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Abstract: Today, the prevalence of major amputation in France can be estimated between 90,000 and 100,000 and the incidence is about 8300 new amputations per year (according to French National Authority for Health estimation). This prevalence is expected to increase in the next decade due to the ageing of the population. Even if prosthetic fitting allows amputee people recovering the walking ability, their autonomy remains limited when crossing obstacles such as slopes, stairs or cross-slopes frequently encountered during outdoors displacements. The aim of the project APSIC was to complete scientific knowledge about adaptation strategies to situations of daily living compared to level walking through an extensive motion analysis study of transtibial and transfemoral amputee compared to non-amputee people. APSIC succeeded in identifying physiologic joint functions and current prosthetic joint limitations in the studied situations, which notably resulted in the design of a prototype of ankle-knee prosthesis adapted to multimodal locomotion of transfemoral amputee. Perspectives of the clinical use of motion analysis within the rehabilitation process were explored and proved to be relevant for personalized approach of motor learning. [Copyright &y& Elsevier]

Purpose : Limb amputation is followed by an important rehabilitation process, especially when a prosthesis is involved. The objective of this study is to assess the nature of factors related to health related quality of life (HRQL) of persons with limb amputation. Method : The Nottingham Health Profile (NHP) treated 1011 subjects with major amputation of one or several limbs. Correlations were sought in multivariate regression model analyses between the six categories of distress explored by the NHP and age, sex, cause and level of amputation and rehabilitation programme. Results : Response rate was 53.3%. HRQL measured by the NHP was mostly impaired in the categories of physical disability, pain and energy level. Controlling for sex and age, young age at the time of amputation, traumatic origin and upper limb amputation were independently associated with better HRQL. Conclusion : It is concluded that HRQL is largely related to factors which are inherent to the patient and the amputation. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was the French cross-cultural adaptation and validation of The Trinity Amputation and Prosthetic Experience Scales-Revised (TAPES-R-F), in a lower limb amputation population. This self-reported multidimensional amputee-specific questionnaire [1] evaluates with 33 items psychosocial adjustment (3 subscales), activity restriction (1 subscale) and satisfaction with prosthesis (2 subscales). Patients and methods One hundred and twenty-nine patients with a mean age of 62 years and with lower limb amputations for at least 1 year were recruited in 5 clinical centers. Translation and cross-cultural adaptation were made according to international guidelines. Internal consistency of each subscale was measured with Cronbach's alpha. Test-retest reliability was assessed by intraclass correlation in a sub- group of 24 subjects who completed the TAPES-R twice with an interval of 7 days. Construct validity was estimated through correlations with 2 main components of SF-36 (MCS, PCS). Correlations were also calculated with 3 scales of the Brief Pain Inventory (BPI). Results Cronbach's alpha was high, ranging from 0.85 to 0.95. Reliability was acceptable to high (ICC = 0.72 to 0.91) for all subscales with the exception of the Social adjustment (ICC = 0.67) and Adjustment to limitation (ICC = 0.42) subscales. The 2 component of SF-36 was significantly correlated with all subscales (PCS: r = 0.24 to 0.66); MCS: r = 0.30 to 0.58), except with aesthetic satisfaction and adjustment to limitation. Regarding the BPI, significant correlations were found for all subscales ( r = –0.20 to –0.68) with the exception of adjustment to limitation. Ceiling or floor effects (>15%) were found for all but Activity Restriction and Functional Satisfaction Scales. Discussion The TAPES-R-F has acceptable psychometric properties for most of its subscales. Our results may suggest that the French version is more useful in a population research perspective than in an individual perspective. Other studies are necessary to clarify the role and the psychometric properties of this measurement. [ABSTRACT FROM AUTHOR]

Objectives If the benefits of single-event multilevel surgery (SEMS) in ambulatory children with cerebral palsy have already been validated, especially in terms of functional outcomes, fewer studies have evaluated SEMS in terms of quality of life and satisfaction with surgical outcomes, especially pertaining to the opinions of children and their family. The objectives of this study were to confront the perceptions of parents and the experience of their operated children in terms of quality of life and surgical outcomes. Materials and methods This was an observational, descriptive, single-center study conducted in a regional Pediatric Physical Medicine and Rehabilitation (PM&R) center, which is considered a reference center in this region of France. The subjects recruited were ambulatory children with cerebral palsy (CP) who had SEMS between 2009 and 2011, and one of their parents. The specific “child” and “parent” CP-related modules of the DISABKIDS questionnaire were used to assess these children's quality of life post-surgery. Perceptions of parents and children regarding gait evolution and satisfaction with surgical outcomes were analyzed via a questionnaire developed by the author. Regarding quality of life and surgical outcomes, the correlation between the perception of parents and experience of children was estimated using the intraclass correlation coefficient (ICC) or prevalence-adjusted bias-adjusted kappa values (PABAK). Results Twelve children (83% of them boys) and their parents participated in the study. For the DISABKIDS questionnaire, a moderate correlation was found regarding functional impact (ICC = 0.58; P < 0.0178) but a high correlation was reported for the communication item of the questionnaire (ICC = 0.73; P = 0.0025). Regarding satisfaction with surgical outcomes, results showed a good correlation (PABAK = 0.64). Conclusion Concerning quality of life and satisfaction with surgical outcomes, our study showed a good or even high correlation between parents’ perceptions and their child's experience. It is however essential to privilege the child's opinion whenever possible. [ABSTRACT FROM AUTHOR]

