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PubMed | Center Appareillage Ouest Orthopedie, CHRU de Brest and University of Western Brittany
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

Traumatic lower limb amputation is rare in pediatric population, and surgeons always try limb salvage. But rarely, later amputation occurred when the traumatic limb is painful. It is a difficult and irreversible decision needed a multidisciplinary approach. We report how we managed a programmed trans-tibial amputation on 13-years-old boy, 20 months after a foot trauma.Our patient is an adolescent victim of a left foot crash. The first checkup showed a degloving injury, dislocation of the interphalangeal joints and of all toes. Foot salvage was decided, but necrotic evolution required minor distal amputation and frequent dressings and skin grafts. Despite physiotherapy, orthosis (anti-equinus orthosis, orthopedics sole, orthopedics shoes) an equinus appeared. Moreover, he presented intense neuropathic foot pain, which required drugs, TENS and psychologic counseling. The foot presented secondary ulcerations requiring surgical cushioning. Seventeen months after trauma, the boy presented a painful, non-functional and ulcerative foot with important impact on quality of life (QOL). After multidisciplinary consultations, the boy and his parents decided a trans-tibial left amputation. A specific multidisciplinary preparation lasted 3 months: he met amputees, psychologist with and without his mother, certified prosthetist orthoptist, specialists of physical and functional rehabilitation, pediatric surgeon. Twenty months after trauma, trans-tibial amputation was carried out. One month after amputation: he walked with crutches, 3 months after: walked and could walks up and down the stairs. One year after: he had no pain, took no drug, got a satisfied gait on quantitative 3D gait analysis (3D GA), practices several sports, says that he has a normal teenager life, has an objective normal participation.There is no case on literature reported on late amputation on child after a trauma. So, there is no recommendations to prepare amputation or to know what can we expected from it. We report a specific preparation and objective results (QGA, participation, QOL). This experience can be useful for team facing this particular and difficult situation.

PubMed | CHRU de Brest
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

Maintaining physical activity for patient with neurological disorders is recommended for patient with multiple sclerosis (MS). The main objective was to assess physical activity and rehabilitation programs in patients with multiple sclerosis and compared it to recently published recommendations. The secondary objective was to evaluate the patient self-perception of these interventions on pain, fatigue, strength and global satisfaction.A prospective multicenter study conducted in the four counties of Brittany for patients with MS attending a consultation with a neurologist in the MS network NeuroSEP Bretagne. Data were collected by a self-administered questionnaire including: neurological involvement, qualitative and quantitative practice of rehabilitation activity and/or sport, self-evaluation using a Liekert scale and evaluation of fatigue using the fatigue severity scale (FSS).One hundred and sixty seven questionnaires were analyzed (out of 250 sent). Only 32.34% (n=54) of patients had regular physical activity (including sport and/or physiotherapy) in accordance to recommendations, and 30% had no physiotherapy and physical activity. In a multivariate analysis, an EDSS superior to 4 was the only negative predictor of physical activity (p=0.049). Physical activity is considered beneficial for symptom respectively 63.1% (n=77) of patients with an average of 0.71 on the Liekert scale for sport, and 85.9% (n=67) of patients for physiotherapy with an average 1.14.The level of physical activity in MS patients is insufficient in our population. Educational programs and adapted activities are needed to improve patients care.

Houx L.,CHRU de Brest | Brochard S.,CHRU de Brest | Lempereur M.,CHRU de Brest | Remy-Neris O.,CHRU de Brest
Prosthetics and Orthotics International | Year: 2012

