after surgical intervention. OBJECTIVE Our objective is to demonstrate that sciatica with motor deficit in the lower limb may reveal an underlying pathology, such as meningiomas in our case. MATERIAL AND METHODS We present the case of a 54-year-old female patient who experienced right lumbosciatica for two years, progressing to functional impairment while walking, requiring the use of an external brace. The patient was initially managed in the orthopedic department, where a diagnosis of paralyzing lumbosciatica due to L5 disc herniation was established based on CT scans and electromyographic findings. The patient underwent discectomy surgery. However, at postoperative day 15, she suffered a fall resulting in a left fibular fracture, requiring immobilization for eight weeks. After the removal of the cast, the patient experienced functional impotence and began using a wheelchair, leading to her referral to the Physical Medicine and Rehabilitation (PMR) department for further management. Clinical examination at admission to the PMR department revealed a chronic spinal syndrome characterized by lumbodorsal pain, sensory disturbances (hypoesthesia from T5 level) affecting tactile and thermal pain sensations, and a bilateral pyramidal deficit, specifically paraparesis at the D12 level (muscles between 2-3 on the right side ), accompanied by spontaneous and provocation-induced lower limb spasms, which were bothersome, painful (EVA 5/10), and ranked as 2 on the Penn scale. Additionally, the patient exhibited vesicosphincter disorders, including dysuria and a significant post-void residual urine volume on the micturition chart. Considering these findings, a spinal MRI was performed (figure 1,2) , revealing an extramedullary intradural tumor at the right posterolateral T3 level, causing spinal cord compression and suggestive of a meningioma. The patient was then transferred to the neurosurgery department, where she underwent total resection of the meningioma and laminectomy. Histopathological examination confirmed a Grade 1 meningothelial meningioma. RESULTS In our case, the diagnosis and treatment of the disc herniation delayed the true diagnosis of the meningioma. The patient’s management in the PMR department lasted for two years, during which she experienced a slow but complete recovery of muscle deficit. The patient regained the ability to walk without assistive devices but still practices intermittent self-catheterization due to persistent post-void residual urine. CONCLUSION Spinal meningiomas most commonly affect the dorsal region and are more frequent in older individuals. They can be recognized late in this population, with symptoms often attributed to joint pathologies. Therefore, a detailed neurological examination and comprehensive spinal imaging (MRI) (3) are necessary to identify these pathologies. A transdisciplinary diagnostic approach is crucial for cases of sciatica with motor deficit in the lower limb, as it may uncover other underlying pathologies. REFERENCES 1) Xiaoxiong Wang 1, Jiabin Wang 1, Liankun Wang 2, Yongdong Lin 3, Mingchun Yang 1, Xiaoli Chen 4, Lei Teng 1, Hua Guo 4, Xiaofeng Chen 5. Surgical Resection of Dorsal Spinal Meningiomas with the Inner Dura Layer-An Improved Preservation Technique of Spinal Dura in 40 Cases. World Neurosurg. 2022 Apr;160:e250-e255. doi: 10.1016/j.wneu.2021.12.118. (2) Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD. Prise en charge des méningiomes spinaux : résultats chirurgicaux et revue de la l i t t é r a t u r e . Neurosurg Focus 2007;23:E14 (3) Hakan Sercan KURTOĞLU, Selçuk YAVUZ, Nurettin TAŞTEKİN, Murat BİRTANE. Spinal Dorsal Meningioma. Turk J Phys Med Rehab 2014;60:345-7 (4) M. Makhchoune ⁎ , A. Laidi, Y. Tahrir, A. Jhiri, A. Naja. Les méningiomes rachidiens : à propos de 6 cas. Neurochirurgie Volume 66, Issue 4, August 2020, Page 299.
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Autonomy in clean intermittent catheterization for a tetraplegic paptient: which device?
Autonomy in clean intermittent catheterization for a tetraplegic paptient: which device?S. Aggoune, K. Damouche, K. Talbine, M. Tair Service de MPR, Hopital Militaire Universitaire Spécialisé orthopédie, Rééducation, Appareillage Algiers Algéria INTRODUCTION Tetraplegic patients with spinal cord injuries have a number of deficits that lead to restrictions and incapacities, particularly in bladder emptying. Intermittent catheterisation is the method of choice(1) , but remains impossible for the patient due to hand dexterity deficits, resulting in dependence on a third party. Various treatment options are available: rehabilitation surgery on the upper limb or urological surgery for continuous cutaneous urinary diversion, or a technical aid (1) which is a simple and less costly means used to obtain autonomy in intermittent catheterisation OBJECTIVES Enable a tetraplegic patient with reduced dexterity to perform clean intermittent catheterisation independently.   MATERIAL AND METHODS We report the case of a young quadriplegic patient, with a post-traumatic C7 tetraplegia (asymmetric, mainly on the right). The Patient is predominantly right-handed but has a left-handed preference. We assessed both hands to determine the feasibility of clean intermittent self-catheterization in our management plan. It is important for a male subject to have the use of both hands in order to perform self-catheterization via the native urethra. One hand is needed to hold the catheter while the other hand holds the penis (2).During the grip assessment, the left hand scored 26/30, indicating below-normal function, while the right hand scored 6/30, rendering it unusable. The pencil and paper test (PP test) yielded a score of 6/15, indicating that the skills of both hands were insufficient to perform urethral self-catheterization. A score below 10 signifies an inability to meet the requirements for self-catheterization (3).The identified issue was the inability of the right hand to grasp the penis, while the left hand demonstrated the capability to manipulate the catheter. This prompted consideration for an assistive device. An orthosis was devised and fabricated by the occupational therapist, employing a thermoformable material. The orthosis comprised two components: the initial component was a static anterior orthosis shaped to conform to the functional position of the right hand. The subsequent component consisted of a cylindrical plastic element with a central cavity. The second component was affixed to the center of the first component through adhesive means (figure 1,2).  The patient was able to put on the technical aid on his own and insert his penis into it, stabilising it in an upright position. He was also able to insert the catheter into the urinary meatus, of course, after a period of training with the occupational therapist. RESULTSThe utilization of the technical aid facilitated the feasibility (Figure 3,4,5) and autonomy of intermittent catheterization. This development led to the patient’s acceptance, reproducibility, and satisfactory long-term compliance. CONCLUSION Intermittent catheterization is the recommended treatment for neurogenic urinary disorders (4). However, it can be challenging for tetraplegic patients with reduced manual dexterity. Technical aids can assist in overcoming this deficit, thereby improving the autonomy and quality of life for tetraplegic patients. REFERENCES(1) J Lapides, A C Diokno, S J Silber, B S Lowe. Clean, intermittent self-catheterization in the treatment of urinary tract disease J Urol . 1972 Mar;107(3):458-61. (2) X. Gamé  Clean intermittent self-catheterization: which patients? . Prog Urol. 2009 Dec;19(12):885-9. PMID: 19963185. DOI: 10.1016/j.purol.2009.10.011. (3) Pencil and paper test: a new tool to predict the ability of neurological patients to practice clean intermittent self-catheterization Gerard Amarenco  1 , Amandine Guinet, Marylene Jousse, Delphine Verollet, Samer Sheikh Ismael J uro 2011 Feb;185(2):578-82. doi: 10.1016/j.juro.2010.09.106. Epub 2010 Dec 18. (4) P Di Benedetto.Clean intermittent self-catheterization in neuro-urology. Eur J Phys Rehabil Med 2011 Dec;47(4):651-9. PMID: 22222962 CONTACTEmail: aggoune.sabrina@hotmail,fr
298
Guillain Barre Syndrome Rehabilitation and Recovery
Guillain Barré Syndrome Rehabilitation and Recovery Mitsostergiou Panoraia, Gklantzouni Aikaterini, Galata Angeliki, Manola Margarita Eleni, Tsiamasfirou Damiani, Petropoulou Konstantina 2nd PRM Department, National Rehabilitation Centre, Athens, Greece Background Guillain-Barré syndrome (GBS) is a heterogeneous condition associated with immune-mediated, self-limiting peripheral neuropathies. It is considered as one of the most common causes of acute, acquired weakness and is often provoked by a preceding infection. GBS may be complicated in some cases by respiratory failure or autonomic dysfunction. The incidence rate for GBS is rare, affecting 1-3 persons in 100,000 annually. Most patients eventually reach a full or nearly full recovery with the ability to walk unassisted after 5 months and only minor residual symptoms by the end of the first year after onset. Aims Assessment of motor and functional recovery in patients with GBS that were hospitalized in our PRM department in the period of 2015 – 2023. Methods We retrospectively reviewed 20 inpatients with confirmed GBS, of which 12 men and 8 women, in the period of 2015-2023. They underwent an investigation and individualized rehabilitation program, including physiotherapy, ergotherapy, hydrotherapy and logotherapy when needed. The motor recovery was assessed with clinical examination, while the functional recovery with Barthel Index score. Results • Average length of hospitalisation: 5 months and 28 days, 20% of patients required readmission • 80%: incomplete tetraplegia • 20%: incomplete paraplegia • 20%: additionally cranial nerve lesions. These patients needed a temporary tracheostomy and had an extended length of inpatient rehabilitation • No one had any kind of dysfunction regarding the lower urinary tract (LUT) • 60% required orthosis for gait training, 15% needed still orthosis at the discharge • Barthel Index score of all our patients was > 80/100 at the discharge. Conclusions GBS is a demyelinating disease, which mainly affects men, usually manifests itself in the form of incomplete tetraplegia and does not cause LUT symptoms. Need of temporary tracheostomy correlated with longer hospitalisation and time of recovery. All patients were independent at the discharge. References Muley, S. A. (2023). Guillain-Barré syndrome in adults: Treatment and prognosis. UpToDate. Retrieved May 30, 2023 from https://www.uptodate.com/contents/guillain-barre-syndrome-in-adults-treatment-and-prognosis Shahrizaila, N., Lehmann, H. C., & Kuwabara, S. (2021). Guillain-Barré syndrome. In The Lancet (Vol. 397, Issue 10280, pp. 1214–1228). Elsevier B.V. https://doi.org/10.1016/S0140-6736(21)00517-1
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Clinical features and outcome of Guillain–Barre syndrome IN TUNISIA after COVID-19 in a rehabilitation departement: a Tunisian case series
Clinical features and outcome of Guillain–Barre syndrome in TUNISIA after COVID-19 in a rehabilitation departement:a Tunisian case series Auteurs:R,Chiraz R.Moncer,M.Gaddour,S.Laayouni.S.Frigui,W.Ouaness,S.Jemni
Services: medecine physique sahloul Background and aims  Guillain-Barre syndrome (GBS) is a rare immune-mediated disease, possibly triggered by a recent infection. We aim to identify the epidemiological, clinical, neurophysiological characteristics ,therapeutic features and the evolution of GBS who were hospitalised in the rehabilitation department after COVID 19 . Methods  A retrospective monocentric study reviewing the medical records of all patients with GBS between January 2020 to march 2022, identified from the database of physical medicine and rehabilitation department of Sahloul hospital. Results : 14 patients were identified, including 8 woman and 6 man . The mean age was 42 years old [17-69] 5patients were infected with COVID 19. Only 6 patients had covid vaccine. 71.43% reported an antecedent illnesse: 6 patients had a history of respiratory infection : in fact 3 patients developed GBS manifestations after COVID-19 and 6 had a history of intestinal infection. The distribution of clinical variants resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form. Cranial nerve involvement was descriebed in one case and only one patient presented ophtalmoplegia. In addition 9 patients had difficulty in swallowing and two patients needed non-invasive ventilation. Cerebrospinal fuid analysis have been done for 10 patients.71.43% of them presented an albuminocytological dissociation. Detailed electroneurography results were reported in 57.14% of the cases. MRI were performed for 4 patients at a median of 7 days after symptom onset Almost most cases (9 patients) were treated with intravenous immunoglobulin (IVIG) and 80% of patients showed a good prognosis after treatment. 35.61% of the patients fully recovered after discharge,and a 64.29%had long-term residual disability and needed an outpatient rehabilitation. Conclusion: GBS is the main cause of acute paralysis.It‘s diagnosis and management can be complicated.In fact he treatment of GBS requires a multidisciplinary approach References [1] Guillain-Barré syndrome: a retrospective, hospital-based study, Zhonghua Yi Xue Za Zhi (Taipei) . 2002 Nov;65(11):540-7. [2] GBS and COVID-19: Untangling the Knots ,Can J Neurol Sci . 2022 Jan;49(1):1-2. doi: 10.1017/cjn.2021.128. Epub 2021 J
301
The management of myofascial pain syndrome associated with chronic neck pain using myofascial release techniques
The management of myofascial pain syndrome associated with chronic neck pain using myofascial release techniques Sghir M.¹, Hadj Salah A.¹, Belghith S.¹, Krifa B.¹, Mhenni W.², Mahjoub S.², Kessomtini W.¹ • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital of Mahdia, Tunisia • School of Physiotherapy, Physiotherapist, Monastir, Tunisia Background and aims Myofascial pain syndrome (MFPS) is defined as the sensory, motor, and autonomic symptoms caused by trigger points, which typically develop after muscle overuse. It is common in patients presenting chronic neck pain. However standard rehabilitation methods are insufficient. The aim of this study was to evaluate the effectiveness of treatment of myofascial trigger points in chronic neck pain. Methods A randomized controlled study included 20 patients with MFPS associated with chronic neck pain. Patients were divided into 2 equal groups: A and B. The group A benefited from a protocol associating myofascial release techniques to a conventional rehabilitation program. Patients in group B benefited from a conventional rehabilitation program alone. Evaluation parameters were noted at baseline and after 3 months of the rehabilitation protocol. Pain was assessed using the Visual Analog Scale (VAS), cervical mobility and muscle tension using the Nilsson scale and the functional impact using the Neck Disability Index (NDI). Results Twenty patients with a mean age of 40.67 ± 5.26, participated in this study. Mean VAS score was Statistically significant change was present for pain, cervical mobility with P < 0.05 for both groups. A greater decrease in muscle tension and functional abilities were noted in group A. Discussion The term myofascial pain, denoting pain coming from myofascial (muscle) TrPs, was popularized by Travell and Simons. They emphasized the concept of pain arising from specific small, hardened, tender regions in muscle identifiable by palpation. They called these hardened and tender spots trigger points. Their revolutionary concept was that pain caused by TrPs could be manifest at a distance from the TrP, which is termed referred pain, the principal mechanism by which myofascial TrP pain is manifest clinically. There is still controversy as to the relevance of TrPs. The physiological effect of MFR on the relief of pain intensity in patients may be related to the removal of the obstruction of deep fascia and surrounding muscle fibers. The technique has potential benefits in promoting fluid circulation in and around tissues, strengthening the venous and lymphatic systems, and clearing areas of fluid deposition. The MFR can be applied in various forms. It can be conducted either by therapists or by patients. Moreover, it is most effective using the hands or with a foam roller and roller massager, which can both promote the extension of soft tissues and restore the muscle function, thereby reducing pain. In recent years, the number of studies on MFR have increased, and is only used in the treatment of chronic neck pain, but also in the rehabilitation of shoulder, knee and ankle joint injuries. At present, there are few reviews summarizing the effect of MFR on the treatment of neck pain, and meta-analysis on MFR for neck pain has not yet been searched. Therefore, it is necessary to conduct a meta-analysis on the effect of MFR on patients with chronic neck pain and summarize the therapeutic effect. Conclusions Myofascial release techniques are effective in the management of MFPS. They may decrease pain and improve function. References: [1] Gerwin RD. Myofascial Trigger Point Pain Syndromes. Semin Neurol. 2016 Oct;36(5):469-473. doi: 10.1055/s-0036-1586262. Epub 2016 Sep 23. PMID: 27704503. [2] Chen Z, Wu J, Wang X, Wu J, Ren Z. The effects of myofascial release technique for patients with low back pain: A systematic review and meta-analysis. Complement Ther Med. 2021 Jun;59:102737. doi: 10.1016/j.ctim.2021.102737. Epub 2021 May 10. PMID: 33984499. [3] C.J. Manheim The myofascial release manual Slack Incorporated (2001)
