Objectives. - Studies have shown that there is co-activation between abdominal and pelvic floor muscles (PFM) in physiological conditions. This study aimed to assess pelvic floor and isokinetic trunk flexors function in non-active incontinent women, and to investigate the association between the strength of these muscle groups and the severity of stress urinary incontinence (SUI). Methods. - A cross-sectional study was carried out. Twenty-five incontinent women were enrolled after one-hour pad test results and compared to twenty asymptomatic women. Theseverity of SUI was determined by the Pad test and Urinary Distress Inventory, Short Form( UDI-6). PFM function was assessed using the modified Oxford Scale, intra-vaginal PFM electromyography, and PFM endurance according to the PERFECT scheme. Trunk flexors strength was assessed using a Cybex Norm II dynamometer. Results. - Incontinent women had a weaker PFM and isokinetic abdominal muscle strength compared to continent women (P < 0,05). SUI severity was negatively correlated with PFM strength (r = -0,620, P = 0,001), isokinetic trunk flexors strength (r = -0,605, P = 0,001), and PFM endurance (r = -0,561, P = 0,003) in incontinent women. A positive correlation between PFM function and isokinetic trunk flexors strength was found in incontinent women (r = 0,488, P = 0,013). Conclusion. - Non-active incontinent women had weaker pelvic floor muscles and isokinetic trunk flexors strength compared to continent ones. The positive correlation found betweenthese two muscle groups may be explained by their synergic activity. These findings suggestthat the severity of SUI could be related not only to PFM strength but also to abdominal muscle weakness. Further research is needed to recommend abdominal wall training as an alternative method to treat SUI.

Le muscle tibial postérieur (MTP) est le principal inverseur du pied et peut aider à une puissante flexion plantaire. Son évaluation fonctionnelle est particulièrement utile chez les patients présentant un steppage pour différencier une atteinte du nerf fibulaire d’une radiculopathie L5. Deux voies d’insertion de l’aiguille de l’électromyographie (EMG) dans le MTP ont été rapportées : une approche antérieure et une autre postérieure. Cependant, plusieurs auteurs considèrent toujours que le placement de l’aiguille de l’EMG dans ce muscle difficile, avec moins de 10 % de précision même avec une stimulation électrique. Le but de ce manuscrit est d’illustrer et de comparer les approches antérieure et postérieure de l’EMG échoguidée du MTP qui est considéré comme un muscle clé dans le diagnostic étiologique du step-page. Les deux approches antérieure et postérieure pour effectuer l’EMG échoguidée du MTP sont valides et sûres. Avec le contrôle échographique, le praticien doit clairement identifier ce muscle et devrait éviter de piquer les structures neurovasculaires de la jambe ainsi que les autres muscles adjacents. Cela nécessite non seulement une bonne connaissance de l’anatomie échographique de la jambe, mais aussi une technique rigoureuse de manipulation bimanuelle et d’insertion aseptique de l’aiguille de l’EMG.

Devant un steppage, le diagnostic différentiel entre une atteinte radiculaire L5 et une neuropathie fibulaire est assez difficile mais facilité par l’étude clinique et électrique du muscle tibial postérieur. Cependant, plusieurs études ont montré que le placement de l’aiguille de l’électromyographie n’est pas assez précis ni facile et que le repérage échographique facilite la détection électromyographique des éléments anatomiques difficiles (petits et/ou profonds) et la rend accessible surtout pour les cliniciens les moins expérimentés. Nous rapportons deux cas de steppage chez deux hommes âgés de 55 et 66 ans. Le premier avait une atteinte radiculaire L5 sans atteinte du muscle tibial postérieur (MTP) en rapport avec une récidive de sa hernie discale L5. Le second avait une atteinte du MTP (confirmée par électromyographie échoguidée) en rapport avec un kyste mucoïde périneural du nerf sciatique poplité externe. Cela démontre clairement l’apport du guidage échographique de la détection électromyographique à l’aiguille du MTP dans le diagnostic étiologique du steppage.

