Biomedical subjects

I Bonan

Publications and source records attributed to I Bonan.

9 recordsLinked to original sources

PubMed2006

Fatigue after stroke.

OBJECTIVES: To examine the phenomenon of fatigue after stroke and to review the knowledge about frequency, consequences, associated factors, physiopathology and treatment. MATERIALS AND METHOD: Medline was systematically searched with the following keywords: stroke, fatigue, sleep disorders, exercise, and rehabilitation. All relevant articles found in the references were screened as well. RESULTS AND DISCUSSION: Fatigue is a common complaint after stroke and occurs in 39-72% of stroke survivors. Some studies show a severe functional impact of this symptom as well as a high mortality rate. Available evidence concerning associated factors is limited, but fatigue is clearly multifactorial. Some studies show that limited exercise capacity, increased gait energy cost, sleep-disordered breathing and sleep disorders can be related to physical fatigue. Other studies show a link between fatigue and depression. The existence of primary fatigue is still controversial. Treatment must follow a diagnostic approach. Treadmill training, among other treatments, improves fitness reserve and lowering of the energy cost of hemiparetic gait, which could be useful in relieving fatigue.

Depression↗

PubMed2006

[Visual dependence after recent stroke].

INTRODUCTION: After chronic stroke, inability to use pertinent somatosensory or vestibular information have been described. The aim of the study was to determine whether visual dependence occurred early after stroke before rehabilitation. METHOD: Thirty patients with recent hemiplegia (16 right and 14 left hemispheric stroke) performed the rod and frame test (RFT). Patients were asked to adjust the rod to the vertical position under 3 conditions: basically, with a frame tilted 18 degrees to the right and then with the frame tilted to the left. Bias in each condition (mean, SD) was recorded and compared to adjustments of the rod by 23 controls. Motor control, sensibility, functional level (functional independence measure), age, neglect, and then balance by the postural assessment scale for stroke were assessed. RESULTS: Fifty-six per cent (17/30) of patients but only 26% of controls were influenced by the tilt of the frame on the 2 sides (visual dependence). No correlation was found between visual dependence and the characteristics of the patients. DISCUSSION: Many patients with recent hemiplegia seem to rely on visual input. The mechanisms of such visual dependence are discussed. Rehabilitation programs should take into account the possible impairment of sensory organisation and should include exercises to be performed under visual disturbances.

Data Interpretation, Statistical↗

PubMed2005

[Evaluation of the disabilities of hemiplegic patients].

OBJECTIVES: To identify and describe the most useful functional disability scales for assessing post-stroke hemiplegic patients and those used largely in clinical trials. METHODS: A literature review of Medline about the functional parameters for balance, gait and mobility, upper extremity functional abilities, and activities of daily living. The metrologic properties of the scales were specified as were their clinical use. RESULTS: Thirty-three scales were evaluated and classified into five categories: balance (6 scales), gait and mobility (4), upper limb function (11), global motricity scales (5) and independence in activities of daily living (7). DISCUSSION AND CONCLUSION: Many functional scales are useful for assessing post-stroke hemiplegic patients. To assess balance, the Postural Assessment Stroke Scale and Berg Balance Scale are the most interesting. The Functional Ambulation Classification and the Timed Up and Go Test are the most relevant to assess gait and mobility. The Action Research Arm Test is largely used to assess upper limb functional abilities. The Functional Independence Measure and the Barthel Index are largely used to assess independence in activities of daily living.

Disability Evaluation↗

PubMed2002

[Efficacy at six months of the botulinum toxin A in the post-stroke lower limb's muscular overactivity].

OBJECTIVE: Post-stroke hemiplegic patients are often disabled by a muscular overactivity of the lower limb which can be treated by botulinum toxin A (BTX). The aim of this study was to assess the length of this efficiency as expressed by the patient. MATERIAL AND METHOD: The study was conducted among consecutive patients with post-stroke hemiplegia, disabled by a distal muscular overactivity of the lower limb. The injection of BTX (Botox Allergan) was given under electrostimulation guidance. Efficiency was assessed by the patient at 1, 3 and 6 months, by means of a three-point scale (absent, real but not enough, very good), on the basis of individual objectives previously defined after the precise description of the symptoms, their type of triggering and their functional impact. RESULTS: Fifty-seven sessions were conducted in 36 patients. At 1 month, 81% of the sessions were efficient, 39% with very good results. At 6 months, 57% of the sessions were still efficient with 25% of very good results. The best results were observed on the permanent extension of the great toe: the efficiency remained very good at 6 months for 47% of the sessions. CONCLUSION: Having been assessed by the patients on the basis of individual objectives, the good result of the treatment by BTX can persist for more than 6 months. This assessment is partly subjective but is, in clinical use, the main basis for the treatment discussion.

Adult↗

PubMed2000

Anatomic motor point localization for partial quadriceps block in spasticity.

OBJECTIVE: To identify the location of the vastus intermedius nerve and its motor point (point M) and to precisely identify its coordinates in relation to anatomic surface landmarks. DESIGN: Descriptive study. SETTING: Anatomy institute of a university school of medicine. PARTICIPANTS: Twenty-nine adult cadaver limbs immobilized in anatomic position. INTERVENTION: Anatomic dissection to identify point M. Anatomic surface landmarks were point F, the issuing point of femoral nerve under the inguinal ligament; point R, the middle of superior edge of the patella; segment FR, which corresponds to thigh length; point M', point M orthogonal projection on segment FR. MEAN OUTCOME MEASURE: Absolute vertical coordinate, distance FM, relative vertical coordinate compared to the thigh length, FM'/FR ratio; absolute horizontal coordinate, distance MM'. RESULTS: The absolute vertical coordinate was 11.7+/-2 cm. The relative vertical coordinate was at .29+/-.04 of thigh length. The horizontal coordinate was at 2+/-.5 cm lateral to the FR line. CONCLUSION: Point M can be defined with relative precision by two coordinates. Application and clinical interest of nerve blocking using these coordinates in quadriceps spasticity should be studied.