302
Sever’s disease in rehabilitation department: epidemiological and clinical study
Sever’s disease in rehabilitation department: epidemiological and clinical study Hadj Salah A.¹, Belghith S.¹, Krifa B.¹, Chebbi R.², Sghir M.¹, Kessomtini W.¹ • Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital • Department of Family Medicine, University of Monastir Background and aims Sever’s disease (SD) is the most common cause of heel pain in children. The risk factors are varied. The treatment is symptomatic, but it must be above all preventive. The aim of our study was to describe the epidemiological and clinical characteristics and to determine the therapeutic modalities of (SD) in rehabilitation department. Methods It is a descriptive cross-sectional study including children examined for heel pain related to SD from 2014 to 2022. We determined the epidemiological and clinical characteristics, and therapeutic modalities. Results The study included 9 patients with a mean age of 10 years and a sex ratio of 3.5. Overweight and morpho-static foot disorders were the two main risk factors noted. Heel pain was often bilateral and asymmetric. X-rays revealed nonspecific signs of hyper-condensation and/or fissuring in 7 children. Management consisted essentially in stopping sports activities, prescription of analgesics and/or NSAIDs, and rehabilitation with the use of foot orthoses. The evolution was favorable with resumption of sports activity after a median of 12 months in 2 patients. One boy developed Achilles tendonitis 1 year after the onset of symptoms. Discussion: The main theory reported in the literature concerning the pathophysiology of SD suggests a syndrome of hyper-solicitation in the form of repetitive microtrauma by high shear stresses, which causes small-scale avulsion micro-fractures at the level of the immature ossification center. In addition, during the period of rapid pubertal growth, there is a difference in growth between the bone and the myotendinous system, which favors excessive traction. Concerning risk factors, the authors described various intrinsic and extrinsic factors such as overweight, which is consistent with our results where 44.4% of our patients were found to be overweight. The short Achilles tendon, also described as an associated risk factor, was found in 2 of our patients. In our study, all the children had a pathological podoscopic examination. Indeed, biomechanical misalignment has been described as a risk factor. Children with flat or hollow feet have a greater impact on their heels. In the same category, an over-pronated foot with hindfoot valgus may favor the onset of SD. This type of foot leads to reduced shock absorption by the heel, which increases the micro-trauma exerted on it, resulting in instability of the talocrural joint or eversion of the calcaneus. To restore balance during physical activity, the sural triceps muscles must generate greater force on the calcaneal apophysis. Also, the inequality of two lower limbs has been incriminated by its excessive stress on the Achilles tendon. Extrinsic risk factors, such as wearing footwear unsuited to the type of sporting activity, can increase the risk of developing SD. Although hyperdensity or fragmentation of the calcaneal apophysis cannot be used as positive signs of SD as they are also present in asymptomatic youngsters, Volpon and de Carvalho Filho in 2002 found a higher frequency of these signs in children with SD. Similarly, after treatment for SD, Hoşgören and colleagues noted the disappearance of areas of hyperdensity on ultrasound examination. Conclusions Although preventive treatment is the most important component in the management of SD, there is no denying in the effectiveness of rehabilitation. References: [1] Döderlein L, Dussa C. Physiological and Pathological Development of calcaneal apophysis in Children. Orthopade 2016;45:233-41. [2] Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res 2018;13:309. [3] Smith JM, Varacallo M. Sever disease. Treasure Island (FL): StatPearls Publishing; 2021. [4] Volpon JB, de Carvalho Filho G. Calcaneal apophysitis: a quantitative radiographic evaluation of the secondary ossification center. Arch Orthop Trauma Surg 2002;122:338-41.
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Influence of bracing on quality of life of children with idiopathic scoliosis
Influence of bracing on quality of life of children with idiopathic scoliosis  Hadj Salah A, Belghith S, El Arem S, Krifa B, Sghir M, Kessomtini W. Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital, Mahdia, Tunisia Background and aims Bracing treatment of idiopathic scoliosis (IS) can have a negative physical and psychological effect, especially in adolescents. The aim of our study was to determine the impact of Chêneau brace treatment on the quality of life (QOL) of adolescents with IS. Methods This cross-sectional study conducted over a period of six months (September 2021-February 2022) included adolescents with IS divided into two groups: (G1) included patients treated by brace and rehabilitation, and (G2) by rehabilitation only. We assessed their QOL by the QLPSD, the SRS-22 and the VAS QL and studied the correlation between the QOL and the correction’s angle, the treatment’s duration, the age, and the Risser index. Results Twenty-seven girls (56%) and 21 boys (44%) participated with a mean age of 14 ± 2 years. The QLPSD was better for G2 according to the three scales with a significant difference. According to VAS QL, we observed a correlation between QOL and correction angle in corset wearers. As for the QLPSD, we found significant associations between brace wearers’ psychosocial status and age, correction angle, and length of treatment. The SRS-22 showed that satisfaction was correlated with brace correction and treatment duration. Discussion: Based on our findings, it appears that the quality of life of adolescents with idiopathic scoliosis who were treated with a brace was significantly decreased compared to those who only underwent rehabilitation. These findings indicate that even though wearing a brace for idiopathic scoliosis treatment has benefits such as being lightweight, discreet under clothing, causing minimal discomfort during daily activities, and can be manufactured on an outpatient basis, it still results in a significant alteration of the patient’s quality of life. Some papers including a meta-analysis have reported no decrease in QOL in patients with AIS who received brace treatment. For instance, Olafsson found that bracing did not have a negative impact on the self-image of adolescent patients. While it was noted that bracing may reduce self-esteem at the beginning of treatment, there were no significant differences in the rate of psychopathologies between brace-treated patients and healthy individuals of the same age. Furthermore, Noonan and colleagues found slight differences in the psychological well-being of scoliotic adolescents who received bracing compared to healthy controls. These differences tended to disappear in adulthood. Conclusions Although bracing treatment can alter the quality of life in adolescents with IS, it remains a preponderant therapeutic tool in IS. References : [1] Meng Z-D, Li T-P, Xie X-H, Luo C, Lian X-Y, Wang Z-Y. Quality of life in adolescent patients with idiopathic scoliosis after brace treatment : a meta-analysis. Medicine (Baltimore). 2017;96(19): e6828. [2] Olafsson Y, Saraste H, Ahlgren RM. Does bracing affect self-image? a prospective study on 54 patients with adolescent idiopathic scoliosis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 1999;8(5):402-5. [3] Schwieger T, Campo S, Weinstein SL, Dolan LA, Ashida S, Steuber KR. Body image and quality-of-life in untreated versus brace-treated females with adolescent idiopathic scoliosis. Spine. 2016;41(4):311-9.
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Clinical case of quadriceps femoral muscle plastic in patients with post-traumatic knee extension stiffness (PECK)
CLINICAL CASE ON QUADRICEPS FEMORIS MUSCLE PLASTICITY IN A PATIENT WITH POST-TRAUMATIC STIFFNESS IN KNEE EXTENSION (PECK) Camilla Paniccia, Claudia Vellucci, Alessandro Laurini, Valentina Truglio, Maria Chiara Viselli, Arturo Tallarico INTRODUCTION Traumatic fractures of the distal femur could often be complicated by severe stiffness in knee extension (PECK), this type of damage can cause many difficulties in performing activities of daily living (ADL). Very often, only rehabilitation treatment may not be resolving, and in some cases is required a more invasive surgical procedure, as arthromyolysis of the quadriceps femoris muscle according to Judet’s technique. This operation is markedly demolitive, but, at the same time, it allows to control the bending range after each stage of dissection, thus offering the opportunity to stop the procedure as soon as it is achieved an adequate functional flexion. GOAL The purpose of this study was to evaluate the effectiveness of immediate and costant post-operative rehabilitation treatment for the first few months after surgery in patients undergoing quadriceps femoris muscle arthromiolysis according to Judet. Several considerations were made by assessing the increase in joint range, improvement in gait pattern, the ability to perform stairs and complete recovery in simple ADL. MATERIALS AND METHODS This article documents the clinical case of a 41-year-old patient, suffering from post-traumatic complete knee stiffness in extension, in Orthopaedic Trauma Centre (CTO) in Rome, where the patient has undergone both surgery and rehabilitation treatment. The patient had road a injury during a bicycle ride, with an exposed supra-intercondylar fragmentary fracture of the right distal femur also affecting the knee joint. This fracture was previously treated by osteosynthesis surgery with Hoffman 2 external bridge fixator. This treatment had caused him severe right lower limb stiffness in extension. Subsequently, he was operated for plastic surgery of the quadriceps femoris muscle according to Judet’s technique and during this procedure he achived a knee joint flexion obtained was 130°. The second post- operative day, in the General Orthopaedic Department of the CTO, the patient started the rehabilitation treatment on the right knee with Continuous Passive Motion (CPM) cycles using Kinetec (setted to 80° in flexion – 0° in extension). On the 9th post-operative day, he was transferred to the CTO’s Rehabilitation Department , where he stayed for twenty days. He underwent physiotherapy sessions, twice a day, for 90 minutes per session. The rehabilitation treatment was based on passive, active and active-assisted mobilisation of the right lower limb. These exercises could to implement the flexion and the extension of the right knee joint, to improve proprioception and stabilisation exercises of the trunk, to walk alternating gait school with two Canadian canes and after with one. In addition, during this period, the patient has suffered pain on the right patellar tendon level in the anterior knee area. For this reason, he has been subtended for five consecutive days to daily laser therapy sessions. RESULTS The results obtained with the rehabilitation treatment at discharge were estimated through a deep physiatric evaluation and the help of the Barthel index to measure the patient’s ADL. The active right knee ROM at discharge from Rehabilitation department was 80° in flexion and -5° in extension, against 30° in flexion to the previous admission. The patient has managed to keep autonomously a good control of the trunk and the pelvis in the various postural transitions and transfers. The patient has carried out a good deambulation with the aid of two Canadian canes and after one, instead ascent and descent of stairs training with both. Before the surgical and rehabilitation treatment, the patient had a great difficulty to sit correctly and he presented a walking gait with an escape lameness on the right side. Thanks to rehabilitation treatment, the patient presented a consistent increase consistently his ability to move in the space. In addition, the Barthel index calculated at discharge of RD increased from 44/100 at the admission to 70/100 at discharge. These results support the importance of good rehabilitation treatment to improve the standard of living in the patients exposed to this type of surgery. CONCLUSION The results collected during the rehabilitation treatment revealed some of the desired functional targets. Conservative treatment allowed the patient to get back the daily living activities as before the injury. In addition, it is important to note that the rehabilitation course in this type of patient should be continued and carried out consistently for at least 6 months after surgery, because the risk of PECK’s relapse during this period is higher. For this reason, after discharge from the RD, the patient continued the exercise in Day Hospital Rehabilitation setting and he is still followed by orthopaedics and physiatrics in CTO hospital. REFERENCES Ali F, Saleh M: Treatment of isolated complex distal femoral fractures by external fixation. Injury 31: 139–146, 2000. The judet quadricepsplasty for elderly traumatic knee extension contracture: a case report and review of the literature. September 2019; DOI: 10.1051/bmdcn/2019090321 Merchan EC, Myong C: Quadricepsplasty: The Judet technique and results of 21 postraumatic cases. Orthopedics 15:1081–1085, 1992. Bari MM SI, Shetu NH, Wahidur Rahman, Mahfuzer Rahman, Mashiur H Munshi, Golam Mostofa. Judet’s Quadricepsplasty for Extension Contracture of the Knee (Stiff Knee), 2015 Daoud H, O’Farrell T, Cruess RL: Quadricepsplasty: The Judet technique and results of six cases. J Bone Joint Surg 64B:194–197, 1982.
