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Abstract: Objective: To assess the level of comprehension of the courses taught in English at the annual European school on Physical and Rehabilitation Medicine (PRM) (European School Marseille). Materials and methods: The English level of 37 students, mainly from European countries, was tested using three written questionnaires: an initial test of English grammar, a questionnaire about comprehension at the end of a basic PRM class taught in English by a French specialist and a final multiple-choice test (MCT) on the contents of the course. Results: We found a difference between the level of English given by the residents and the level shown by the initial test. The overall level of English comprehension of the group was good, an average of 8.2/10 (S.D.: 2.1) on a Visual Analogue Scale. The mean MCT score on the contents of the course was good, an average of 6.1/10 (S.D.: 2.2). For residents with lower levels of English, the level of comprehension for courses taught in English by the French specialist was greater than the level of comprehension for courses taught by native English speakers (p =0.033). Conclusion: The level of comprehension of most European PRM residents for courses taught in English by French PRM specialists and by English-speaking specialists is good. The level of comprehension is, of course, influenced by the English level of European residents. It thus appears worthwhile to organize programmes taught in English for European PRM residents. Nonetheless, it is important to assess the language skills of the residents and to use specific tools to help the small number of trainees whose English level is to low. [Copyright &y& Elsevier]

Abstract: Objective: To investigate modification of postural control after treatment with botulinum toxine in leg muscles of stroke patients. Methods: We performed a retrospective study of stroke patients who benefitted from injection of botulinum toxine in leg muscles between June 2003 and October 2004. The assessment before and after the injection relied on clinical examination and on posturographic recording on 2 force plates with the patient standing, with eyes open performing or not a double task consisting of an arithmetic test and with eyes closed. We also compared patients to healthy subjects. Results: Eight patients were included in the study. Botulinum toxine injection in the leg muscles significantly decreased the triceps spasticity, with no change in clinical assessment of balance control (Fugl-Meyer scale). The posturographic data show a decrease in the area of centre of pressure displacement in the double-task situation after the injection. Conclusion: Thanks to the posturographic recording in the double-task situation, we showed a modification of postural control after treatment with botulinum toxine in leg muscles of stroke patients. [Copyright &y& Elsevier]

Abstract: Objective. – To compare lateral rotator (LR) and medial rotator (MR) muscle strength of both shoulders in a sport involving asymmetrical movements (tennis), symmetrical movements (swimming), and symmetrical and asymmetrical movements (volley-ball). Materials and methods. – Retrospective study of 42 healthy elite athletes (18 women: 14 tennis players, 19 swimmers and 9 volleyball players. We evaluated the strength of LR and MR of both shoulders by Cybex Norm® isokinetic dynamometer, in the concentric mode, in the modified Davies position, at 2 different speeds (60° and 180°s−1) and analysed peak torque of LR and MR and LR/MR ratios. Results. – Tennis: the MR peak torque of the dominant shoulder was significantly higher than that of the non-dominant shoulder. The LR/MR ratio of the dominant shoulder was significantly lower than the non dominant shoulder in women. Swimming: the LR strength and LR/MR ratio of the dominant shoulder was higher than the non dominant side in men at 60°/second. Both shoulders showed comparable strength in women. Volleyball: shoulder muscular strength was symmetrical. Conclusion. – The higher strength of MR muscles in the dominant shoulder of tennis players (asymmetrical movements) has been reported in the literature. Athletes show asymmetrical shoulder strength in swimming, a symmetrical sport and similar LR and MR strength in both shoulders in volleyball, a sport with asymmetrical movements. To our knowledge, these results have never been reported before. [Copyright &y& Elsevier]

Résumé: Objectifs. – Mettre en évidence les asymétries chronométriques, cinétiques et cinématiques de l''initiation de la marche chez un sujet hémiplégique ayant un pied varus équin. Méthode. – Nous avons réalisé chez un sujet hémiplégique une analyse cinétique, avec deux plateformes de force AMTI® et cinématique, avec un système optoélectronique ELITE® de l''initiation de la marche. Résultats. – Les durées des phases de l''initiation de la marche étaient asymétriques. La phase d''appui monopodale était plus courte en appui sur le membre inférieur hémiplégique qu''en appui sur le côté sain. La propulsion longitudinale était réalisée essentiellement par le membre inférieur sain. La répartition du poids du corps sur les membres inférieurs était asymétrique. Le membre inférieur sain supportait une charge plus importante que l''autre membre inférieur. L''extension maximale de cheville du côté hémiplégique se produisait pendant la phase oscillante. Le passage du pas se faisait en levant le genou plus haut pour éviter l''accrochage du pied. L''attaque du pas était plantigrade. Conclusion. – Cette étude préliminaire a permis de montrer que l''initiation du pas est asymétrique chez le sujet hémiplégique. L''analyse cinématique de l''initiation de la marche chez un sujet hémiplégique n''avait jamais été réalisée dans des études antérieures. L''étude de l''initiation de la marche pourra nous aider à mieux comprendre les stratégies adaptatives de contrôle de la posture et du mouvement chez les sujets hémiplégiques. [Copyright &y& Elsevier]

