Maintien des capacités des myopathes ou l'art de prescrire l'exercice physique [How to maintain the motor capacities in neuromuscular disorders or the art to prescribe physical exercises].

Optimum management of non-acquired neuromuscular disorders requires a multidisciplinary approach in order to prevent secondary complications related to the progression of the disease and to maintain the patient's independency in daily activities. For treatments, the physiotherapists and occupational therapists must have precise and measurable goals to quantify muscle strength and functions in conjunction with a specialist in neurorehabilitation. Examples of simple motor scores or scales are given in order to transmit precise information to the GP and the multidisciplinary team, and type of orthosis and physiotherapy programmes are given as pieces of advice to assume the follow-up of patients.

Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial.

BACKGROUND: Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. METHODS: Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups. RESULTS: Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to -0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to -1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to -0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to -5.7). Insufficient evidence for group differences was found in remaining outcomes. CONCLUSIONS: This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly. TRIAL REGISTRATION: Trial registration number: NCT01496144.

Exercises Referral Lincolnshire

Increase Physical Activity levels to prevent and treat disease

Cardiorespiratory responses during running and sport-specific exercises in handball players

To determine whether a 4-a-side handball (HB) game is an appropriate aerobic stimulus to reach and potentially enhance maximal oxygen uptake (V O(2)max), and whether heart rate (HR) is a valid index of V O(2) during a handball game. Nine skilled players (21.0+/-2.9 yr) underwent a graded maximal aerobic test (GT) where V O(2)max and HR-V O(2) relationship were determined. V O(2), HR and blood lactate ([La](b)) were recorded during a 2 x 225 s (interspersed with 30s rest) 4-a-side handball game and were compared to those measured during an 480-s running intermittent exercise (IE). Mean V O(2) tended to be higher in handball compared to IE (93.9+/-8.5 vs. 87.6+/-7.4% O(2)max, p=0.06), whereas HR was similar (92.3+/-4.9 vs. 93.9+/-3.9% of the peak of HR, p=0.10). [La](b) was lower for handball than for IE (8.9+/-3.5 vs. 11.6+/-2.1 mmol l(-1), p=0.04). Time spent over 90% of V O(2)max was higher for handball than for IE (336.1+/-139.6s vs. 216.1+/-124.7s; p=0.03). The HR-V O(2) relationship during GT was high (r(2)=0.96, p<0.001) but estimated V O(2) from HR was lower to that measured (p=0.03) in handball, whereas there was no difference in IE. 4-a-side handball game can be used as a specific alternative to IE for enhancing aerobic fitness in handball players. Nevertheless, the accuracy of HR measures for estimating V O(2) during handball is poor.

Spiritual Kinship, Political Mobilization and Social Cooperation: a Swiss Alpine valley in the Eighteenth and Nineteenth Centuries

In this chapter I will present some observations and results about Ritual Kinship and political mobilization of popular groups in an Alpine valley: the Val de Bagnes, in the Swiss canton of Valais, - a mountain valley, well known today thanks to the tourist station of Verbier - where we can rely on excellent sources about local families. This region presents a particular political situation, because the 11 major villages of the valley form only one commune, which includes the whole valley.¦There are two major reasons to choose the Val de Bagnes for our inquiry on kinship and social networks in a rural society:¦A. The existence of sharp political and social conflicts during the 18th and the 19th centuries;¦B. The existence of almost systematic genealogical data between 1700 and 1900. (Casanova, Gard, Perrenoud 2005-08)¦The 18th century was characterized by the struggle of an important part of the community of Bagnes against the feudal lord, the abbot of St-Maurice. The culminating point was a local upheaval in 1745 in Le Châble, during which the abbot was forced to sign several documents in accordance with the wishes of the rebels (Guzzi-Heeb 2007). In the 19th century feudal lordship was abolished, but now the struggle confronted a liberal-radical faction and the conservative majority in the commune.¦The starting point of my presentation focuses on this question: which role did spiritual kinship play in the political mobilization of popular groups and in the organization of competing factions? This question allows us to shed light on some utilizations and meanings of spiritual kinship in the local society. Was spiritual kinship a significant instrument for economic cooperation? Or was it a channel for privileged social contacts and transactions?

Effectiveness of core stability exercises and recovery myofascial release massage on fatigue in breast cancer survivors: a randomized controlled clinical trial.

