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International audience; Objective: To establish international recommendations for the management of spastic equinovarus foot deformity. Design: Delphi method. Setting: International study. Participants: A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). Interventions: Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. Main Outcome Measures: A consensus was established when at least 80% of experts agreed on a statement Results: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. Conclusion: The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.

Contains fulltext : 292574.pdf (Publisher’s version ) (Open Access) Stroke significantly impacts the quality of life. However, the long-term cognitive evolution in stroke is poorly predictable at the individual level. There is an urgent need to better predict long-term symptoms based on acute clinical neuroimaging data. Previous works have demonstrated a strong relationship between the location of white matter disconnections and clinical symptoms. However, rendering the entire space of possible disconnection-deficit associations optimally surveyable will allow for a systematic association between brain disconnections and cognitive-behavioural measures at the individual level. Here we present the most comprehensive framework, a composite morphospace of white matter disconnections (disconnectome) to predict neuropsychological scores 1 year after stroke. Linking the latent disconnectome morphospace to neuropsychological outcomes yields biological insights that are available as the first comprehensive atlas of disconnectome-deficit relations across 86 scores - a Neuropsychological White Matter Atlas. Our novel predictive framework, the Disconnectome Symptoms Discoverer, achieved better predictivity performances than six other models, including functional disconnection, lesion topology and volume modelling. Out-of-sample prediction derived from this atlas presented a mean absolute error below 20% and allowed personalize neuropsychological predictions. Prediction on an external cohort achieved an R2 = 0.201 for semantic fluency. In addition, training and testing were replicated on two external cohorts achieving an R2 = 0.18 for visuospatial performance.This framework is available as an interactive web application (http://disconnectomestudio.bcblab.com) to provide the foundations for a new and practical approach to modelling cognition in stroke. We hope our atlas and web application will help to reduce the burden of cognitive deficits on patients, their families and wider society while also helping to tailor future personalized treatment programmes and discover new targets for treatments. We expect our framework’s range of assessments and predictive power to increase even further through future crowdsourcing. 16 p.

International audience; Neuro-orthopedic surgery is an alternative to the conservative treatment of spastic equinovarus foot (SEF) in adults. The objective of the present narrative review was to summarize current practice with regard to patient assessment, the choice of treatment, the various neuro-orthopedic procedures, and the latter's outcomes. We searched literature databases (MEDLINE, EMBASE, Cochrane) for original articles or opinion papers on surgical treatment of spastic equinovarus foot in adults. Neuro-orthopedic approaches require a careful analysis of the patient's and/or his/her caregiver needs and thus relevant treatment goals. Surgical planning requires detailed knowledge of impairments involved in the spastic equinovarus foot deformity based on a careful clinical examination and additional information from diagnostic nerve blocks and/or a quantitative gait analysis. Procedures mainly target nerves (neurotomy) and tendons (lengthening, transfer, tenotomy). These procedures reduce impairments (spasticity, range of motion, and foot position), improve gait and walking function, but their impact on participation and personalized treatment goals remains to be demonstrated. Neuro-orthopedic surgery is an effective treatment option for spastic equinovarus foot in adults. However, practice is still very heterogeneous and there is no consensus on the medical strategies to be applied before, during and after surgery (particularly the type of anesthesia, the need for immobilization, rehabilitation procedures).

With about one third of adults aged 65 years and older being reported worldwide to fall each year, and an even higher prevalence with advancing age, aged-related falls and the associated disabilities and mortality are a major public health concern. In this context, identification of fall risk in healthy older adults is a key component of fall prevention. Since dual-task outcomes rely on the interaction between cognition and motor control, some studies have demonstrated the role of dual-task walking performance or costs in predicting future fallers. However, based on previous reviews on the topic, (1) discriminative and (2) predictive powers of dual tasks involving gait and a concurrent task are still a matter of debate, as is (3) their superiority over single tasks in terms of fall-risk prediction. Moreover, less attention has been paid to dual tasks involving postural control and transfers (such as gait initiation and turns) as motor tasks. In the present paper, we therefore systematically reviewed recent literature over the last 7 years in order to answer the three above mentioned questions regarding the future of lab-based dual tasks (involving posture, gait initiation, gait and turning) as easily applicable tests for identifying healthy older adult fallers. Despite great heterogeneity among included studies, we emphasized, among other things, the promising added value of dual tasks including turns and other transfers, such as in the Timed Up and Go test, for prediction of falls. Further investigation of these is thus warranted. 50;6

