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See detailActualités thérapeutiques dans la prise en charge des tendinopathies
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Forthomme, Bénédicte ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1), 050-003

“Conventional” treatments of tendinopathies are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are ... [more ▼]

“Conventional” treatments of tendinopathies are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common. In contrast to the passive pattern of many therapies dedicated to tendon disorders, some authors have promoted an eccentric training mode. Such active eccentric training programs are aimed at thwarting an aetiopathogenic theory proposing insufficient tensile strength of the tendon exposed to external loads which could progressively damage it. Though the literature remains incomplete on tendon architecture remodelling and real histological adaptations following an adapted eccentric training, clinical results following such therapy appear promising. Due to its noninvasiveness, low complication rate and high applicability combined with good results, extracorporeal shock wave therapy has become a well known option within the therapeutic spectrum for many tendinopathies. More specifically, it has been successfully applied in chronic tendinopathy resistant to a conservative training program including eccentric exercises. Platelets release different cytokines and growth factors that could promote angiogenesis, tissue remodelling (bone, skin etc.), and wound healing. Platelet-rich plasma (PRP) is obtained by centrifuging autologous blood to have a high concentration of platelets depending on the isolation method. For this reason, different PRP preparation techniques cannot provide a consistently identical final product, but there is currently no international consensus on this issue. Despite the proven efficacy of PRP tissue regeneration in labs, there is currently little tangible clinical evidence for chronic tendon disorders. The few studies that have been performed appear unlikely to be comparable. Up to now, randomised controlled studies with appropriate placebo groups are needed to determine the real effectiveness of PRP for treating chronic tendon conditions. However, this therapeutic option remains very popular in sports, and many top athletes are using it in case of musculoskeletal conditions. What is more, it has been removed from the doping lost of the World AntiDoping Agency. Other new therapeutic options (infiltrations of polidocanol, hyaluronic acid, botulinum toxin, patches of derivatives Nitro...) for treating tendinopathies are also discussed in this review. [less ▲]

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See detailEffects of 3 months of aerobic training on fitness of Parkinson's disease patients
Demonceau, Marie ULg; rodriguez de la Cruz, carlos; kalimira, kinja et al

in Annals of Physical and Rehabilitation Medicine (2013)

Objectives.– To assess the effects of an aerobic training for people with Parkinson's disease (PD). Methods.– Fourteen patients with Hoehn & Yahr stage [1] < III of PD were allocated to either 3 months of ... [more ▼]

Objectives.– To assess the effects of an aerobic training for people with Parkinson's disease (PD). Methods.– Fourteen patients with Hoehn & Yahr stage [1] < III of PD were allocated to either 3 months of twice-weekly aerobic training (AT group; n = 8), or a control group (C group; n = 6). AT consisted in progressive stationary bike training between 50 and 70% of peak work load (PWL). Maximal incremental test on a cycloergometer was performed before and after rehabilitation. Anxiety, depression and quality of life were assessed using questionnaires. An Anova for repeated measures was used for statistical analysis. Results.– There was a significant “group by time” effect for peak work load (+21% for patients of AT group vs –9% for people of C group). Heart rate 2 minutes after test completion was also significantly decreased in AT group (post hoc analysis, P < 0.01). Patients of AT group also increased their ratio of predicted VO2 peak (+17%) but in a non-significant way. No significant changes in anxiety, depression or quality of life could be highlighted. Conclusions.– This study showed significant improvement of PWL and faster recovery in patients with PD of the AT. Significant effect on VO2 peak could need a more intense training program. [less ▲]

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See detailStrength improvement after 3months of resistance training among Parkinson's disease patients
Demonceau, Marie ULg; rodriguez de la cruz, carlos; NAVEAU, Florence ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(s1), 196

Objectives.– To assess the feasibility and the effects of a strengthening program for people with Parkinson's disease (PD). Methods.– Fourteen patients with Hoehn and Yahr stage [1] < III of PD were ... [more ▼]

Objectives.– To assess the feasibility and the effects of a strengthening program for people with Parkinson's disease (PD). Methods.– Fourteen patients with Hoehn and Yahr stage [1] < III of PD were allocated to either 24 sessions of strength training (ST group; n = 8) or to a control group (C group; n = 6) for 3 months. Concentric knee muscle strength and a maximal cycling incremental test were performed at baseline and after training. Training consisted of progressive resistive exercises on leg press, leg extension, leg curl, between 50 and 80% of 1RM and was completed by non-instrumented exercises for trunk and upper limbs muscles. Anxiety, depression and quality of life were assessed using questionnaires. An Anova for repeated measures was used for statistical analysis. Results.– Six patients of the ST group (75%) fully completed the program. There were significant “group by time” effects for all knee muscles strength measures of less involved side (P < 0.05). A significant “group by time” effect was also found for knee flexors of the most involved side, but only at angular speed of 180°/s (P = 0.03). Patients of ST group also increased maximal aerobic power (+13%) whereas patients of C group decreased their performances (–9%; “group by time” effect, P = 0.04). No changes in anxiety, depression or quality of life could be highlighted. Conclusions.– The increase of some strength measures in ST group showed that progressive strength training counteracts strength decrease among people with Parkinson's disease. Strengthening also had a positive effect on maximal aerobic power. [less ▲]