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Injuries and athlopathies among Basketball Athletes: A Questionnaire Survey
Injuries and athlopathies among Basketball Athletes: A Questionnaire Survey Santoro A.1; Zuncheddu R.1; Soffietti M.2; Giordani L.1; Foti C.1 1School of Specialization in Physical and Rehabilitation Medicine, Clinical science and translational medicine department, University of Tor Vergata, Rome, Italy 2Department of motor science, University of Tor Vergata, Rome, Italy Background Basketball is an alternating aerobic-anaerobic activity, a limited contact sport, and it is the very nature of physical contact that in most cases determines the injury. An injury is defined as any event that causes a damage of a given severity on a physical level such that it may require removal from sport or not. When we talk about sports injuries, we refer to injuries of a traumatic, accidental nature, but also caused by mechanisms common to all motor activities and wear and tear injuries that in medicine are defined as athlopathies1. The main injuries that occur in basketball are ankle and knee sprain with possible rupture of the anterior cruciate ligament (ACL), jumper’s knee syndrome, injuries to the lumbar spine, scapular dyskinesia, trauma to the fingers and hands and finally, more rarely, trauma to the eyes and teeth2. The factors that predispose the athlete to the possibility of a damaging event can be divided into intrinsic (age, postural problems, sex, nutrition) and extrinsic factors (set of variables that cannot be controlled in order to prevent the injury such as environmental conditions, footwear, inappropriate coaching) Aims Our study tries to answer two questions: “Can the athlopathies affecting professional basketball players be compared in any way with the injuries suffered by athletes in minor categories?” and “How many athletes injured, after a rehabilitation protocol, turned to a motor science doctor to perform prevention and pre-qualification training, and how important is it to do so?”. Materials and Methods 39 players of various ages were recruited, for a total of 95 injuries. We created a questionnaire made up of 25 questions with the aim of collecting information on four different areas: • Player’s personal data (Name, Surname, Year of birth) • Information related to sport practice (Championship to which the player belongs, role held, weekly training sessions, total training hours and match minutes) • Injury history (Type of trauma and description of it, rest period and aid used like crutches or orthopedic brace) • Rehabilitation and re-athletization (surgery, PRM examination, physiotherapy, reconditioning exercises). Results Questionnaires showed a close relationship between match minutes, weekly training hours and incidence of injuries. The damaging events most affect those athletes who are called upon to make the competitive effort for above-average periods, thus increasing exposure to traumatic events, fatigue and loss of neuromuscular control. Another aspect is that the lack of specific prevention exercises significantly increases the percentage of risk of incurring an injury, or worse still, of having relapses on the same structures involved in previous injuries. We compared our results with those obtained from studies carried out for the NBA3,4 that showed that ankle injury is still the most frequent and that a high number of minutes in a game, with a tight games schedule and reduced rest periods, are the most important factors in athletes’ injuries Conclusions From this study emerges a close relationship between playing time, weekly training hours and the incidence of injuries. The right balance between training hours and minutes played in the game, combined with adequate preventive exercise with the help of a motor science doctor, is a favourable condition for reducing the probability of incurring athlopathy and injury. Bibliography • Pozzi, G. The modern conception of “athlopathy” or “sports technopathy”. (1962) The Journal of sports medicine and physical fitness • Quartey J, Davor SF, Kwakye SK. An injury profile of basketball players in Accra, Ghana. S Afr J Physiother. 2019 • Teramoto M, Cross CL, Cushman DM, Maak TG, Petron DJ, Willick SE. Game injuries in relation to game schedules in the National Basketball Association. J Sci Med Sport. 2017 • Drakos MC, Domb B, Starkey C, Callahan L, Allen AA. Injury in the national basketball association: a 17-year overview. Sports Health. 2010
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Guillain Barre Syndrome: Correlation of the Electrophysiological Study with the Functional Status of the Patients Following Inpatient Rehabilitation
Guillain-Barre Syndrome: Correlation of the Electrophysiological Study with the Functional Status of the Patients Following Inpatient Rehabilitation Gklantzouni A., Mitsostergiou P., Manola M., Tsiamasfirou D., Galata A., Gkroumas N., Petropoulou K. 2nd PRM, National Rehabilitation Center, Athens, Greece Βackground and aims: Τhe purpose of the study is to compare the clinical and functional status of patients with Guillain-Barre Syndrome with the results of the electrophysiological examination after following an extended rehabilitation program. Methods: During 2015-2023 a total of 20 patients with Guillain-Barre Syndrome were hospitalized in the PRM department. Amongst the above, seven patients underwent electrophysiological testing upon admission, and subsequently received repeat testing 2 to 6 months after disease onset. The subset of patients who underwent testing had a range of ages and disease severity scores, with both male and female patients represented. The rehabilitation routine that was followed included physical therapy, occupational therapy, respiratory therapy, speech therapy, pain management and psychological support. Results: After completing a 5 to 6 month inpatient intensive rehabilitation program, patients with Guillain-Barre Syndrome demonstrated significant clinical and functional improvement. They were able to stand upright and walk with partial use of their upper limbs, indicating substantial progress. Electrophysiological testing was conducted 5 to 6 months after the disease onset, revealing common EMG findings as follows:  Reduced Compound Muscle Action Potentials (CMAPs) indicating impaired nerve conduction (66%).  Prolonged Distal Motor Latencies (DMLs) suggesting delayed nerve impulse transmission (66%) .  Presence of fibrillation potentials and positive sharp waves, indicating denervation of muscles (83%).  Absent or decreased sensory responses indicating impaired sensory nerve function (33%). The above electromyographic findings did not correspond to the improved functional status of the patients. Conclusion: Despite variations in electromyographic findings observed 5 to 6 months after diagnosis, patients with Guillain-Barre Syndrome demonstrated significant clinical recovery. Therefore, while monitoring their progress through electrophysiological testing remains important and necessary, the true measure of their recovery lies in their functional and neurological improvement, which can only be evaluated clinically. Jose Berciano, 2019, Very early Guillain-Barré syndrome: A clinical-electrophysiological and ultrasonographic study, Elsevier, Volume 5, 2020, pages 1-9, https://doi.org/10.1016/j.cnp.2019.11.003 Gupta A, Taly AB, Srivastava A, et al., 2012, Rehabilitation in Guillain-Barré syndrome: Analysis of the impact on physical function and factors influencing outcome, Journal of Neurology Sciences, Volume: 315, Issue: 1-2, Pages: 41-47, DOI: 10.1016/j.jns.2011.12.026 The data for this study are from the 2nd PRM Department of the National Rehabilitation Center in Athens during the period 2015-2023.
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Factors predicting of falls after stroke: A preliminary study
Introduction Falls are common after stroke and occur in up to 73% of patients after one year. Moreover, balance disorders in vascular hemiplegia are frequent and can lead to dangerous accidents. The objectives of this study were to evaluate the balance in vascular hemiplegia as well as the predicting factors of falls. Methods This three-month prospective study was performed on patients over the age of 16 who were followed up for vascular hemiplegia at Mahdia Tunisia’s physical medicine and rehabilitation department. An already created form was used to gather the data. Muscle strength was assessed using the MRC and spasticity using the modified Ashworth scale.. Static balance was evaluated by the Tinetti score, as well as by the Timed UP and GO (danger of falling when > to 13.5 sec). Regarding the function, it has been evaluated by the Barthel index. We also evaluated the presence of sensitivity disorders, vesico-sphincter disorders, as well as neuro-orthopedic disorders. Results Forty-one patients were included with an average age of 61.6 years with a sex ratio of 2. The majority had an ischemic stroke (90.2%) and 43.9% were fall victims. Most of the fallers were males 66.6%, left side was concerned in 59.1% of cases and 72.2% were under antihypertensive treatment. The Barthel index average was 79 ± 17.74, indicating moderate dependency. The Timed Up and Go score average was 20.8 sec in our patients. For Tinetti score, the average was 22.58±4.02, indicating a high fall risk. Left hemiplegics were more significantly affected (p=0.035),as well as those with a motor disorder (p<0.001) and those with spasticity (p<0.001). Similarly, falls were more frequent in patients with exteroceptive sensation disordes (p=0.026) and vesico-sphincter disorders (0.01). Patients with a low Barthel index had a higher fall risk (p<0.001). Factors predicting falls found in our study were spasticity (OR 13.88 (95% CI: 1.443-133.718)), vesico-sphincter disorders (OR; 17.318 (95% CI: 1.1- 272.77) ) while a high Tinetti score was found to be a protective factor for falls with an OR of 0.347 (95% CI: 0.176-0.684), p=.002. Discussion In the literature, spasticity has been shown to be a fall predicting factor1, as well as for urinary incontinence2, which is consistent with our study. Also, literature has demonstrated the involvement of sensitivity and balance disorders in the occurrence of falls in vascular hemiplegics1. Conclusion This study identified predictive factors for falls in stroke patients with hemiplegia, which can help develop future prevention strategies for these patients.1 2 Réferences 1-Foucault P, Visentin C, Meklat H, Bergeal E, Benaïm C, Kemoun G, et al. Facteurs prédictifs de la chute chez l’hémiplégique vasculaire en centre de médecine physique. Annales de Réadaptation et de Médecine Physique. déc 2005;48(9):66874. 2-Nyberg L, Gustafson Y. Patients falls in stroke rehabilitation. Stroke1995;26:838–42.
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Osgood-Schlatter Disease – A Case Report
OSGOOD-SCHLATTER DISEASE IN ADOLESCENT ATHLETE: A CASE REPORT BACKGROUND AND AIMS: Osgood-Schlatter disease (OSD) was first documented in the early 1900s and it is a osteochondrosis pathology more prevalent during adolescence. OSD was originally reported to occur more frequently in boys, but with increasing number of female athletes, this disease is now being seen at a similar rate to young males. It is caused by traction of the muscle-tendon unit at tibial tuberosity, which affects teenagers, particularly athletes. The predisposing factors include rapid growth and physical activity. The  possible causes are multiple small avulsion fractures from contractions of the quadriceps muscles at their insertion into the proximal tibial apophysis. The treatment consists of reduced physical activity, analgesia and rehabilitation with educational measures and efforts to minimize pain and inflamation. METHODS: A 12-year-old male athlete with 40Kg of weight (85th percentile) and 165cm of height (>95th percentile) presented to the paediatric consultation with several months of worsening bilateral knee pain that intensifies with physical activity, but with no need of analgesia. The patient played rugby and he denied any recent trauma.  RESULTS: Systemic symptoms, including fever, weight changes and fatigue, were absent. On examination, he had tenderness at the tibial tuberosity, but no overlying effusion, erythema or limited range of motion. Although the diagnosis is based on clinical findings, knees films demonstrated fragmentation of the tibial tuberosity and soft tissue swelling (Figures 1 and 2), confirming the diagnosis of OSD. CONCLUSIONS: In early stages, OSD runs a self-limiting course, and complete recovery is expected with closure of the tibial growth plate. Patients who have history of a rapid spurt of growth and participate in intense sports in their early age present with anterior knee pain during activities. Overall prognosis is usually good, except for some discomfort in kneeling and activity restrictions in a few cases. In this case, although the advanced stage of OSD, the athlete was able to play rugby again due to our measures and advices.
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The efficiency of Motor Imagery and Mirror therapy in the management of lower limb phantom pain
The efficiency of Motor Imagery and Mirror therapy in the management of lower limb phantom pain El Arem S. ¹, Ben Khelifa M. ¹, Haj Salah A.¹, Saidi R.², Chouchène I.², Sghir M.¹, Kessomtini W. ¹ 1 : Physical and Rehabilitation Medicine Department, Taher Sfar Hospital, Mahdia, Tunisia 2 : College of Health Sciences and Technology, Monastir , Tunisia Introduction: The aim of this study was to compare the effectiveness of motor imagery versus mirror therapy in the rehabilitation of phantom limb pain in lower limb amputees. Patients and methods : A Comparative prospective study conducted over a period of 4 months, involving transtibial amputees with algohallucinosis. The patients were divided into 2 groups. Group A benefited from conventional rehabilitation associated with mirror therapy and Group B benefited from conventional rehabilitation associated with motor imagery. The observational period lasted 6 weeks with a rhythm of 3 sessions per week. Pain was assessed by the Visual Analog Scale (VAS), the functional outcome by Barthel index and psychological state with Hospital anxiety and Depression scale (HAD). Patients were assessed at the beginning and at the end of the study. RESULTS: Our study population consisted of thirty patients whose average age was 58.6 years. At the end of the therapeutic protocol, we noted a decrease of pain in both groups. Thus, the average VAS score gain was 3.1 for group A and 2 for group B. Similarly, we noted an improvement in hip and knee mobility in both groups. Functionally, the mean gain of the Barthel score was 10 in group A and 18 in group B. Finally, a psychological improvement was noted in both groups and was greater in group B. CONCLUSIONS: Motor imagery seems more effective than mirror therapy in the management of phantom pain in lower limb amputees.
