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Biomedical subjects

M P Le Bot

Publications and source records attributed to M P Le Bot.

6 recordsLinked to original sources
PubMed2000

Clinical experience with functional electrical stimulation-assisted gait with Parastep in spinal cord-injured patients.

STUDY DESIGN: Clinical evaluation of the Parastep method, a six-channel transcutaneous functional electrical stimulation device, in spinal cord-injured patients. OBJECTIVES: To investigate the motor performances of this new technique regarding energy expenditure and to evaluate its advantages and limitations, especially in social activities involving ambulation. METHODS: This study was conducted in 15 thoracic spine-injured patients. The lesion was complete except in two patients. The gait ability and the functional use were judged clinically. Energy cost was evaluated from heart rate, peak oxygen uptake, and lactatemia. RESULTS: Thirteen patients completed the training (mean: 20 sessions) and achieved independent ambulation with a walker. The mean walking distance, without rest, was 52.8 +/- 69 m, and the mean speed was 0.15 +/- 0.14 m/sec. One patient with incomplete lesion, who had been nonambulatory for 8 months after the injury, became able to walk without functional electrical stimulation after five sessions. The follow-up was 40 +/- 11 months. Five patients pursued using functional electrical stimulation-assisted gait as a means of physical exercise but not for ambulation in social activities. The patients experienced marked psychological benefits, with positive changes in their way of life. In three subjects, a comparison of physiologic responses to exercise between a progressive arm ergometer test and a walking test with the Parastep (Sigmedics, Inc., Northfield, IL) at a speed of 0.1 m/sec was performed, showing that the heart rate, the peak oxygen uptake, and lactatemia during gait were close to those obtained at the end of the maximal test on the ergometer. CONCLUSIONS: In spite of its ease of operation and good cosmetic acceptance, the Parastep approach has very limited applications for mobility in daily life, because of its modest performance associated with high metabolic cost and cardiovascular strain. However, it can be proposed as a resource to keep physical and psychological fitness in patients with spinal cord injury.

Adolescent↗
PubMed1998

Vesicourethral dysfunction and urodynamic findings in multiple sclerosis: a study of 149 cases.

OBJECTIVE: Vesicourethral dysfunction is common in people with multiple sclerosis and results in significant impairment. We studied the clinical and urodynamic findings in such patients to define risk factors for incontinence and upper urinary tract infections. DESIGN AND SETTING: A cohort study of 149 patients with multiple sclerosis and urinary symptoms seen in our urodynamic laboratory. INTERVENTION: A complete urodynamic study of each patient with urethrocystometry and continuous recording of the urethral sphincter electromyography and assessment of postvoid residual. RESULTS: Detrusor hyperreflexia and sphincter dyssynergia were the main dysfunctions. No significant relation between clinical features and urodynamic patterns was found. Women with low maximal urethral pressure were particularly prone to incontinence, which occurred in 69% of the patients. Pyelonephritis was associated with a postvoiding residual urine of > 30% of the functional detrusor capacity, and was found more often in the male population. CONCLUSION: Urodynamic assessment of bladder function is critical to direct therapy for urinary complaints in people with multiple sclerosis.

Adult↗
PubMed1998

Treatment of detrusor sphincter dyssynergia by transperineal injection of botulinum toxin.

Detrusor-sphincter dyssynergia is an involuntary contraction of the external urethral sphincter during the detrusor contraction. It causes voiding dysfunction and can lead to urologic complications such as hydroureteronephrosis and renal failure. Patients with spinal cord injuries are particularly vulnerable. Botulinum toxin has been used via cystoscopy to decrease the activity of the external urethral sphincter. This report describes the treatment of 5 tetraplegic patients by single transperineal injections of botulinum toxin for detrusor-sphincter dyssynergia, proved by a urodynamic study with electromyography. A total of 15 injections was given, resulting in improved bladder function in all patients. Urodynamic assessment after treatment showed an increase of the functional detrusor capacity and a decrease of the maximal detrusor pressure during voiding. These results confirm the consideration of botulinum toxin as a treatment for detrusor sphincter dyssynergia. A single transperineal injection is a valuable, less invasive treatment using a cystoscopic technique.

Adult↗
PubMed1998

Influence of urinary management on urologic complications in a cohort of spinal cord injury patients.

OBJECTIVE: To study urologic complications in patients with spinal cord injury (SCI) in relation to their bladder management. DESIGN AND SETTING: A cohort study of patients with SCI in a rehabilitation center. PARTICIPANTS: One hundred eighty-two patients were studied; demographic data, disease characteristics, and urologic history were obtained for each. INTERVENTION: Patients responding to a questionnaire were given a clinical exam. Their medical records were reviewed, with particular attention given to the following urologic complications: lithiasis, urinary infections, orchiepididymitis, urethral trauma, vesicorenal reflux, and renal failure. RESULTS: Results are reported for 123 patients. Time since SCI was 8 years. Intermittent catheterization was the main method of bladder management. Only 32 patients had changed their method of vesical voiding. Urinary complications had developed in 75% of patients. The most common complication was urinary infection. Vesicoureteral reflux occurred in 26% of patients using percussion. Trauma related to catheterization was the main problem with intermittent catheterization, responsible for a high rate of orchiepididymitis. CONCLUSION: Intermittent catheterization is the most-used method of bladder management, but with a nonnegligible rate of urethral trauma in men. Percussion and Credé maneuver appear to be acceptable techniques of bladder management if the patient is closely monitored.

Adult↗
PubMed1994

[Heterotopic ossification and vascular compression].

Heterotopic ossification is common in patients with spinal cord or brain injury. Whereas the articular complications of heterotopic ossification have been well documented, the vascular complications are less well known. We report three cases with vascular compression and discuss the diagnosis and treatment in the light of a review of the literature.

Adult↗