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Background and Purpose: Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke. Methods: Phase III, parallel, concealed allocation, randomized controlled, multicenter trial, with 12-month follow-up. Patients aged 18 to 80 years, 3 weeks to 3 months poststroke with a Fugl-Meyer Assessment score of 10 to 40 points, were randomized to the Exo or control groups. All undertook two 30-minute self-rehabilitation sessions/day, 5 days/wk for 4 weeks in addition to usual rehabilitation. The Exo group performed games-based exercises using a gravity-supported mechanical exoskeleton (Armeo Spring). The control group performed stretching plus basic active exercises. Primary outcome was change in upper extremity Fugl-Meyer Assessment score at 4 weeks. Results: Two hundred fifteen participants were randomly allocated to the Exo group (107) or the control group (108). Mean age (SD), 58.3 (13.6) years; mean time poststroke, 54.8 (22.1) days; and mean baseline Fugl-Meyer Assessment score, 26.1 (9.5). There was no between-group difference in mean change in Fugl-Meyer Assessment score following the intervention: 13.3 (9.0) in the Exo group and 11.8 (8.8) in the control group ( P =0.22). There were no significant between-group differences in changes for any of the other outcomes at any time point (except for perception of the self-rehabilitation). There was no between-group difference in cost utility at 12 months. Conclusions: In patients with moderate-to-severe impairment in the subacute phase of stroke, the purchase and use of complex devices to provide additional upper limb training may not be necessary: simply educating patients to regularly move and stretch their limbs appears sufficient. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01383512.

Background Illusion of movement induced by tendon vibration is commonly used in rehabilitation and seems valuable for motor rehabilitation after stroke, by playing a role in cerebral plasticity. The aim was to study if congruent visual cues using Virtual Reality (VR) could enhance the illusion of movement induced by tendon vibration of the wrist among participants with stroke. Methods We included 20 chronic stroke participants. They experienced tendon vibration of their wrist (100 Hz, 30 times) inducing illusion of movement. Three VR visual conditions were added to the vibration: a congruent moving virtual hand (Moving condition); a static virtual hand (Static condition); or no virtual hand at all (Hidden condition). The participants evaluated for each visual condition the intensity of the illusory movement using a Likert scale, the sensation of wrist’s movement using a degree scale and they answered a questionnaire about their preferred condition. Results The Moving condition was significantly superior to the Hidden condition and to the Static condition in terms of illusion of movement (p Conclusions This study showed the interest of using congruent cues in VR in order to enhance the consistency of the illusion of movement induced by tendon vibration among participants after stroke, regardless of their clinical severity. By stimulating the brain motor areas, this visuo-proprioceptive feedback could be an interesting tool in motor rehabilitation. Record number in Clinical Trials: NCT04130711, registered on October 17th 2019 (https://clinicaltrials.gov/ct2/show/NCT04130711?id=NCT04130711&draw=2&rank=1).

Introduction Motor Imagery (MI) is a powerful tool to stimulate sensorimotor brain areas and is currently used in motor rehabilitation after a stroke. The aim of our study was to evaluate whether an illusion of movement induced by visuo-proprioceptive immersion (VPI) including tendon vibration (TV) and Virtual moving hand (VR) combined with MI tasks could be more efficient than VPI alone or MI alone on cortical excitability assessed using Electroencephalography (EEG). Methods We recorded EEG signals in 20 healthy participants in 3 different conditions: MI tasks involving their non-dominant wrist (MI condition); VPI condition; and VPI with MI tasks (combined condition). Each condition lasted 3 minutes, and was repeated 3 times in randomized order. Our main judgment criterion was the Event-Related De-synchronization (ERD) threshold in sensori-motor areas in each condition in the brain motor area. Results The combined condition induced a greater change in the ERD percentage than the MI condition alone, but no significant difference was found between the combined and the VPI condition (p = 0.07) and between the VPI and MI condition (p = 0.20). Conclusion This study demonstrated the interest of using a visuo-proprioceptive immersion with MI rather than MI alone in order to increase excitability in motor areas of the brain. Further studies could test this hypothesis among patients with stroke to provide new perspectives for motor rehabilitation in this population.