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Pain in diabetic patients with lower limb amputation
Pain in diabetic patients with lower limb amputation El Arem S. ¹, Belghith S.¹, Haj Salah A.¹, Krifa B. ¹ Sghir M.¹, Kessomtini W. ¹ 1.Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital, Tunisia Introduction The aim of our study was to search the aspects of pain in diabetics followed for a lower limb amputation in physical medicine and rehabilitation (PMR) department. Patients and methods A retrospective study carried out on diabetic patients referred to PMR department for lower limb amputation. Results Fifty patients were included in the study. Their mean age was 61.4 ± 15.7 years with a sex ratio of 3.2. Most patients (65%) were type 2 diabetics with a history of 15 years of diabetes, 52.4% were hypertensive and 40% had obliterating arteriopathy of the lower limbs (OALL). Infectious origin (gangrene) was the most common cause of amputation (90.5%), followed by vascular origin (4.4%). The mean delay to PMR consultation after amputation was 7.9 ± 9.5 months. Amputations involved the leg (84.4%), the thigh (13.3%) and the foot in 4.4% of cases. They were unilateral in 73.3% of cases. Re-amputation was necessary in 6 cases. Patients experienced neuropathic pain in 57.6% of cases and a sensation of non-painful phantom limb in 84.4% of cases. Neuromatous pain was noted in 6.7% of cases and overlying joint pain (in the knee or hip) was found in 17.8% of patients. Half of the patients (50.3%) received their prosthesis and 8% of them presented with a painful conflict prosthesis requiring some corrections. Conclusion Pain in amputees can have several aspects to consider and seek by the clinician to ensure adequate management.
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Exercise counteracts the complications of COVID-19
Exercise counteracts the complications of COVID-19 M. C. Parisi1,3, O. Mingrino1,3, B. Pepi2, C. Crescimanno1, D. Di Corrado3, Iraci G4., A. Sberna5, V. C. Francavilla1,3,6 1 Department of Medicine and Surgery, University of Enna “Kore”, 94100 2 Degree in Sports Science 3 Department of Human and Social Sciences, University of Enna “Kore”, 94100 4 U.O.C. Medicine Director, Piazza Armenina, 94015 5 Provincial Delegate CONI of Enna. Dac Master Forensic Chemical and Chemical-Toxicological Analyses, Alma Mater Studiorum, Bologna, 40126 6 International University Gorazde Bosnia, 73000 Background and aims COVID-19 pandemic caused by SARS-cov-2 was a difficult challenge that does not stop with the negativization continues its threat with the “Covid long”. The virus usually invaded and infected the lung and respiratory tissue and subsequently created dysfunctions in other organs. We hypothesized that exercise, which involves the whole body and breathing, could improve the health of people who have contracted the virus, so the goal of the study was to assess the effectiveness of exercise and its therapeutic capabilities in these people. Methods 25 people were recruited for the study. Their age ranged from 19 years to 74 years. Everyone followed an adapted motor protocol, with breathing exercises and active mobilization. The motor protocol adapted was proposed twice a week from January 2022 to February 2023. The investigative method was used, with pulmonary function tests. Spirometry, oxygen saturation both before and after exercises, blood gas analysis and chest circumferences were performed. Results: The results obtained could demonstrate the effectiveness of physical exile in subjects who had contracted Covid. From the results one could say that the FEV1 had an increase of 13.56%, the FVC value of 7.11% and finally the PEF value of 45%. Saturation from a T0 value of 90% increased to T3 by 98/99%. Chest circumferences could also be confirmed to be improving. The same have been gradually and progressively increased; albeit to a lesser extent than the other parameters analyzed. It has been noted that the progression is inversely proportional to the age and therefore, the older subjects have obtained less benefits than the younger ones, while following the same protocol. Conclusion: Increased breathing capacity can benefit the activity of daily life, providing a basis for a better quality of life. The current study has shown that the method used, together with physical exercise, leads to a significant improvement in breathing and endurance. Our findings suggested that a motor plan adapted to post Covid 19 patients could be a promising option to ensure health and well-being and to limit the specific symptoms of “Long Covid”. Ultimately, exercise can be a therapeutic tool, if properly planned and adapted to the characteristics and needs of patients.
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Physical exercise in diabetes: pathophysiology and therapeutic effects
Physical exercise in diabetes: pathophysiology and therapeutic effects M.C. Parisi 1,2, O. Mingrino1, D. Di Corrado2, G. Messina3, C. Crescimanno1, V. C. Francavilla 1,4 1 Department of Medicine and Surgery, University of Enna “Kore”,94100 2 Department of Human and Social Sciences, University of Enna “Kore”, 94100 3 Department of Psychology, Educational Science and Human Movement, University of Palermo, 90100 4 International University Gorazde Bosnia Background and aims: Diabetes is a chronic disease of different etiology, which subjects’ patients to different comorbidities. Some complications can be prevented or their effects can be slowed down. Sedentary lifestyle increases the risk of obesity and consequently the predisposition to diabetes II. The article aimed to demonstrate the positive and negative effects of exercise on active and sedentary diabetics and on pathophysiology, evaluating the effects after 3 and 6 months. Methods: The study recruited 90 patients, 35 females and 55 males aged 45 years. We have been recruiting diabetic patients for at least five years, excluding those who have serious complications from diabetes. The randomized patients were divided into two groups. Group A (sedentary): 50 patients, including 20 females and 30 males sedentary, in conventional therapeutic and dietary treatment; Group B (active): 40 patients, 15 females and 25 males, active (EXE) who were given moderate exercise to be performed daily. The parametriclinics and biochemists examined were: Body Weight, Body Mass Index or Body Mass Index, Systolic and Diastolic blood pressure, glycaemia, glycosylated hemoglobin, cholesterol. All dosages were made with the Clinical Chemestry System ilab 300 Plus- Instrumentation Laboratory. The hba1c was measured with a high-performance liquid chromatography system using the Hi-AUTO A1C, TM HA 8121 system (DI, Daiichi, Kogaku, Japan). The glycaemia was dosed using the enzymatic method IL Test, GLUC (Glucose Oxidase). The cholesterol was measured using the enzymatic method IL Test ³ CHOL – 00 18480200. The BMI was calculated according to the known formula: Weight (Kg) / height² (mt). The Method was quantitative, statistical and scientific. Results: in group A improvements were less noticeable than group B. The most improved parameter was blood sugar, Glycemic values increased from 160/150 to 130 in group A, while in group B from 140 to 120/110; followed by BMI, which has decreased by 45%. Cholesterol and Hb1Ac decreased but more slowly than previous parameters. Conclusion: From the results obtained, we assume that the physical exercise adapted to touch has therapeutic power on diabetics, both sedentary and active. Teamwork between trainer, diabetologist and sports doctor was also necessary. We could argue that physical activity is an adjunct to insulin therapy. Diet, insulin therapy and exercise should also be given to people suffering from juvenile diabetes, presenting no side effects.
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Psychological Distress in Amputees with Phantom Limb Pain
Psychological Distress in Amputees with Phantom Limb Pain Haddada I1, Belghith S1, Hadj Salah A1, Dorgham I1, Sghir M1, Kessomtini W1. Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital of Mahdia, Tunisia Background and aims Phantom limb pain (PLP) is a neuropathic pain affecting the territory of an amputated limb. It can be source of chronic suffering if not treated. The aim of this study was to evaluate the psychological impact of phantom limb pain in individuals with lower-limb loss (LLL). Methods this is a cross-sectional study, conducted in physical medicine and functional rehabilitation department at CHU Taher Sfar Mahdia during a period of 4 months (June – September 2022) including subjects with an amputation of one or two lower limbs for more than a year. The Arabic version of PHQ9 score was used to evaluate depression. Results Thirty patients were included with a significantly male predominance (sex ratio M/F = 5). The mean age was 68.5 ± 5.04 years. The majority of lower-limb amputations was below the knee (83,6%). Time since amputation ranged from 2 to 6 years. Twenty-five patients (83,6%) had a unilateral lower-limb amputation, whereas the other patients had a bilateral one. Phantom limb sensation was observed in 76,6% of cases with a mean intensity of 5.2 ± 2.1 out of 10. The mean PHQ-9 score was 17.83 ± 6.68 with extremes ranging from 3 to 27. Depressive symptoms (PHQ-9 >5) were noted in 93.3% of cases. Major depressive disorder (PHQ-9 >20) was present in 53.5% of cases. Univariate analysis revealed a significant association between Psychological Distress (PHQ-9) and PLP intensity (p<0,05). Discussion: The aim of the study was to examine the impact of psychological distress in phantom limb pain. The literature on this topic is extremely limited. Furthermore, the studies conducted are often poorly designed. Implicit in the design and conduct of earlier studies was the assumption that psychological factors play a causal role in phantom pain. Later studies focused more explicitly on the relationship between psychological distress and adjustment, but only in the early period after amputation. Thus, given the focus of this study, little is known about the role of psychological distress in chronic phantom pain. Several studies have noted that measures of depression in chronic pain patients may be inappropriate because they contain specific health-related items. However, more recent research has shown that despite this overlap, the measure may be useful in pain settings, where account is taken of pain-related items. Pre-existing personality has also been identified as an important feature in the development of phantom limb pain. For example, a Parkes study found that those with persistent phantom limb pain scored high on personality measures such as "obsessive-compulsive independence" and "rigidity." Parks hypothesizes that people with "fixed" personalities dislike and resist change and therefore experience persistent phantom pain as they struggle to cope with the inevitable changes that come with amputation. Additionally, Parks noted, those with "compulsive self-reliance" may also experience ongoing pain due to the helplessness that often accompanies amputation. When these people have to depend on others to do things they used to do on their own, they feel distressed, which leads to distress. Conclusions Our study showed that the prevalence of PLP was high and the majority of our amputees patients suffered from mood disorders; 93.3% had signs of depression. Targeted interventions may be needed to ameliorate both mental health and pain to ameliorate their quality of life. References: [1] Whyte AS, Niven CA. Psychological distress in amputees with phantom limb pain. J Pain Symptom Manage. 2001 Nov;22(5):938-46. doi: 10.1016/s0885-3924(01)00352-9. PMID: 11728797. [2] Hill A. Phantom limb pain: a review of the literature on attributes and potential mechanisms. J Pain Symptom Manage. 1999 Feb;17(2):125-42. doi: 10.1016/s0885-3924(98)00136-5. PMID: 10069153. [3] Parkes CM. Factors determining the persistence of phantom pain in the amputee. J Psychosom Res. 1973 Mar;17(2):97-108. doi: 10.1016/0022-3999(73)90010-x. PMID: 4741689.
322
Metatarsalgia in rehabilitation department: A DESCRIPTIVE STUDY
Metatarsalgia in rehabilitation department: A DESCRIPTIVE STUDY Hadj Salah A, Ameur.A, Krifa,B, Haddada I, Jemni A, M, Sghir M, Kessomtini W Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital Background: Metatarsalgia is a frequent reason for consultation in podiatric pathology (1,2), with a significant predominance of women (3). This pathology requires a biomechanical and systematic approach to fully understand its cause and presentation in a variety of clinical forms. Aim(s): To describe the epidemiological and clinical characteristics of metatarsalgia and to determine the different modalities of the management in a rehabilitation department Methodology: Descriptive study including a patient with metatarsalgia was carried out in the Physical Medicine and Functional Rehabilitation Department (MPR) of the Tahar Sfar Hospital in Mahdia over a period of 3 months (from April 2022 to June 2022). We identified each patient’s socio-demographic (age, gender, side affected, origin, medical and surgical history, history of metatarsal trauma, physical activity…), clinical, and paraclinical characteristics. Results: Fifty-two patients were collected with an average age of 44.6 years [16 to 79]. On clinical examination, plantar hyperkeratosis was found in 42.3% of patients and plantar callosities in 27% of cases. Toe claw was observed in 16 cases. On podoscope, we found 57.7% of patients with hollow feet and 40.4% with flat feet. The 2nd ray syndrome was found in 17.3% of cases. Standard foot radiographs were performed in only 28.8% of the patients and foot ultrasound was performed in 3 patients among 4 diagnosed with Morton’s neuroma. Static foot disorders were the most frequent etiology in 83% of cases. Morton’s neuroma was observed in 7% of cases, while Freiberg’s disease was found in 4% of patients and fatigue fracture in 6% of patients. Corticosteroid-based infiltrations were performed in 3 cases of inter-metatarsal neuralgia, and custom-made foot orthoses were prescribed in 88.6% of patients. Seven patients had received physical therapy. Conclusion: Metatarsalgia is one of the most common reports in patients with foot problems. There is great variability in possible causative factors, but all of them seem to be related to gait mechanics and foot and ankle deformity. An individualized treatment protocol is required. Bibliography : 1- Goldcher A. Syndrome capitométatarsien; la plus fréquente des métatarsalgie statiques. Médicine Chir Pied. 2004;20(4):93102. 2- Ray A. [Metatarsalgia: diagnosis and treatment]. Rev Med Suisse. 2013;9(411):236670. 3- Bardelli M, Turelli L, Scoccianti G. Definition and classification of metatarsalgia. FootAnkle Surg. 2003;9(2):7985.