The carriage of carbapenemase-producing Enterobacteriaceae (CPE) might lengthen the time to functional recovery (TTFR) for inpatients in post-acute care (PAC) units.We aimed to assess the impact of CPE carriage on TTFR in a PAC facility.This 2-year retrospective cohort study included 20 CPE-positive patients and 54 CPE-negative patients admitted to 3 PAC units (general, orthopaedic and neurological rehabilitation units) in a teaching hospital from January 2017 to December 2019. Potential risk factors and demographic data were collected from patients' medical records, the French national hospital discharge database, and the hospital's CPE surveillance database. Functional recovery was defined as the median difference in functional independence measure (FIM) between admission and discharge from each unit. Survival analysis and multiple Cox regression models were used to predict the TTFR and identify factors associated with functional recovery.The overall median [interquartile range] TTFR was 50 days [36-66]. Longer median TTFR was associated with CPE carriage (63 vs 47 days in the CPE-negative group; adjusted hazard ratio (aHR) 0.35, 95% CI 0.13-0.97) and presence of a peripheral venous catheter (aHR 3.51, 1.45-8.46); shorter TTFR was associated with admission to an orthopaedic versus general rehabilitation unit (aHR 3.11, 1.24-7.82).CPE carriage in inpatient PAC facilities was associated with long TTFR. Further studies are needed to explore the mechanisms involved in these adverse events and to identify possible preventive measures.

Chaque annee, il est recense un grand nombre de nouveaux cas de personnes victimes d’un Traumatisme Crânien (TC). Cet evenement neurologique touche bien souvent des personnes jeunes, et induit des troubles cognitifs et comportementaux qui ont d’importantes repercussions sur la vie quotidienne des personnes et de leur famille. Le devenir des personnes victimes d’un TC est bien connu a 18-24 mois, il semble a present primordial d’etudier l’avancee en âge des personnes TC chez qui il est evoque des risques importants de developper un vieillissement pathologique. L’identification des facteurs du bien vieillir pour la personne TC est egalement important pour leur(s) aidant(s) qui presente(nt) egalement un vieillissement precoce d’origine multifactorielle. De futures recherches aideront a mieux anticiper, comprendre et prendre en charge l’avancee en âge des personnes TC.

In spastic patients, shortening wrist arthrodesis (SWA) is indicated in cases of severe fixed flexion contracture. At present, the most commonly used technique is dorsal plate osteosynthesis. Ideally, fixation with smaller hardware volume farther from the tendons would limit postoperative tendon irritation and reoperation rates for hardware removal. The objective of our study was to evaluate the efficacy of Rush pin SWA in adults. A retrospective study included all patients with a central neurological impairment, undergoing SWA using a Rush pin inserted through the head of the third metacarpal, and with at least 6 months' follow-up. Attainment of preoperative objectives was evaluated by Global Assessment of Response to Treatment (GART, ranging from -4 to +4) and, for functional objectives, the House score and the Frenchay Arm Test. Consolidation and any degenerative changes in the third metacarpophalangeal joint were assessed on X-ray. Fifteen patients were included, with a mean follow-up of 13 months (range, 6-29). In general, the preoperative objectives were attained: mean GART score was 2.7 (range, 1-4). Functional objectives were attained in 3 of the 11 patients followed up (27%). In all cases, the arthrodesis had healed at a mean 74 days (range, 39-102). Three had hardware removed after consolidation; 1 experienced discomfort at the head of the third metacarpal. Rush pin arthrodesis is an interesting alternative to plate arthrodesis in the management of severe wrist flexion contracture in spastic patients. It gives satisfactory results with regard to preoperative objectives and is not associated with complications. LEVEL OF EVIDENCE: IV, retrospective study without control group.

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 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).

BACKGROUND Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery - a complex procedure with potential complications. OBJECTIVE We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered. METHODS We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or gathered in a phone interview. RESULTS Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1-12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits. CONCLUSION An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS - even after private-practice physiotherapy had failed.

