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Hentzen C, Chesnel C, Teng M, Blouet E, Le Breton F, Lagnau P, Miget G, Amarenco G. Influence of urodynamic conditions on bladder sensations and detrusor activity in patients with multiple sclerosis. Neurourol Urodyn 2022; 41:1898-1905. [PMID: 36098451 DOI: 10.1002/nau.25042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/08/2022] [Accepted: 08/31/2022] [Indexed: 11/08/2022]
Abstract
AIMS The study aimed to assess the impact of bladder filling rate and fluid temperature during urodynamics on bladder sensations and volume of apparition of detrusor overactivity in patients with multiple sclerosis (PwMS). METHODS Consecutive PwMS assessed with a standardized urodynamic test including three consecutive cystometries (20 ml/min, 100 ml/min, and 100 ml/min with 4°C fluid (Ice water test [IWT]) between June 2020 and March 2022 were included in this retrospective study. Data collected were bladder sensation with first desire to void (FDV) and strong desire to void (SDV). The presence of detrusor overactivity (DO) and the volume of the first uninhibited detrusor contraction were recorded. RESULTS One hundred and fifty-seven patients (mean age 47.4 ± 11.8 years, median EDSS 3 IQR[2-5], 73.9% of women) were included. Increased filling rate induced delayed bladder sensations (FDV 219 ± 109 ml vs. 194 ± 100 ml; SDV 349 ± 113 ml vs. 322 ± 124 ml for 100 ml/min and 20 ml/min filling rate, respectively, p < 0.001). Ice water increased bladder sensations with earlier reports of needs to void (FDV 163 ± 99 ml vs. 218 ± 117 ml; SDV 263 ± 104 ml vs. 351 ± 112 ml respectively; p < 0.001). Thirty-four patients had DO during both 20 ml/min and 100 ml/min fillings, without difference in the volume of apparition (p = 0.78). Forty-four patients had DO during both 100 ml/min and IWT. Detrusor overactivity appeared for a reduced volume during IWT compared with room temperature fluid perfusion (-68 ml [-95 to -41]; p < 0.001). CONCLUSION Filling rate and fluid temperature impact bladder sensations during cystometry in PwMS. Ice water decreased the volume of the first uninhibited detrusor contraction.
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Affiliation(s)
- Claire Hentzen
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Camille Chesnel
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Maëlys Teng
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Emilie Blouet
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Frederique Le Breton
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Philippe Lagnau
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Gabriel Miget
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
| | - Gerard Amarenco
- GRC 01, GREEN Group of clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, Sorbonne University, Paris, France
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Pouyau C, Grasland M, Leroux C, Chesnel C, Turmel N, Sheikh Ismael S, Le Breton F, Amarenco G, Hentzen C. Relationship between desire to void and bladder capacity and rectal sensory function in patients with multiple sclerosis and anorectal disorders. Neurourol Urodyn 2020; 39:1129-1136. [PMID: 32163639 DOI: 10.1002/nau.24330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/24/2020] [Indexed: 11/09/2022]
Abstract
AIMS The primary aim of this study was to assess the relationship between a strong desire to void (SDV) and rectal sensory function in patients with multiple sclerosis (PwMS) and anorectal disorders. The secondary aim was to identify clinical, urodynamic or manometric factors associated with greater rectal sensory function impairment in this population. METHODS Thirty PwMS (mean age 49.2 ± 10.9 years) with anorectal disorders (constipation and/or fecal incontinence) participated in this observational study. Rectal sensory parameters during anorectal manometry were recorded at a strong desire to void and after urination (PV, post-void). The primary outcome was the desire to defecate volume. Secondary outcomes were first perception and maximum tolerated threshold volumes, presence and modulation of recto-anal inhibitory reflex. RESULTS The mean desire to defecate volume was 125 ± 59 mL at SDV and 104 ± 64 mL at PV (P < .001). The mean maximum tolerated volume was 167 ± 61 mL at SDV vs 141 ± 64 mL after urination (P = .01). The other parameters were not different between SVD and PV conditions. No predictive factors for greater impairment of rectal sensory function were identified. CONCLUSION This study suggests a relationship between bladder sensation and thus bladder capacity, and rectal sensory function in PwMS and with anorectal disorders.