International audience; Unilateral cerebral palsy (uCP) causes upper limb movement disorders that impact on daily activities, especially in bimanual condition. However, a few studies have proposed bimanual tasks for 3D motion analysis. The aim of this study was to validate the new version of a child-friendly, 3D, bimanual protocol for the measurement of joint angles and movement quality variables. Twenty children with uCP and 20 typically developing children (TDC) performed the five-task protocol integrated into a game scenario. Each task specifically targeted one or two upper limb degrees of freedom. Joint angles, smoothness and trajectory straightness were calculated. Elbow extension, supination, wrist extension and adduction amplitudes were reduced; hand trajectories were less smooth and straight in children with uCP compared to TDC. Correlations between the performance-based score and kinematic variables were strong. High within and between-session reliability was found for most joint angle variables and lower reliability was found for smoothness and straightness in most tasks. The results therefore demonstrated the validity and reliability of the new protocol for the objective assessment of bimanual function in children with uCP. The evaluation of both joint angles and movement quality variables should increase understanding of pathological movement patterns and help clinicians to optimize treatment. ClinicalTrials.gov identifier: NCT03888443.

The "Be an Airplane Pilot" (BE-API) protocol is a novel 3-D movement analysis (3DMA) protocol assessing the bimanual performance of children during a game.This study aimed to investigate the reliability and validity of this protocol in children with unilateral cerebral palsy (uCP).Angular waveforms (WAVE), maximum angles (MAX) and range of motion (ROM) of the trunk, shoulder, elbow and wrist joints were collected in children with uCP and in typically developing children (TDC) during 4 tasks of the BE-API protocol designed to explore specific degrees of freedom (DoF). The inter-trial reliability for children with uCP was assessed with the coefficient of multiple correlation (CMC) for WAVE and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for MAX and ROM. Clinical performance-based measures, including the Assisting Hand Assessment (AHA) and ABILHAND-Kids scores, were used to explore correlations between clinical measures and kinematic parameters in children with uCP.20 children with uCP (13 boys; mean age 12.0 [SD 3.2] years) and 20 TDC (11 boys; mean age 11.9 [SD 3.4] years) were included. In children with uCP, most kinematic parameters showed high reliability (WAVE: CMC≥0.82; MAX and ROM: ICC≥0.85, SEM≤4.7°). Elbow extension, forearm supination, and wrist adduction were reduced and wrist flexion was increased for children with uCP versus TDC (P0.01). In children with uCP, MAX and ROM values were moderately correlated with clinical assessments (AHA score: r=0.48-0.65; ABILHAND-Kids score: r=0.48-0.49).The BE-API protocol is a 3DMA-bimanual performance-based assessment that is highly reliable in children with uCP. Children with uCP and TDC significantly differed in some clinically relevant kinematic parameters. The BE-API is a promising playful tool, helpful for better understanding upper-limb motor movement abnormalities in bimanual conditions and for tailoring treatments to individual deficits.

International audience; Background. - Neck muscle vibration (NMV) is increasingly used for its modulation of body orientation and spatial perception, but its mechanisms of action are still not well known. Objectives. - To describe the effects of NMV on postural orientation and spatial perception, in both healthy people and patients with disturbed balance potentially related to distorted body orientation perception. Methods. - Following the PRISMA guidelines, a systematic search was performed using the databases MEDLINE, EMBASE, Cochrane library and PEDrO with the key words ((Postural balance) OR (Spatial reference)) AND (Neck muscle vibration) for articles published through to July 2016. Results. - A total of 67 articles were assessed; these exhibited wide heterogeneity and generally poor quality methodology. In healthy subjects, under bilateral NMV, the body tilts in the anterior direction (Level of Evidence LoE II). Under unilateral NMV, the visual environment moves towards the side opposite the vibration (LoE II) and the subject's experience of "straight ahead" is shifted towards the side of the vibration (LoE II). NMV also modulates both spatial and postural bias between stroke and vestibular patients. Discussion. - NMV modulates both spatial and postural bias and could thus be proposed as a tool in rehabilitative therapy. However, due to the heterogeneity of published data and the various significant shortfalls highlighted, current research does not allow clear guidelines to be proposed. (C) 2019 Elsevier Masson SAS. All rights reserved.

