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Resume Introduction En neuro-urologie pediatrique, la mise en place des sondages intermittents puis l’apprentissage des auto-sondages sont des etapes importantes pour les enfants presentant une vessie neurologique. Il n’existe pas d’echelle d’evaluation specifique de l’enfant de l’adherence et de la satisfaction aux sondages (auto- ou hetero-). L’objectif de cet article est d’etudier la faisabilite de l’InCaSaQ (Intermittent Catheterization Satisfaction Questionnaire) et de l’ICAS (Intermittent Catheterization Adherence Scale) chez l’enfant, et d’en realiser les premieres etapes de validation. Materiel et methodes Etude monocentrique de validation d’echelle. Les criteres d’inclusion etaient la presence chez les patients d’une vessie neurologique, la realisation reguliere de sondages intermittents (auto- ou hetero-) et un âge inferieur a 18 ans. Les questionnaires InCaSaQ et ICAS etaient envoyes a deux reprises entre mars et avril 2017, puis remplis par l’enfant ou ses parents selon qui effectuait les sondages. La consistance interne (alpha de Cronbach) mesurait la validite de construit. La reproductibilite etait mesuree par le cœfficient de correlation (CCI) et les tests de Wilcoxon et de McNemar. La pertinence et la facilite de remplissage etaient evaluees pour chaque score (evaluation sur une echelle de 0 a 10 par la personne remplissant le questionnaire). Resultats Vingt deux patients ont ete inclus, et 50 questionnaires ont ete recuperes (25 ICAS et 25 InCaSaQ), a deux reprises. La consistance interne est satisfaisante pour InCaSaQ (alpha de Cronbach > 0,7) et la reproductibilite est bonne pour les deux questionnaires (CCI > 0,7 pour la majorite des items). Les patients sous auto-sondages avaient une moins bonne adherence que les parents realisant des hetero-sondages (ICAS a 3,25 contre 0,70 chez les enfants sous hetero-sondages). L’item le plus abaisse dans l’InCaSaQ etait la maniere de se debarrasser de la sonde. Conclusions L’InCaSaQ et l’ICAS sont des outils qui peuvent etre utilises chez l’enfant sous auto-sondages ou hetero-sondages. Des etudes de plus grande ampleur seront necessaires pour en finaliser la validation. Niveau de preuve 4.

Resume Objectif Le traitement par neurostimulation tibiale posterieure transcutanee (NTPT) a montre son efficacite dans le traitement de l’hyperactivite vesicale (HAV), mais son effet chez les patients diabetiques est mal connu. Le but de cette etude etait de comparer l’efficacite du traitement par NTPT chez les patients diabetiques ayant une HAV et chez les patients ayant une HAV sans diabete. Methodes Une etude prospective monocentrique incluait tous les patients traites par NTPT pour troubles vesico-sphincteriens entre 2012 et 2016. Le critere de jugement principal etait l’efficacite ≥ 50 % de la symptomatologie evaluee au moyen d’une echelle visuelle analogique (EVA) a deux mois. Le traitement instaure consistait en une seance de NTPT quotidienne de 20 min. Les criteres de jugement secondaires etaient les donnees du calendrier mictionnel, l’Urinary Symptom Profile (score d’hyperactivite vesicale), le retentissement sur le moral et sur les activites de la vie quotidienne evalues par EVA. Resultats Soixante et onze patients ont ete inclus, dont 10 etaient diabetiques. Le taux d’efficacite (EVA ≥ 50 %) n’etait pas significativement different dans le groupe des patients diabetiques (70 % vs. 44,1 % dans le groupe non diabetique ; p = 0,17), de meme que l’EVA efficacite moyenne (4/10 vs. 4/10 ; p = 0,98). Le sous-score USP HAV diminuait significativement dans les deux groupes a 2 mois (−3 points dans le groupe diabetique ; −1,9 points dans le groupe non diabetique ; p = 0,03 et p Conclusion Les resultats fonctionnels de la NTPT semblent similaires dans le traitement de l’HAV chez les patients diabetiques et chez les patients non diabetiques. Niveau de preuve 4.

Introduction L’asymetrie posturale et l’augmentation des oscillations sont des caracteristiques frequentes retrouvees sur plateforme de force apres AVC. L’asymetrie persiste au long cours et son origine ainsi que son impact sur l’equilibre sont discutes. En dehors de la faiblesse musculaire, la diminution de la sensibilite ou la spasticite, les troubles de la representation de l’espace en est probablement au moins en partie responsable. La correction de l’asymetrie posturale est integree depuis longtemps dans les programmes de reeducation classique de maniere top down. Mais la correction de l’asymetrie posturale peut egalement etre obtenue par stimulation sensorielle (proprioception, vestibulaire, visuelle). Il s’agit alors d’une correction de type bottom up qui est interessante surtout chez des patients cerebraux leses droits qui ont souvent des troubles attentionnels est une anosognosie. Un ensemble assez consequent d’etudes ont ete realises sur l’effet instantane d’une seance de stimulation sensorielle. Methodes/Resultats Nous avons teste des stimulations repetees par vibration des muscles du cou sur une petite population de 32 AVC a plus de six mois qui a montre que les AVC droits qui etait initialement plus devies retrouvaient une asymetrie comparable a celle des AVC droit. Plus recemment nous avons mene une etude multicentrique randomisees controlees sur 85 AVC droits avec 4 bras (adaptation prismatique/vibration/prisme + vibration/controle) dont les resultats sont en cours d’interpretation. Conclusion La modulation de l’asymetrie posturale apres AVC par les stimulations sensorielles represente une nouvelle voie de traitement interessante et facile a mettre en œuvre.

Introduction La contemplation et la perception d’une œuvre d’art au complet implique le regard et l’orientation de la tete. Cette derniere depend des informations proprioceptives du cou. L’application des vibrations sur les muscles du cou stimulent ces informations, et peut generer des reponses posturales. Nous voulons determiner si l’application de vibrations nucales modifie l’exploration visuelle d’une œuvre d’art, et comment la tâche d’exploration affecte les reponses posturales aux vibrations. Materiel et methode Vingt adultes en bonne sante porteront un systeme de suivi du regard (Tobii) et l’application App Balance de mesure de l’equilibre. En position debout, ils exploreront trois tableaux (largeur > 1 m) et identifieront 7 details. L’exploration se fera sans ou avec vibrations nucales (gauches et droites) (VB115, TechnoConcept) de maniere randomisee. Un test d’exploration visuelle de type papier-crayon (test des cloches) sera egalement effectue en position assise. Analyse Les tableau seront divises en 7 colonnes ; la 1re colonne exploree, les temps de fixation et le nombre de visite sur chaque colonne, ainsi que l’activite posturale seront compares entre les differentes conditions. Resultats attendus L’application de vibrations nucales modifiera l’exploration visuelle. Les reponses posturales aux vibrations seront attenuees lors de l’exploration, du fait du meilleur ancrage visuel fourni par l’exploration. Discussion Les personnes avec des deficits de la perception visuelle pourraient beneficier de ce type d’intervention, en situation ecologique. Les donnees des sujets en bonne sante aideront a interpreter les resultats de ces patients recrutes dans une future etude.

International audience; Objective: To investigate the postural effect of 2 types of sensory stimulation in patients with a left hemispheric lesion (LHL) or right hemispheric lesion (RHL) compared with controls. Methods: 35 patients (18 LHL, 17 RHL) and 27 controls (Mean age 54.1 years), with a mean delay post-stroke of 3.0 months were enrolled. Subjects stood on a force platform and were stimulated on the left and right side by optokinetic (Okn) and galvanic vestibular (Gv) stimulation. Lateral displacement following stimulation towards the right and left directions was calculated as the mean position of the centre of pressure (CP) during the stimulation period minus the mean position at rest. Results Postural asymmetry was reduced in LHL and RHL patients. CP displacement was higher in cases of left-sided stimulation in the RHL group compared with control subjects and LHL patients (respectively 2.8 and 2.4 times higher, group effect, p

Objectifs La neurostimulation du nerf tibial posterieure transcutanee (NSTP) est devenue ces dernieres annees, pour les patients ayant une hyperactivite vesicale (HAV), une option therapeutique reconnue. Le but de cette etude etait de rapporter les resultats de la NSTP chez les patientes atteintes d’HAV. Methodes Les donnees cliniques des patientes ayant une HAV, traitees par NSTP ont ete collectees prospectivement entre 2013 et 2018 dans un centre universitaire. Le traitement etait auto-administre par les patientes, au domicile a l’aide du dispositif urostim 2. Les seances devaient durer 20 minutes, quotidiennement, sur une periode minimum de 3 mois. Une seance de formation initiale d’une heure avec une infirmiere dediee etait realisee. Le critere de jugement principal etait l’impression d’amelioration, evaluee par la patiente a 3 mois a l’aide d’une echelle visuelle analogique (EVA) allant de 0 a 10. Les criteres secondaires etaient les donnees du calendrier mictionnel et le questionnaire USP. Resultats Soixante-deux patientes ont ete incluses. La moyenne d’âge des patientes etait de 58,3 ans. Cinquante-trois patientes avaient une incontinence urinaire par urgenturie (85,5 %) et 9 avaient une HAV sans fuites (14,5 %). La plupart des patientes avaient une hyperactivite detrusorienne au bilan urodynamique (71,1 %) et la majorite etaient resistantes aux traitements anticholinergiques (67,7 %). La moyenne de l’EVA efficacite a 3 mois etait de 4,8 (± 3,5). Le score d’HAV de l’USP diminuait significativement de 11,1 (± 4,1) a 9 (± 4) a 12 semaines (p = 0,0006). La capacite vesicale fonctionnelle s’ameliorait significativement avec un volume urine passant de 309,2 (± 168,5) a 355 (± 213,3) mL (p = 0,02). Le nombre d’episodes d’incontinence urinaire quotidien diminuait significativement egalement passant de 4,9 a 3,4 (p = 0,002). Le taux d’arret du traitement a 3 mois etait de 46,9 %. Conclusion La NSTP transcutanee semble etre une option therapeutique efficace chez les patientes atteintes d’HAV. Des etudes complementaires sont necessaires pour evaluer l’efficacite, les effets secondaires et le cout-efficacite de ce traitement comparativement a la NSTP percutanee.