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Prevalence and factors associated with chronic low back pain in hospital staff
Prevalence and factors associated with chronic low back pain in hospital staff Hadj Salah A, Ameur.A, Krifa,B, El Arem S, Khnissi M, Sghir M, Kessomtini W Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital Introduction: Chronic low back pain (CLBP) is a public health problem due to its frequency (1) and consequences in the workplace. Hospital staff represents a population at risk due to difficult working conditions (2), with different postures adopted, stretchers, and care activities (3). Objective: To determine the prevalence and factors associated with CLBP in hospital staff. Methods: Cross-sectional study, conducted at the CHU Taher Sfar of Mahdia, on hospital staff from different services among different categories, over a period starting from January to April 2022. These employees have responded to a pre-established questionnaire with 46 items. Results: Our study included 203 staff with a mean age of 35.64 ± 9.39 years [23 to 60]. Overweight was noted in 54.2% of the staff and 16,3% were obese (BMI≥30) [17,30 à 41,02 kg/m2]. The majority of them had sleep disorders (36,5%), psychological disturbances (37,4%), and a history of rheumatic diseases (16,7% of cases). The mean value of professional seniority was 9.41±9.1 years with an average number of working hours of 40.38±10 hours per week [15 à 78]. Lumbar spine movements in tension were noted in 156 (76,84%) personnel, while exposure to trauma or vibration was mentioned in 25.1% of cases. The prevalence of low back pain was 71.4%. The associated factors were a history of rheumatic disease (p=0.007), anxiety (p=0.01), delivery by cesarean section (p=0.003), monotony (p=0.001), and high psychological demands (p=0.027). Sport and sharing of tasks were rather protective factors. Discussion\Conclusion: The prevalence of CLBP among hospital staff is significant. Several factors are associated with this disease that justifies the implementation of a general prevention strategy. Health education on posture and correct lifting techniques can be introduced to reduce the burden of CLBP among these workers. Bibliography: 1-Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. Mars 2020;8(6):299. 2-Yoshimoto T, Oka H, Ishikawa S, Kokaze A, Muranaga S, Matsudaira K. Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey. BMJ Open. sept 2019;9(9):1-7. 3-Bejia I, Younes M, Hadj Belgacem J, Khalfallah T, Ben Salem K, Touzi M, et al. Prévalence et facteurs associés à la lombalgie commune chez le personnel hospitalier. Rev Rhum. mai 2005;72(5):427‐32.
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Legg-Calve-Perthes disease: an epidemiological and clinical study
Legg-Calve-Perthes disease: an epidemiological and clinical study Hadj Salah A, Sfar Z, Ameur.A, El Arem S, Haddada I, M, Sghir M, Kessomtini W Physical Medicine and Rehabilitation Department, Tahar Sfar University Hospital Introduction: Primary hip osteochondritis or Legg-Calve-Perthes disease (LCP) is an idiopathic hip disorder that produces ischemic necrosis of the growing femoral head. Several factors have been incriminated without being able to be proven (1). Our study aims to describe the epidemiological and diagnostic aspects and report the particularities of therapeutic management. Methods: A retrospective study of patients in the physical medicine and orthopedics department at CHU Taher Sfar of Mahdia was affected by PCL over a period of 21 years, from 2001 to 2022. The parameters studied were epidemiological (age, gender..) clinical (medical histories, pain hip, stiffness, inequality of lower limb length..) radiological (standard radiography, ultrasound, MRI), and therapeutic (conservative or surgical therapy). Results: Our series included 24 children with a mean age of 5 years [3 to 15] and a sex ratio of 1.66. The main revealing symptom was painful lameness in 33.3% of cases. The disease was unilateral in 75% of cases. On physical examination, Hip joint mobility was preserved in 7 hips (23.33% of cases), limited in the abduction and internal rotation in 15 hips (50% of cases), and stiff in 8 hips (26.66% of cases). A Derhmann sign was positive in 12.5% of cases. Quadriceps amyotrophy was reported in only one case. Inequality of the lower limbs was noted in 6 children (25% of cases). Radiologically and at the time of diagnosis, 8 hips (26.66%) were at the condensation stage, 13 hips (43.33%) were at the fragmentation stage, 6 hips at the reconstruction stage (20%) and only 3 hips were at the sequellae stage (10%). According to the Herring classification, 10 hips were in stage A. A device associated with Functional rehabilitation was indicated in 16 children. The indication for an abutment operation was in only one case. Conclusion: PCL disease is a rare condition that should be considered in the presence of any painful limp in the child. The prognosis depends essentially on the precocity of the diagnosis. The choice of treatment depends on prognostic factors such as age, the extent of epiphyseal involvement, and the degree of cephalic exenteration. Bibliography: 1- Zamzam M : Maladie de Legg-Calve-Perthes : impact des critères pronostiques sur le plan de prise en charge. J Musculoskelet Surg Res.2021, 5 :1. 10.4103/jmsr.jmsr_141_20.
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Six-month functional prognosis of patients hospitalized in ICU for severe/critical COVID-19
Background and aims The sequelae of COVID-19 infection can lead to disability and impact activities and participation in patients who required intensive care. The purpose of this study was to describe the 6-month follow-up of the functional status of COVID-19 survivors and to analyze which variables predict a limited functional status. Methods Patients hospitalized in ICU for severe/critical COVID-19 were invited to participate in our survey between March and June 2021. We quantified a 6-month functional outcome in COVID-19 survivors using Post-COVID-19 Functional Status Scale (PCFS). We examined the risk factors for the incomplete functional status defined as the loss of at least 1 point on the PCFS scale at a 6-month follow-up after discharge. We performed multivariable analyses to identify factors associated with functional decline. Results Of 57 individuals analyzed, 36 (63.2%) were male with a median age of 57.9 (13.35) years. A total of 84.2% required mechanical ventilation and were hospitalized for more than 15 days. 89.5% continued hospitalization in a rehabilitation center. At 6 months, functional decline occurred in 36 (63.16%) patients, with a median worsening of 3 points. Results of the multiple linear regression indicated that there was a collective significant effect between independent variables, (F(8.298) = 2, p = .001, R2 = .23). The individual predictors were examined further and indicated that baseline PCFS (t = 2.839, p = .006) and days in ICU (t = 2.743, p = .008) were significant predictors in the model. Other variables (age, mechanical ventilation, Charlson Comorbidity Index, and body mass index did not show clinical variables associated with worse functional status at month follow-up after discharge. Conclusions Six months after the disease, the patients presented functional limitations according to the PCFS. Such patients may benefit from follow-up rehabilitation programs.
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Non alcoholic Wernicke’s Encephalopathy: about a tunisian case
Non alcoholic Wernicke’s Encephalopathy: a case report  Auteurs:C.Rahmani,R.Moncer1,A.Arfaoui1,J.Dhoubi1,I.Haddada2,W.Ouanes 1,S.Jemni1 Background Wernicke’s encephalopathy (WE) is an acute neurological condition caused by thiamine deficiency and traditionally associated with alcoholism,but it may occur in response to abdominal diseases and chronic vomiting. Background Wernicke’s encephalopathy (WE) is an acute neurological condition caused by thiamine deficiency and traditionally associated with alcoholism,but it may occur in response to abdominal diseases and chronic vomiting. Observation A17 years old boy,non alcoholic,with glycogen storage disease, was with one-month history of persistent vomiting due to appendicular plastron. He was presented in emergency departement with an episode of generalized tonic clonic seizures and became unconscious.He was admitted in intensive unit care. Mechanical ventilation with full ventilatory support was started. Supportive treatment,including antiepileptics was instaured. Brain MRI showed hyper intensity in frontal ,parietal lobes and thalami. Blood thiamine testing was significantly below the normal limit.He was diagnosed with WE. A parental thiamine treatement was instaured for 3 days . There was a good response to the treatement ,the patient became conscious and started to obey verbal commands.He also responded well to spontaneous breathing trials.As he improved, he started to tolerate enteral feeding through a nasogastric tube.The patient was transfered to rehabilitaion departement after 3 months . During the admission he was presented with a spastic tetraparesis and broca aphasia.The patient presented myoclonic seizures involving the neck and upper arms.EEG was done showing centrotemporal spikes and the patient was put on levetiracetam. The patient had a significant improvement in his symptoms after inpatient rehabilitaion.an important motor recovery was noted. Conclusions:WE is a neurological emergency requiring immediate attention that occurs in both alcoholic and non-alcoholic populations.patients may not present with all the classic features. References: [1] Clinical Characteristics and MR Imaging Features of Nonalcoholic Wernicke Encephalopathy American Journal of Neuroradiology 29(1):164-9
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Correlation of developmental delay degree with somatosensory evoked potentials in children with psychomotor delay
Correlation of developmental delay degree with somatosensory evoked potentials in children with psychomotor delay Zorica Jelic1, Dejan Nikolic2,3, Ivana Petronic2,3 1Institute of Neonatology, Belgrade, Serbia 2Faculty of Medicine, University of Belgrade, Belgrade, Serbia 3Department of Physical Medicine and Rehabilitation, University Children’s Hospital, Belgrade, Serbia Background and aim: Children with psychomotor delay often present with central nervous system pathology. We aimed to analyze correlation of psychomotor development level assessed with Brunet-Lezine scale with results of somatosensory evoked potentials (SEP) in children with developmental delay. Methods: Twenty-five patients were screened by Brunet-Lezine scale. Brunet-Lezine scale results was categorized into seven categories. Additionally, SEP diagnostic was performed in every child from tibial nerve on lower extremities and median nerve on upper extremities. SEP findings were categorized as normal, mild, moderate and severe. Results: According to results categories from Brunet-Lezine scale, there were 2 (8.0%) patients below average, 3 (12.0%) with borderline, 7 (28.0%) with mild, 7 (28%) with moderate, 5 (20.0%) with severe and 1 (4.0%) with profound delay. For SEP on upper extremities there were 9 (36.0%) patients with normal findings, 11 (44.0%) with mild, 2 (8.0%) with moderate and 3 (12.0%) with severe degree of central afferents dysphunction. For SEP on lower extremities there were 1 (4.0%) patient with normal findings, 12 (48.0%) with mild, 9 (36.0%) with moderate and 3 (12.0%) with severe degree of central afferents dysphunction. There is significant correlation between Brunet-Lezine scale results and SEP findings on upper extremities (rho=0.634, p=0,001) as well as with SEP findings on lower extremities (rho=0.522, p=0.007). Conclusion: Our findings demonstrated that degree of developmental delay is in correlation with dysphunction of central afferents in children with psychomotor delay.
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Efficacy of rehabilitative approaches to reduce hemiplegic shoulder pain in stroke survivors: systematic review with meta-analysis
Efficacy of rehabilitative approaches to reduce hemiplegic shoulder pain in stroke survivors: systematic review with meta-analysis Anna Tasselli, Nicola Marotta, Isabella Bartalotta, Maria Sgro, Roberta Zito, Paola Audino, Annunziata Filippo, Roberta Siciliano, Ambrogio Vimercati, Lucrezia Moggio, Alessandro de Sire, Antonio Ammendolia Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy Background Hemiplegic shoulder pain (HSP) is a common complication that could be experienced by stroke survivors. It is characterized by functional impairment of the upper limb, including motor function and dexterity, along with the presence of painful symptoms, resulting in challenges in performing daily activities. The incidence of HSP varies between 30% and 65%, with symptoms typically appearing within 6 months following the stroke event. In this context, the rehabilitation could have a significant impact for stroke survivors. To date, there is a lack in the scientific literature on the role of conservative approaches for these patients. Therefore, aim of this systematic review and metanalysis was to define the effects of rehabilitative techniques in reducing HSP in stroke survivors. Methods PubMed, Scopus, and Web of Science were searched to identify RCTs involving stroke survivors with HSP who underwent rehabilitative techniques to decrease pain intensity. Moreover, we conducted a network meta-analysis and a risk of bias evaluation using the Cochrane Risk of Bias tool for randomized trials version 2. Results Out of the 1139 articles identified, only 12 were included (Fig.1). Due to the heterogeneity of interventions performed in the included studies, a network meta-analysis was conducted to indirectly compare the various rehabilitative techniques (Fig.2). All the studies included in the systematic review showed improvement after specific rehabilitative treatment. The network meta-analysis, using random-effects Bayesian analysis, demonstrated a significant reduction in pain intensity overall, with an effect size of 2.78 (Fig.3). In particular, significant reductions in HSP were observed after botulinum toxin type A injection (BoNT-A), pulsed radiofrequency of the suprascapular nerve (PRF), suprascapular nerve block (SSNB), and dry needling (TrP-DN). The risk of bias analysis conducted using the ROB 2 tool revealed that 5 out of 12 studies (41.6%) exhibited a low risk of bias (Fig. 4). Conclusions In conclusion, the results obtained from this systematic review and meta-analysis strongly support the integration of more effective rehabilitative techniques alongside conventional rehabilitation in the management of HSP in stroke survivors. Specifically, interventions like BoNT-A, PRF, SSNB, and TrP-DN show significant efficacy in reducing short-term pain. However, further RCTs are needed to address potential bias risks associated with heterogeneous HSP treatments, emphasizing the importance of ongoing scientific investigation and evidence-based practice to enhance therapeutic approaches for HSP. References Marotta N, Demeco A, Moggio L, Ammendolia A. The adjunct of transcranial direct current stimulation to Robot-assisted therapy in upper limb post-stroke treatment. J Med Eng Technol. 2021 Aug;45(6):494-501. Vasudevan JM, Browne BJ. Hemiplegic shoulder pain: an approach to diagnosis and management. Phys Med Rehabil Clin N Am. 2014 May;25(2):411-37. Kumar P. Hemiplegic shoulder pain in people with stroke: present and the future. Pain Manag. 2019 Mar 1;9(2):107-110
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Functional proprioceptive stimulation in intensive care patients with local vibratory device (Vibramoov®)
FUNCTIONAL PROPRIOCEPTIVE STIMULATION IN INTENSIVE CARE PATIENTS WITH LOCAL VIBRATORY DEVICE (VIBRAMOOV®) Burnham PM1, Urbez Mir MR2, Alexandres Ríos de los Ríos D2, Gómez Hijosa V1, Pellico Nebreda A1 1 Physiotherapist, 2 Physical Medicine and Rehabilitation Physician Physical Medicine and Rehabilitation Department Hospital Universitario La Paz, Madrid. SPAIN Background and aims Critical illness myopathy affects one in three ICU patients. We assessed changes in muscle mass of ICU patients receiving treatment with local vibratory device (Vibramoov®), evaluating its safety and feasability in the ICU environment. Design: ICU patients. Prospective study, 15 days duration. Methods Two stable ICU patients with critical illness myopathy and an overall MRC score of 2 or under. Local vibratory treament at the ankle and knee joints with the Vibramoov® device was applied daily for 15 minutes over 15 days. The functional proprioceptive stimulation (FPS) generated at the myotendinous junction specifically targets the muscle spindle, projecting a stimulus to the brain that is similar to that projected during real movement. In our patients we sought to project a walking pattern. No additional physiotherapy treatments were carried out. To quantify changes in muscle mass, rectus femoris thickness and area were measured via ultrasound at the midpoint between the anterior superior ileac spine and the superior patellar margin. Measurements were taken prior to starting treatment and at 7 and 15 days following implementation of FPS. Results There was a quantifiable improvement in rectus femoris (RF) muscle thickness and cross-sectional area (CSA) in both patients receiving treatment with Vibramoov®, based on ultrasound measurements. Conclusions Muscle mass improved for both patients receiving treatment with the Vibramoov® device. Treatments were deemed to safe and feasable in the ICU environment. Active patient participation was not a prerequisite. Further studies with larger patient samples, assessment of multiple muscle groups and with longer treatment periods are required. These may yield statistically significant results. Bibliography: • Roll, R; Kavounoudias, A; Albert, F; Legré, R; Gay, A; et al. Illusory movements prevent cortical disruption caused by immobilization  NeuroImage, 2012 Aug 1;62(1) 510-519. DOI:10.1016/j.neuroimage.2012.05.016 • Avvantaggiato C, Casale R, Cinone N, Facciorusso S, Turitto A, Stuppiello L, Picelli A, Ranieri M, Intiso D, Fiore P, Ciritella C, Santamato A. Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review. Eur J Phys Rehabil Med. 2021 Feb;57(1):44-60. doi: 10.23736/S1973-9087.20.06390-X. Epub 2020 Oct 28. PMID: 33111513. • Costantino C, Galuppo L, Romiti D. Short-term effect of local muscle vibration treatment versus sham therapy on upper limb in chronic post-stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2017 Feb;53(1):32-40. doi: 10.23736/S1973-9087.16.04211-8. Epub 2016 Sep 6. PMID: 27598342.