International audience; Objective. - We aimed to test a repeated program of vibration sessions of the neck muscles (rNMV) on postural disturbances and spatial perception in patients with right (RBD) versus left (LBD) vascular brain damage. Methods. -Thirty-two chronic stroke patients (mean age 60.9 +/- 10 yrs and mean time since stroke 4.9 +/- 4 yrs), 16 RBD and 16 LBD, underwent a program of 10 sessions of NMV over two weeks. Posturography parameters (weight-bearing asymmetry (WBA), Xm, Ym, and surface), balance rating (Berg Balance Scale (BBS), Timed Up and Go (TUG)), space representation (subjective straight ahead (SSA), longitudinal body axis (LBA), subjective visual vertical (SW)), and post-stroke deficiencies (motricity index, sensitivity, and spasticity) were tested and the data analyzed by ANOVA or a linear rank-based model, depending on whether the data were normally distributed, with lesion side and time factor (D-15, D0, D15, D21, D45). Results. -The ANOVA revealed a significant interaction between lesion side and time for WBA (P< 0.0001) with a significant shift towards the paretic lower limb in the RBD patients only (P=0.0001), whereas there was no effect in the LBD patients (P=0.98). Neither group showed a significant modification of spatial representation. Nonetheless, there was a significant improvement in motricity (P=0.02), TUG (P=0.0005), and BBS (P< 0.0001) in both groups at the end of treatment and afterwards. Conclusions. - rNMV appeared to correct WBA in RBD patients only. This suggests that rNMV could be effective in treating sustainable imbalance due to spatial cognition disorders. (C) 2020 Elsevier Masson SAS. All rights reserved.

Background Adjunct therapies (ATs) may further improve outcomes after botulinum toxin injections in spastic patients, but evidence was unclear in previous systematic reviews. Objective To assess the efficacy of non-pharmacological ATs in spastic adults according to the International Classification of Functioning, Disability and Health and build an expert consensus-based on a Delphi process. Methods Four electronic databases were searched up to May 2020 for reports of comparative trials of non-pharmacologic ATs after botulinum toxin injections in spastic adults. Then, 25 French experts participated in a two-round Delphi process to build recommendations on the use of ATs. Results We included 32 studies (1202 participants, median 32/study) evaluating the effects of physical agents (n = 9), joint posture procedures (JPPs, n = 11), and active ATs (n = 14), mainly after stroke. The average quality of articles was good for randomised controlled trials (median [interquartile range] PEDro score = 7 [6–8]) but moderate (n = 2) or poor (n = 2) for non-randomised controlled trials (Downs & Black checklist). Meta-analysis was precluded owing to the heterogeneity of ATs, control groups and outcome measures. There is evidence for the use of JPPs except low-dose manual stretching and soft posture techniques. Continuous postures (by taping or casting) are recommended; discontinuous postures (by orthosis) may be preferred in patients with active function. Device-free or device-assisted active ATs may be beneficial in the mid-term (> 3 months after botulinum toxin injections), particularly when performed at a high-intensity (> 3 h/week) as in constraint-induced movement therapy. Self-rehabilitation remains understudied after a focal treatment, but its interest is highlighted by the experts. The use of physical agents is not recommended. Conclusions JPPs and active ATs (device-assisted or device-free) may further improve impairments and activities after botulinum toxin injections. Further studies are needed to better define the best strategies for ATs as a function of the individual treatment goals, participation and quality of life. Review Registration PROSPERO (CRD42018105856).

Objective To evaluate recurrence and early postoperative complications (sepsis) following surgical excision combined with radiotherapy for troublesome hip heterotopic ossification in patients with spinal cord injury and traumatic brain injury. Design Retrospective case-control study. Setting Data relating to patients with spinal cord injury or traumatic brain injury who underwent surgical excision of hip heterotopic ossification were retrieved from the BANKHO database. Case patients underwent excision + radiotherapy and controls underwent excision only. Control patients were matched to case patients according to sex and age (± 4 years). Participants Data from 19 case patients and 76 controls were analysed. Interventions Not applicable. Main outcome measure The primary end-point was recurrence of heterotopic ossification. Secondary end-points were postoperative complications and, more specifically, sepsis that required surgical revision. Results There was no difference between the odds ratios (OR) for recurrence for each group (OR case group = 0.63, OR spinal cord injury subgroup = 0.45 and OR head injury subgroup = 1.04). The rate of sepsis requiring surgical revision was significantly higher in the case group (p Conclusion Based on the results of this case-control study, we suggest that radiotherapy should not be combined with surgery in patients with troublesome hip heterotopic ossification undergoing excision. Radiotherapy does not appear to prevent recurrence and, moreover, it is associated with an increased risk of postoperative sepsis.

INTRODUCTION AND OBJECTIVE:Stress urinary incontinence (SUI) is relatively common in women with spina bifida. However, there is very little data available on the outcomes of surgical treatment of S...