Introduction Muscle vibrations can be used to induce a body tilt. Even though several muscle sites have been tested for various diseases their respective mode of action were not highlighted. The objective was to compare the effects of neck muscle vibrations (NMV) and gluteus medius vibrations (GMV) on posture in healthy subjects. Material and methods Thirty-one healthy subjects (23yr ± 2) were tested, closed eyes, in standing position on force platform with Optitrack 3D capture system. They received successively a 5 min-session of NMV and 5 min-session of GMV in a randomized order. They were evaluated during the vibration, immediately at the end of the vibration and 5 minutes after. Results GMV induced a Center of Pressure tilt to the opposite side of the vibration (−7.6 ± 2 mm P Discussion These results are in favor of a different mode of action between neck and gluteus medius vibrations.

Introduction Postural asymmetry is a cause of disability for subjects after a stroke and generally assessed with the force platform (FP). The objectives were to map out the characteristics of assessing postural asymmetry; thereafter to synthesize on how postural asymmetry develops in time after a stroke and finally, to describe postural asymmetry and its relations. Material and methods Following the PRISMA guidelines, a systematic search was performed using the databases MEDLINE, EMBASE, Cochrane library and PEDrO with the key words (Weight-Bearing Asymmetry OR Center of Pressure) AND (Stroke) for articles published through to November 2017. Results One hundred and ninety-five articles were included and highlighted certain heterogeneity in the manner in which the evolution was performed. As expected postural asymmetry was found at an acute stage and still persistent at a chronic stage with a possible difference between left and right brain damage. Thirty-two articles were included in the meta-analysis, which revealed an important number of correlations (124) carried out with postural asymmetry with heterogeneity in the results. Discussion The variability and the heterogeneity in the measurement method as well as the important number of correlations carried out with postural asymmetry does not allow us to draw a reasonable conclusion from the information presented and furthers studies are needed.

International audience; Introduction - Quantitative evaluation of upper limb (UL) kinematics in children with unilateral cerebral palsy (uCP) remains challenging for researchers and clinicians, especially during bimanual situations. This study proposed a new 3D bimanual protocol dedicated to children with uCP, called "Be an Airplane Pilot" (BE-API protocol) and assessed its reliability for typically developing children (TDC). Methods - this protocol is composed of four bimanual tasks that allow the exploration of all degrees of freedom of the hemiplegic/non-dominant UL. Twenty TDC (mean age 11.9 ± 3.4) carried out three protocol sessions. Reliability was investigated through three kinematic parameters: angular waveforms (WAVE) using the coefficient of multiple correlation (CMC), range of motion (RoM) and maximum angles (MAX) both using the intra-class correlation coefficient (ICC) and the standard error of measurement (SEM). Results - A very good reliability was observed for the three kinematic parameters in most cases (WAVE: CMC ≥0.90, RoM & MAX: ICC ≥0.81, SEM ≤5.0°). Discussion - the very good reliability can be partly explained by the high level of rigor of the protocol. Such promising results open the door to validation tests on children with uCP. The BE-API protocol could pretend to support clinical decisions by objectively assessing the efficiency of therapeutics, e.g. injection of botulinic toxin.

Objectifs L’objectif de cette etude etait de comparer les resultats de la cystectomie par voie ouverte (CO), par voie laparoscopique pure (CL) et par voie robot-assistee (CRA) associee a une derivation cutanee non continente trans-ileale chez les sujets neurologiques. Methodes Tous les patients ayant eu une cystectomie pour vessie neurologique dans un centre entre 2006 et 2017 ont ete inclus dans une etude retrospective. La derivation etait une derivation cutanee trans-ileale non continente type Bricker dans 100 % des cas dans les 3 groupes, toujours realises en extra-corporel. La plupart des CO et CL etaient realisees par un chirurgien experimente (> 20 cystectomies au debut de l’etude et > 50 procedures laparoscopiques) et la plupart des CRA par un autre chirurgien sans aucune experience de la cystectomie et ayant realise moins de 10 interventions laparoscopiques ou robot-assistees en autonomie au debut de l’etude. Resultats Quatre-vingt-dix patients ont ete inclus : 41 robot, 23 cœlioscopique et 26 ouvert ( Tableau 1 ). La duree operatoire etait plus courte dans le groupe CO que dans les groupes CL et CRA (295,6 vs. 383,7 vs. 374,4 min ; p = 0,03). La duree d’hospitalisation etait plus courte dans le groupe CRA et dans le groupe CL que dans le groupe CO (16,5 vs. 13,5 vs. 13,2 jours ; p = 0,03). Le taux de complications majeures etaient plus importants dans les groupe CO et CL que dans le groupe CRA (30,8 % vs. 30,4 % vs. 9,8 % ; p = 0,05) de meme que le taux d’utilisation d’une PCA morphine en postoperatoire (62,5 % vs. 77,8 % vs. 22,9 % ; p = 0,003). Le taux de complications tardives etait similaire dans les 3 groupes (13 % vs. 14,3 % vs. 21,9 % ; p = 0,60) ( Tableau 2 ). Conclusion La voie laparoscopique, qu’elle soit ou non robot-assistee, pourrait diminuer la duree d’hospitalisation par rapport a la voie ouverte pour l’exerese d’une vessie neurologique avec derivation cutanee non continente trans-ileale, au prix d’une duree operatoire plus longue. L’avantage de la voie robotique sur la voie cœlioscopique pourrait etre une reduction du taux de complications majeures et des douleurs postoperatoires.

Introduction Les asymetries posturales et troubles de la marche sont frequents et sont a l’origine d’une augmentation du risque de chute. La vibration du muscle gluteus medius pourrait corriger cette asymetrie, mais l’effet a long terme n’a pas encore ete teste. L’objectif de cette etude etait d’etudier les effets d’un programme de vibrations repetees du muscle gluteus medius (rGMV) sur l’asymetrie posturale et la marche chez des patients apres un AVC en phase chronique. Materiel et methodes Huit patients a la phase chronique d’un AVC (âges de 58,6 ans ± 8 ; delai AVC de 4 ans ± 1) ont suivi un programme de 10 seances de GMV (30 minutes) lors d’une seance de physiotherapie basee sur la marche. Les parametres de marche (phase d’appui (StP), phase d’oscillation (SwP)), les parametres posturographiques (pourcentage d’appui (WBA), surface, Xm, Ym), bilan d’equilibre (echelle de Berg (BBS), Timed Up and Go), et les caracteristiques de l’hemiplegie (motricite, sensibilite, spasticite) ont ete testes avec une analyse de variance a mesures repetees avec comme facteur le cote de la lesion et le temps (J0, J15, J21, J30, J60). Resultats Les resultats preliminaires n’ont montre aucune amelioration apres l’intervention (J15) ni sur les parametres de marche (StP : p = 0,54 ; SwP : p = 0,54) ni sur les parametres de la posturographie (WBA : p = 0,74 ; Xm : p = 0,74 ; Ym : p = 0,28) en dehors de la surface (p = 0,05). Discussion/Conclusion Apres l’intervention, une diminution de la surface a ete constatee. Une possible fatigabilite a J15 pourrait expliquer l’absence d’amelioration des parametres de la marche et de posturographie.