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See detailUne infiltration de plasma riche en plaquettes (PRP) pour traiter les tendinopathies rotuliennes supérieures chroniques
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1),

Objective: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons ... [more ▼]

Objective: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. Infiltration of platelet-rich plasma (PRP) could be a new therapy for such chronic tendinopathies. Materiel and methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10-point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub-maximal eccentric reeducation. Results: Pain during daily activities significantly decreased with time (especially after 6 weeks and continued to a lesser extend up to 3 months). During functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. Discussion: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic jumper’s knee in patients non-responsive to classical conservative treatments. [less ▲]

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See detailRéaction inflammatoire exubérante comme effet secondaire d’une infiltration de PRP
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; LEONARD, Philippe ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1), 068

Introduction : Infiltrations of plasma rich platelets (PRP) represent a new treatment of tendinopathies. Currently, no side effects were reported in this indication. Case report: We report the case of a ... [more ▼]

Introduction : Infiltrations of plasma rich platelets (PRP) represent a new treatment of tendinopathies. Currently, no side effects were reported in this indication. Case report: We report the case of a 35-year-old type 1 diabetic patient with right upper patellar tendinopathy that had persisted for more than 6 months. The patient benefited from an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm3, almost no red or white blood cells) after a carefully disinfection but without local anesthesia. Typically, a standardized program of sub-maximal eccentric rehabilitation should be started 1 week after infiltration. However, the patient experienced local swelling with erythema, increased heating and pain, which appeared just underneath the patella, without biological inflammatory syndrome. In absence of septic general symptoms, no blood or wound culture were made. At 2 weeks post-infiltration, a greatly increased Doppler signal in a thicker tendon was observed by ultrasounds compared to that before infiltration, but there was no sign of infection demonstrated by either MRI or CT. However, the local inflammation did not decrease after a 3-week treatment of local cryotherapy, local and oral NSAID, and adjunct use of colchicine 1 mg. Thus, an insidious infection was suspected, even though there was no evidence of biological inflammatory syndrome or sign of infectious lesion on imagery examination. Antibiotic therapy (rifampicine 600 mg + minocycline 100 mg), was initiated for three months. Due to a lack of improvement via imaging and clinical examination, a 3-phase bone scintigraphy was performed. The results suggested the presence of a complex regional pain syndrome type 1. The patient benefited from classical physical therapy and concomitant pain killers. The evolution was favorable after 6 months of treatment. Discussion : Even though PRP infiltration represents a new and promising treatment for tendinopathy, more studies are needed both to verify its clinical efficacy. Moreover, implementing this innovative treatment requires caution because of potential adverse events. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment, especially in patients with type 1 diabetes. [less ▲]

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See detailCONTRIBUTION OF NEW TECHNIQUES TO STUDY GAIT IN THE OLDERS
GILLAIN, Sophie ULg; Petermans, Jean ULg

in Annals of Physical and Rehabilitation Medicine (2013), 56

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See detailComparison of gaseous cryotherapy with more traditional forms of cryotherapy following total knee arthroplasty
Demoulin, Christophe ULg; Brouwers, M.; Darot, S. et al

in Annals of Physical and Rehabilitation Medicine (2012), 55

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See detailSudden dysphagia in an elderly quadriparetic patient
Kaux, Jean-François ULg; Ongena, France; Wang, François ULg et al

in Annals of Physical and Rehabilitation Medicine (2009), 52(1), 62-65

Clinical case: We report the case of a 92-year-old quadriparetic patient who suddenly presented a major swallowing disorder following trauma to the neck. A diagnosis of myasthenia gravis was suggested by ... [more ▼]

Clinical case: We report the case of a 92-year-old quadriparetic patient who suddenly presented a major swallowing disorder following trauma to the neck. A diagnosis of myasthenia gravis was suggested by single-fibre EMG of the extensor digitorum communis muscle. In view of the continued absence of dysphagia after 6 months of pyridostigmine treatment, this diagnosis was considered as definitive. Discussion: We review the various characteristics of myasthenia gravis and ways of investigating dysphagia. Conclusion: It is important to be aware of and investigate all the direct and indirect signs of dysphagia and establish the exact aetiology, in order to provide the best possible treatment. [less ▲]

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