Background and Aim: In order to increase understanding of the biomechanical consequences of equinus foot on gait, we developed an orthosis to induce an adjustable degree of unilateral equinus. The aim of this study was to evaluate its feasibility and consequences on 3D ankle kinematics and kinetics.Technique: 3D gait analysis was carried out in 10 healthy children without the orthosis, with the non-adjusted orthosis and with the orthosis adjusted to +10°, 0°, -10°, -20° of ankle dorsiflexion and maximum plantarflexion (MP). The amount of dorsiflexion at initial contact was close to the goniometric measurement. Significant kinematic and kinetic changes occurred at -10°, -20° and MP. The mean maximum equinus at initial contact -21.65° ± 4.17 and during stance -11.61° ± 4.82 were larger than those obtained with previous described devices.Discussion: Our device was easy-to-use and induced an adjustable, well tolerated equinus. It provides a new way to simulate equinus and its biomechanical consequences on gait.Clinical relevanceThis study validated an orthotic device which induced an adjustable equinus. This device can be used to carry out biomechanical studies in children, increasing understanding of pathological problems and thus improving therapeutic management. © International Society for Prosthetics and Orthotics International 2011.

Brochard S.,CHRU de Brest | Alter K.,U.S. National Institutes of Health | Damiano D.,U.S. National Institutes of Health
Muscle and Nerve | Year: 2014

Introduction: We characterized bilateral shoulder strength and the balance of antagonist/agonist muscle pairs in children with brachial plexus palsy (BPP) and with typical development (TD). Methods: In 15 children with unilateral BPP and 11 with TD, bilateral maximal isometric shoulder strength in flexion/extension, internal/external rotation, and abduction/adduction was recorded using a hand-held dynamometer. Correlation between strength and active range of motion were evaluated using the Mallet score. Results: Children with BPP had strength asymmetry in all muscles, whereas children with TD had significant strength asymmetry for flexors and abductors. In children with BPP, extensors and external rotators were the weakest muscles, leading to sagittal and transverse plane muscle imbalances. Higher strength values were related to better active range of motion. Conclusions: This study highlights the importance of documenting shoulder strength profiles in children with BPP which may help predict deformity development. © 2013 Wiley Periodicals, Inc.

Le Borgne S.,CHRU de Brest
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2014

Falls are a frequent phenomenon among the elderly and sometimes fraught with consequences. Some falls question the clinician as to their mental determinism and as for their suicidal intentionality. Certain clinical situations are sometimes in favor of a suicidal initiative of the elderly person through his/her fall. All this makes falls a means of non-verbal communication; when the words are running out, the subject lets go and falls. The suicidal risk increases as the person gets older. The prevention of the suicidal risk involves a screening for nervous breakdown, often under-diagnosed and under-treated. © 2014 Elsevier Masson SAS.

Robinet G.,CHRU de Brest
Revue des Maladies Respiratoires Actualites | Year: 2014

Brain metastases have a poor prognosis. However, there are local therapies which may provide a cure for cancers with few or no metastases. © 2014 Elsevier Masson SAS.

PubMed | CHRU de Brest and Service de reanimation medicale
Type: Journal Article | Journal: Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine | Year: 2016

Hospital-acquired anemia is common, especially in the most critically ill patients. It may be associated with poor patient outcomes. It may result from increased blood loss, impaired red cell production or reduced red cell life span. Multiple associated factors may contribute simultaneously or sequentially to the decrease in hemoglobin level. Some of them are related to the underlying disease and others are iatrogenic. Clinicians should be aware of the importance and consequences of iatrogenic anemia caused by diagnostic blood sampling. Strategies and measures to minimize iatrogenic blood loss should be prioritized. They may reduce the risk of developing anemia and then red blood cells transfusion requirement.

PubMed | Brest University Hospital Center, CHRU de Brest, French Institute of Health and Medical Research and University of Western Brittany
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