Bonan M2S; International audience; Balance disorders related to disturbances in perception of spatial reference systems are common especially after right hemispheric stroke. Mental misrepresentation of bodily orientation in space is then often superimposed upon other factors affecting imbalance such as motor and sensory impairments. Traditional rehabilitation for balance recovery has not been specifically designed to improve balance disorders related to spatial cognition. The traditional approach, consisting of stimulating the conscious perception of body orientation in space, is demanding and laborious. The approach based on sensorial stimulation is completely different. The relevance of this method lies in the fact that, firstly it is specifically active in the cognitive component of balance disorders; and secondly, it can passively be applied with minimal patient participation, which is of particular importance for this patient group characterized by disorders of attention and concentration. These techniques, such as proprioceptive, visual or vestibular stimulation, have been found to correct spatial neglect but also postural bias. Clinical and data from functional neuro-imaging suggest a direct central action on cortical structures involved in the elaboration of spatial representation. These are promising techniques for the rehabilitation of postural disturbances related to spatial cognition disorders but are as yet at the stage of preliminary results

Resume But Decrire les troubles vesico-sphincteriens et anorectaux chez les enfants paralyses cerebraux (PC), en precisant leur retentissement sur la qualite de vie. Materiel Il s’agissait d’une etude monocentrique prospective. Le recueil de donnees etait : type de PC, Gross Motor Function-Classification System (GMF-CS), scolarisation en milieu ordinaire ou non, mesure d’independance fonctionnelle chez l’enfant (MIF-mome), questionnaires standardises de symptomes vesico-sphincteriens, et de qualite de vie (question specifique du retentissement des troubles sphincteriens et echelle generique Kidscreen-52). Resultats Entre janvier et mars 2013, 19 enfants âges de 5 a 17 ans etaient inclus, dont 16 scolarises en milieu ordinaire. Sur les 19, 16 avaient des troubles vesico-sphincteriens : 14 incontinences urinaires, 3 nycturies, 6 dysuries, 12 urgenturies, aucune infection urinaire. Sur les 14 incontinents urinaires, 13 etaient scolarises. Parmi les 16 enfants scolarises, 5 avaient une incontinence fecale diurne et 2 une incontinence fecale nocturne. Les scores fonctionnels (GMF-CS et MIF-mome) des enfants incontinents urinaires etaient inferieurs a ceux des enfants continents urinaires ( p = 0,04 et 0,0007). Ces troubles avaient un retentissement specifique sur leur qualite de vie pour 10 enfants. Tous etaient scolarises dont huit (80 %) en milieu ordinaire. Conclusion Les troubles vesico-sphincteriens etaient frequents chez les enfants atteints de PC. Ils entrainaient un retentissement sur la qualite de vie chez plus de la moitie des enfants etudies, dont une majorite scolarisee en milieu ordinaire.

Introduction/Background Neurofeedback (NF) consists on training self-regulation of brain activity by providing real-time information about the participant brain function. Few works have shown the potential of NF for stroke rehabilitation however its effectiveness has not been investigated yet. NF approaches are usually based on real-time monitoring of brain activity using a single imaging technique. Recent studies have revealed the potential of combining EEG and fMRI to achieve a more efficient and specific self-regulation, which may be critical in clinical applications. In this case report, we tested the feasibility of applying bimodal EEG-MRI NF on stroke patients. Material and method Two chronic patients affected by left hemiplegia (subcortical lesion) participated. The protocol included a calibration step (motor imagery of hemiplegic hand) and two NF sessions (5 minutes each). The experiment was run using a NF platform performing real-time EEG-fMRI processing and NF presentation ( Fig. 1 ). The NF metaphor consisted of a ball moving on a gauge proportionally to the average BOLD and EEG activity in regions of interest (ROI) identified over the ipsilesional motor cortex during calibration. Results Both patients were able to self-regulate their brain activity during the NF sessions. The EEG activity was harder to modulate than the BOLD activity ( Fig. 2 , Fig. 3 ). The correlation of the BOLD signal with the task varied depending on the ROI targeted and was particularly high for the supplementary motor area. The patients were highly motivated to engage and satisfied with the NF animation, as assessed with a qualitative questionnaire. Conclusion We performed two NF experiments involving chronic stroke patients: preliminary results showed the feasibility and the potential of applying EEG-fMRI NF for stroke rehabilitation.

Introduction/Background Muscle vibration, in particular applied to the neck muscle is increasingly being used as a mean of rehabilitation treatment. Neck muscle vibration (NMV) is thought to have an effect on the representation of the body in space through sensory recalibration. The objective of this systematic scoping review was to map out the characteristics of the existing studies and gather the effect of neck muscle vibration on both spatial frame of reference and on postural balance. Material and method following the PRISMA guidelines, a systematic search was carried out using the databases MEDLINE, EMBASE, Cochrane library and PEDrO applying the following key words [(Postural balance) OR (Spatial reference)] AND (Neck muscle vibration) for those articles published through to July 2016. Results Altogether 67 studies were assessed and they unveiled both a large heterogeneity and a standard quality of methodology with a total of 1522 participants included. Under unilateral neck muscle vibration, the visual environment (illusion of a visual target) seemed to move towards the opposite side of the vibration, and both the visual vertical and the straight ahead were shifted towards the vibrated side. In addition, NMV produce a body tilt. This effect is however not constant at all times. Conclusion NMV is considered as a useful remedy tool in rehabilitation therapy which has shown to induce a body sway on the force platform and a deviation of the spatial representation in both healthy subjects and patients. That said, however, owing to the heterogeneity of the experiences and the various significant shortfalls highlighted, this research does not allow us to firmly conclude our results.

Introduction/Background After stroke, standing balance is usually described as a predictor of functional recovery. Regarding literature, various type of physical therapy (PT) is used to improve balance. The aim of this meta-analysis is to evaluate the effects of PT directly focused on balance training (DFBT) and theses of PT indirectly focused on balance training (IFBT) on balance after stroke. Material and method Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017). Results One hundred and ninety-three parallel and crossover RCT from 9337 records were included, involving 8018 subjects [study sample: mean 41.5 (SD 49.7) subjects, age: pooled mean 61.7 (pooled SD 12.78) years]. A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS (DFBT: 7 studies, mean difference [MD] 1.38; 95% confidence interval [CI] [0.71; 2.05]. IFBT: 18 studies, MD 1.88; 95% CI [1.31; 2.45]). Only IFBT PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (DFBT: 1 study, MD 5.33; 95% CI [−4.68; 15.34]. IFBT: 26 studies, MD 1.85; 95% CI [0.67; 3.03]). Conclusion These results show immediately after the intervention: –that balance can be improved by PT aiming directly or indirectly at the recovery of balance compared to no treatment; –an improvement of balance by PT indirectly focused on the recovery of balance compared to sham treatment or usual care.

Introduction/Background Asymmetrical postural behaviors are frequent and related to poor equilibrium after a stroke. Proprioceptive neck vibration corrects in the short term the postural asymmetry probably through a sensory recalibration, but the effects of repetitive has yet to be tested. The objective was to test the effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in right (RBD) and left (LBD) brain damage patients. Material and method Thirty-two chronic stroke patients (mean age 60.9 ± 10 y and mean delay after stroke 4.9 ± 4 years), 16 RBD and 16 LBD, underwent a program of 10 sessions of vibrations (10 min) during a period of two weeks. Postural asymmetry on force platform (Weight Body Asymmetry WBA), spatial frames (Subjective Straight Ahead SSA, Longitudinal Body Axis LBA, Subjective Visual Vertical SVV) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, Time Up and Go) were ascertained at the end of the vibrations (D + 15) and at D + 22, D + 45. Results In the post-test, the results were depending of the side of the lesion with a significant reduction in WBA in the RBD (P = 0.0001), whereas no effect was observed in the LBD. No significant modification was found on the spatial frame in both groups. A significant improvement was found for the Motricity, TUG and BBS in the both groups at the end and at distance. Conclusion rNMV causes a reduction of postural asymmetry only in the RBD patients. These results suggest that rNMV could be effective on sustainable disorders of balance of spatial cognition disorders. Further, this result was not maintained at distance.

Introduction/Background The objective is to describe lower urinary tract and anorectal disorders in children with cerebral palsy (CP) and evaluate their impact on quality of life (QoL). Material and method Ten months monocentric prospective study about 5 to 17 years old children with CP. Datas collected were: CP type, GMFCS level, Wee-FIM, MACS level, voiding and defecation diary, standard questionnaire, Akbal questionnaire, WPPSI-3 or WISC-4, parents and children Kidscreen-52 scale. Results Between October 2014 and July 2015, 24 children from 5 to 17 years old were included. Twenty-three children (89%) had lower urinary tract dysfunction. Twenty-one from those 23 were in normal school. Six had a pollakiuria, 5 a nycturia, 20 an urgenturia [in which 11 had urinary incontinence (UI)], 9 a dysuria, 2 a urinary infection, 12 a UI (6 day and night UI, others only day UI). Seven children going in normal school had a fecal incontinence (3 day and night, others only day). Urinary incontinent children Wee-FIM scores were lower than non-urinary incontinent ones (P = 0.007). Seven children with a low GMFCS level and going in normal school had an impact of their lower urinary tract disorders on their QoL. All had an overactive bladder syndrome, 3 a dysuria, 2 a nycturia, 1 a pollakiuria. Kidscreen-52 QoL score estimated by children with UI were significantly different than non-urinary incontinent ones (P = 0.0264). Conclusion This study shows the importance of lower urinary tract and anorectal disorders impact on children with CP QoL. Most of those children are in normal school. Detection is not systematic enough during follow-up consultations and parents often underestimate those troubles. Questioning and flow measurement seem to be important first steps to detect them.