Introduction The aim of this study is to evaluate the efficiency, users’ satisfaction and tolerance of the Knee Ankle Foot Orthosis (KAFO) in treatment of painful genu recurvatum (PGR). Material and method Epidemiologic retrospective monocentric study. Patients having a clinical PGR on stance phase confirmed by a practitioner. The main outcome was the pain before and after having the KAFO evaluated with the numerical verbal scale (NVS) of pain rated on 100 and the simple verbal scale (SVS) of pain. The secondary outcomes were the French version of the Quebec user evaluation of satisfaction with assistive technology (QUEBEC 2.0) and a numerical scale of satisfaction (NSS) rated on 100. Results Twenty-seven patients but 31 KAFO have been analyzed (4 patients had both KAFO): 25 free knee joints/6 locked knee joints. Before and after having the KAFO, the NVS of pain decreased from a mean of 80/100 to 26.9 ( P ≤ 0.001) and the SVS of pain from “extreme” to “weak” ( P ≤ 0.001). The French version of the QUEBEC 2.0 had a total of 4.04 and the NSS had a mean of 86/100. Discussion With this study, it was shown that treating a PGR with a KAFO is efficient on pain whatever the pathology from which the patient is suffering, and the patient satisfaction is good. [ABSTRACT FROM AUTHOR]

Objective To perform a systematic review of the literature regarding amputee self-care, and analyze current experts’ opinions. Method The research in Medline and Cochrane Library databases was performed using the keywords “amputee self-care”, “amputee health care”, “amputee education”, and “amputee health management”. The methodological quality of the articles was assessed using four levels of evidence and three guideline grades (A: strong; B: moderate; C: poor). Result One prospective randomized controlled study confirm the level of evidence of self-care amputee persons with grade B, which is similar others chronic diseases self-care. Self-care of amputee persons contributes to improve functional status, depressive syndrome, and also health-related quality of life. A review of the patients’ needs and expectations in self-care amputee persons has been established thanks to the presence of qualitative focus group study. Conclusion A multidisciplinary self-care of amputee persons can be recommended. Regarding literature date, the level of evidence of self-care amputee persons is moderate (grade B). Experts groups are currently working on a self-care amputee persons guideline book in order to standardize practicing and programs in the physical medicine and rehabilitation departments. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of the Physical and Rehabilitation Medicine (PRM) day hospital''s short-stay program is to propose a one- or two-day medical and psychosocial assessment to patients with disabilities. The day hospital is run by an interprofessional team, using interdisciplinary cooperation and a hospital/community network. Objectives: To describe a tool for assessing patient satisfaction and to present the results of our survey. Patients and methods: A self-administered questionnaire about patient satisfaction was created and given to patients coming to the PRM day hospital. The questionnaire included 27 multiple-choice questions, two visual analogic scales, and one free-response question. The survey was conducted over two months. For the 603 annual day hospital sessions, 143 questionnaires on 143 sessions were filled out. Results: Patients found the questionnaire easy to use, but a few needed help to fill it out. It permitted us to highlight the places where the short-stay program performed unsatisfactorily. Conclusions: The self-administered questionnaire seems to be appropriate for assessing patient satisfaction. The highest scores helped to emphasize where the program was functioning correctly, and the lowest scores allowed us to identify the points that needed to be improved. [Copyright &y& Elsevier]

The use of posture and movement analysis methods has developed during the past 15 years. These methods are of special interest in the field of sport sciences and have allowed to improve the understanding of physiology of posture and movement in athletes. More recently these methods have been used in the field of sport medicine. In some cases, they have helped to identify abnormalities which cannot be seen on standard clinical examination and to understand the mechanism of lesions occurring during sport activities. For the future these methods should provide useful information for understanding the physiopathology of lesions, for developing prevention of pathologies related to sport and for elaborating and assessing new treatment protocols in the field of sport medicine. [Copyright &y& Elsevier]