Distal sensorimotor polyneuropathy (DPN) is a leading risk factor of developing ulcer, including increased pressures at the forefoot. The rocker sole shoes are prescribed to decrease pressures but could induce instability [1]. The aim of this study was to compare the postural stability between normal shoes (NS) and rocker sole shoes (RSS) in patients with type 2 diabetes and DPN.In this preliminary, randomized, controlled study, NS and RSS were compared during static standing and gait. The primary outcome was the biomechanical variable COP-COM (corresponding to the mean distance between the center of pressure and the center of mass) [2]. The center of mass (COM) was calculated with the anthropometric table [3] using the motion analysis system Vicon, when the ground reaction forces and moments were recorded by 2 AMTI force platforms allowing to compute the center of pressure (COP). The root mean square (RMS) amplitudes were calculated in both anterior/posterior (AP) and medial/lateral (ML) directions, eyes open (EO) and closed (EC). The secondary outcomes were the clinical variables Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) and a score determinated from 9 spatiotemporal parameters: the Gait Variability Index (GVI).Eighteen patients with type 2 diabetes were included with a mean age 63.38.6years, and BMI 30.35.1. There was no statistically difference between NS and RSS for the COP-COM variable in all conditions (AP: P=0.96 EO and P=0.68 EC; ML: P=0.75 EO and P=0.13 EC), and also for the other variables BBS, DGI and GVI (P>0.05). However, the stance time was significantly reduced (P=0.01) and the swing time was significantly increased (P=0.02).The rocker sole shoes seem to induce postural change during gait, without significant differences in quiet standing. For future studies, more sensitive assessment must be used and the number of subjects has to be increased to confirm these results.

PubMed | CHRU de Brest
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

Different ankle-foot orthoses (AFO) are often prescribed in children with cerebral palsy (PC) although their efficiency on gait remains unclear.(1) To determine the effect of AFOs on gait in children with CP and (2) to evaluate the effect of each types of AFO.Studies in English with control condition (barefoot or shoes) assessing effect of AFO about children with CP gait were search on the Pubmed, CINAHL+, Web of Science, Cochrane Library databases. Quality of each study was assessed by modified PEDRO scale. Only studies with a score more than 4 were selected. 10 gait parameters were extracted in each study. Effect size and 95% confidence interval were calculated for each parameter.Seventeen studies (490 subjects) were included. Comparing AFOs to control condition, stride length increased (15 studies) d=1.04 [95% CI: 0.69; 1.38], velocity increased (16 studies) d=0.27 [95% CI: 0.14; 0.41], cadence decreased (15 studies) d=-0.69, [95% CI: -0.95; -0.43]. Ankle dorsiflexion increased at initial contact (11 studies) d=1.64, [95% CI: 1.16; 2.11] and in swing phase (7 studies) d=5.21, [95% CI: 1.91; 8.52]. Ankle power generation in stance phase decreased (6 studies) d=-0.26, [95% CI: -0.38; -0.14]. The duration of tibialis anterior activation and energy data did not changed significantly. Four types of orthosis were found: dynamic AFO, hinged AFO, solid AFO, supra-malleolar orthosis. Hinged AFO was the orthosis that improved the greater number of gait parameters and was the only one to improve velocity with an effect size>0.8 (large effect).This study shows clinically significant effect of AFO on stride length, ankle dorsiflexion at initial contact and swing phase. Hinged AFO seems to have the greatest effect on gait. New data are needed to refine the choice of the orthosis according to the child gait pattern.

PubMed | University of Western Brittany, CHRU de Brest and service dhygiene hospitaliere
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2016

Flexible cystoscopes are high temperature sensitive devices that must undergo high-level disinfection according to Spaulding classification. The objective of this study is to provide epidemiological data on the monitoring of microbiological quality of cystoscopes used in a teaching hospital, in order to determine the compliance rate of disinfection and to describe the main identified microorganisms.Prospective study of all the results of microbiological samples taken for 8 years at the Brest teaching hospital. The analysis results were interpreted according to the ministerial recommendations.During the study, 87 microbiological tests were performed. The rate of non-compliant samples was 19.5% (17/87). This rate reached 24.5% (12/49) of the programmed controls. The microorganisms identified were present in small amounts, corresponding mainly to bacteria from the environment.The rate of non-compliance of the microbiological tests performed on cystoscopes is relatively high (19.5%), but the infectious risk seems limited. Hidden microorganisms are present in small quantities and identified germs are not known to be responsible for urinary tract infections. Educating professionals responsible for cystoscopes reprocessing and conducting regular audits may help to ensure a good level of cystoscope disinfection.

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