Introduction/Background Children with unilateral cerebral palsy (uCP) have upper limb (UL) motor impairments that hinder the realization of activities of daily life, particularly in bimanual situations. The existing three-dimensional motion analysis (3DMA) protocols are limited to unimanual situations or have not been validated. This work aims at proposing a 3DMA child-friendly bimanual protocol and at assessing its feasibility and its reliability on typically developing children (TDC) and uCP children. Material and method Twenty TDC (11.9 ± 3.4 years) and 20 uCP children (12.0 ± 3.2 years) participated by realizing 3 consecutive sessions of the protocol. The protocol consists of 4 complementary bimanual tasks that are integrated into a scenario game of “becoming an airplane pilot” ( Fig. 1 ). It allows the exploration of all degrees of freedom of the UL. Kinematics of the non-dominant/hemiplegic UL was measured using an optoelectronic system (12 cameras). The reliability of the angular waveforms (WAVE), the maximum angles (MAX) and the range of motion values (RoM) has been assessed. Results Results showed an excellent reliability for TDC (WAVE: CMC ≥ 0.90; MAX & RoM: ICC ≥ 0.82, SEM ≤ 5.0°) and a very good reliability for uCP children (WAVE: CMC ≥ 0.82; MAX & RoM: ICC ≥ 0.75, SEM ≤ 4.7°), at the exception of a few minor cases. A lower elbow extension, a lower supination and a higher wrist flexion were observed in uCP children compared to TDC. Conclusion The very high reliability of the protocol is a very promising result. Its feasibility was excellent for TDC and uCP children, at the exception of one task for uCP children with a high level of deficit (MACS III). Future work consists of adjusting this protocol to all uCP children (MACS I, II, III) and assessing the between-day reliability, before its future deployment as a clinical routine.

Introduction/Background Cerebral palsy (CP) is the first cause of children motor disability. In unilateral CP, upper limb dysfunctions are the main cause of dependence and participation restriction. Effects of mirror therapy are well known in others disorders, especially in adult population but its benefit is not yet determined in children with cerebral palsy. The aim of this study is to determine the efficacy of mirror therapy in children with unilateral cerebral palsy on bimanual activity. Material and method This study was a prospective, randomized, single-center, controlled, single-blind study. The primary efficacy variable was the Assisting Hand Assessment (AHA). Thirty-two hemiparesis (17 in mirror therapy group and 15 in control group) children aged over 7 were evaluated using the AHA to score functional activity performance. The mirror therapy group used a mirror, the comparison group used an opaque partition between their arms. Each participant had 5 rehabilitation sessions for 5 weeks. Each child was evaluated initially (S0), at 5 weeks (S5) and 10 (S10) weeks. Results AHA score at 5 weeks were 61.44 ± 11.99 for the 32 patients, 61.60 ± 11.72 in control group, 61.29 ± 12.58 in mirror therapy group (P = 0.9440). At 10 weeks, scores were 61.9 ± 11.4 for the entire population, 61.4 ± 11.8 in control group and 62.4 ± 11.4 in mirror therapy group (P = 0.8178). Conclusion There were no significant differences in outcomes and their progression S5 and S10 between the mirror therapy group and control group. Neither primary nor secondary efficacy variables have shown significant differences. Even though our study did not show improvement in AHA score after 5 weeks of mirror therapy, we can observe an improvement tendency that could be statically significative with a larger population.

Objectifs Le spina bifida est une anomalie de fermeture du tube neural au cours de l’embryogenese. Cette malformation engendre des troubles de la motricite, de la sensibilite, des troubles vesico-sphincteriens, ano-rectaux et genito-sexuels. Les donnees sur l’atteinte sexuelle des femmes spina bifida sont rares. L’objectif de cette etude etait d’evaluer les dysfonctions sexuelles chez des femmes atteintes d’un spina bifida et rechercher les facteurs associes a ces dysfonctions. Methodes Les donnees de tous les patients spina bifida consultant dans un centre pluridisciplinaire entre 2007 et 2019 ont ete colligees prospectivement. Tous les patients avaient initialement une evaluation pluridisciplinaire comprenant une evaluation urologique, proctologique, sexuelle, sociale et de medecine physique et reeducation. La fonction sexuelle etait evaluee a l’aide d’un auto-questionnaire (FSFI : Female Sexual Function Index ; score allant de 2 a 36). L’etude a inclus les femmes âgees de plus de 18 ans atteintes d’un spina bifida, capables de lire et comprendre le questionnaire et ayant donne leur consentement. Resultats Sur les 322 femmes atteintes d’un spina bifida ayant consulte sur la periode d’etude, 146 ont repondu au questionnaire de dysfonction sexuelle feminine (FSFI = Female Sexual Function Index). Un score FSFI inferieur ou egal a 26,55 est admis comme indiquant une dysfonction sexuelle. La prevalence de la dysfonction sexuelle dans cette population etait de 100 %. Ni l’âge (p = 0,54), ni le mode mictionnel (p = 0,36), ni le type de dysraphisme (ouvert vs ferme ; p = 0,33), ni le statut locomoteur (marche vs fauteuil ; p = 0,33) n’etaient significativement associes au FSFI. Les patientes nullipares avaient un FSFI plus bas que les patientes ayant des enfants (8,6 vs 10,9 ; p = 0,01), les patientes celibataires avaient un FSFI plus faible que les patientes mariees (7,2 vs 10,7 ; p = 0,0007) et divorcees (7,2 vs 10,3 ; p = 0,03) ( Fig. 1 ). Conclusion La prevalence de la dysfonction sexuelle etait de 100 % dans cette cohorte de patientes spina bifida. Les patientes celibataires et/ou nullipares avaient une dysfonction sexuelle plus severe sans que le lien de causalite puisse etre determine en raison du caractere transversal de l’etude.

Objectifs L’objectif de cette etude etait de mesurer les performances diagnostiques de 6 marqueurs urinaires (NGF, BDNF, TIMP-2, TGF-B1 et PGE2) pour l’evaluation du regime de pression vesicale et du risque d’atteinte du haut appareil urinaire chez les adultes spina bifida. Methodes Une etude prospective monocentrique a ete menee entre mars 2015 et mars 2017 incluant tous les patients spina bifida adultes ayant consulte consecutivement pour examen urodynamique. Une imagerie de l’appareil urinaire etait egalement effectuee chez tous les patients. A la fin de la periode d’inclusion, les prelevements urinaires etaient decongeles pour realisation des dosages de NGF, BDNF, TIMP-2, PGE2, TGF-B1 a l’aide de kits ELISA dedies et de MMP-2 par zymographie. Le trouble de la compliance etait defini comme une compliance Resultats Quarante patients ont ete inclus. Le TIMP-2 et le MMP-2 etaient les seuls marqueurs urinaires significativement associe au trouble de la compliance vesicale (p = 0,043 et p = 0,039 respectivement). Il n’y avait pas d’autres associations statistiquement significatives entre marqueurs urinaires et parametres urodynamiques (compliance, Pdetmax, capacite cystomanometrique ou hyperactivite detrusorienne). Le TIMP-2 etait egalement le seul marqueur urinaire associe a une atteinte du haut appareil urinaire (OR = 19,8 ; p = 0,02). Le trouble de la compliance et la Pdetmax etaient les seuls parametres urodynamiques significativement associes a l’atteinte du haut appareil urinaire (p = 0,01 et p = 0,02). Les performances diagnostiques du TIMP-2 urinaire pour l’atteinte du haut appareil urinaire etait legerement superieur a celle de la Pdet max et au trouble de la compliance (voire courbes ROC, Fig. 1 ) avec une aire sous la courbe de 0,72. Conclusion Le TIMP-2 et le MMP-2 urinaire pourraient etre associes au trouble de la compliance vesicale et le TIMP-2 urinaire a l’atteinte du haut appareil urinaire chez les adultes spina bifida. Ces resultats confirment la forte implication physiopathologique du remodelage de la matrice extracellulaire dans les troubles vesico-sphincteriens a haut risque des patients spina bifida. Cela pourrait constituer une cible therapeutique.

Introduction Asymmetrical postural behaviours are frequent and related to poor equilibrium after a stroke. Proprioceptive neck vibration could correct the postural asymmetry through a sensory recalibration but the long lasting effect has not yet tested. Objective To test the long-lasting effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in chronic patients. Methods Twenty chronic stroke patients (mean age: 61.4 y11, mean delay since stroke: 5.5y3), 10 right (RDB) and 10 left (LDB) brain damage, underwent a program of 10 vibrations of 10 min sessions during two weeks–the evaluation of postural asymmetry on force platform (weight body asymmetry WBA), spatial frames (subjective straight ahead SSA, longitudinal body axis LBA, subjective visual vertical SVV) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, time up and go) were ascertained before (D−15, D0) and at the end of the vibrations (D + 15, D + 22, D + 45). Results In the post-test, a significant reduction in WBA was established in the RBD (P = 0.009) and was maintained at D + 15 (P = 0.01) and D + 22 (P = 0.05), no effect was observed in the LBD. In addition, no significant modification was found on the spatial frame in both group. A significant improvement was found for the motricity and time up and go in the RBD. Discussion rNMV causes a reduction of postural asymmetry in the RBD group independently of the space representation improvement. Likewise, rNMV can modify the postural asymmetry in chronic patients but this result was not maintained at D + 45.