Introduction : Devant un steppage, le diagnostic différentiel entre une atteinte radiculaire L5 et une neuropathie fibulaire paraît délicat et rarement débattu dans la littérature. Notre étude avait pour objectif de souligner l’intérêt du varus de l’arrière-pied à la phase oscillante de la marche comme un signe clinique clé pour différencier entre l’atteinte fibulaire et l’atteinte radiculaire L5 chez des patients présentant un steppage. Nous avons aussi démontré l’intérêt de l’étude électromyographique dans l’enquête étiologique du steppage chez nos patients. Matériel et méthodes : Nous avons colligé des patients présentant un steppage d’étiologie périphérique. Nous avons réalisé une analyse visuelle et vidéographique de la marche notamment à la recherche d’un varus de l’arrière-pied à la phase oscillante. Nous avons effectué une évaluation de la force musculaire globale ainsi qu’un testing segmentaire du membre inférieur à l’aide de l’échelle du testing musculaire manuel du Conseil de recherches médicales (MRC). Nous avons complété par l’étude électroneuromyographique (ENMG) des membres inférieurs. Nous avons eu recours à des explorations neuroradiologiques chez cinq patients pour affiner le diagnostic étiologique du steppage. Résultats : Six patients avec steppage d’origine périphérique étaient inclus dans notre étude, que nous avons répartis en deux groupes en fonction de la présence ou de l’absence du varus de l’arrière-pied à la phase d’oscillation de la marche : le groupe « GF » comportait trois patients avec varus, alors que le groupe « GR » comprenait trois patients sans varus. Tous les patients avaient un déficit des muscles releveurs du pied. Contrairement aux patients du GF, les patients du GR avaient un déficit au testing des muscles moyen fessier et tibial postérieur et un réflexe ischiojambier interne L5 aboli. L’ENMG a révélé des tracés neurogènes des muscles moyen fessier et tibial postérieur chez les patients du GR, ces muscles étant normaux à la détection dans le GF. Une échographie du genou a montré une compression du nerf fibulaire par un processus expansif chez deux patients du GF. Une IRM du rachis lombaire a mis en évidence une hernie discale conflictuelle avec la racine L5 homolatérale au steppage chez tous les patients du GR. Nous avons pu retenir une radiculopathie L5 comme étiologie du steppage dans GR où les patients n’avaient pas de varus de l’arrière-pied, tandis qu’une neuropathie fibulaire était retenue chez les patients du GF qui présentaient un varus de l’arrière-pied. Conclusion : Devant un steppage d’étiologie périphérique, le varus de l’arrière-pied est une clé diagnostique pour la différentiation entre une atteinte radiculaire L5 et une neuropathie fibulaire. Le complément par étude électromyographique, et notamment par la détection à l’aiguille du tibial postérieur, permet de retenir de façon certaine l’atteinte nerveuse incriminée dans le steppage.

Le Ramadan correspond à un modèle de jeûne intermittent recommandé chez les obèses [1]. Cependant, l’effet de l’exercice pendant le mois du jeûne n’est pas encore investigué. L’objectif de cette étude était d’explorer l’effet de l’entraînement associé au jeûne du Ramadan (JR) chez des hommes obèses. 20 hommes obèses, effectuant régulièrement le JR, ont été randomisés en 2 groupes : entraînement (ENT) (n = 10) et contrôle (CON) (n = 10). Les participants ont été demandés de maintenir un régime alimentaire stable et un sommeil régulier le long de l’étude. Le groupe ENT a participé à un entraînement combiné (force- endurance) durant le mois de Ramadan. Le groupe ENT a montré une diminution significative du % graisse (−10.6 % vs −3,98 % ; p = 0,015), la glycémie (−13,3 % vs −4,9 % ; p = 0,046), le cholestérol total (−11,37 % vs −4,34 % ; p = 0,046) et de triglycérides (−37,66 % vs −5,95 % ; p = 0,048), par rapport au groupe CON. Aucune différence significative n’a été observée au niveau de la masse corporelle (−5,07 % vs −2,58 % ; p = 0,054), cholestérol−HDL (+6,49 % vs +0,47 % ; p = 0,13), et du cholestérol−LDL (−44,44 % vs −15,24 % ; p = 0,26) après le JR, respectivement pour les groupes ENT et CON. L’entraînement combiné semble majorer les effets bénéfiques du JR sur la santé métabolique chez la personne obèse.