Abstract: Patellofemoral pain is likely due to compressive force acting on the patella related in turn to knee extension moment. The latter variable was assumed to be (i) reduced during short-distance free walking in case of patellofemoral pain syndrome and (ii) increased after therapeutic pain reduction. Peak knee extension moment at beginning of stance phase was recorded by three-dimensional gait analysis in 22 controls and in 23 patients with patellofemoral pain syndrome before and after rehabilitation of knee extensors and flexors to reduce the pain. Pain would occur mainly in stressful activities such as stair negotiation or squatting and was quantified by the anterior knee pain scale. Peak knee extension moment was significantly reduced in all the patients before treatment (n =23) compared to controls, although no one had pain during free walking. In the 17 patients who experienced significant post-rehabilitation pain reduction in their stressful activities, the peak knee extension moment was significantly reduced before treatment compared to controls and significantly increased after treatment, reaching values similar to control values. The peak knee extension moment during free walking appears to be a good kinetic variable related to a compensatory mechanism limiting or avoiding anterior knee pain and may be of interest in assessing knee dynamics alteration in patients with PFPS. [Copyright &y& Elsevier]

Introduction/Background The assessment and rehabilitation of aphasia through a neurolinguistic approach is well known, so as its functional impairments to communicate, and its psycho-social consequences. We make the hypothesis that severe aphasia might leads gradually to a decrease of communication among inpatients whose needs are supplied by the institution. We propose to evaluate a new tool, the Communication Independence Measurement (CIM) scale, built like the Functional Impairment Measurement (FIM) scale. Material and method The CIM scale was used among aphasic's inpatients in a neurorehabilitation center, at baseline (M0) and 3 months (M3), by 4 different professionals (2 speech therapists and 2 nurses or carers). Four subdomains were evaluated, from 1 to 7 (motivation to communicate, expression, understanding, interaction). Psychometric properties and correlation to the Boston Diagnostic Aphasia Examination (BDAE) severity grade were analysed. Results Fifty-five patients (mean age 48 ± 11.8 years old, sex ratio 0.83) were consequently included, at 0.91 ± 1.49 months from stroke. Seventeen of them were evaluated at M3. Inter-rater validity was good, with no statistically difference between the 4 examiners at M0 (Kruskal–Wallis test P = 0.77) and at M3 (Kruskal–Wallis test P = 0.96). CIM was highly correlated to BDAE at M0 [intraclass correction (ICC) = 0.60–0.69] and at M3 (ICC = 0.82–0.85). We founded that patients who obtained a score less than the cut-off value of 35 had a bad daily communication. Conclusion The CIM scale seems to be a reliable tool to measure communication in aphasics in rehabilitation center. It might help identifying and thus helping patients with a negative prognosis of communication early during post-stroke rehabilitation time. [ABSTRACT FROM AUTHOR]

Summary Introduction Evolution of comatose patients can be made either towards a persistent vegetative state (or unresponsive wakefulness syndrome–UWS), minimally conscious state or a recovery of self and environment awareness. Investigations remain insufficient to estimate the prognosis and optimize the orientation and long-term follow-up of these patients in physical and rehabilitation medicine (PRM). Multimodal magnetic resonance imaging (MRI) are being evaluated for the diagnosis and prognosis of altered consciousness states [1,2] . Diffusion tensor imaging (DTI) could predict the mid-term evolution within a 95%-specificity. Case report A 29-years-old woman gives birth by vaginal delivery (pre-eclampsia) with the onset of a HELLP syndrome. At 4 A.M., comatose state (GCS: 3/5). TDM showed a parenchymal pontine and midbrain hematoma. No sign of awakening. The brain MRI (M3) showed atrophy (pons, midbrain, and middle cerebellar peduncles). DTI sequence with tractography shows a complete interruption of the left corticospinal tract as well as a rarefaction of inferior cerebellar peduncle fibers. The patient occasionally opens her eyes, without eye-tracking or other awakening sign (M10). The question then arises of the orientation of this patient in a persistent vegetative states unit and the future taking care by PRM team. Discussion DTI MRI with measure of anisotropy fraction could be a promising tool in order to predict the prognosis of altered conscious states and optimize the orientation and long-term follow-up of these patients in PRM. [ABSTRACT FROM AUTHOR]

Objective Exercise behavior has shown its interest in cancers and may have a prognosis value in brain tumors [1] . The aim of this prospective study is to show the effectiveness of a guided personalized rehabilitation-reconditioning program in brain tumors. Patients Inclusion criteria: patients over 18; complain of fatigue and decrease or interruption of a physical activity; histological diagnosis of brain tumor; Karnofsky Performance Status > 60. Exclusion criteria: major neurological or cognitive impairment; cardiac or pulmonary contraindication; high risk of tumor progression. Methods Patients underwent an incremental, physician-supervised cardiopulmonary exercise test (CPET) before including the personalized rehabilitation reconditioning program. The program included 5 to 10 individualized sessions, supervised by a physiotherapist; from 30 to 45 minutes per session; 1 to 2 times per week; altered or continuous on walking treadmill or bicycle. The endurance phase was calculated depending on results of the CPET. The objectives of the sessions were personalized; the physical therapist gave the patient therapeutic advices to continue physical activity after the reconditioning program, with a written notebook of follow-up for self- sessions provided at home. The primary outcome was a 6-minute walk test (6MWT) [2] . Results Nineteen patients, mean aged of 53 years old (standard deviation 14.2) were proposed by the neurologist to follow the program; 11 had high-grade glioma and 8 of them low-grade glioma. Fourteen patients were included; 9 completed the program, 3 are currently following it. At follow up, all patients who had completed the program increased their walking speed from 1.68 m/sec (6 km/h) to 1.92 m/sec (6.9 km/h) ( p = 0.022). Discussion Brain tumor survivors can improve walking function after a personalized and guided rehabilitation reconditioning program. This study is a preliminary study before a controlled study measuring the effects of such a program on quality of life and survey in glioblastoma. [ABSTRACT FROM AUTHOR]