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The usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.This was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.We reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%-10%; P0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P0.05).Disabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.

Introduction/Background Ambulatory care is the most frequent type of rehabilitation for chronic diseases. French guidelines recommend after a stroke assessment and rehabilitation by a multidisciplinary team for all the patients with a persistent deficiency. According to the needs of each patient, different ways to provide home rehabilitation can be used in France. For simple needs targeting specific deficiency, rehabilitation can be provided by a professional alone in ambulatory care. Only Physiotherapy (PT) and speech therapy (ST) are refunded by the national health insurance. For complex needs a PRM multidisciplinary team, can be ordered either in day hospital (the patient living home and receiving rehabilitation during repeated stays) which is the main organization, or mobile rehabilitation team, the team coming each day at home like an early supported discharge team (not very developed in France). Material and method We report here the global activity base on the analysis of the national registry on the 80,000 annual new strokes (excluding transient attacks and deceased) Results After the acute care, 37% of stroke patients received a multidisciplinary rehabilitation during a mean of 3 months (33% in an inpatient center and 4% in an outpatient center). For the patient discharge at home 30% (directly discharge from an acute center) to 50% (discharge from a rehabilitation center) receive PT and 9 to 15% ST. At the chronic phase 35% of the patients receive PT at home. Ambulatory occupational therapy and ST are less developed and less available. Conclusion Effort is needed to improve multidisciplinary rehabilitation at home in France. Home hospital could be interesting to develop for dependent and fragile patients, mobile rehabilitation team for the rehabilitation of the instrumental activities of daily livings, and day hospital for rehabilitation requiring technical platform of a rehabilitation center.

Objective The positive effects on motor cortical excitability of stimulating proprioception with tendon vibration therapy have previously been reported in healthy individuals and in chronic stroke patient (Marconi et al., 2008 and 2011). The aim of this study is to evaluate the feasibility of a protocol of tendon vibration therapy in a neurorehabilitation service, with a view to proceeding to an efficacy study. Material/Patients and methods We performed a prospective, single-centre study, including 11 patients, 8 men, mean age 61,7 ± 10,6, with upper limb motor deficit secondary to a first stroke (5 ischaemic). Average time post-stroke was 116.8 days. Mean NIHSS at inclusion was 7,9 ± 5,7. Two 15-minute sessions per day for 5 days of vibration therapy associated to voluntary movement were applied to the elbow and wrist flexor and extensors of the hemiplegic arm. The vibration therapy was in addition to standard rehabilitation. The feasibility was assessed by the implementation of the protocol (logistic regression of sessions, who did it? Where? When?), adverses outcomes and tolerance. Assessment of motor function at baseline and at day 7 was performed with Fugl-Meyer (upper limb), ARAT, Box and Blocks Test and ARMEO was used to assess the volume of exploration of the arm. Functional recovery was measured by the difference between the two scores. Results Nine patients were eligible (1 transferred to another ward for a septicaemia; 1 incomplete assessment at day 7). 97.7% of planned vibration sessions were performed. There were no adverse outcomes. Treatment was well tolerated; 1 patient reported transient paraesthesias and 4 patients reported significant fatigue whilst undergoing therapy. Every patient improved motor control: mean delta (±SD): ARAT: +8.6 points ± 14.2; BBT: +3.5 points ± 10.8; Fugl Meyer: +3.3 points ± 4.2; volume of exploration ARMEO: +38% ± 75.1%. Discussion - Conclusion This preliminary, open-labelled, study demonstrates that this protocol is achievable in a neurorehabilitation clinic setting. Given the functional improvement seen, randomised controlled trials should be performed to further evaluate the effects on motor control.

Objective Patient's endurance capacities are decreased after a central nervous system damage. Due to their motor impairment, the cardiorespiratory capacity assessment is compromised. The goal of this study was to assess the feasibility of an endurance-training program, without an exercise stress test but with cardiologic predefined parameters. Material/patients and methods An individualized endurance training program of 30 sessions divided into 3 sessions per week, was developed from predefined cardiovascular criteria: the heart rate (HR) throughout the exercise must be lower than that defined by Karvonen formula [Training HR = resting HR + 0.6 (220 – age – resting HR)] and the blood pressure (BP) must be lower or equal to 190 mmHg. Based on these criteria, exercise's duration and power were adjusted to obtain, in the first session, an exercise duration of 20 minutes with a perceived exertion ≤ 11/20, assessed with Borg scale. The duration and the power were gradually increased respecting a perceived exertion ≤ 12/20, to obtain, at the fifth session an exercise duration of 30 minutes. For next sessions, the duration of the effort was 30 minutes and the power was gradually increased and adjusted to keep a perceived exertion ≤ 14/20. Results Twenty-eight patients [age 51.3 ± 12.6, ratio M/F: 15/13, stroke: 19 (68%)] have fully underwent the first session of this program. Eleven have been assessed onto an arm motor driven, 11 onto a leg motor driven and 6 on a treadmill. Throughout the session, the perceived exertion was 12 ± 2, the training HR has been reached for only two patients and the blood pressure was lower than 180 mmHg for all patients. Discussion – conclusion This endurance training program can be proposed in patients after central nervous system damage to improve their endurance capacities.