The main aim of this study was to show the efficiency of botulinum toxin A (BT-A) injections not only on spasticity and functional capacities but also on the quality of life in children with cerebral palsy, and to describe their long-term evolutivity profile while précising our developing country particularities. Sixty children were included in this study aged from 2 to 18 years old; who received repeated injections of BT-A (Dysport®). An evaluation was done before and after these injections. It included an evaluation of the spasticity using the Modified Ashworth Scale (MAS), the functional evaluation using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), an evaluation of satisfaction (Visual analogical Scale) and an evaluation of the quality of life using the Child Health Questionnaire Parent Form 50 (CHQ-PF50). The change from baseline of MAS ranged from 2.25 to 3 for the muscles of the lower limbs and ranged from 2 to 2.86 for the upper limb muscles. The average number of injection sessions was of 3.18 (1 to 6). The percentage of children improved (in GMFCS and MACS) and the average of the visual analogical satisfaction scale as well, increased from one injection to another reaching a constant level in the last two injections (P < 0.001). Our study proved the efficiency of repeated BT-A injections on the spasticity. It also revealed an improvement in both the gross function and the motor skills of children suffering from cerebral palsy. The quality of life of these children was significantly enhanced after injections.

Objective. - To translate and linguistically validate in classical Arabic; the French version of the neurogenic bowel dysfunction (NBD).Patients and methods. - Arabic translation of the NBD score was obtained by the "forward translation/backword translation" method. Patients with multiple sclerosis (MS) and spinal cord injury were included. Evaluation of intestinal and anorectal disorders was conducted by the self-administered questionnaire NBD, which was filled twice two weeks apart. An item-by-item analysis was made. The feasibility, acceptability, internal consistency using Cronbach's alpha, and test-retest repeatability by non-parametric Spearman correlation were studied.Results. - Twenty-three patients with colorectal disorders secondary to neurological disease were included, the average age was 40.79 +/- 9.16 years and the sex-ratio was 1.85. The questionnaire was feasible and acceptable, no items were excluded. The spearman correlation was of 0.842. Internal consistency was judged good through the Cronbach's alpha was of 0.896.Conclusion. - The Arabic version of NBD was reproducible and construct validity was satisfactory. The study of its responsiveness to change with a larger number of patients will be the subject of further work. (C) 2016 Elsevier Masson SAS. All rights reserved.

To assess a therapeutic education (TE) project in children with cerebral palsy (CP). Prospective study including children with CP randomized into two groups: the group G1 included children who underwent a rehabilitation associated to a TE, and the group G2 included children who underwent only rehabilitation. We realized two seminars, one week apart, of TE for parents (for children aged less than 6 years) and for children with their parents (for children aged more than 6 years). The program of TE included the definition of the CP, the interest of rehabilitation, self-rehabilitation, speech therapy and occupational therapy, the indications and the supervision of the orthotics. The educational tools used were audio-visual systems and pamphlets distributed to participants. The evaluation of TE seminars was carried out by a questionnaire performed at the end of each session. The assessment of G1 and G2 was realized one month, three months and six months after the seminars. It focused on the observance of rehabilitation, the duration of the orthotics use and the quality of life by the questionnaire “Cerebral Palsy Child-Quality of Life”. We have enrolled 47 children divided into G1 (23 children) and G2 (24 children). Both groups were homogeneous in terms of the severity of motor impairment and intellectual quotient. The gain was significantly better in G1 concerning the observance of rehabilitation (P < 0.001), the duration of orthotics’ use (P < 0.001) and the children and parents quality of life (P < 0.001). These results were maintained 6 months later. Several publications have focused on the TE in chronic diseases such as diabetes and asthma [1]. But, at the best of our knowledge, no study was interested in TE of children with CP. Our study shows what TE has added to the adherence to treatment and the children and parents quality of life in CP.