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Pulmonary rehabilitation reduces supragastric belching: a case report
REHABILITATION REDUCES SUPRAGASTRIC BELCHING: A CASE REPORT Burnham PM1, Urbez Mir MR2 1 Physiotherapist, 2 Physical Medicine and Rehabilitation Physician Physical Medicine and Rehabilitation Department Hospital Universitario La Paz, Madrid. SPAIN Background and aims Belching is defined as an audible escape of air from the oesophagus or the stomach into the pharynx. It becomes pathological if it is excessive and becomes bothersome. According to Rome IV diagnostic criteria, a belching disorder exists when when one experiences bothersome belching (severe enough to impact on usual activities) more than 3 days a week. Oesophageal impedance can differentiate between gastric and supragastric belching.  Supragastric belching (SGB) might be reduced with diaphragmatic breathing exercises. We present a case where pulmonary rehabilitation was effective in reducing SGB. Methods A 26-year-old male with a diagnosis of SGB had an incompetent cardias and belching refractory to several medications, alongside a productive cough. He did not have any gastro-oesophageal reflux disease. On assessment we found an abnormal maximal inspiratory pressure (MIP) of 60cm/H2O (47% predicted). His completed Nijmegen questionnaire score of 23/64 was indicative of dysfunctional breathing. He received treatment with respiratory physiotherapy, focusing on diaphragmatic breathing exercises and inspiratory muscle training (IMT). His home exercise plan included two 15-minute sessions using the Phillips Respironics IMT device, with resistance set to 30cm/H2O (50% of his MIP). Two to three forceful breaths with the IMT were followed by 3-4 normal breaths and he repeated this for 15 minutes, twice daily. After a 1-month program he expressed a greater than 50% reduction in belching symptoms as measured by VAS and improved quality of life (QoL) scores. Nijmegen scores also improved. Results The patient received five outpatient physiotherapy sessions in order to work on improving his diaphragmatic breathing and to ensure correct use of his IMT. He continued with his home exercise plan for a month. After this period, the belching VAS score decreased from 9 to 3, Nijmegen scores improved (from 23/64 to 9/64) and his MIP rose to 120 cm/H2O (94% predicted). Conclusions We found a standardized protocol for diaphragmatic breathing exercises and respiratory rehabilitation program using an IMT device to reduce belching and increase QoL in patients with refractory supragastric belching. Bibliography • van Dixhoorn J, Folgering H. The Nijmegen Questionnaire and dysfunctional breathing. ERJ Open Res. 2015 May 15;1(1):00001-2015. doi: 10.1183/23120541.00001-2015. PMID: 27730128; PMCID: PMC5005127. • Souza, Miguel & Lima, Maria & Martins, Giovanni & Nobre, Rivianny & Souza, Marcellus & Oliveira, Ricardo & Santos, Armenio. (2013). Inspiratory muscle training improves antireflux barrier in GERD patients. American journal of physiology. Gastrointestinal and liver physiology. 305. 10.1152/ajpgi.00054.2013. • Popa SL, Surdea-Blaga T, David L, Stanculete MF, Picos A, Dumitrascu DL, Chiarioni G, Ismaiel A, Dumitrascu DI. Supragastric belching: Pathogenesis, diagnostic issues and treatment. Saudi J Gastroenterol. 2022 May-Jun;28(3):168-174. doi: 10.4103/sjg.sjg_405_21. PMID: 35562166; PMCID: PMC9212115.
338
Pulmonary rehabilitation in critical care. Intrapulmonary percussive ventilation: two successful case reports
PULMONARY REHABILITATION IN CRITICAL CARE. INTRAPULMONARY PERCUSSIVE VENTILATION: TWO SUCCESSFUL CASE REPORTS Authors: Urbez-Mir M.R1., Burnham P.M2., Alexandres-Rios de los Rios D1 1 Physical Medicine and Rehabilitation Physician, 2Physiotherpeut Pulmonary Rehabilitation. Physical Medicine and Rehabilitation Department. Hospital Universitario La Paz. Madrid. Spain Background and aims Intrapulmonary percussive ventilation (IPV) is used in various clinical settings to promote secretion clearance, treat atelectasis and improve gas exchange. Few studies report on the use of IPV in critical care, with little data available. We present two case reports of ICU patients for whom IPV was key to the resolving their critical care situation. Methods Case 1. 51 year-old male with acute myeloid leukaemia, having received allogeneic hematopoietic stem cell transplantation in December 2021. In December 2022 he was admitted to ICU with respiratory failure. The patient was clinically deteriorating due to a viral pneumonia with bacterial superinfection and copious secretions. He did not respond to usual treatment measures so we decided to implement IPV. After 7 treatment sessions the patient improved sufficiently to be discharged from ICU. Case 2. 72 year-old male in ICU following cardio-thoracic surgery. He had a dysfunctional and ineffective cough from a previous stroke. After extubation from mechanical ventilation he had several complete left lung atelectasis due to mucous plugging, requiring repeated fibrobronchoscopies. We decided to adapt IVP and 6 days later he was discharged from ICU. Results A total of 20 treatment sessions were delivered between the two subjects. No major adverse events were reported with IPV. Our experience indicates that IPV can be a key treatment modality within a respiratory rehabilitation plan in the ICU setting in cases where the usual treatment options are ineffective. Conclusions Application of IPV was feasible and safe in non-ventilated adult patients in ICU. BIBLIOGRAPHY • Gutmark E, Anand V, Wheeler A, Zahn A, Cavari Y, Eluk T, Hay M, Katoshevski D, Gutmark-Little I. Demonstration of mucus simulant clearance in a Bench-Model using acoustic Field-Integrated Intrapulmonary Percussive ventilation. J Biomech. 2022 Nov;144:111305. • Hassan A, Milross M, Lai W, Shetty D, Alison J, Huang S. Feasibility and safety of intrapulmonary percussive ventilation in spontaneously breathing, non-ventilated patients in critical care: A retrospective pilot study. J Intensive Care Soc. 2021 May;22(2):111-119 • Reper P, van Looy K. Chest physiotherapy using intrapulmonary percussive ventilation to treat persistent atelectasis in hypoxic patients after smoke inhalation. Burns. 2013 Feb;39(1):192-3 • Spapen HD, De Regt J, Honoré PM. Chest physiotherapy in mechanically ventilated patients without pneumonia-a narrative review. J Thorac Dis. 2017 Jan;9(1):E44-E49.  • Riffard G, Buzenet J, Guérin C. Intrapulmonary percussive ventilation superimposed on conventional mechanical ventilation: comparison of volume controlled and pressure controlled modes. Respir Care. 2014 Jul;59(7):1116-22.
344
Аpplication to exercise protocol in postmenopausal osteoporosis: a pilot study
Аpplication to exercise protocol in postmenopausal osteoporosis: a pilot study Koevska V, Mitrevska B, Manoleva M, Geracaroska-Saveska C, Gocevska M, Kalcovska B University Clinic for Physical Medicine and Rehabilitation, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Republic of N. Macedonia Abstract Background: Osteoporosis is a multifactorial progressive skeletal disease characterized by a decrease in bone density and disruption of bone microarchitecture, predisposing the bone to fracture. These fractures are very often associated with increased morbidity, mortality, loss of function, and high economic cost. Objectives: To assess the effectiveness of exercises protocol in patients with postmenopausal osteoporosis. Material and methods: Randomized controlled research included 92 patients diagnosed with osteoporosis who signed an informed consent to participate in the study. Exercises protocol consisted of : exercises for strengthening and stretching the paravertebral muscles, muscles of the upper and lower extremities, exercises for strengthening the abdominal muscles and exercises for balance. Bone mineral density was determined by dual energy X-ray absorptiometry, ad quality of life was determined by Qualeffo-41, specific for osteoporosis the beginnig and after twelve months. The patients were followed for one year. Results: The results showed that 83.69% of respondents have deformity, ie 58.69% have kyphosis. After one year, the results in the average vitamin D in the blood (p<0.001) were diferrent. BMD showed a significant difference after one year from treman (p=0.001) on lumbar spine and femur (p=0.001). Total Qualeffo scor show a significant statistics difference, a reduction in values, which means a better quality of life. Conclusion: Exercises protocol have a significant role in improving bone mineral density and quality of life in patients with osteoporosis. KEY WORDS: postmenopausal osteoporosis, exercises protocol, bone mineral density.
345
The use of proprioceptive insoles and postural evaluation to prevent injuries in tennis players
THE USE OF PROPRIOCEPTIVE INSOLES AND POSTURAL EVALUATION TO PREVENT INJURIES IN TENNIS Messina G1,2 Francavilla V3 Lima F4 Mantia F5 Secolo G4 , Secolo I4 Iovane A4 1- Department of Human Sciences and Promotion of the Quality of Life San Raffaele University, Rome (Italy) 2- Posturalab Research Institute (Italy) • Department of Medicine and Surgery, Kore University, Enna (Italy) • Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Palermo (Italy) • Centro Medico Mantia, Palermo (Italy) Background and aims Tennis is a sport that requires adequate physical and psychological preparation to prevent injuries. We suggested a new approach for adolescent tennis players which combines the use of proprioceptive foot orthosis and a specific training program to improve the sport performance and to reduce risk of injury. Methods 50 males, competitive tennis players, between 14 and 19 years old with BMI> 18.5 and <25 were recruited. We performed the analysis of the plantar impression with podoscope then with baropodometric and stabilometric platform (Sensor Medica, Base model 40x40, frequency 50Hz). The two instrumental investigations were used to evaluate the COP (Center of Posture) and the surface of the ellipse in mm2. The evaluations were performed in three stages: at the first (T0) the researchers met the athletes to 
 explain the program and to obtain the informed consent;
 0 after 5 days from T0, the group was divided into two groups the first 25 athletes received a tailored proprioceptive insoles to wear 8 hours a day for 30 days, the second 25 an individual postural exercises program. During the second meeting, on the 30th day of therapy (T1), all the previously described evaluations were conducted again and the therapies were reversed: the athletes were asked to suspend the therapy for 5 days, and then start the new path. The athletes who had used the proprioceptive plantar orthosis began postural exercises and vice versa, for a period of 30 days, after which the final evaluations were performed (T2). Results There were no dropouts and complications during the treatment. The data analysis showed an improvement of the postural parameters evaluated with stabilometric test in the three evaluation times. In particular, the mean of the CoP values were at T0 301+- 35.1 mm, at T1 293.3+- 35.8mm and at T2 273.5 +-33.2 mm and the mean values of the ellipse surface were at T0 90.6 +-15.8mm2, T1 84.5 +-28.3mm2 and T2 65.8 +-33.2mm2. .The results for both groups were similar. 