The purpose of the present paper was to evaluate the effects of an 8-week multimodal program focused on core stability exercises and recovery massage with DVD support for a 6-month period in physical and psychological outcomes in breast cancer survivors. A randomized controlled clinical trial was performed. Seventy-eight (n = 78) breast cancer survivors were assigned to experimental (core stability exercises plus massage-myofascial release) and control (usual health care) groups. The intervention period was 8 weeks. Mood state, fatigue, trunk curl endurance, and leg strength were determined at baseline, after the last treatment session, and at 6 months of followup. Immediately after treatment and at 6 months, fatigue, mood state, trunk curl endurance, and leg strength exhibited greater improvement within the experimental group compared to placebo group. This paper showed that a multimodal program focused on core stability exercises and massage reduced fatigue, tension, depression, and improved vigor and muscle strength after intervention and 6 months after discharge.

Adaptação cultural e validação da Underwood's Daily Spiritual Experience Scale - versão brasileira

Este estudo objetivou adaptar culturalmente e analisar as propriedades psicométricas da versão brasileira da Underwood's Daily Spiritual Experience Scale (DSES). A adaptação seguiu as etapas internacionalmente recomendadas e a versão adaptada manteve equivalência com a original, após ajustes na redação de cinco itens. Na aplicação a 179 pacientes médico-cirúrgicos mostrou evidências de consistência interna (alfa de Cronbach=0,91), estabilidade temporal (ICC=0,94 no teste e reteste) e validade de construto convergente, na correlação com a subescala Religiosidade Intrínseca do instrumento DUREL (r=0,56; p<0,001). A análise fatorial exploratória extraiu três componentes, explicando 60,5% da variância do total. A versão brasileira da DSES apresenta evidências de confiabilidade e validade junto a pacientes hospitalizados. São necessários mais estudos para confirmar a sua composição fatorial e testar a sua aplicabilidade em diferentes populações.

Measuring spiritual well-being in older rehabilitation patients using the facit-sp

Objectives: To determine psychometric properties of the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp) in a cohort of older patients admitted to rehabilitation. Method: Patients aged 65+, with MMSE score>19, admitted consecutively over 6 months in post-acute rehabilitation were enrolled (N=144, 81.27.2 years, 68.8% women). Data on medical, functional, and mental status were systematically collected upon admission. Spiritual well-being was assessed within 3 days after admission using the FACIT-Sp (12 items, score from 0 to 48, high spiritual well-being defined as a score ≥36) and the single question "Are you at peace?" (score from 0 to 10 on a visual analog scale). Results: FACIT-Sp scores ranged from 7 to 44(mean=29.87.7). Overall, 24.3% of the patients had high spiritual well-being. Internal consistency was optimal for total score (Cronbach's alpha =0.85). Itemto- total correlations were all significant, ranging from 0.28 to 0.73. A confirmatory factorial analysis yielded a 2-factor solution, consistent with Meaning and Faith proposed subscales and accounting for 52% of the variance . FACIT-Sp total score correlated positively with the question «Are you at peace ?» (Spearman's rho 0.49, P<.001) and negatively with depressive symptoms (Spearman's rho -0.37, P<.001), confirming FACIT-Sp validity. Compared to the others, patients with higher spiritual well-being had significantly better function at admission (Barthel's score 74.817.1 vs 68.514.1, P=.014). Conclusions: The FACIT-Sp remains a reliable and valid measure to assess spiritual well-being in older patients undergoing rehabilitation. The relatively low proportion of patients with high spiritual well-being deserves further investigation.

The spiritual distress assessment tool: an instrument to assess spiritual distress in hospitalised elderly persons.

BACKGROUND: Although spirituality is usually considered a positive resource for coping with illness, spiritual distress may have a negative influence on health outcomes. Tools are needed to identify spiritual distress in clinical practice and subsequently address identified needs. This study describes the first steps in the development of a clinically acceptable instrument to assess spiritual distress in hospitalized elderly patients. METHODS: A three-step process was used to develop the Spiritual Distress Assessment Tool (SDAT): 1) Conceptualisation by a multidisciplinary group of a model (Spiritual Needs Model) to define the different dimensions characterizing a patient's spirituality and their corresponding needs; 2) Operationalisation of the Spiritual Needs Model within geriatric hospital care leading to a set of questions (SDAT) investigating needs related to each of the defined dimensions; 3) Qualitative assessment of the instrument's acceptability and face validity in hospital chaplains. RESULTS: Four dimensions of spirituality (Meaning, Transcendence, Values, and Psychosocial Identity) and their corresponding needs were defined. A formalised assessment procedure to both identify and subsequently score unmet spiritual needs and spiritual distress was developed. Face validity and acceptability in clinical practice were confirmed by chaplains involved in the focus groups. CONCLUSIONS: The SDAT appears to be a clinically acceptable instrument to assess spiritual distress in elderly hospitalised persons. Studies are ongoing to investigate the psychometric properties of the instrument and to assess its potential to serve as a basis for integrating the spiritual dimension in the patient's plan of care.