Introduction La vibration des muscles du cou (NMV) est de plus en plus utilisee malgre un mecanisme d’action encore peu connu. L’objectif de cette revue est de faire un etat des lieux des etudes recensant les effets de la NMV sur la perception spatiale et l’equilibre postural, en analysant le niveau de preuve (LoE). Materiel et methodes Suivant les directives PRISMA, une recherche systematique a ete realisee sur les bases de donnees MEDLINE, EMBASE, Cochrane Library et PEDrO avec les mots cles ((postural balance) OR (reference spatiale)) AND (Neck muscle vibration) pour les articles publies jusqu’en juillet 2016. Resultats Soixante articles ont ete inclus et ont revele a la fois une grande heterogeneite et une methodologie de faible qualite. Chez les sujets sains, sous NMV unilaterale, l’environnement visuel (illusion d’une cible visuelle) se deplace du cote oppose a la vibration (LoE IIa) et la verticale visuelle (LoE IV) et le droit devant (LoE IIa) sont devies vers le cote vibre. De plus, la NMV produit une inclinaison du corps (LoE IV). Les memes resultats ont ete trouves pour les patients ayant subi un AVC, avec une correction du biais initial, tandis que pour les patients vestibulaires, les effets se sont reveles moins consensuels. Discussion/Conclusion La NMV module a la fois les biais spatiaux et posturaux. Cette technique pourrait etre proposee comme outil de therapie de readaptation. En raison de l’heterogeneite et de la faible qualite methodologique des etudes, les conclusions de cette recherche restent provisoires.

Objectifs Rapporter les resultats fonctionnels a tres long terme apres implantation d’un sphincter artificiel urinaire (SAU) chez une population d’homme spina bifida. Methodes De 1982 a 2014, 34 patients spina bifida de sexe masculin ayant une incontinence urinaire par insuffisance sphincterienne ont beneficie d’un SAU. Les taux d’explantation et de revision ont ete evalues a partir de la date de l’implantation jusqu’a la derniere visite de suivi, en utilisant la methode de Kaplan–Meier. Le taux de survie des SAU (sans revision ni explantation) en fonction du mode mictionnel (spontane vs sondage intermittent) a egalement ete rapporte. La continence, definie par l’absence de port de protections, a ete evaluee au terme du suivi. Resultats Au total, 42 SAU ont ete implantes chez 34 patients. L’âge median des patients au moment de la chirurgie etait de 19 ans (IQR 15–29). La duree mediane de suivi etait de 21 ans (IQR 10–25). Au terme du suivi, 100 % des patients ont eu au moins une intervention. Le taux de survie sans revision des SAU etait de 56 %, 31 %, 8 % et 0 % a 10, 15, 20 et 25 ans. Le taux de survie sans explantation etait de 77 %, 59 %, 52 % et 45 % a 10, 15, 20 et 25 ans. En considerant le mode mictionnel, la duree mediane sans revision ni explantation est plus logue dans le groupe « miction spontane » que dans le groupe « sondage intermittent » (12,9 ans vs 4,9 ans ; p Conclusion Le SAU implante chez les patient spina bifida de sexe masculin semble offrir a long terme un resultat fonctionnel acceptable mais au prix d’un taux de re intervention eleve.

Introduction/Background “The lack of formalised monitoring following in the year after the stroke establishes a reduction of likelihood in the course of patient care.” (DGOS instruction 2015) A third of the patients return home at best with only a single follow-up neurological consultation. Within the context of this reality establishing the deficits is therefore held up, favouring a negative socio-professional impact. To overcome this, a Multidisciplinary Consultation Post-stroke program (CM post-stroke) was developed at the University Hospital of Rennes in 2016 (French National Stroke Program 2010–2014). The particular characteristic of our consultation was to single out those patients who neither went through the neurovascular pathway. Material and method Patients hospitalized in the CHU for stroke were extracted from the Program For Medicalization of Information Systems. Patients who neither went through the neurovascular pathway were selected. Neurologist and PMR physician cheeked together the medical history of these patients. During a telephone interview, our occupational therapist coordinator filled out a questionnaire orienting the choice of professionals met at the consultation. The consultation was personalized and centred on the patient specific needs. A feedback was made for the treating physician permitting for continuous follow-up of the patient. Results On the basis of a sample of patients selected over 6 months, we study 80 patient files, they were interviewed and 40 consultations were organized (including 25 with 2 professionals and 15 with more 2 professionals), 9 were directed towards the physical medicine and rehabilitation department, 30 to a liberal professional and only 1 did not have any change in his Physical Medicine and Rehabilitation care. This tends to show interest in the follow-up of these patients. Conclusion The CM post-stroke appears as a link filling a deep in the follow-up of the care of post-stroke patients and a transversal work between neurologic and PMR departments.

Introduction/Background Robots-assisted gait rehabilitation are used in association with conventional rehabilitation but it's necessary to improve their functionality. This paper presents a psychosocial intervention framework to support the development of a mobile robot for gait training: ROBO-K. The aim was to facilitate the integration of the robot in the walking rehabilitative process and thus, ensure its diffusion. Material and method The representation of the robot's use and its evolutions (i.e., the usual trajectory) has been first studied. Then two multicenter studies were performed in 2013 and 2015. In the first one, patients (n = 34) and practitioners (n = 74) were interviewed to define acceptable functional specifications (i.e., social acceptability). After this first study, a prototype was developed in collaboration with an industrial partner. In the second one, patients (n = 36) and physiotherapists (n = 4) tested the co designed prototype in ecological situation during 1 to 6 months (i.e., acceptance and appropriation). Results The results showed that the robot is perceived positively by the patients and the physiotherapists because it's perceived as useful to improve balance and gait and provide safety and motivation. This perception persisted along the experimental procedure. For the physiotherapists, the robot helped to better manage their inner physical effort. In the other hand, the mental load was high. The results seemed also very encouraging in terms of clinical effectiveness. For example, the FAC (Functional Ambulation Classifications) increases by 40% on average. Conclusion Finally, these psychosocial approach with industrial, clinical researchers collaboration is an excellent pathway for innovation conception.

Introduction/Background Several studies highlight that the physical therapy (PT) timing is important in rehabilitation process from physical disability after stroke. The purpose of this meta-analysis was to investigate the effect of all PT on balance after stroke and to evaluate whether changes are related to stroke stage of recovering [acute and subacute (ASS) or chronic stage (CS)]. Material and method Randomised controlled trials (RCT), without language restriction, until October 2015, assessing the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke, the posturographic parameters in static condition and measures of independence in activities of daily living were included. Two independent authors (AH and JDM) led this selection following the Cochrane recommendations (Hugues et al., 2017). Results One hundred and ninety-three parallel and crossover RCT from 9337 records were included, involving 8018 subjects [study sample: mean 41.5 (SD 49.7) subjects, age: pooled mean 61.7 (pooled SD 12.78) years]. A significant difference in favor of PT compared to no treatment was immediately found after the intervention for the BBS at ASS and CS (ASS: 11 studies, mean difference (MD) 3.14; 95% confidence interval (CI) [2.21; 4.06]. CS: 12 studies, MD 1.31; 95% CI [0.79; 1.82]. Mixed: 2 studies, MD 0.89; 95% CI [−0.63; 2.40]). Only at CS, PT is more effective than sham treatment or usual care immediately after the intervention for the BBS (ASS: 12 studies, MD 2.21; 95% CI [−0.37; 4.78]. CS: 13 studies, MD 2.50; 95% CI [1.00; 3.99]. Mixed: 2 studies, MD −1.17; 95% CI [−2.94; 0.60]). Conclusion These results show immediately after the intervention: –that balance can be improved by PT compared to no treatment whatever the stage of stroke; –an improvement of balance by PT compared to sham treatment or usual care at chronic stage.

Introduction/Background Spinal dysraphism is the first congenital cause of neurogenic bladder. Open spinal dysraphism (mainly myelomeningocele) being diagnosed in the neonatal period, neurogenic lower urinary tract dysfunctions (NULTD) are well-known as they have been described in many series. Conversely, closed spinal dysraphisms are often diagnosed later and little data regarding NULTD exist. The aim of this study was to compare the NULTD in patients with closed dysraphism (CD) to those in patients with open dysraphism (OD). Material and method A prospective study was conducted between 2007 and 2016 including all spina bifida patients seen in a multidisciplinary national referral center. At the first visit, lower urinary tract function was assessed as follow: history of past urological surgery, type of spinal dysraphism, Abbreviated Injury Scale, method of bladder emptying, Urinary Symptom Profil (USP) and Qualiveen scores and urodynamic parameters. Results In total, 395 patients were included: 274 with OD (69.4%) and 121 with CD (30.6%). Patients in the CD group were older (35.9 vs. 29.5 years, P Conclusion NLUTD were as frequent and troublesome in patients with open vs. closed spinal dysraphism. However the need for a surgical treatment was more common in patients with OD.

Introduction/Background Rehabilitation robotics has been proposed as an efficient strategy to improve upper extremity (UE) motor function after stroke especially at the subacute phase. Many trials with several robots have been performed but very few large multicenter RCTs at the subacute phase. Material and method A multicenter parallel group, two arm, single blind, phase III, superiority, randomized, controlled trial has been conducted in France in 22 rehabilitation centers equipped with an Armeo Spring robot. Two hundred and twenty subjects must be included. The main inclusion criteria were an UE Fugl Meyer (UEFM) score between 10 and 40 and an occurrence of the stroke between 3 and 12 weeks before inclusion. The main outcome measure was the UE FM 30 days. Each patient performed usual treatment (2 hours a day of motor rehabilitation) with 20 additional rehabilitation sessions (1 h each, 5 days a week, 4 weeks). Patients were randomized either to rehabilitation robotic sessions with the Armeo Spring device or to self-rehabilitation (stretching and self paced movements) in equal timed sessions. Secondary outcome measures were, pain, hypertonia, functional improvement (FIM and Action research arm test ARAT) and quality of life (EQ5D and stroke impact scale). Evaluation were performed at day 30, 3, 6 and 12 months after inclusion. Results Two hundred and eighteen subjects have been included and an attrition rate of 10% at 6 months and 20% at 12 months was observed. The gain in the main outcome criteria was not significantly different at day 30 nor any other secondary criteria except ARAT. Conclusion An additional time 1 h a day during 4 weeks of rehabilitation robotics to usual intensive rehabilitation seems not significantly influence the motor deficiency prognosis of the upper limb after stroke. It might influence functional outcome but this has to be explored in another design randomized control study.