 Conclusions The reults obtained suggest that a careful postural evaluation and the consequential correction of postural deficits is a fundamental step for the management of the competitive tennis player. In particular, it is clear that good postural control improves sports performance and reduces the risk of injury.
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Long head of biceps calcification: an atypical site of shoulder calcification.
LONG HEAD OF BICEPS CALCIFICATION: AN ATYPICAL SITE OF SHOULDER CALCIFICATION Mantia F1 Francavilla V2 Lima F3 Secolo G3 , Secolo I3 Messina G4,5 Iovane A3 • Centro Medico Mantia, Palermo (Italy) • Department of Medicine and Surgery, Kore University, Enna (Italy) • Department of Psychological, Pedagogical and Educational Sciences, Sport and Exercise Sciences Research Unit, University of Palermo (Italy) • Department of Human Sciences and Promotion of the Quality of Life San Raffaele University, Rome (Italy) 5- Posturalab Research Institute,Italy Background Shoulder calcific tendinopathy is a common non- traumatic pain condition that occurs predominantly in the supraspinatus tendon. Ultrasound-guided percutaneous irrigation of calcific tendinopathy (US- PICT) of calcification is a valid management in the resorptive phase. Migration of deposits outside tendon structure is a complication of calcific tendinopathy. We describe an atypical site of shoulder calcification Methods A 53-year-old female complained right shoulder pain which irradiated to the anterior brachial and deltoid regions; despite having undergone NSAID therapy (Diclofenac 150mg/day for 5 days) the pain was evaluated 8/10 by VAS.. A RX performed two days before highlighted a subacromial calcification. The ultrasound examination, showed a calcification in the long head biceps tendon; the integration with Color Power Doppler showed an area of peri-calcific hyperemia related to phenomena of neoangiogenesis and capillary proliferation typical of the resorptive phase. The patient was treated whit US-PICT. Results 
Conclusions The long head of biceps tendon is a possible, although rare, atypical site of shoulder cuff calcifications. Moreover ultrasound-guided percutaneous treatment has proven to be a valid option for pain relief and recovery of the shoulder in cases with calcific deposits inside long head of biceps tendon. At the first check at 2 weeks from the procedure the patient reported the persistence of minimal pain (VAS 2/10). Ultrasound examination showed the disappearance of hyperechoic area in the long head of biceps tendon. The patients started a physiotherapy program to recover complete shoulder ROM. The final clinical and ultrasound evaluation was performed at 45 days from the procedure (T2); the patient reported the remission of the pain symptoms with complete recovery of the joint ROM in all movement; the ultrasound examination showed the absence of calcific deposits and RX check showed the absence of the previous described calcification.
350
Narrative review of non-invasive treatment options for sacroiliac joint dysfunction
NARRATIVE REVIEW OF NON-INVASIVE TREATMENT OPTIONS FOR SACROILIAC JOINT DYSFUNCTION Ioannis – Alexandros Tzanos1, Christos Georgakopoulos2, Maria Nianiarou1, Aikaterini Kotroni1 1. PRM Department, KAT General Hospital, Kifissia, Greece 2. Rheumatology Department, KAT General Hospital, Kifissia, Greece • Background and aims Sacroiliac joint (SIJ) pain equates to anatomical dysfunction with consequent joint hypermobility or hypomobility, in conjunction with concurrent or resultant arthritic inflammation. Clinical manifestations include intense pain inferolateral to the joint that deteriorates with changing positions or rotation of pelvis. The most common causes are immoderate axial loading or joint stress, degenerative alterations, trauma, pregnancy, and inflammatory conditions. The aim of this work is to illustrate the main non-invasive therapeutic options regarding SIJ dysfunction. • Methods Literature research of the last 15 years using the web engines, “PubMed”, “Google Scholar” and “Cochrane Library”. Keywords used were “sacroiliac joint pain conservative” and “sacroiliac joint pain rehabilitation” • Results Initially, it is substantial to use the biopsychosocial model to design a therapeutic plan that focuses on the individual needs of the patient. Apart from analgesic medication such as nonsteroidal anti-inflammatory agents and muscle relaxants in case of concomitant muscle spasm, conservative measures such as therapeutic exercise, mobilization, and belts, are potential options for pain control. If these treatments are ineffective, then one may consider fluoroscopic, ultrasound, or CT–guided intra-articular or peri-articular injections, nerve blocks, and radiofrequency. Nevertheless, psychologists, occupational therapists, recreation therapists, dieticians and social workers have also an important role within the interdisciplinary rehabilitation team. • Conclusions Conservative treatment for SIJ pain mainly includes mobilization, antiinflammatory drugs and joint belts and it is generally considered as effective. 
357
Clinical and epidemiological profiles of cervical spondylotic myelopathy
CLINICAL AND EPIDEMIOLOGICAL PROFILES OF CERVICAL SPONDYLOTIC MYELOPATHY Nedra El Fani¹ ,soumaya elaream 2,soumaya belguith, houcembenzarti¹ , ghanmimaroua¹ , 2, mtaoua sahbi¹ wassia kossentini2 ¹Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Tunisia 2¹Physical Medicine and Rehabilitation Department, Taher sfar University Hospital, Tunisia Introduction: Cervical spondylosis, or cervical osteoarthritis (OA), is an umbrella term to comprise various osteoarthritic changes arising in the cervical spine Cervical myelopathy stemming from degeneration of the cervical spine is a common cause of neurologic impairment in adults, particularly in the elderly. However, the epidemiology of this type of myelopathy has not been fully understood so far, probably due to inconsistent nomenclature Objectif: The aim of this study is to establish the epidemiological characteristics of cervical spondylotic myelopathy in patients presenting physical medicine and rehabilitation department
DESIGN: This is a descriptive study involving patients suffered of cervical spondylotic myelopathy followed at a Physical Medicine and Rehabilitation department in Tunisia. The data analyzed were epidemiological and clinical characteristics. RESULTS: Forty five patients were included in this study, the average age was
61.4 ± 5 years with a male predominance (sex ratio 2.3). Ten patients (22.2%)
were from rural areas. The majority of our patients (86.7%) were married. We found that the most frequent reason for consultation was Weakness of upper limbs was seen in 32.5%, lower limbs in 22.5%,42.5% of patients complained of neuropathic pain of upper and or lower limbs. 30% of patients had urinary incontinence, 27.5% had positive Lhermitte’s sign, 60% spasticity. Multi-level disease was seen in the MRI in the majority of patients, with C5/6 being the most commonly affected level followed by C3/ 4. Single disc disease was seen in 8 out of 45 patients (17.7%), with multi-level disease in the remaining 37 (82.2%). In this group there was evidence of broad-based disc osteophytic bars in 34 out of 45 cases Conclusions : Cervical myelopathy is an uncommon cause of cord compression with insidious onset that can present with a number of different symptoms and requires a high index of suspicion to diagnose.
358
Post Covid-19 fatigue in patients followed in the physical medicine department
POST COVID-19 FATIGUE IN PATIENTS FOLLOWED IN THE PHYSICAL MEDICINE DEPARTMENT Nedra El Fani¹ houcembenzarti¹ , ghanmimaroua¹ , 2, mtaoua sahbi¹ ¹Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Tunisia INTRODUCTION Much of the spotlight for coronavirus disease 2019 (COVID-19) is on the acute symptoms and recovery. However, many recovered patients face persistent physical, cognitive, and psychological symptoms well past the acute phase. Of these symptoms, fatigue is one of the most persistent and debilitating. Aim: In the present study we aim to investigate the prevalence of post-COVID fatigue and associated factors in physical medicine outpatient clinic. Methods We conducted a cross sectional study through patients recovered after one year at least from COVID-19, followed in physical medicine outpatient clinic. For all of them we collected one month demographic, clinical characteristics, Covid status. We evaluated fatigue severity according to Fatigue Severity Scale (FSS). Results A total of 80 subjects were included. Females represented the 70% of the study sample. Participants hospitalized for COVID-19 with low-flow oxygen supplementation represented the 32% of the study sample while 3% received noninvasive ventilation (NIV) or invasive ventilation. they were followed in rehabilitation for osteoarthritis in 69% of the cases and for stroke in 20%. The most common co-morbidities were hypertension and diabetes. They were living with their family in the majority of the population. The proportion of patients having persistent fatigue was 40%. The covid-19 severity was correlated to the Fatigue(p<0,05) in the post Covid syndrome. No other clinical or demographic variable was found to predict post-COVID fatigue Conclusion: Fatigue is one of the most commonly reported symptoms in the context of the post-COVID-19 syndrome. It is reported to be relatively severe and causes significant daily life impairment. Il’s therefor important to identify the post-COVID fatigue and to tailor specific treatment and rehabilitation interventions to foster recovery.
359
Foot musculoskeletal disorders and pain in older persons
FOOT MUSCULOSKELETAL DISORDERS AND PAIN IN OLDER PERSONS Poster N:359 Nedra El Fani¹ , houcembenzarti¹ , ghanmimaroua¹ , mtaoua sahbi¹ ¹Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Tunisia Introduction: Foot disorders are common in the elderly. Although foot disorders are common and often the subject of medical attention, it is not clear whether they are associated with pain or functional limitation. Such an association would determine, in part, whether further diagnostic and treatment considerations are warranted. Although foot pain is associated with disability, it is not known whether foot disorders themselves are associated with poor functional outcomes independent of pain.1-2 Objectif:To investigate the prevalence of foot pain in older people and its association with foot disorders. Materials and methods: This was a cross-sectional descriptive study involving the patients aged 65 years and over who were independent in self-care and walking followed at the physical medicine and rehabilitation department of the university hospital of sousse over 3 months. The analysed data focused on the epidemiological and clinical characteristics, the visual analogue scale (VAS ) pain was used to assess pain intensity. Results There were 45 subjects: 18 men, 27 women with a mean age of 69.6 [65-86] years. Foot deformities presented in 87%,the most common foot musculoskeletal disorder were Halux valgus 31%,followed by Mallet toe 15%. Arch of foot classified by physical examination revealed that pes planus was presented in 35% of cases. There was a significant correlation between obesity and foot pain(p=0,001) . Eigty percent of patients have a foot pain, and foot problems interfered with mobility in only 7% of patients The causes of pain were plantar fasciitis, hallux valgus, callus, metatarsalgia, and inappropriate footwear. Falls were reported in 33.3 of patients. Falls were significantly associated with Hallux valgus, mallet toe and pain (p<0.05). Discussion: This study demonstrated that, of the studied foot disorders, only Hallux valgus and, to a lesser degree, callus were associated with foot-pain This study found that foot pain was associated with increased odds of recurrent falls. Similar results have been reported in other studies relating foot problems.3 Conclusion: Foot pain is associated with specific conditions of the feet and disability in instrumental activities of daily living. Adequate assessment and treatment of foot problems may prevent foot pain and potentially reduce risk of disability References: • Leveille SG, Guralnik JM, Ferrucci L et al. Foot pain and disability in older women. Am J Epidemiol 1998;148:657–665. • . Benvenuti F, Ferrucci L, Guralnik JM et al. Foot pain and disability in older persons: An epidemiologic survey. J Am Geriatr Soc 1995;43:479–484. • Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319: 1701–1707.
360
Management of the vesico-sphincter disorders secondary to compressive spondylodiscitis
Management of the vesico-sphincter disorders secondary to compressive spondylodiscitis Nedra El Fani¹ , houcembenzarti¹ , ghanmimaroua¹ , mtaoua sahbi¹ ¹Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Tunisia Introduction Complications of infectious spondylodiscitis can be devastating due to its ability to cause bone destruction, spinal deformity, and para or quadriplegia. Spinal cord involvement manifests itself in multi-visceral deficiencies including vesicosphincteric disorders (VSD) which are responsible for significant morbidity and mortality with a significant deterioration in the quality of life. The neurological bladder must be the subject of specific care The objective of our work is to describe the clinical aspects of VSD, their management and the associated factors. Materials and methods : Retrospective study of thirty hospital patients in the physical medicine and functional rehabilitation department, collected over a period of 8 years from 2012 to 2020. Clinical, paraclinical and therapeutic data were collected from medical records. HAD “the Hospital Anxiety and Depression scale ”was used to assess the psychological profile. Results: The mean age of our patients was 53.7% ± 13 with a sex ratio of 1. The most frequent reason for consultation was inflammatory back pain in 66.6% of cases and walking disorders in 60% of cases. The causative organism was tuberculosis in 50% of cases followed by brucellosis and pyogens at 13.5% and 36.5% respectively. The level of involvement was in 73.33% cervico-dorsal, with 93.4% of the paraplegic patients and 6.6% quadriplegic. Sixty-six percent of patients underwent decompressive surgery with postoperative recovery in only 16.7% of patients. All of our patients had a neurological bladder: 73.3% central bladder and 26.6% peripheral bladder. The most common symptoms were urgency urinary incontinence in 30% of patients, urinary retention in 60% of patients. A bladder diary was practical in all patients and a Urodynamic evaluation in 40%. A treatment by intermittent auto or hetero-catheterization was instituted in 40% of the patients and in the absence of means or by refusal of the patient, a catheter was put in place. Treatment with anticholinergics was initiated in 30% of patients. The mean HAD-D score was 11.23 ± 4.96 and depression was positively correlated with VSD. Conclusion: The VSD should be researched and the use of intermittent catheterization is important to pass urine and protect the upper urinary tract. Multidisciplinary care is very important and aims to reduce the morbidity and mortality of VSD and improve the quality of life.