Our objective was to show the effects of botulinum toxin injections (BT) on function and quality of life in children with cerebral palsy (CP). A prospective study including 60 children, aged from 2 to 18 years old, who received repeated injections of BT was conducted. Evaluations were done before and after injections including spasticity using the modified Ashworth scale (MAS), functional evaluation using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS), a videographic record, an evaluation of satisfaction (Visual Analogical Scale) and an evaluation of the quality of life using the Child Health Questionnaire Parent form 50 Questionnaire (CHQ-PF50). The average of the MAS was 2.5 for all injected muscles. Sixty-five percent of children were classed level I, II or III of MACS. All our patients had BT injections. The sural triceps was the most injected muscle. The improvement of spasticity after BT injections in the lower limb was more important for 6-year-old children (improvement of 46%, P < 0.001). We noted a significant increase of the number of walking patients (P < 0.001) and a beneficial effect on the pattern gait especially for children level III of GMFCS. The percentage of children improved (in GMFCS and MACS) and the average of visual analogical satisfaction scale as well, increased from one injection to another reaching a constant level in the last 2 injections (P <0.001). We have noted an improvement in the score of CHQ-PF50 (physical and psychosocial score), which was correlated with the functional improvement. Our study shows how BT injections can induce a functional gain in children with CP. An improvement of upper extremity's function, gait pattern and the quality of life upturn were plainly noticed after these injections. Similar benefits of BT [1], [2] were mentioned in literature.

Anesthetic blocks are used by many teams for assessing spasticity and its complications. However, this utilization is still restricted. Our objective was to specify the interest of anesthetic blocks in therapeutic decision and management of spasticity in our country where conditions are limited. A prospective study including 84 patients with spasticity in their lower limb. A clinical evaluation was made before and after the block with a determination of spasticity, a measurement of articular amplitudes, a quotation of voluntary control and a functional evaluation. We did 108 blocks. The injected sites were dominated by the posterior tibial nerve (63 blocks). We noted a gain from one to three points in the score Aschworth and from 19 to 22° in the articular amplitudes. The results obtained allow optimal therapeutic orientation. Botulinum toxin was indicated in hamstrings in 2 cases, in adductors in 20 cases and in soleus and/or in gastrocnemius in 64 cases. Ten orthopedic surgical procedures were indicated. Neurotomy of the tibial nerve was performed in two cases. The results of the neurotomy 1 year after surgery were similar to that observed by the block. The anesthetic blocks take still an important place in the assessment of spastic patient. In fact, they give us both a differential diagnosis (between spasticity and retraction) and an idea about prognosis (shows us the effect of an eventual definitive treatment for a short period of time). This will give us the opportunity to choose the least expensive means of therapy which can be available in our country. It allows us to take a new decisional diagram not only scientific but also adapted to our real situation.

Our objective was to study the effect of the association of weight loss intervention and pelvic floor muscle training (PFMT) on unirary incontinence (UI) in obese women. This prospective study included 107 obese women with urinary incontinence (UI) randomized into three groups: G1 including women who underwent a training program with a low calorie diet, G2 women who underwent the same training associated to a PFMT and G3 women without any therapeutic intervention. An evaluation was realised a week before the beginning and after 12 months. A reduction of the BMI (body mass index) was noted in G1 and G2 (P < 0.001). Sixty-six percent of women in G1 and 85.3% of women in G2 reported that their condition improved. The score of PFM strength was significantly improved only in G2 (P < 0.001). Only in the two first group, we noted a significant reduction in the number of voiding and of leakages per day (P < 0.001), a significant amelioration in the 24-hour pad test (P < 0.001) and a significant improvement of the Urinary Disability Measure (UHM) and the score of quality of life (P < 0.001). The improvement of all these parameters was more important in G2 (P < 0.001). There are studies that report the effect of either weight loss intervention or PFMT for treating female UI [1], [2]. However, there is no study that reveals whether or not there were additional effects of adding weight loss intervention to PFMT for UI in obese women. This work shows that the best management for UI in obese women must include weight loss intervention and PFMT with making women aware of their floor pelvic muscles. However, the limited nature of follow-up beyond the end of treatment means that the long-term outcomes of use of PFMT or weight loss intervention remain uncertain.