Introduction La dystonie peut etre une complication chez certains patients parkinsoniens traites chirurgicalement (Tolosa et al., 2006). L’injection de toxine botulinique peut parfois ameliorer de maniere significative la dystonie du pied dans cette population (Anupam Datta Gupta et al., 2016). Nous rapportons notre demarche diagnostique et therapeutique face a une deformation fixee non amelioree par la toxine. Materiel et methodes Un homme de 65 ans, opere pour stimulation cerebrale profonde bipallidale, a presente dans les suites une deformation du pied droit (varus equin 30°–griffe d’orteils). Marche avec rolator, risque de chute moyen selon la BERG (35/56). Deformation non reductible en eteignant la stimulation et durant un OFF dopaminergique. Resultats Injections de toxine botulique (350 UI incobotulinumtoxinA) : pas d’amelioration. Bloc moteur anesthesique du nerf tibial posterieur droit : pas de modification de la deformation. Examen clinique sous courte anesthesie generale : pas d’amelioration de l’equin ni meme avec adjonction de curare. Devant une retraction tendineuse confirmee, indication chirurgicale retenue. Realisation de tenotomies : allongement du tendon calcaneen, du tibial posterieur, de l’abducteur de l’hallux et tenotomie a la base des 4 orteils. Apres 5 semaines d’immobilisation, puis 4 semaines de reeducation, reduction complete de l’equin (0°), marche sans aide technique et risque de chute faible selon la BERG (53/56). Conclusion Chez le patient extrapyramidal presentant une dystonie fixee du pied, les tenotomies peuvent permettre de corriger la deformation et d’ameliorer la marche.

Introduction Muscle vibration can be used to improve the center of pressure (CoP) shift. Several muscle sites have been used for various diseases without that we know their respective interest. Objective To compare the effects and post-effects of neck muscle vibrations (NMV) and gluteus medius vibrations (GMV) on balance in healthy subjects Methods Thirteen healthy subjects, mean: 23 years, right handed were tested on posturography, closed eyes, in standing position. They received successively left NMV and right GMV in a randomized order. The variation of the deviation of CoP on the mediolateral plane was evaluated under vibration stimulation (5 min), at the end of the vibration and 5 minutes after. Results GMV induce a CoP movement to left side (9 responders) (mean: 5.21 mm; SD: 4.79; P = 0.003). At the end of the vibration, the effect remained significant (mean: 4.73, SD: 4.02; P = 0.001) and after 5 minutes, the subjects restored their initial balance (mean: 1.25, SD: 6.82; P = 0.33). For NMV, a movement toward left side was observed only in 5 subjects but this deviation seemed to be maintained at 5 min. The CoP deviation was not significant during (P = 1), immediately after (P = 0.72), and after 5 minutes of NMV (P = 0.89). Discussion GMV cause a lateral shift in 70% of the subjects of nearly 5 mm. The effect of NMV was lower and less constant (only 5 responders) but sustainable. This could be explained by a sensorimotor peripheral action for GMV while NMV would involve high level body representation in space.

Resume Objectifs. – Identifier et decrire les echelles d'incapacites fonctionnelles utiles pour l'evaluation des patients hemiplegiques vasculaires. Preciser les instruments de mesure les plus utilisables en pratique clinique et ceux les plus utilises dans les essais cliniques. Methode. – Revue de litterature sur la base de donnees Medline en ciblant les parametres fonctionnels suivants : deambulation et marche, equilibre, fonction du membre superieur et independance dans les activites de vie quotidienne. Les parametres metrologiques des differents instruments de mesure sont precises, ainsi que leur utilite en pratique clinique quotidienne. Resultats. – Trente-trois outils de mesure ont ete analyses et classes en cinq categories : equilibre (6 outils), deambulation et marche (4), capacites fonctionnelles du membre superieur (11), echelles globales de motricite (5) et independance dans les activites de vie quotidienne (7). Discussion et conclusion. – Il existe de tres nombreuses echelles fonctionnelles utiles pour l'evaluation des patients hemiplegiques vasculaires. Elles ont toutes un interet propre. Pour mesurer l'equilibre, la Postural Assessment Stroke Scale et la Berg Balance Scale sont les plus interessantes. La Functional Ambulation Classification et la Timed Up and Go Test sont les plus pertinentes pour mesurer les capacites de deambulation et de marche. L'Action Research Arm Test est la plus utilisee pour mesurer les capacites fonctionnelles du membre superieur. La mesure de l'independance fonctionnelle et l'index de Barthel sont les plus reconnus pour l'independance dans les activites de vie quotidienne.

Introduction L’hemiplegie cerebrale infantile provoque une alteration du fonctionnement des membres superieurs (MS), ce qui impacte la qualite de vie des enfants atteints au quotidien. L’evaluation de la fonction motrice des MS represente un interet considerable : elle permet d’orienter les decisions medicales et de quantifier les progres realises grâce aux therapies mises en place. Cependant, les mouvements des MS sont difficiles a evaluer et les outils a disposition presentent des limites considerables, a savoir un manque d’objectivite ou le choix de mouvements codifies et trop eloignes des situations rencontrees par les enfants au quotidien. Notre etude avait pour objectifs : – d’elaborer un nouveau protocole d’analyse 3D des mouvements des MS ludique et ecologique ; – d’analyser la variabilite des trajectoires articulaires chez des enfants sains lors de ce protocole ; – de cibler les trajectoires articulaires d’interet pour chaque tâche (reproductibles et potentiellement discriminantes). Materiel et methodes Dix-sept enfants sains âges de 5 a 15 (moyenne = 10,70 ± 3,15) ans ont realise un nouveau protocole d’evaluation 3D compose de 24 tâches en majorite bi-manuelles et proches de mouvements realises dans la vie quotidienne. Les donnees etaient recoltees a l’aide d’un systeme de capture du mouvement optocinetique compose de 16 cameras Resultats Les trajectoires angulaires des angles du tronc, des epaules, des coudes et des poignets etaient calculees au cours de chaque tâche. La reproductibilite de ces trajectoires etait evaluee pour chaque angle et chaque tâche a travers le coefficient de correlation moyen entre les sujets, ainsi que l’erreur RMS et l’erreur RMS « recentree ». Discussion–conclusion Les sessions d’enregistrement montrent que ce nouveau protocole court et ludique est adapte a la population d’enfant ciblee. Les resultats ont permis d’identifier les tâches les plus reproductibles et de determiner les trajectoires angulaires d’interet lors de ces tâches. Ce travail est une premiere etape dans la construction d’un nouvel outil d’evaluation. Il a permis d’ajuster le protocole elabore et de creer une base de donnees a laquelle pourront etre compares les enfants hemiplegiques. L’outil 3D semble pouvoir se reveler pertinent dans le cadre de l’evaluation fonctionnel en situation ecologique.

Objectifs Apparus il y a plus de 10 ans, les ballonnets Adjustable Continence Therapy (ACT®) sont une option therapeutique dans le traitement de l’incontinence urinaire d’effort (IUE) par insuffisance sphincterienne dont la place reste actuellement imparfaitement definie et variable. L’objectif de l’etude etait d’evaluer l’impact d’un antecedent de radiotherapie pelvienne (RT) et d’un âge > 80 ans sur les resultats des ballonnets ACT®. Methodes Toutes les patientes presentant une IUE par insuffisance sphincterienne chez qui des ballonnets ACT® avaient ete implantes entre 2012 et 2016 ont ete incluses dans une etude retrospective monocentrique. L’indication des ballonnets ACT® etait une IUE par insuffisance sphincterienne moderee ou les patientes jugees trop fragiles pour l’implantation d’un SAU ou le refusant. L’evaluation preoperatoire et postoperatoire a 1, 3 et 6 mois comprenait un pad test, un score USP et un bilan urodynamique en preoperatoire. Les resultats peri-operatoires et fonctionnels ont ete compares entre les patients > 80 ans et Resultats Vingt patientes ont eu des ballonnets ACT®. Les caracteristiques preoperatoires etaient similaires entre les patientes > 80 ans et Tableau 1 ) hormis la pression de cloture (23 vs. 33 cm H2O ; p = 0,04). Le taux de patientes ameliorees (PGII = 1,2 ou 3) etait comparable chez les patientes > 80 ans et Tableau 2 ). Le taux de patientes ameliorees etait plus important chez les patientes RT sans atteindre la significativite (100 % vs. 60 % ; p = 0,26) et les taux de complications etaient similaires (40 % vs. 27 % ; p = 0,62). Conclusion Sous reserve d’un effectif limite, l’âge > 80 ans et la RT n’ont pas d’impact sur les resultats peri-operatoires et fonctionnels des ballonnets ACT® chez la femme hormis une duree d’hospitalisation plus longue chez les femmes > 80 ans. Les ballonnets ACT® pourraient ainsi constituer un traitement de choix chez ces patientes fragiles.