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Affiliation(s)
- Camille Pouyau
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Matthieu Grasland
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Camille Leroux
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Camille Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Nicolas Turmel
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Samer Sheikh Ismael
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Frederique Le Breton
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Claire Hentzen
- Sorbonne Université, GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
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Hentzen C, Turmel N, Chesnel C, Miget G, Le Breton F, Charlanes A, Tan E, Amarenco G. What criteria affect a patient's choice of catheter for self‐catheterization? Neurourol Urodyn 2019; 39:412-419. [DOI: 10.1002/nau.24223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/28/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Claire Hentzen
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Nicolas Turmel
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Camille Chesnel
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Gabriel Miget
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Frederique Le Breton
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Audrey Charlanes
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Eliane Tan
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
| | - Gérard Amarenco
- GREEN GRC 001, Groupe de Recherche Clinique en Neuro‐Urologie, Hôpital Tenon Ap‐Hp Sorbonne Université Paris France
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Motavasseli D, Charlanes A, Chesnel C, Menoux D, Charoenwong F, Le Breton F, Jousse M, Amarenco G. Urethro-vaginal reflux during micturition: An underestimated cause of urinary incontinence in adult women. Neurourol Urodyn 2019; 38:1953-1957. [PMID: 31436352 DOI: 10.1002/nau.24098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/18/2019] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate if urethrovaginal reflux (UVR) is an underestimated cause of insensible or postmicturition incontinence in adult women. METHODS An observational and retrospective study was carried out on the computerized records of a neuro-urology department. Female patients who had insensible or postmicturition incontinence were investigated. Retrograde and voiding urethrocystography (UCG), urodynamic evaluation, urethral pressure profilometry, and anamnestic and clinical examination had to be available. RESULTS Among the 79 adult female patients with insensible or postmicturition incontinence in whom the whole set of required evaluations was achieved, 16 had a UVR (mean age 47 ± 15 years). There were no urethral diverticula, urethrocele, vesicovaginal, or urethrovaginal fistula on their UCG. All of them also had a cystoscopy and a CT urography which did not establish any abnormality. CONCLUSIONS UVR is not an exclusive pathology of children. This mechanism seems to be an underestimated cause of urinary incontinence in adult women. Retrograde and voiding UCG appears to be the gold standard to confirm the intravaginal reflux.
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Affiliation(s)
- Damien Motavasseli
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
| | - Audrey Charlanes
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
| | - Camille Chesnel
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
| | - Diane Menoux
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
| | - Francis Charoenwong
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
| | - Frederique Le Breton
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
| | - Marylène Jousse
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,Physical and Rehabilitation Medicine Department, Fernand Widal Hospital, APHP Hospital Group, Paris, France
| | - Gérard Amarenco
- Neuro-Urology Department, Tenon Hospital, APHP East Hospital Group, Paris, France.,GRC-UPMC 01 GREEN, Neuro-urology Department, Sorbonne Université, Paris, France
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Gerbaud F, Charlanes A, Chesnel C, Voiry C, Le Breton F, Amarenco G, Manceau P. Effect of radical prostatectomy on involuntary pelvic floor muscle contraction. Neurourol Urodyn 2019; 38:1093-1099. [PMID: 30843273 DOI: 10.1002/nau.23959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/18/2018] [Accepted: 02/03/2019] [Indexed: 11/08/2022]
Abstract
AIMS Radical prostatectomy may cause stress urinary incontinence (SUI). We compared continent and incontinent men after radical prostatectomy, in regard to the change of the temporal pattern of pelvic floor activation during cough. METHODS Twenty-two patients were included in this prospective, multicentric study. All patients gave their informed consent. Simultaneous recordings of electromyographic activity of external anal sphincter (EAS EMG) and external intercostal muscle (EIC EMG) during cough were performed with a pair of pregelled surface electrodes. Cough effort caused an involuntary pelvic contraction. Intercostal muscles recording was chosen because they are one of the muscular components of cough initiation with diaphragm muscle. Twenty-four-hour pad-weighing test was used to quantify urinary incontinence. The primary endpoint was the latency between the onset of EIC EMG and EAS EMG (RT3), during a cough effort. We also measured the contraction time, the maximum EAS EMG activity, and the area under the curve. RESULTS All the patients were analyzed: 12 continent and 10 with SUI. The median age was 66 years old. Both groups were similar except in term of follow-up. Median latency was increased by -1.7 ms (-47.9; +34.2) to 55.8 ms (+47.5; +80) in patients with SUI (P = 0.0033; Table 2). The duration of the contraction, the maximum EAS EMG activity and the area under the curve were not different. CONCLUSIONS The latency between the onset of EIC EMG and EAS EMG is increased in patients with SUI after radical prostatectomy. It may be one of the reasons for SUI in these patients.