International audience; Aims - To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with Valsalva versus those using clean-intermittent catheterization (CIC). Methods - We conducted a retrospective analysis including all spina bifida patients with neurogenic acontractile detrusor with a minimum follow-up of 12 months. Patients were then divided in two groups according to their bladder management: voiding with Valsalva versus CIC. The primary endpoint was any de novo or worsened rectal and/or pelvic organ prolapse (POP) diagnosed during follow-up. The secondary outcome was urinary complications defined as febrile urinary tract infections (UTI) and/or urolithiasis and/or renal failure. Results - Fifty-five patients (50.9% were males) met the inclusion/exclusion criteria: 28 voiding with Valsalva and 27 performing CIC. At baseline, the rates of vaginal prolapse (44.4% vs 50%; P = 0.99), and rectal prolapse/intussusception (25.9% vs 21.4%; P = 0.76) were similar in both groups. After a median follow-up of 80.6 and 65.6 months, respectively (P = 0.29), the rate of de novo or worsened rectal prolapse/intussusception was higher in the Valsalva voiding group than in the CIC group (32.1% vs 3.7%; P = 0.01). De novo or worsened vaginal prolapses were also more common in the Valsalva voiding group, but it did not reach statistical significance (33.3% vs 11.1%; P = 0.29). Conclusions - Valsalva voiding might be harmful in adult spina bifida patients with neurogenic acontractile detrusor as it may increase the risk of rectal prolapse/intussusception. Overall, the prevalence of POP and rectal prolapse was high in both groups.

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.

Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking.Eighteen experts selected on the basis of their recognized experience by the scientific committees of the French PRM (SOFMER) and Anesthesia and Intensive care (SFAR) societies were invited to work and propose guidelines for the use of loco-regional anesthetic drug for motor nerve blocks in PRM setting. Eight issues were addressed: which neural blocks for which indications; drugs and contraindications; medical survey and attitude in case of adverse event; injection and guidance material; patient preparation and pain relief; efficacy assessment; patient information; education of PRM physiatrists. The Medline, Cochrane and Embase databases for the period 1999 to 2018 were consulted and 355 papers analyzed. The drafts were commented then approved by the whole group using electronic vote, before final approval by scientific committee of each society.No scientific evidence emerged from the literature. Thus, these guidelines are mainly based on the opinion of the expert panel. Guidelines for each issue are reported with the main points of arguments. The main question deals with the recommendation about doses for each drug: for lidocaine - up to 2mg/kg - "check contraindications, emergency truck available, no need of previous anesthetic consultation nor presence of anesthetic physician"; for ropivacaine - up to 1.5mg/kg, with a maximum of 100mg - the same but after intravenous line. Beyond these doses, SFAR guidelines have to be applied with the need of anesthetic physician.These are the first organizational guidelines devoted to increase the security of motor nerve block use in PRM settings.

INTRODUCTION AND OBJECTIVES:To assess the relative risks of pelvic organ prolapse (POP) and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor voiding with V...

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.

International audience; Aims - To compare the neurogenic lower urinary tract dysfunction (NLUTD) in patients with closed spinal dysraphism (CSD) versus patients with open spinal dysraphism (OSD) as well as their management patterns. Methods - A prospective cross-sectional study was conducted between September 2007 and December 2015 including all spina bifida patients seen at the multidisciplinary French national referral center for spina bifida. NLUTD and its management were compared between the OSD and CSD groups. Results - Three hundred and eighteen patients were included for analysis: 100 with a CSD (31.5%) and 218 with an OSD (68.6%). The prevalence of urinary incontinence did not differ significantly between the two groups (43% vs 52.8%; P = 0.11), the mean Qualiveen score was also similar (2.7 vs 2.5, P = 0.22). The voiding mechanism was clean intermittent catheterization, spontaneous voiding, suprapubic tube, and ileal conduit in 55% versus 44%; 29.8% versus 47%; 2.8% versus 3% and 11.9% versus 6% of OSD and CSD patients, respectively (P = 0.02). There were comparable prevalences of detrusor overactivity (36.5% vs 38.8%; P = 0.68) and impaired bladder compliance (34.9% vs 31.7%; P = 0.56) in both groups. Augmentation cystoplasty was more common in patients with OSD (32.1% vs 11%; P