Background In contrast to wearable tools (like in-shoe) sensors, lab-based gait assessment (using pressure-sensitive mats or cameras) only acquire data over short distances in non-ecological environments. Research question To examine the concurrent validity of a wearable ZeroWire® footswitch system (Aurion Srl, Milan, Italy) vs. the GAITRite® walkway (CIR systems Inc., NJ, USA) for recording temporal gait parameters. Methods We included 40 healthy participants in a prospective, single-center study. Temporal gait parameters were recorded simultaneously with the ZeroWire® and GAITRite® systems while each participant walked at three different speeds (slow (60steps/min), comfortable and maximum). To measure the validity, we calculated the interclass correlation coefficient (ICC) and the coefficient of variation (CV) for each parameter (gait cadence, stride time, step time, stance time, and single-support and double-support times). We also performed a graphical analysis using the Bland and Altman method. Results The footswitch system showed moderate-to-excellent concurrent validity vs. the GAITRite mat. The degree of agreement between the two assessments was greatest at the maximum gait velocity showed, with very good validity (ICC > 0.91) seen for most parameters, whereas agreement ranged from moderate to very good for the other speeds. Independently of the gait speed, the highest levels of agreement were recorded for gait velocity, cadence, stride time, step time, and stance time. According to the CVs, both systems showed the same accuracy and double-support time was the more variable parameter. Significance The ZeroWire® footswitch system appears to be valid for assessing temporal gait parameters (and particularly gait cadence and stride, step and stance times in healthy participants). It is likely to be well suited to the assessment of gait parameters under ecological conditions and in dual-task gait paradigms.

Introduction/Background The posterior parietal cortex (PPC) is a key structure for visual attention and upper limb function, two features that could be impaired after stroke, and could be implied in their recovery. If it is well established that stroke is responsible for intra- and interhemispheric connectivity troubles, little is known about those existing for the contralesional PPC. Material and method In this study, we aimed at mapping the functional (using resting state fMRI) and structural (using diffusion tensor imagery) networks associated with 3 subparts of the PPC of the contralesional hemisphere (the anterior intraparietal sulcus (aIPS), the posterior intraparietal sulcus (pIPS) and the superior parieto-occipital cortex (SPOC)) in 12 chronic stroke patients compared to 13 healthy controls. We also aimed at assessing the relationship between connectivity and the severity of visuospatial and motor deficiencies. Results We showed that intrahemispheric functional connectivity between the contralesional PPC and posterior frontal regions (especially premotor areas) was altered, as were interhemispheric functional and structural connexions between each part of the contralesional PPC and their homologous area in the ipsilesional hemisphere. Neglect severity was associated with several alterations in intra- and interhemispheric connectivity, the behavioral/connectivity correlations were far less evident for motor deficiency. Conclusion The results of this exploratory study shed a new light on the influence of the contralesional PPC in post-stroke patients, they have to be confirmed and refined in further larger studies.

Objective: The objective was to characterize the gait abnormalities in myotonic dystrophy type 1 patients. Material and Methods: Outcomes variables were kinematic and kinetic parameters, timing of muscles, mechanical work and energy cost, and the motor function measure. Results: Despite a high cadence and a low ankle range of motion ratio, ankle extension power, and first extension moment of the knee during the stance, the mechanical work and energy cost were normal. The duration of electromyography activation of the gastrocnemius lateralis (GL) muscle was abnormally long. Conclusion: The hypothesis of a myotonic activity of the GL during the swing phase should be investigated.

Background: Stroke may cause sentence comprehension disorders. Speech segmentation, i.e. the ability to detect word boundaries while listening to continuous speech, is an initial step allowing the ...