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Affiliation(s)
- Florian Gerbaud
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Audrey Charlanes
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Camille Chesnel
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Caroline Voiry
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Frederique Le Breton
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Gérard Amarenco
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
| | - Philippe Manceau
- Neuro-Urology Department, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France.,GRC 01, Green - groupe de recherche clinique en neuro-urologie, Sorbonne Universités, AP-HP, Hôpital Tenon, Paris, France.,Service de Neuro-Urologiex, Hôpital Tenon, 4, rue de la Chine, Paris, France
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Haddad R, Hentzen C, Le Breton F, Sheikh Ismael S, Amarenco G. Lumbosacral radicular pain during micturition, defecation or orgasm. Eur J Pain 2019; 23:1091-1097. [PMID: 30697909 DOI: 10.1002/ejp.1372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/01/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to describe, in a cohort of patients followed for bladder, bowel or sexual dysfunctions, the occurrence of radicular pain during micturition, defecation and/or orgasm. METHODS The study included all patients referred in our neuro-urology department and who suffered from radicular pain before, during or after micturition, defecation and/or orgasm. Data included demographic and medical variables, urodynamic and perineal electromyographic diagnosis. RESULTS A total of 30 patients (men: 70%, mean age 45.4 ± 11.8,) complained of radicular pain before, during or after orgasm (51.4%), micturition (34.3%), or defecation (14.3%). In 30% of cases, radiculopathy was found and was predicted by micturition pain. Other pathologies were as follows: vertebral (16.5%), pelvis and sacral (16.5%), inflammatory central nervous system (10%) lesions and peripheral neuropathies (6.7%). Neurological level of injury was between the lumbar and the sacral level. All spinal cord lesions were lesions of the conus medullaris. Patients also complained of lower urinary tract symptoms (70%), sexual (63.3%) and bowel (60%) disorders. In most cases, the urodynamic diagnosis was neurogenic bladder with peripheral abnormalities and the electromyographic diagnosis was distal neuropathy. CONCLUSION Radicular pain occurring during micturition, defecation or orgasm is a rare condition. The most common underlying lesion seems to be radiculopathy, from lumbar to sacral spine. The presence of these symptoms, in the absence of any known neurological condition, should suggest the practitioner a radiculopathy in most of the cases. In consequence, appropriate additional tests should be offered to these patients. SIGNIFICANCE Few data are available on sciatica during micturition, defecation or orgasm. This study underlines the need for appropriate tests if a patient complaint from this type of symptom. Indeed, the most common underlying lesion is a radiculopathy but can also be a lesion of conus medullaris.
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Affiliation(s)
- Rebecca Haddad
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Claire Hentzen
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Frederique Le Breton
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Samer Sheikh Ismael
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Gerard Amarenco
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
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Yelnik AP, Le Breton F, Colle FM, Bonan IV, Hugeron C, Egal V, Lebomin E, Regnaux JP, Pérennou D, Vicaut E. Rehabilitation of Balance After Stroke With Multisensorial Training: A Single-Blind Randomized Controlled Study. Neurorehabil Neural Repair 2008; 22:468-76. [DOI: 10.1177/1545968308315996] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To compare 2 rehabilitation strategies to improve balance after stroke: (1) a multisensorial approach based on higher intensity of balance tasks and exercise during visual deprivation and (2) a conventional neurodevelopmentaltheory-based treatment (NDT) that used a general approach for sensorimotor rehabilitation. Methods . This prospective, multicenter, randomized, parallel-group study measured outcomes with blinded assessors. Sixty-eight patients able to walk without human assistance were entered from 3 to 15 months (mean, 7 months) after a first hemispheric stroke. They received 20 sessions in 4 weeks of NDT or multisensorial rehabilitation. On day 0, day 30, and day 90, assessment included the Berg Balance Scale (BBS), posturography, gait (velocity, double stance phase, climbing 10 steps, amount of walking per day), the Functional Independence Measure, and the Nottingham Health Profile. Results. All subjects improved significantly in balance and walking parameters. Regarding the main dependent variable (BBS on day 30), no difference between groups was found. Analysis of secondary outcomes suggested small differences in favor of the experimental group, but the differences are not likely to be clinically relevant. Conclusion. No evidence was found for the superiority of a multisensorial rehabilitation program in ambulatory patients with impairments beyond the time of inpatient therapy. Additional studies are recommended.
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Affiliation(s)
- Alain P. Yelnik
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris,
| | - Frederique Le Breton
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Florence M. Colle
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Isabelle V. Bonan
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Caroline Hugeron
- Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches
| | - Véronique Egal
- Physical Medicine and Rehabilitation Department, G.H. Lariboisière-F. Widal, Université Paris 7, Paris
| | - Elizabeth Lebomin
- Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches
| | - Jean-Philippe Regnaux
- Physical Medicine and Rehabilitation Department, Hôpital Raymond Poincaré, Université Versailles, Garches
| | | | - Eric Vicaut
- Unité de Recherche Clinique, G.H. Lariboisière-E.Widal, Université Paris 7, Paris France
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