Introduction/Background Asymmetrical postural behaviours are frequently observed after a stroke. They are due in part to the sensorimotor deficit, but could also be related to a disorder of the representation of the body in space. The objective was to determine whether the asymmetrical postural behaviours of chronic stroke patients are related to a disruption of the perception of spatial frame. Material and method Thirty chronic stroke patients (mean age 60.3 y ± 10, mean delay post-stroke 4.78 y ± 3) 15 patients with right brain damage (RDB) and 15 patients with left brain damage (LBD) and 20 healthy subjects participated in the study. Postural asymmetry was detected by the evaluation of body weight repartition on a force platform (weight body asymmetry) and was related to the longitudinal body axis (LBA) and the subjective straight ahead (SSA) (egocentric space representation) and also to the subjective visual vertical (SVV) (allocentric space representation) by means of a multivariate analysis of variance (MANOVA) which was adjusted with motor function and sensitivity as covariables. Results Both patients with RBD (35% ± 8) and LBD (39% ± 4) had a body weight asymmetry and there was still space misperception at this stage of recovery, especially in the RBD group. WBA was related to LBA when considering both patients with RDB and LDB (P = 0.03). However, this relation was dependent on the side of the lesion (P = 0.0006) with a stronger relation in the RBD group (58.26%). No relation with WBA was found neither with SSA (P = 0.58) nor with SVV (P = 0.47). Conclusion This study pointed out a strong relationship between disturbance in the perception of the longitudinal body axis and postural asymmetry in chronic strokes, and predominantly within the RBD group. Whereas other spatial perturbations did not seem to be involved in this particular postural behaviour.

Background Botulinum toxin (BTX) injection alone is not sufficient to treat spasticity in children, notably those with cerebral palsy; thus, there is an emerging trend for adjunct therapies to offer greater outcomes than BTX alone. Objective The aim of this systematic review was to evaluate the general effectiveness of adjunct therapies regardless of their nature in children with spasticity. Methods Medline, Cochrane and Embase databases were searched from January 1980 to March 15, 2018 for reports of parallel-group trials (randomized controlled trials [RCTs] and non-RCTs) assessing adjunct therapies after BTX injection for treating spasticity in children. Two independent reviewers extracted data and assessed the risk of bias by using the PEDro scale for RCTs and Downs and Black scale (D&B) for non-RCTs. Results Overall, 20 articles involving 662 participants met the inclusion criteria. The average quality was good for the 16 RCTs (mean PEDro score 7.4 [SD 1.6]) and poor to moderate for the 4 non-RCTs (D&B score 9 to 17). Adjunct therapies consisted of casting/posture, electrical stimulation, resistance training and rehabilitation programmes. Casting associated with BTX injection improved the range of passive and active motion and reduced spasticity better than did BTX alone (9 studies), with a follow-up of 1 year. Resistance training enhanced the quality and performance of muscles without increasing spasticity. Only 3 rehabilitation programmes were studied, with encouraging results for activities. Conclusion Lower-limb posture with casting in children has a high level of evidence, but the long-term efficacy of short-leg casting needs to be evaluated. A comparison between the different modalities of casting is missing, and studies specifically devoted to testing the different kinds of casting are needed. Moreover, the delay to casting after BTX injection is not clear. Data on electrical stimulation are not conclusive. Despite the small number of studies, resistance training could be an interesting adjunct therapy notably to avoid loss of strength after BTX injection. Rehabilitation programmes after BTX injection still need to be evaluated.

International audience; Aim - To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance. Method - Twenty-three children with unilateral CP (mean age 11y 10mo [SD 2y 8mo]) underwent evaluation of bimanual performance (Assisting Hand Assessment [AHA]) and a three-dimensional movement analysis to measure deviations in the movement of their affected upper limb, and compared with 23 typically developing children (TDC) (mean age 11y 11mo [SD 2y 5mo]). Kinematic indices, such as the Global Arm Profile Score (APS), which summarizes the global movement deviation of the upper limb from the norm, and the Global Arm Variable Score (AVS), which represent movement deviations for a given joint, were calculated and correlated to AHA. Results - Values of kinematic indices were significantly higher in children with unilateral CP than in TDC. A strong correlation between Global-APS and AHA score (r=-0.75) was found. Other significant correlations were found with Global-AVS, especially in distal joints. Interpretation - Children with unilateral CP had more movement deviations than TDC. The global movement deviation of the impaired upper limb was strongly correlated with bimanual performance. The influence of distal abnormalities confirms the importance of considering these limitations in therapeutics. What this paper adds - Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks. A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance.

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.

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.