ObjectiveThe aim of this study was to evaluate whether mutations in ERLIN2, known to cause SPG18, a recessive hereditary spastic paraplegia (SP) responsible for the degeneration of the upper motor neurons leading to weakness and spasticity restricted to the lower limbs, could contribute to amyotrophic lateral sclerosis (ALS), a distinct and more severe motor neuron disease (MND), in which the lower motor neurons also profusely degenerates, leading to tetraplegia, bulbar palsy, respiratory insufficiency, and ultimately the death of the patients.MethodsWhole-exome sequencing was performed in a large cohort of 200 familial ALS and 60 sporadic ALS after a systematic screening for C9orf72 hexanucleotide repeat expansion. ERLIN2 variants identified by exome analysis were validated using Sanger analysis. Segregation of the identified variant with the disease was checked for all family members with available DNA.ResultsHere, we report the identification of ERLIN2 mutations in patients with a primarily SP evolving to rapid progressive ALS, leading to the death of the patients. These mutations segregated with the disease in a dominant (V168M) or recessive (D300V) manner in these families or were found in apparently sporadic cases (N125S).ConclusionsInheritance of ERLIN2 mutations appears to be, within the MND spectrum, more complex that previously reported. These results expand the clinical phenotype of ERLIN2 mutations to a severe outcome of MND and should be considered before delivering a genetic counseling to ERLIN2-linked families.

BackgroundDecompressive hemicraniectomy (DH) increases survival without severe dependency in patients with large middle cerebral artery (LMCA) infarcts. The objective was to identify predictors of 1-year outcome after DH for LMCA infarct.MethodsWe conducted this study in consecutive patients who underwent DH for LMCA infarcts, in a tertiary stroke centre. Using multivariable logistic regression analyses, we evaluated predictors of (1) 30-day mortality and (2) poor outcome after 1 year (defined as a modified Rankin Scale score of 4–6) in 30-day survivors.ResultsOf 212 patients (133 men, 63%; median age 51 years), 35 (16.5%) died within 30 days. Independent predictors of mortality were infarct volume before DH (OR 1.10 per 10 mL increase, 95% CI 1.04 to 1.16), delay between symptom onset and DH (OR 0.41, 95% CI 0.23 to 0.73 per 12 hours increase) and midline shift after DH (OR 2.59, 95% CI 1.09 to 6.14). The optimal infarct volume cut-off to predict death was 210 mL or more. Among the 177 survivors, 77 (43.5%) had a poor outcome at 1 year. Independent predictors of poor outcome were age (OR 1.08 per 1 year increase, 95% CI 1.03 to 1.12) and weekly alcohol consumption of 300 g or more (OR 5.30, 95% CI 2.20 to 12.76), but not infarct volume.ConclusionIn patients with LMCA infarcts treated by DH, stroke characteristics (infarct volume before DH, midline shift after DH and early DH) predict 30-day mortality, while patients’ characteristics (age and excessive alcohol intake) predict 1-year outcome survivors.

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.

Resume Introduction Le transfert du muscle tibialis posterior (TTP) est le traitement palliatif le plus realise pour pallier le deficit neurologique des releveurs du pied. S’il a ete bien etudie apres atteinte peripherique, il reste peu evalue en cas d’atteinte centrale, ou il est souvent accuse de provoquer un effondrement de la voute du pied. Aussi nous avons mene une etude retrospective afin de : (1) de mesurer son retentissement sur la statique du pied, (2) savoir si ce transfert associe a d’autres gestes chirurgicaux permettait une amelioration des conditions de marche. Hypothese Le TTP peut provoquer un effondrement de l’arche mediale du pied. Patients et methodes Treize patients (13 pieds) ont ete revus a 65 mois (12–108) apres une chirurgie incluant un TTP. Les etiologies etaient 5 accidents vasculaires cerebraux, 3 traumatismes crâniens, 2 traumatismes medullaires, une myelopathie cervicarthrosique, une paralysie cerebrale et une tumeur cerebrale. Cliniquement, les principales evaluations portaient sur la statique de l’avant-pied et le type d’empreinte plantaire au podoscope. Radiographiquement, on relevait sur des cliches en charge, (1) sagittalement : l’angle de Djian, l’angle de Meary-Tomeno, l’angle de l’arche laterale et l’inclinaison calcaneenne, (2) transversalement et frontalement, l’angle talo-metatarsien et l’angle Djian-Annonier. Resultats Cliniquement, on relevait 6 empreintes plantaires normales et 7 pieds creux. Aucun ne presentait de pied plat. Deux patients presentaient des deformations en pronation et 2 en supination. Radiologiquement, les seules les differences entre les 2 pieds concernaient l’angle d’arche laterale et l’angle d’inclinaison calcaneenne en faveur de pieds creux du cote opere (respectivement, cote opere, 142,7° [136–156] ; p = 0,041 et 24° [14–33] ; p = 0,028). Discussion Contrairement a notre hypothese, on ne notait pas de tendance a la decompensation en pied plat valgus des patients avec atteinte centrale chez qui a ete realise un transfert du tibial posterieur sur le dos du pied. Niveau de preuve IV, etude retrospective sans groupe temoin.