Notre objectif était d'étudier si l'amélioration de l'activité de la maladie observée après un programme de rééducation intensive était associée à l'amélioration du ratio des couples de force musculaire maximale du rachis chez des patients avec spondyloarthrite axiale Étude monocentrique prospective, ouverte. Critères d'inclusion: (1) Spondyloarthrite axiale répondant aux critères de classification de l'ASAS; (2) âgés de 18 à 70 ans; (3) avec maladie encore active (BASDAI ≥ 3/10 et Douleur rachidienne ≥ 4/10) malgré un traitement stable depuis plus de 3 mois. Critères d'exclusion: ankylose rachidienne, CRP >5 mg/l, contre-indication à la balnéothérapie, grossesse. Tous les patients ont participé à un programme rééducation intensive avec 4 heures d'activités physiques quotidiennes pendant 3 semaines avec étirements globaux, renforcement musculaire, travail respiratoire et balnéothérapie. Les données collectées à l'inclusion et à la fin du programme incluaient l'activité de la maladie (BASDAI, ASDAS), la fonction (BASDFI, EIFEL) et les paramètres musculaires rachidiens mesurés par test isocinétique (ratio de couple de force maximale des fléchisseurs/extenseurs F/E et les couples de force maximale des fléchisseurs et extenseurs à 30°/s et 120°/s). Critère principal: association entre variation du BASDAI (ΔBASDAI) et la variation du ratio de couple de force maximale F/E. Analyse comparative par tests non paramétriques de Mann-Whitney pour les variables qualitatives à 2 modalités A l'inclusion, les 14 patients inclus (7 femmes, âge moyen 42,9 ± 11,0, 71,4 % avec biomédicaments, 50 % avec AINS ≥ 2 fois/semaine) avaient un BASDAI moyen de 4,1 ± 2,1, ASDAS moyen, BASFI moyen est 31,4 ± 20,3, EIFEL moyen est 9,0 ± 4,5. Les paramètres musculaires moyens à l'inclusion étaient: ratio du couple de force maximal F/E: 0,63 ± 0,27 et 0,68 ± 0,38, couple de force maximale des fléchisseurs 2,1 ± 0,5Nm/Kg et 1,6 ± 0,9Nm/Kg, couple de force maximale des extenseurs 3,7 ± 1,6Nm/Kg et 2,8 ± 1,4Nm/Kg, à 30°/s et 120°/s, respectivement. Après le programme de rééducation, le ΔBASDAI moyen était 1,0 ± 0,47, le ΔASDAS était 0,65 ± 0,06 le ΔBASFI moyen était 9,2 ± 6,9, le ΔEIFEL était 3,07 ± 0,52. Les paramètres musculaires moyens post-rééducation étaient: ratio du couple de force maximal F/E: 0,56 ± 0,26 et 0,61 ± 0,23, couple de force maximale des fléchisseurs 2,22 ± 0,70Nm/Kg et à 1,92 ± 0,72Nm/Kg, couple de force maximale des extenseurs 4,21 ± 1,22Nm/Kg et à 2,96 ± 1,23 Nm/Kg, à 30°/s et 120°/s, respectivement. On a observé une amélioration du ratio de couple de force maximale F/E chez 57,1 % des patients à 30°/s et chez 85,7 % des patients à 120°/s. Nous n'avons pas mis en évidence d'association significative entre le ΔBASDAI et l'amélioration de la force musculaire du rachis à 30°/s (p = 0,637) et à 120°/s (p = 0,686). Nous avons montré que les patients atteints de spondyloarthrite axiale amélioraient significativement l'activité de leur maladie et leurs paramètres musculaires rachidiens après un programme de rééducation intensive, mais que ces deux paramètres n'étaient pas associés. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Physical and rehabilitation medicine physicians commonly see patients with chronic functional ankle instability. The main anatomical structures involved in ankle stability are the peroneus (fibularis) brevis and peroneus longus muscles. Several anatomical muscle-tendon variations have been described in the literature as being sometimes responsible for this instability, the peroneus quartus muscle being the most frequent. The objective of this clinical study is to discuss the implication of the bilateral peroneus quartus muscle in functional ankle instability. Clinical case: This 26-year-old patient was seen in PM&R consultation for recurrent episodes of lateral ankle sprains. The clinical examination found a moderate hyperlaxity on the right side in bilateral ankle varus. We also noted a bilateral weakness of the peroneus muscles. Additional imaging examinations showed a supernumerary bilateral peroneus quartus. The electroneuromyogram of the peroneus muscles was normal. Discussion: In the literature the incidence of a supernumerary peroneus quartus muscle varies from 0 to 21.7%. Most times this muscle is asymptomatic and is only fortuitously discovered. However some cases of chronic ankle pain or instability have been reported in the literature. It seems relevant to discuss, around the clinical case of this patient, the impact of this muscle on ankle instability especially when faced with lingering weakness of the peroneus brevis and longus muscles in spite of eccentric strength training and in the absence of any neurological impairment. One of the hypotheses, previously described in the literature, would be the overcrowding effect resulting in a true conflict by reducing the available space for the peroneal muscles in the peroneal sheath. [Copyright &y& Elsevier]