Objective The positive effects on motor cortical excitability of stimulating proprioception with tendon vibration therapy have previously been reported in healthy individuals and in chronic stroke patient (Marconi et al., 2008 and 2011). The aim of this study is to evaluate the feasibility of a protocol of tendon vibration therapy in a neurorehabilitation service, with a view to proceeding to an efficacy study. Material/Patients and methods We performed a prospective, single-centre study, including 11 patients, 8 men, mean age 61,7 ± 10,6, with upper limb motor deficit secondary to a first stroke (5 ischaemic). Average time post-stroke was 116.8 days. Mean NIHSS at inclusion was 7,9 ± 5,7. Two 15-minute sessions per day for 5 days of vibration therapy associated to voluntary movement were applied to the elbow and wrist flexor and extensors of the hemiplegic arm. The vibration therapy was in addition to standard rehabilitation. The feasibility was assessed by the implementation of the protocol (logistic regression of sessions, who did it? Where? When?), adverses outcomes and tolerance. Assessment of motor function at baseline and at day 7 was performed with Fugl-Meyer (upper limb), ARAT, Box and Blocks Test and ARMEO was used to assess the volume of exploration of the arm. Functional recovery was measured by the difference between the two scores. Results Nine patients were eligible (1 transferred to another ward for a septicaemia; 1 incomplete assessment at day 7). 97.7% of planned vibration sessions were performed. There were no adverse outcomes. Treatment was well tolerated; 1 patient reported transient paraesthesias and 4 patients reported significant fatigue whilst undergoing therapy. Every patient improved motor control: mean delta (±SD): ARAT: +8.6 points ± 14.2; BBT: +3.5 points ± 10.8; Fugl Meyer: +3.3 points ± 4.2; volume of exploration ARMEO: +38% ± 75.1%. Discussion - Conclusion This preliminary, open-labelled, study demonstrates that this protocol is achievable in a neurorehabilitation clinic setting. Given the functional improvement seen, randomised controlled trials should be performed to further evaluate the effects on motor control.

Objective/Introduction Children with hemiplegic cerebral palsy (HCP) have upper limb limited motion and decreased hand function in daily activities. The aim of this study was to evaluate the relationship between the severity of the kinematic motion abnormalities and bimanual performance of the impaired upper limb. Patients and methods Twenty-three children with HCP (mean age 11.9 ± 2.7 years) were evaluated using the Assisting Hand Assessment (AHA) [1] to score functional activity performance. We used a standardized 3D-analysis protocol to evaluate upper limb movements, containing two reach tasks, three gross motor tasks, and two reach-to-grasp tasks. Summary kinematic indexes were calculated according to Jaspers’ method [2] to evaluate the severity of upper limb movement abnormalities in children with HCP, compared to a database of 28 typically developing children (mean age 11.8 ± 2.2 years). Results The results show high correlation between the Global-Arm Profile score (APS), a kinematic index, which summarizes the overall severity of upper limb movement pathology for all tasks, and the AHA score ( r = −0.75). The APS were highly correlated with the AHA during reach-to-grasp tasks ( r = −0.75) and two of the three gross motor tasks ( r = −0.74). Concerning the Global-Arm Variable score, which represents the deviation for a single joint angle, significant correlations were found for wrist flexion ( r = −0.85), elbow flexion ( r = −0.61) and pronation ( r = −0.47). Discussion/Conclusion The severity of movement abnormality in children with HCP is strongly correlated with the level of functional activity performance. This correlation is best demonstrated in reach-to-grasp or gross motor tasks. The influence of wrist and elbow movement abnormality confirms the importance of taking into account these distal limitations in therapeutics.

Albert TA, Yelnik A, Bonan I, Lebreton F, Bussel B. Effectiveness of femoral nerve selective block in patients with spasticity: preliminary results. Arch Phys Med Rehabil 2002;83:692-96. Objectives: To determine if the vastus intermedius nerve can be blocked by using surface coordinates and to measure the effects of selective nerve block on quadriceps spasticity and immediate gait. Design: Case series. Setting: Physical medicine and rehabilitation department of a university hospital. Participants: Twelve patients with hemiplegia disabled by quadriceps overactivity. Intervention: Anesthesic block of the vastus intermedius by using surface coordinates, femoral nerve stimulation before and after block, and surface electrodes recording of the amplitude of the maximum direct motor response of each head of the quadriceps. Main Outcome Measures: Assessment of spasticity, voluntary knee extension velocity, speed of gait, and knee flexion when walking. Results: To be effective, the puncture point (.29 of thigh length and 2cm lateral) had to be slightly modified to 1cm laterally from a point situated at 0.2 of the thigh length. A selective block of the vastus intermedius could not be achieved, but a block of the vastus lateralis was always achieved, twice associated with a block of the vastus intermedius, resulting in decreased quadriceps spasticity, no changes in gait parameters, no decrease in voluntary knee extension velocity, and subjective improvement in gait for 3 patients. Conclusion: Selective block of the vastus lateralis with or without the vastus intermedius can be achieved by using surface coordinates without any dramatic effect on knee extension velocity, and it could be useful for phenol or alcohol block or surgical neurotomy. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Resume OBJECTIF : Apres accident vasculaire cerebral, le patient hemiplegique est souvent gene par une hyperactivite musculaire du membre inferieur. La toxine botulique est un traitement efficace de cette hyperactivite musculaire. Ce travail a ete conduit afin d’en evaluer la duree telle que ressentie par le patient. MATERIEL ET METHODE : L’etude a porte sur une cohorte de patients victimes dˈaccident vasculaire cerebral unique, genes par une hyperactivite musculaire distale du membre inferieur. L’injection intramusculaire de toxine botulique (Botox Allergan) etait realisee sous reperage par electrostimulation. L’efficacite etait mesuree par le patient, a un, trois et six mois, sur une echelle en trois points (aucune, reelle mais insuffisante, tres bonne) sur la base d’objectifs individualises, precisant pour chaque symptome le mode de declenchement et la gene que l’on souhaite attenuer. RESULTAT : Cinquante-sept seances ont ete pratiquees chez 36 patients. A un mois, 81 % des seances avaient un resultat positif, 39 % des resultats tres satisfaisants. A six mois, 57 % des seances maintenaient un resultat positif dont 25 % de resultats tres satisfaisants. Les meilleurs resultats portaient sur l’extension du gros orteil : 94 % d’efficacite a un mois, 47 % de resultats tres satisfaisants persistant a six mois. CONCLUSION : Lorsque le traitement par toxine botulique est apprecie par le patient apres definition d’objectifs personnalises, le resultat favorable obtenu peut persister largement au-dela de six mois. Les resultats doivent etre relativises par l’aspect partiellement subjectif de l’analyse proposee ici, mais celle-ci constitue le plus souvent en pratique la seule base possible des discussions therapeutiques.

Objectifs Des donnees recentes suggerent que la neuromodulation sacree serait aussi efficace chez les patients ayant une hyperactivite vesicale (HAV) avec et sans hyperactivite detrusorienne. L’impact de la presence ou non d’une hyperactivite detrusorienne sous-jacente sur l’efficacite de la neurostimulation tibiale posterieure (NTPT) pour HAV n’a jamais ete evalue. Le but de cette etude etait de comparer l’efficacite du traitement par NTPT transcutanee dans le traitement de l’HAV avec et sans hyperactivite detrusorienne sous-jacente. Methodes Les donnees de tous les patients traites par NTPT pour troubles vesicosphincteriens entre 2012 et 2016 dans un centre ont ete colligees prospectivement. L’evaluation initiale et a 2 mois comprenait un calendrier mictionnel sur 48 heures, un questionnaire Urinary Symptom Profile une evaluation de l’efficacite par echelle visuelle analogique (EVA) allant de 0 (aucune efficacite) a 10 (efficacite maximale). Le materiel utilise etait un URO-stim Schwa medico 2®. Les patients ont ete divises en 2 groupes : presence (HAD) ou absence (no HAD) d’une hyperactivite detrusorienne sur le bilan urodynamique pretherapeutique. Resultats Soixante-dix patients ont ete inclus, parmi lesquelles 22 n’avaient pas d’hyperactivite detrusorienne au bilan urodynamique preoperatoire (31 %). L’EVA efficacite moyenne tendait a etre plus eleve dans le groupe no HAD (4,7 vs 3,6 ; p = 0,19) de meme que le taux de patients ayant une amelioration ≥ 50 % a 2 mois egalement similaire (57 % vs 42 % ; p = 0,22). Le taux de patients ayant achete le dispositif au bout de 6 mois etait superieur dans le groupe no HAD sans que cette difference n’atteigne la significativite (42 % vs 22 % ; p = 0,12). L’amelioration du sous-score USP HAV a 2 mois etait comparable dans les deux groupes (–2 vs–2,1 points ; p = 0,85). Conclusion La neurostimulation tibiale posterieure transcutanee semble au moins aussi efficace dans le traitement de l’HAV sans hyperactivite detrusorienne que dans le traitement de l’HAV avec hyperactivite detrusorienne.