Summary Objective To test the effect of gluteus medius (GM) vibration on the reduction of asymmetric body weight distribution in individuals with hemiparesis (HP) at two stages of postural recovery. Methods The effects of GM vibration according to the shift of the body weight (%Shift) onto the paretic leg during GM vibration were registered while standing on a force-platform in 40 HP (19 left and 21 right; mean age 54.7 ± 10.6 years, mean time after stroke 2.0 ± 1.3 months), as soon as they could stand without assistance and 4 to 6 weeks later, and in 40 control subjects (mean age 54.7 ± 10.5 years). Results Without vibration, baseline body weight (BW) distribution was characterized by underloading of the paretic limb (mean BW on the paretic limb 37.2% ± 13.1%). At the early stage of balance recovery, % shift toward the paretic limb induced by GM vibration differed significantly between left and right HP ( P = 0.049) and between left HP and controls (C) ( P = 0.022) and was related to BW asymmetry (r = 0.437, P = 0.004). Later, GM vibration reduced asymmetric BW distribution in most HP and no difference was found between left and right HP and between left and C. Conclusion At an advanced stage of postural recovery, GM vibration could help encourage HP to put weight on the affected limb. Interestingly, a behavioral difference was initially observed between right and left HP that could probably be explained by a different strategy due to the baseline severity of the BW asymmetry.

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 and hypothesis We aimed to compare outcomes of open and robot-assisted artificial urinary sphincter (AUS) implantation in female patients.

International audience; Balance disorders after stroke have a particularly detrimental influence on recovery of autonomy and walking. The present study is aimed at assessing the effect of proprioceptive stimulation by neck muscle vibration (NMV) on the balance of patients with right hemispheric lesion (RHL) and left hemispheric lesion (LHL). Thirty-one (31) patients (15 RHL and 16 LHL), mean age 61.5 years (±10.6), mean delay 3.1 (±1.6) months after one hemispheric stroke were included in this prospective study. The mean position in mediolateral and anteroposterior plane of the CoP (center of pressure) and the surface were evaluated using a force platform at rest and immediately after 10 min of vibration on the contralesional dorsal neck muscle. NMV decreases the lateral deviation balance induced by the stroke. Twenty patients (64.5 %) experienced a visual illusion of light spot moving toward the side opposite stimulus. These patients showed more improvement by vibration than those without visual illusion. There was an interaction between sensitivity and side of stroke on the effect of NMV. Proprioceptive stimulation by NMV reduces postural asymmetry after stroke. This short-term effect of the vibration is more effective in patients susceptible to visual illusion. This result was consistent with a central effect of NMV on the structures involved in the elaboration of perception of body in space. © 2016, Springer-Verlag Berlin Heidelberg.

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.

International audience; Introduction The asymmetry of support when walking, common after a stroke, is a known risk factor for falls. The objective of this study is to assess effects of muscle vibrations on various sites on correcting this asymmetry. Methods Twenty-one patients (61 ± 13 years) with hemiplegia (10 right, 11 left) chronic vascular (mean time post stroke 48 ± 44months) received vibratory stimulation transcutaneous 70 Hz at the posterior cervical lesion contralateral muscles (NMV), the gluteus medius lesion side (GMV) and the biceps contralateral lesion (sham). An analysis of the percentage of one-foot support measured by GAITRite was performed before, during, and 2 and 10 minutes after each stimulation. Results Before stimulation, supporting asymmetry is noted with a percentage of the push side hemiplegic averaged 31.5% (±6.0%, min = 20%, max = 37%). Under GMV we find that this increases to 35.0% (±5.9%, min = 28.8%, max = 41.2%) against 31.1% (±7.5%, min = 20%, max = 42%) in NMV and 32.0% (±6.9%, min = 28.6%, max = 39.4%) in the sham. 2 minutes, the effect persists for GMV stimulation with 35.5% (±9.0%, min = 35%, max = 42.4%) 4% improvement then disappears in 10 minutes. The results are more significant in left hemiplegia with 7% improvement for GMV (P < 0.005). There is a more moderate effect on the NMV with a post effect at 2 min (32.6%) and 10 min (32.2%). Discussion–conclusion Vibratory stimulations therefore seem to improve support asymmetric walking hemiplegic patients. Different kinetic effect is observed between the cervical stimulation and gluteus medius. These results seem to reflect a different pathophysiology between the gluteus medius and cervical postural muscles. These could act through a central mechanism of spatial cognition while the hip muscles have a more immediate effect proprioceptive device. These analyses were complemented by a 3D gait analysis in an attempt to better understand the mechanisms of adaptation. This is the first study concerned with the effectiveness of vibratory stimulation on dynamic balance