Objective To show the superiority of early specialized management of children with cerebral palsy (CP) in specific structures. Materials and methods This was a prospective study including 100 newborns with risk of PC recognized on clinical and radiological criteria and followed since the age of 4 months. They were divided into 2 groups according to the type of management and the place of habitat: G1 included children who received a specialized management since an early age in specialized centers and G2 included children with an external and irregular management. All these children have been regularly assessed, especially at 2 years old. Results The diagnosis of PC was retained in 62 children who were divided into 30 children in G1 and 32 children in the G2. These two groups were comparable according to the different risk factors: the gestational age, follow-up and complications of pregnancy, circumstances of birth, postnatal complications and clinical assessment at output of service. Evaluation at 2 years old showed that the number of walking children in G1 was more important with a younger age of walk acquisition. These differences were not significant. The language development was better in G1 ( P  = 0.01). The absence of language was 13.4% in G1 versus 28.1% in G2. The number of children with difficulties in cognitive development was higher in G2 ( P  = 0.02). Behavior problems were more frequent in G2 with a significant difference for hyperactivity ( P  = 0.014). Discussion The management of children with risk of neurosensory impairments remains today an ethical and public health priority. Early interventions take a special place. According to the European Academy for Childhood Disability, although its effectiveness is not scientifically proven and the appropriate assessment methods are lacking, it is now accepted as a right [1] . The results of this study confirm clearly the interest of early treatment in a specialized structure.

Introduction: The aim of this study was to evaluate the effects of a physical activity program for 4 months on aerobic capacity and on rating of perceived exertion exercise test in obese children according to their gender.Method: fourteen children (8 boys vs. 6girls) who participated in an exercise program for 4 months at 4 sessions per week with an intensity of 70 to 85% of maximum heart rate observed in the initial exercise test.Results: For the boys group the Waist circumference loss was 2cm (P < 0.001), the percentage of Fat Body Mass (% FM) was decreased 2,6% (P < 0.001) and total Fat Free Mass (FFM) has increased 3,3kg (P < 0.001). For the girls group (GF), (WC) loss was 1cm (P < 0.05), the (% FM) was decreased 1.7% (P < 0.01) and total (FFM) has increased 2,7kg (P < 0.001). When we compared the variation of aerobic parameters between (GF) and (GG) , there were differences in maximal Metabolic Equivalent of Task (10,8% vs 4%, P = 0.2), in maximal workload (15% vs 3,3% P < 0.001) and in maximum Heart Rate (0,9% vs 3,5%; p=0.04). The scores of rating of perceived exertion at baseline and at the end were respectively for GG and GF (7,22

To evaluate trunk and knee muscle strength in patients with chronic sciatica in order to optimize the program of management in a rehabilitation setting. This is a prospective study which included 68 subjects. The first group (G1) comported 28 patients with right-side chronic sciatica. The second group (G2) comported 40 healthy controls. The strength of both trunk and knee muscles was evaluated by the isokinetic dynamometer. Quadriceps and hamstring muscle strength were evaluated at concentric velocities of 60 and 120°/s and the trunk muscles were evaluated at concentric velocities of 60 and 90°/s. The two groups were comparable. The peak torque values for the trunk flexors were lower in the group G1 (P < 0.002 and P = 0.01, respectively at 60° and 90°). Similarly, the peak torque values for the trunk extensors was lower in this group (P < 0.001 and P = 0.001, respectively at angular velocities of 60° and 90°). The deficit was higher in the group of the extensor muscles. The peak torque values for the right quadriceps and hamstrings at angular velocities of 60 and 120°/s were also lower in group G1. The differences were statistically significant (P < 0.001). In G1, the quadriceps and hamstrings were significantly weaker on the sciatica side than on the unaffected side. The isokinetic muscle strength evaluation allows the therapeut to optimize the management of patients with chronic sciatica. Some studies showed a reduction in both trunk and knee muscle strength in those patients, when compared with healthy subjects. Neurologic reason appears to be unlikely. This deficit may possibly be explained by muscle atrophy secondary to immobilization imposed by chronic pain. Therefore, the therapeutic program should control the pain but also strengthen both the trunk and lower extremity muscles. Some authors say that muscle atrophy mainly affects selective type II muscle fiber, which leads us to propose a strengthening at different contraction speeds especially the faster one (180°/s) to ensure a successful recovery [1].