Objective The objective of this preliminary study is to test the long-lasting effects of repetitive neck muscle vibration (rNMV) on postural disturbances and on spatial frame reference in chronic patients. Material/patients and methods Twenty chronic stroke patients (mean age 61.4y ± 11, mean delay since stroke 5.5y ± 3), 10 right (RDB) and 10 left (LDB) brain damage, having gained the capacity to stand for more than 30 s were included. They underwent 10 vibrations of 10 min sessions during two weeks – the evaluation of postural asymmetry on force platform (weight body asymmetry [WBA]), spatial frames (subjective straight ahead [SSA], longitudinal body axis [LBA], subjective visual vertical [SVV]) and clinical assessment (Motricity Index, Sensibility, Spasticity, Berg Balance Scale, Time Up and Go) were ascertained twice before (D-15, D0) and ultimately at the end of the vibrations (D + 15, D + 22, D + 45). Results In the posttest, a significant reduction in WBA was established in the RBD (P = 0.009) and was maintained at D + 15 (P = 0.01) and D + 22 (P = 0.05) on the contrary, no effect was observed in the LBD group. In addition, no significant modification was found on the spatial frame in both RBD and LBD. A significant improvement was found for the Motricity and Time Up and Go at D + 22 in the RBD group whereas no modifications were found in the LBD. Discussion – conclusion rNMV causes a reduction of postural asymmetry in the RBD group independently of the space representation improvement. Likewise, rNMV can modify the postural asymmetry of patients at distance from their stroke but this result was not maintained at D + 45.

Summary Aims The presence of stools in the rectum might affect the quality of the abdominal pressure curve during filling cystometry, but, to date, no study has evaluated the impact of bowel preparation before urodynamics. We evaluated the influence of a sodium phosphate enema before urodynamics on the quality of the abdominal pressure curve. Methods A prospective, controlled, single-blind study was conducted in a single center from May to June 2013. The patients were divided into 2 consecutive groups: patients seen in outpatient clinics during the first 6 weeks (group A) who underwent urodynamics without bowel preparation and patients seen in outpatient clinics during the second 6 weeks (group B) who had a prescription of sodium phosphate enema before urodynamics. The primary endpoint was the quality of the abdominal pressure curve evaluated independently by three physicians who were blinded to the study group. The following data were also collected: age, gender, the presence of a neurological disorder, complicated nature of urodynamics and bother related to preparation for it, assessed using a Likert scale (0 to 10), and the equipment used. A per protocol analysis and an intent-to-treat analysis were conducted. Results One hundred and thirty-nine patients were included: 54 in group A and 85 in group B. One-third of patients had neurological conditions. 14 patients in group B did not perform their scheduled enema. Thus, 68 patients performed an enema before urodynamics and 71 did not. There was no difference between groups A and B regarding the complicated nature of urodynamics (Likert scale: 3.12 vs. 3.18; P = 0.91) or bother related to preparation for it (Likert scale: 3.46 vs. 2.97; P = 0.43). In the per protocol analysis, the abdominal pressure curve was considered perfectly interpretable (PI) in 69% of patients who did not receive an enema before urodynamics and in 65% of patients who did ( P = 0.61). The between-group difference was not statistically significant in intent-to-treat analysis ( P = 0.99). In patients who did not receive an enema before urodynamics, the only factors statistically associated with better quality of abdominal pressure curves were age P = 0.001) and the urodynamic equipment used (Dantec ® > Laborie ® ; P = 0.01). Conclusion In this prospective study, routine enema before urodynamics did not improve the quality of the abdominal pressure curve and did not increase the complicated nature of urodynamics or the bother of preparation for it. Level of evidence 3.

The purpose of this study was to evaluate the role of computed tomographic angiography (CTA) for postoperative assessment of carotid endarterectomy (CE). Twenty carotid endarterectomies were performed and controlled by using (1) intraoperative angiography, (2) postoperative duplex scanning and CTA with multiprojection volume reconstruction (MPVR). Intraoperative angiographic controls were deemed satisfactory for all patients. In 12 patients, the postoperative morphological aspect was satisfactory with CTA and duplex scanning. In the eight remaining patients, CTA and/or duplex scanning revealed 12 abnormalities: 3 were equally visualized on CTA and duplex scanning, 6 only on CTA and 3 only on duplex scanning. CTA is a rapid and noninvasive technique allowing the surgeon to get informative and comparative data. It might be an interesting alternative to postoperative angiography.

Resume L'objectif de l'etude a ete d'analyser la strategie d'utilisation des informations sensorielles dans le maintien postural de patients hemiplegiques apres accident vasculaire cerebral unique. Nous avons etudie neuf patients, moyenne d'âge 60 ans (46 a 72 ans), a 16,4 mois en moyenne de leur accident vasculaire (11 a 31 mois). Les patients dont la recuperation motrice etait insuffisante pour leur permettre de tenir en equilibre debout sans aide technique sur plate-forme d'etude ont ete elimines. L'etude de l'equilibre realisee sur plate-forme Equitest comprenait deux series de test: le test dit d'organisation sensorielle au cours duquel les reactions du patient sont analysees dans six conditions sensorielles differentes (les informations visuelles, proprioceptives et vestibulaires sont tour a tour annulees voire trompees); et le test dit de coordination motrice ou l'on mesure la latence de reponse du patient aux translations anteroposterieures de la plate-forme. Les enregistrements ont ete effectues apres un examen neurologique et ORL. Les resultats montrent que les patients adherent de facon anormale a l'afference visuelle lors des conflits sensoriels. Les auteurs discutent la physiopathologie de ce trouble de selection des afferences sensorielles.

Objectifs Les dysraphismes constituent la premiere cause congenitale de neurovessie. Les dysraphismes ouverts (DO) constituent la forme « classique » de neurovessie spina bifida. A l’inverse, les troubles vesico-sphincteriens lies aux dysraphismes fermes (DF) sont moins bien connus. L’objectif de ce travail etait de comparer les troubles vesico-sphincteriens observes chez les patients presentant un DF a ceux observes chez les patients presentant un DO. Methodes Une etude prospective a ete menee entre 2007 et 2016 incluant tous les patients spina bifida consultant consecutivement dans un centre pluridisciplinaire. Lors de la premiere consultation, un bilan du fonctionnement de l’appareil urinaire de chaque patient a ete realise, que le patient rapporte ou non des troubles urinaires. Ce bilan comprenait notamment : antecedents de chirurgie urologique, le type de dysraphisme (ouvert ou ferme), le niveau neurologique sensitif et moteur selon la classification AIS, le mode mictionnel, le score Qualiveen et les donnees du bilan urodynamique. Les caracteristiques des patients ont ete comparees. Resultats Un total de 395 patients ont ete inclus dont 274 DO (69,4 %) et 121 DF (30,6 %). Le mode mictionnel etait miction spontanee, sondage intermittent et derivation cutanee non continente chez 47,1 % vs. 29,3 %, 47,1 % vs. 59,4 % et 5,7 % vs. 11,2 % des patients ayant respectivement un DF et un DO (p = 0,01). La prevalence de l’incontinence urinaire ne differait pas significativement entre les 2 groupes (44,7 % vs. 53,5 % ; p = 0,23), de meme que le score qualiveen moyen (76,6 vs. 81,7 ; p = 0,19). La principale plainte medicale etait urologique chez 26 % des patients ayant un DF et chez 27,8 % des patients ayant un DO (p = 0,73). L’enterocystoplastie d’agrandissement etait plus frequente chez les patients ayant un DO (29,2 % vs. 10,2 % ; p Conclusion Sous reserve d’un possible biais de selection, les troubles vesico-sphincteriens semblent aussi frequents et aussi genants chez les patients ayant un dysraphisme ferme que chez ceux ayant un dysraphisme ouvert. En revanche le recours a un traitement chirurgicale des troubles vesico-sphincteriens est plus frequent chez les patients ayant un DO.

Introduction On dispose actuellement de peu de moyen d’evaluation de l’equilibre postural dynamique des hemiplegiques. Le centre de masse (CdM) pourrait etre utilise. L’objectif est de comparer son deplacement entre hemiplegiques (HP) et volontaires sains lors d’une tâche dynamique d’evitement aleatoire de balles pour determiner sa pertinence en le correlant avec des scores cliniques d’equilibre. Materiel et methodes Trente et un patients HP (15 droits et 16 gauches), d’âge moyen 62,3 ans ± 12,2 a moins d’un an de l’AVC, presentant une asymetrie posturale de 63,91 % ± 10,65 du cote sain sans differences entre les deux groupes hemiplegiques (p = 0,9213) ont ete inclus. Le deplacement du CdM des HP a ete determine lors de la tâche dynamique d’evitement grâce a un systeme de capture 3D de type Optitrack, et compare a celui de volontaires sains apparies en âge. Ce CdM a ete mis en relation avec des scores cliniques d’equilibre notamment TUG et TUG ABS ainsi qu’avec l’asymetrie posturale evaluee sur plateforme de force. Resultats Le deplacement du CdM des HP etait reduit de 39 % par rapport a la population controle (p