Introduction Le demi-tour est evalue en routine a l’aide du nombre de pas exterieurs et de sa duree. Ces deux parametres ne rendent pas compte de toute la cinematique du demi-tour ce que pourraient permettre en routine les capteurs inertiels (IMUs). Nous avons : – compare les strategies de demi-tour spontanees des sujets hemiparetiques droits (HD) et gauches (HG) post-AVC avec des IMUs ; – etudie la correlation des strategies avec la survenue de chute. Materiel et methodes Tous les sujets etaient droitiers ; 17 HD (43 a 73 ans, moyenne 57,5) et 20 HG (43 a 63 ans, moyenne 59,6) ont ete inclus. Ils devaient realiser un demi-tour dans la direction de leur choix apres 10 m de marche en portant 1 IMUs a la ceinture et 1 sur chaque pied. Nous avons defini 3 patterns de demi-tour bases sur le nombre de pas exterieurs (pattern I = 1 ; II = 2–4 pas ; III ≥ 5) et 4 strategies de demi-tour basees sur le cote spontanement choisi pour tourner (sain ou paretique) et le premier pied d’appui du demi-tour (sain ou paretique). Le nombre de chute dans les 6 mois suivant la mesure a ete evalue par questionnaire telephonique. Resultats Les HG et les HD ont des resultats similaires en termes de patterns de demi-tour, cependant 90 % des HG tournent spontanement du cote hemiparetique contre seulement 59 % des HD (p = 0,01, Chi2). Cette difference augmente lorsque l’on regarde les strategies de demi-tour : 85 % des HG versus 29 % des HD (p = 0,04, Chi2) etaient en strategie 4 (demi-tour du cote paretique avec premier appui sur le pied paretique). Les patients utilisant la strategie 4 avaient un risque de chute plus eleve. Discussion – conclusion Les strategies de demi-tour evaluees en routine avec des IMUs pourraient constituer un indicateur supplementaire de chute.

Objective Music therapy enhances awareness of sound perception and musical sensorial experience often highly impaired following a stroke, confirmed by music's neurosciences. The study aims to verify its reception and utility in a Physical Medicine and Rehabilitation (PMR) service with professional team and patients. Material/patients and methods Eleven hospitalized patients were included after stoke (without regular instrumental practice, speech disorder, severe hearing loss nor psychiatric history). They were followed by a music therapist, twice a week, during 40 minutes’ individual sessions with improvisation and music listening, from October 2015 to April 2016 with an instrumentarium. The study consisted of analysing self-administered questionnaires, both to patients (after each session) and professionals, on the feeling and the impact on the primary activity of the service. Results Thirty-one returned questionnaires among the 47 caregivers indicate that sessions were simple to implement (81%) and carried low restrictive measures (94%). For 90%, music therapy can be easily integrated into the course of the day. For 96%, it did not obstruct the proper functioning of the service. Hundred percent believed that it can be helpful for the patient and can improve practices in PMR. Seventy-three percent noticed an improvement in patients, in particular mood, motivation and self-esteem. Hundred and ten sessions were carried out and appreciated by patients. Ninety-eight percent replied that they felt more relaxed, calm, alert, awake, a feeling of well being and rested. Discussion - conclusion Patient compliance and reaction of the team were excellent. Moreover, it was observed that, over the sessions, there had been a progressive development in listening abilities, in creativity and an improvement in rhythmic and melodic skills. Although they were not quantified, it encourages us to continue the study.

Objective Fall is a common complication in post-stroke populations and more likely occurs in left paretic (LP) than in right paretic patients (RP). Since kinematic characteristics of post-stroke patients’ turn have not been clearly established, the goal of this study was to analyze with inertial measurement units (IMUs) spontaneous and constraint 180° turn in those patients and in aged matched healthy controls (HC). Material/patients and methods Seventeen RP patients (43 to 73 years, mean 57.5), 22 LP patients (43 to 63 years, mean 59.6) and 15 healthy controls (36 to 83 years, mean 56.7) were included. All subjects were right handed. They were instructed to turn 180° in a self-selected direction and then in the constraint direction, wearing 3 IMUs on the trunk and on both feet. A synthetic kinematic data representation allowed to observe turning parameters. Results Differences were observed in turn duration, number of external steps and mean angular velocity between HC and RP, HC and LP, but not between RP and LP. The spontaneous side of 180° turn was the paretic side for 50% of RP versus 95% of LP. Spontaneous turn to the paretic side was initiated with the paretic foot (i.e. the paretic foot was first in stance phase after turn onset) for 50% of RP versus 90% of LP. Considering that turning to the paretic (and hypoesthesic) side is at high risk of fall, we propose to grade the risk of fall from 1 (low) to 4 (high): turn to the healthy side initiated with the healthy foot (score 1/4), healthy turn with paretic foot (2/4), paretic turn with healthy foot (3/4) and paretic turn with paretic foot (4/4). In recent post-stroke patients ( Discussion–conclusion This original study permitted us to observe spontaneous and constraint 180° turn in post-stroke patients using a synthetic representation with IMUs. Thanks to sensors, the foot on which the 180° turn was initiated could be determined and showed differences between RP and LP. Those results are consistent with fall epidemiology.

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