Adult↗

PubMed1999

A clinical guide to assess the role of lower limb extensor overactivity in hemiplegic gait disorders.

BACKGROUND AND PURPOSE: The aim of this study was to assess the role of knee and ankle extensor overactivity in the hemiplegic gait observed in stroke victims and to propose a clinical guide for selecting patients before treatment of a supposed disabling spasticity. METHODS: A standardized physical examination procedure was performed in 135 consecutive stroke patients. All patients were able to walk without human assistance. The period after stroke ranged from 3 to 24 months (mean, 11.5+/-7.25 months). Spasticity was evaluated with the stroke victim in sitting position and during walking. Overactivity of the quadriceps was considered disabling when inducing inability to flex the knee during the swing phase despite adequate control of knee flexion in sitting and standing positions; overactivity of the triceps surae was considered to be disabling when heel strike was not possible despite good control of the ankle flexion in sitting position; triceps retraction was also considered. RESULTS: Disabling overactivity was observed in 56 (41.5%) patients: 11 times for the quadriceps femoris, 21 times for the triceps surae, and 21 times for both muscles. It was considered to be the main disorder impairing gait among only 16 (12%) patients: 9 for the quadriceps alone, 3 for the triceps alone, and 4 for both. Sitting spasticity of the lower limb was not predictive of disabling overactivity during walking. CONCLUSIONS: Extensor muscle overactivity is one of the components of gait disorders in stroke patients. The difficulty in assessing spasticity and its real causal effect in gait disturbances are discussed. A clinical guide is proposed.

Adult↗

PubMed1998

Computerized tomographic angiography scan following carotid endarterectomy.

The purpose of this study was to evaluate the role of computed tomographic angiography (CTA) for postoperative assessment of carotid endarterectomy (CE). Twenty carotid endarterectomies were performed and controlled by using (1) intraoperative angiography, (2) postoperative duplex scanning and CTA with multiprojection volume reconstruction (MPVR). Intraoperative angiographic controls were deemed satisfactory for all patients. In 12 patients, the postoperative morphological aspect was satisfactory with CTA and duplex scanning. In the eight remaining patients, CTA and/or duplex scanning revealed 12 abnormalities: 3 were equally visualized on CTA and duplex scanning, 6 only on CTA and 3 only on duplex scanning. CTA is a rapid and noninvasive technique allowing the surgeon to get informative and comparative data. It might be an interesting alternative to postoperative angiography.

Aged↗

PubMed1998

Magnetic resonance imaging of cerebral central sulci: a study of monozygotic twins.

The cerebral central sulci, seat of the sensorimotor cortex, vary anatomically in form, length and depth among individuals and present a left/right asymmetry. The purpose of this work was to measure central sulcus's lengths, at the surface and in-depth, in each hemisphere of monozygotic twins in order to evaluate the influence of environmental factors on the morphometry and asymmetry of this structure. A measurement technique on MR images of the brains using 3 D software was developed. Two operators applied this technique to measure central sulcus lengths at the surface of the brain and in-depth in each hemisphere. Besides the fact that the technique developed gave high Intraclass Correlation Coefficients (ICC) for the surface lengths (mean value 0.94), and slightly less high for the in-depth length (mean value 0.87), we found a weak (from 0.57 to 0.73 for raw data) but significant ICC between homologous sulci in pairs of twins. In addition, the ICC for asymmetry indices were not significant. Hence, if central sulcus morphometry is in part genetically influenced, these results show that nongenetic factors are nonetheless important in their development.

Adult↗

PubMed1996

Changes in the execution of a complex manual task after ipsilateral ischemic cerebral hemispheric stroke.

OBJECTIVE: To analyze behavioral adaptation of hemiplegic patients performing a complex manual task without time constraint. It was postulated that ipsilateral motor disturbance could not be observed after a hemispheric stroke. DESIGN: Two manual tasks were used: (1) a new one, "Pig-Tail," required the patients to run a 3-cm-diameter copper ring in a wooden handle along a wavy copper wire without any time constraint; (2) the second task was the Nine-Hole Peg Test (NHPT). SETTING: A hospital department of rehabilitation. PATIENTS: A consecutive sample of 36 patients, who had all suffered an ischemic stroke in the middle cerebral artery territory, 18 with left hemisphere damage (LHD) and 18 with right (RHD), and who had similar ages (mean 54 +/- 13), stroke severity, time since stroke (mean 60 days), and functional independence according to the FIM. MAIN OUTCOME MEASURE: Main data were number of faults, time in seconds, and difference of time for two trials. Analysis compared the results with the same hand for patients and 86 healthy subjects. RESULTS: Patients scores for NHPT were worse than controls, whatever the side of the lesion (p < .05). For Pig-Tail, the number of faults by patients was greater than by controls (p < .05); time was higher for LHD, but not significantly, and was similar to controls for RHD. All patients and controls speeded up between the two trials. Although the RHD were clumsy, they were always faster than LHD patients. CONCLUSION: There are ipsilateral motor disturbances in a complex manual task after hemispheric stoke, even without a speed constraint, and regardless of the hemisphere damaged. Further studies are needed to examine speed control that seemed impaired by right hemisphere damage and could explain clumsiness in these patients.

Adaptation, Physiological↗