Dynamometric trunk muscle strength and endurance test are performed widely within the rehabilitation management of chronic low back pain. To examine the validity and the reliability of the Sorensen test in patients with chronic low back pain. Fifty-nine subjects were included divided into 2 groups: the first group included 30 chronic low back pain patients and the second group included 29 healthy controls. Anthropometric data of all subjects in both groups were collected for comparability study. Construct validity was investigated with the use of the Spearman rank correlation coefficient (convergent and divergent validity). As for convergent validity, it was investigated via correlation between the Sorensen test with isokinetic dynamometer parameters at 60 and 120°/s, and isometric at 60° trunk flexure, the Borg scale, the 6-minute test, and the Beck Scale. Divergent validity was studied via correlation between the Sorensen test and visual analogue scale (VAS) pain, VAS functional impairment and the Oswestry score. Intra-rater reliability was assessed by use the intra-class correlation coefficient (ICC) and the Bland and Altman method. Both groups were comparable at basic characteristics. Convergent validity of the Sorensen was judged good. We found significant correlations between the Sorensen test and the others parameters: the isokinetic and isometric parameters (respectively [r = 0,5, p < 0,001], [r = 0,58, p < 0,001]), the Borg scale (r = 0,4, p = 0,02), and the Shirado test (r = 0,59, p < 0,001). Divergent validity was good with weak correlations between VAS pain and functional impairment indices (p > 0.05). An intra-raterreliabilityof the Biering-Sorensen test was (ICC = 93.2%) in chronic low back pain patientsand (ICC = 96.6%) in the control group. The Biering-Sorensen test demonstrated his good validity and his reliability in the evaluation of trunk musclesendurance. Consequently, this test could be recommended for the muscular assessment in the management of all patients with chronic low back pain.

Objective. - To study sexual dysfunctions (SD) among patients suffering from multiple sclerosis (MS).Materials and methods. - Prospective study concerning 49 patients with MS questioned about their sex life. In addition to an interview, we used 2 indexes to measure sexual function: IIEF15 for males and FSFI for females. Other information was collected concerning the duration of the MS, the level of disability and the repercussions on the couple's relationship and quality of life.Results. -The prevalence of SD was 46.9% with 70% for males and 34% for females. The most frequent problem for males was erectile dysfunction. Women experienced mainly a reduction in orgasm and a lowering of libido. The MS itself affected all the SF-36 items but no correlation was found between the SD and quality of life. Neither did we note significant repercussions on the couple's relationship. We did however observe a correlation between the frequency of SD and marriage. No correlation was found between the frequency of SD and the severity of the disability, age, level of education and duration of MS.Conclusion. -MS entails a multitude of disorders that patients struggle to deal with. However, they do not speak about SD. Our characteristic culture can certainly explain several differences observed between our work and the literature. (C) 2015 Elsevier Masson SAS. All rights reserved.

To identify clinical and laboratory signs of early screening of cerebral palsy in order to propose an early management of children. Prospective study including 100 newborns with risk factors for CP (relying on gestational age, birth weight, perinatal and neonatal brain injuries). The screening was conducted during a medical consultation by a specialist and was based on clinical setting (neurological examination and neuromotor assessment) and radiological examination (cranial ultrasound, magnetic resonance imaging). The clinical assessment was performed at the 1st, 4th, 9th, 12th, 18th, 24th months and at 5 years after selection of patients. The different clinical factors were weak predictors of becoming during the first month of life. At 4 months, the factors correlated with the evolution to cerebral palsy were: the decrease of lower limbs’ spontaneous movements and the lower limb fixed in extension at suspension maneuvers (P < 0.001), Babinski sign (P < 0.001), as well as absence of an ulnar-palmar grip (P < 0.01). At 9 months, we found more predictive signs of the evolution to CP, particularly the head holding problems (P < 0.001), the absence of acquisition of sitting position (P < 0.001), the absence of precision grip (P < 0.001), the deficit of uprising the lower limbs, of hip abduction, of extension of the knee in the lateral inclinations and drawn-seated (P < 0.001), hyperreflexia (P = 0.004) and the Babinski sign (P < 0.001). At 12, 15 and 18 months, neurological examination showed a peripheral hypertonia in 62% of children. At 24 months, peripheral hypertonia is found only in 43% of cases. 38% of children had an adequate level of psychomotor development and a normal neurological examination hence the diagnosis of transient motor abnormalities (TMA) was retained. For imaging, normal cranial ultrasound was significantly more associated with TMA than CP (P < 0.001). Neurological examination focusing on reflexes and muscle tone is poorly predictive in the first months of life. Neuromotor assessment with the study of spontaneous movements may reflect functional limitations in the first months of life and have been shown to predict later CP. However, the distinction between CP and TMA remains difficult and requires a long follow-up.