L'objectif de l'étude était de décrire les paramètres musculaires et statiques rachidiens de patients atteints de spondyloarthrite axiale, sans atteinte structurale rachidienne sévère, et d'évaluer l'impact de ces paramètres sur l'activité de la maladie. Étude monocentrique transversale, observationnelle. Critères d'inclusion: (1) Spondyloarthrite axiale (critères ASAS); (2) 18 à 70 ans; (3) maladie active (BASDAI ≥ 3/10 et Douleur rachidienne ≥ 4/10) malgré un traitement stable ≥ 3 mois. Données collectées: démographiques, activité de la maladie (BASDAI, ASDAS), fonction (BASFI,), traitements, paramètres statiques pelvi-rachidiens mesurés avec cliché EOS® (incidence pelvienne, pente sacrée, version pelvienne, angle spino-sacré, lordose lombaire), paramètres musculaires mesurés par test isocinétique (ratio de couple de force maximale des fléchisseurs/extenseurs (F/E) et les couples de force maximale des fléchisseurs et extenseurs à 30°/s et 120°/s). Le ratio de couple de force maximale F/E optimal est entre 0,5 et 0,7. Analyse comparative par tests non paramétriques de Kruskal-Wallis et de Mann–Whitney. Au total, 15 patients (8 femmes, âge 43,2 ans ± 10,7) ont été inclus. Principales caractéristiques: BASDAI moyen 4,1 ± 2,0, BASFI 30 ± 21, 73,3 % biomédicaments et 46,7 % AINS. Paramètres statiques pelvi-rachidiens moyens: pente sacrée 39° ± 8, version pelvienne 15° ± 9, incidence pelvienne 53° ± 10, angle spino-sacré 128° ± 8 et lordose lombaire 42° ± 12. Paramètres musculaires moyens: ratio du couple de force max F/E: 0,62 ± 0,26 et 0,7 ± 0,37, couple de force max des fléchisseurs 1,99Nm/Kg et 1,67Nm/Kg, couple de force max des extenseurs 3,62Nm/Kg et 2,63Nm/Kg, à 30°/s et 120°/s, respectivement (Tableaux 1 et 2). Nos résultats suggèrent que les SpA axiales dont la statique rachidienne est anormale et dont le ratio F/E n'est pas optimal ont une activité de la maladie numériquement plus importante. Ces associations touchant l'ensemble des paramètres mesurés méritent d'être confirmées dans un échantillon plus large. [ABSTRACT FROM AUTHOR]

Introduction Acute muscle injuries in the lateral rotator group have been rarely described in the medical literature. The purpose of this study is to describe the diagnosis and treatment of an uncommon injury: obturator externus musculotendinous injury. Case presentation A 30-year-old male patient, professional basketball player, presented with right groin pain during a game, resulting from a controlled slide movement. Pain increased 1 hour after the game in the right groin and radiated to the buttock area. Examination finds no abnormalities during the specific testing of the adductor, hamstring or iliopsoas muscles, but the patient presents with diffuse pain during active hip mobilisation. Muscle testing in resisted external rotation reveals slight but existing specific pain. Slight pain and tenderness to palpation was also noted on the ischial tuberosity. Ultrasound examination and MRI revealed grade III distal obturator externus musculotendinous injury, combined with quadratus femoris muscle oedema. Our patient followed a functional treatment, combining rehabilitation (eccentric and proprioceptive exercises of pelvic and hip stabilising muscles), and reathletisation, which allowed him to return to professional competition 10 days after trauma. Discussion In the medical literature, no international publication has ever reported this type of injury, due to its typical minor functional impact. This injury is caused by an eccentric contraction of the obturator externus. It seems to be under-diagnosed. Discomfort can be minor in daily life, due to muscular compensations, but it can be detrimental for elite athletes. Patients seem to recover rapidly, without an actual relation to the severe imaging findings. In addition, those muscles are not routinely assessed during ultrasound scan, and MRI is not often performed due to relative minor functional limitations. As a consequence, we insist on the need to perform a comprehensive clinical examination which will guide the ultrasound scan to the lateral rotator group of muscles. The ultrasound will confirm the need for hip MRI. Our clinical case shows that targeted rehabilitation will ensure a rapid return to competition without sequelae, and provide excellent functional performance, with a return to pre-injury level of sport. [ABSTRACT FROM AUTHOR]