361
Pain associated factors in tunisian patients with infectious spondylodiscitis
Pain associated factors in Tunisian patients with Infectious Spondylodiscitis Poster N361 Nedra El Fani¹ , houcembenzarti¹ , ghanmimaroua¹ ,rihab moncer2, toulgui emna2, mtaoua sahbi¹ jemni sonia2 ¹Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Tunisia 2¹Physical Medicine and Rehabilitation Department, SAHLOUL University Hospital, Tunisia Introduction: Since pain is associated with a significant reduction in quality of life in infectious spondylodiscitis (ISPD), further study of this important symptom is indicated. The aim of our study was to assess pain and identify its associated factors in patients with ISPD. Materials and methods : Retrospective study of thirty patients hospitalized in the physical medicine and functional rehabilitation department, collected over a period of 8 years from 2012 to 2020. Clinical, paraclinical and therapeutic data were collected from medical records, the visual analogue scale (VAS ) pain was used to assess pain intensity, the DN4 questionnaire was used to confirm the diagnosis of neuropathic pain, and the HAD “the Hospital Anxiety and Depression scale” (HAD) was used to assess the psychological profile. Results: The mean age was 53.7 ± 13.45 years. The symptom revealing ISPD were back pain in 66.7% of cases, gait disturbance in 60% of cases and an infectious syndrome in only 30% of cases. Tuberculosis was identified in 50% of cases, brucellosis in 13.3% of cases and pyogenic germs in the rest of the cases. The dorsal spine was the most affected segment (56.7% of cases). Walking was impossible in 66.7% of patients and possible with assistance in 33.3% of patients. It was tetraplegia or tetra paresis in 6.6% of cases and paraplegia or para paresis in 93.4% of cases. The mean pain VAS was 4 ± 2 and neuropathic pain was detected in 70% of patients with a DN4 greater than 4/10. Treatment with step-I analgesics was initiated in 70% of patients, step-II in 20% of patients and for neuropathic pain, treatment with Pregabalin in 60% of patients and Tegretol in 10%. The mean HAD-D score was 11.23 ± 4.96. Depression was also correlated with the presence of neuropathic pain by DN4 (p = 0.004). Anxiety was associated with DN4 (p = 0.03). Conclusion: The findings indicate that pain is a persistent and common problem in persons with ISPD, highlighting the need for effective and accessible pain treatments for this population.
362
Interest of imaging in the diagnosis of inectious spondylodiscitis
Spinal myoclonus post spinal instrumentation Ni Thu Shan, Sherry Young Rehabilitation Medicine, Changi General Hospital, Singapore Background Spinal myoclonus is a disorder characterized by myoclonic movements in muscles that originate from several segments of the spinal cord and usually associated with spinal cord injury, post spinal instrumentation, spondylosis, tumours, infections, or ischemia. It can interfere with function and can be disabling for the person. In severe cases, it might impede a person’s functional recovery. Case presentation A 50 year-old female, with past medical history of three previous spinal instrumentation was admitted with C4-C6 spinal cord stenosis and underwent posterior decompression and instrumented fusion. She was maintained on a course of analgesics post operation. Once her medical condition was stable, she was subsequently started on a post-operative inpatient rehabilitation program. During this period, she was noted to have involuntary movements (myoclonus) of both upper and lower limbs. These movements were sudden, spontaneous, unpredictable and distractable. She experienced about 1-2 episodes each day, with each episode lasting for a few minutes. No significant trigger factors noted. The neurological examination was stable. The onset of myoclonus affected her rehabilitation process but she continued to have regular physiotherapy input as tolerated. Investigations Investigations done during admission included: full blood count, kidney and liver function tests, calcium, magnesium, phosphate, thyroid and creatinine kinase levels which were all normal. Other investigations done were: electromyographic studies (EMG) and electroencephalogram (EEG) that came back unremarkable. Treatment A working diagnosis of spinal myoclonus was made based on clinical presentation and recent spinal instrumentation. She was started on clonazepam 1 mg once daily then titrated upto 4-6mg according to severity of symptoms. The frequency of her myoclonus episodes gradually decreased and continued to make functional improvement. Outcome and follow up Upon her follow up 3 months after discharge in outpatient clinic, her response to clonazepam was satisfactory. Myoclonus frequencies were reported to have reduced to about 3-4 episodes per week, each time lasting for a few seconds only. Discussion The pathophysiology of spinal myoclonus is poorly understood. Proposed mechanisms included the loss of inhibitory function of local dorsal horn interneurons, abnormal hyperactivity of local anterior horn neurons, aberrant local axons re-excitations and loss of inhibition from supra-segmental descending pathways [1,3,5]. There are two main forms of spinal myoclonus: segmental and propriospinal. These two types of myoclonus may coexist in the same individual as there is overlap in the characteristics attributed to both [2]. Spinal myoclonus may be confused with other movement disorder like tremor or chorea. But it is usually asynchronus, present at rest, slower frequency, not action-induced and often persists during sleep[4]. The responsible site is usually estimated by clinical observation and electrophysiological examination. However, it can be a diagnostic challenge to label such a condition and exclude extensive investigations. In our patient, it was difficult to diagnose myoclonus early on, as all tests were normal and no characteristic EMG findings of myoclonic bursts confined to myotomes were seen [6]. The first consideration of treatment is that underlying aetiology of the myoclonus should be addressed. However, treatment of the underlying disorder is usually not possible or effective for the majority of myoclonus cases and instead, symptomatic treatment is justified if the myoclonus is disabling enough [7]. Clonazepam is considered as a first line agent for the treatment of spinal segmental myoclonus with reports of functional improvement noted in patients [8,9]. Clonazepam is a useful adjunct to treatment by levetiracetam or valproic acid. However, clonazepam occasionally works as a single-therapy. [13] Anticonvulsants like levetiracetam and phenytoin have proved helpful in reducing myoclonus symptoms as well [10,11,12]. There are suggestions that botulinum toxin type A could be beneficial in cases resistant to medical treatment [14] . Deep brain stimulation (DBS) has been reported in some people with myoclonus and other movement disorders. [15]   Conclusion Spinal myoclonus should be considered as one of the complications from spinal instrumentation . This can prevent unnecessary investigations and appropriate medical treatment of this condition can improve the patient’s symptoms and rehabilitation outcome. References 1.Jankovic J, Pardo R. Segmental myoclonus. Arch Neurol. 1986;43:1025–31. 2. Vetrugno R, Provini F, Plazzi G et al. Focal myoclonus and propriospinal propagation. Clin Neurophysiol. 2000;111:2175–2179. [PubMed]  3. Brown P, Rothwell JC, Thompson PD, Marsden CD. Propriospinal myoclonus: evidence for spinal “pattern” generators in humans. Movement Disorders. 1994;9:571-576. 4.Park HD, Kim HT. Electrophysiologic assessments of involuntary movements: tremor and myoclonus. Journal of Movement Disorders. 2009 May;2(1):14. 5. Campos CR, Papaterra Limongi JC, Nunes Machad OFC, Lervolino Brotto MW. A case of primary spinal myoclonus. Clinical presentation and possible mechanisms involved. Arq Neuropsiquiatr. 2003;61:112–4. 6. Kojovic M, Cordivari C, Bhatia K (2011) Myoclonic disorders: practical approach for diagnosis and treatment. Therapeutic Advances in Neurological Disorders 4: 47-62 7. John N. Caviness Treatment of Myoclonus 2013 Sep;10.1007/s13311-013-0216-3 John N.Caviness 8. Obeso JA. Therapy of myoclonus. Clin Neurosci 1995-1996; 3:253. 9. Jankovic J, Pardo R. Segmental myoclonus. Clinical and pharmacologic study. Arch Neurol 1986; 43:1025. 10. Amelioration of spinal myoclonus with levetiracetam. Keswani SC, Kossoff EH, Krauss GL, Hagerty C J Neurol Neurosurg Psychiatry. 2002 Oct; 73(4):457-8. 11. Lee J Y, Chung, K J, Chung M-R C, Young S W, Rim J K, Yeon j. A case of spinal myoclonus with radiculopathy following spine surgery – A case report -. Korean Journal of Anaesthesiology. 2008;55(3):391-394. 12.  Mayo Clinic. Myoclonus. (accessed 12 Feb 2020) 13. Meldrum BS. Drugs acting on amino acid neurotransmitters. Adv Neurol. 1986;43:687–706. [PubMed]  14. Lagueny A, Tison F, Burbaud P, Le Masson G, Kien P. Stimulus-sensitive spinal segmental myoclonus improved with injections of botulinum toxin type A. Mov Disord. 1999;3(1):182–5. doi: 10.1002/1531-8257(199901)14:1<182::AID-MDS1040>3.0.CO;2-8. [PubMed] [CrossRef]  15.Ibrahim W, Zafar N, Sharma.S Myoclonus.Available:https://www.ncbi.nlm.nih.gov/books/NBK537015/ (accessed 25.9.2022)
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Evaluation of Taopatch® effects on spine morphology
Poster MFPRM Conference – Rome 6/8 July 2023 Background And Aim Spine 3D is a device that allow to monitor the spine from a morphological and functional point of view, through a non-invasive analysis widely used in the medical field. A medical device, recently developed, that uses nanotechnology is the Taopatch® (Tao Technologies, Italy). This device is based on quantum dots that are nanocrystals excited with the heat and the sunlight that will be transformed into near-far infrared and ultraviolet light that can have beneficial effects on the human body (1). The Taopatch® is an innovative medical nanotechnology that induce beneficial effects on the human body and it can improve and prolong the effect on proprioception, balance, inducing also postural rebalancing (2). This study aims to highlight whether the application of Taopatch® can improve the spinal morphology’s change of subjects with spinal dysfunction. Methods Forty healthy subjects with spinal dysfunction, such as hyperlordosis, kyphosis, and scoliosis, were enrolled in the study. The subjects were evaluated by the Spine 3D device at the beginning (T0) and after two hours from the application of Taopatch® (T1). Results Comparing the measurements carried out at T0 and T1, a significant change was observed for some variables such as, with respect to: • The mean square of the horizontal lateral deviation of the centers of the vertebral bodies with respect to the connection line VP (Vertebra Prominens) – DM (Point between left dimple and right dimple) (VertebralDeviationMinus_COR) (0.044) with respect to the coronal plane; • The angle between the union of VP and DM and the vertical axis (TrunkImbalance_VPDM_COR) (0.017); • The distance between DM and the vertical through VP (CoronalImbalance_VPDM_COR ) (0.021); • The angle between SL (left acromion) and SR (right acromion) in the coronal plane (SLSR shoulder tilt) (0.047). A significant trend was also found on the distance between the horizontal axis passing through SL and the horizontal axis passing through RS (Shoulder obliquity SLSR) (0.066). Conclusions The application of Taopatch® would appear to have a positive effect on the morphology and rebalancing of the spine and appears to be a useful tool for the long-term support and maintenance of spinal alignment. These preliminary results needs further investigations to define the mechanisms of action of this nanotechnology. References 1. Roggio, F., Petrigna, L., Trovato, B. et al. Thermography and rasterstereography as a combined infrared method to assess the posture of healthy individuals. Sci Rep 13, 4263 (2023). https://doi.org/10.1038/s41598-023-31491-1 2. Amato, A., Messina, G., Feka, K., Genua, D., Ragonese, P., Kostrzewa-Nowak, D., Fischetti, F., Iovane, A., & Proia, P. (2021). Taopatch® combined with home-based training protocol to prevent sedentary lifestyle and biochemical changes in MS patients during COVID-19 pandemic. European journal of translational myology, 31(3), 9877. https://doi.org/10.4081/ejtm.2021.9877
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Impact of the Covid-19 pandemic on physical medicine and rehabilitation department in Tunisia
IMPACT OF THE COVID-19 PANDEMIC ON PHYSICAL MEDICINE AND REHABILITATION DEPARTMENT IN TUNISIA Nedra El Fani¹ houcembenzarti¹ , ghanmimaroua¹ , 2, mtaoua sahbi¹ ¹Physical Medicine and Rehabilitation Department, Ibn Jazzar University Hospital, Tunisia INTRODUCTION: The outbreak of novel coronavirus-2019 (COVID-19) has affected Tunisia very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effect of the strategy to fight the Covid-19 pandemic, on the consultation in the physical medicine and rehabilitation(PMR) department in Tunisia. Methods: This is a comparative study, concerning the impact of Covid-19 on the flow of patients, consulted in PRM departments, during the period from March 12, 2020 to march 30, 2021, comparing it to the same period of the year 2019, in the Central East region of Tunisia (Kairouan, Sousse). Results: A significant decrease of 40% in the flow of patients consulted at the PRM departments in central-eastern Tunisia, during one year at the peak of covid period, compared to the same period of the previous year was documented. This decrease was generally widespread, notified in two PRM departments: Sousse (39%; p<10-3) and kairouan (42%; p<10-3). It focused on the following groups: children with disability, elderly with musculoskeletal disorders and patients with neurological disorders. The cancellation of the consultations caused several complications, namely osteo-articular complications (retractions, vicious attitudes..) and vesico-sphincter complications. Discussion: COVID-19 pandemic adversely affected the training of PRM residents in the Tunisia. Despite the efforts to overcome this, the residents need more support including well-being programs. Every country and training program should continue to evolve to adapt to the crisis and anticipate additional challenges in the near future. Conclusion: The collateral effects of the strategy to fight the Covid-19 pandemic, are «obvious» in PRM practice. A health crisis management plan (including disasters and pandemics) should be better prepared in PRM department, the telerehabilitation and teleconsultation can be the solutions for the future.
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