International audience

International audience; Parietofrontal (PF) networks link the posterior parietal cortex to premotor and prefrontal areas, and are involved in the control of many motor and cognitive behaviors in healthy humans. In recent years, electrophysiological experiments have provided a better understanding of the functional specificity and temporal involvement of the PF networks’ different components during the planning of visually guided upper limb movements. In particular, transcranial magnetic stimulation has been used to temporarily inactivate a cortical area (virtual lesions) or to assess connectivity using paired-pulse protocols)). This approach has shed new light on the neural mechanisms that underlie the planning stages of the reaching and grasping phases of transitive movements. Reaching and grasping were often presented as two distinct processes; in fact, the respective involvement of dorsolateral and dorsomedial networks may depend on the movement's complexity and the need for precise coordination between the two phases. The dorsolateral parietofrontal network (linking the anterior part of the intraparietal sulcus to the ventral premotor cortex) is involved in the grasping phase (i.e. hand shape and grip force scaling), whereas the dorsomedial part (from the posterior part of the intraparietal sulcus and the superior parieto-occipital cortex to the dorsal premotor cortex) appears to be involved not only in the reaching phase but also in more complex visually guided grasping movements. Changes in parietofrontal connectivity following brain injury might explain the impairments in visually guided upper limb movements observed in patients (such as optic ataxia and the motor component of spatial neglect). Lastly, parietofrontal changes may reflect neuronal plasticity in motor function recovery.

To evaluate the objective and subjective functional effectiveness of tibial nerve neurotomy (TNN) in post-stroke spastic equinovarus foot (SEF).In an open study, 23 hemiplegic patients were assessed immediately before TNN and then 5months after TNN. The main outcome measure was the Lower Limb Function Assessment Scale (LL-FAS), which provided an ecologic assessment of impairments in standing and walking (i.e. kinematic abnormalities) and their impacts on activities of daily living. Patients were also assessed for global clinical impression of change, fear of falling, neuromotor impairments, spatiotemporal and video gait parameters and walking capacities.TNN had a very marked effect on the level of spasticity and the range of motion in dorsiflexion (p10(-3)). These changes resulted in better foot positioning when standing and walking (particularly in stance), which was perceived very favorably by the patients. There was a clear, patient-perceived improvement in activities performed when standing and walking (LL-FAS (p0.01)), the global clinical impression of change (p10(-3)) and the fear of falling (p=0.022) that was not revealed by conventional, objective measurements (New Functional Ambulation Classification, Rivermead Mobility Index).TNN is an effective treatment for post-stroke SEF; it is associated with a patient-reported improvement in standing and walking abilities during activities of daily living. Further research must now assess the long-term subjective efficacy of TNN.

The purpose of the study was to determine muscle metabolism adaptation to exercise in facioscapulohumeral muscular dystrophy patients (FSHD) and to study the correlation with clinical functional status (6-min walk test). 8 FSHD patients and 15 age-matched healthy controls (Controls) performed two isokinetic constant-load knee extension exercises: (1) at 20% of their maximal extensors' peak torque (i.e., the same relative workload) and (2) at (20N⋅m) (the same absolute workload) for up to 4 min. All exercises consisted of rhythmic, voluntary, isokinetic, concentric contractions of the quadriceps femoris at 90°/s, whereas the flexion was performed passively at the same speed. Muscle oxygenation in the vastus lateralis was evaluated using near-infrared spectroscopy (NIRS). The FSHD patients displayed a lower maximal peak torque than controls (-41%, p 0.05). During the two-exercise modalities, deoxygenated haemoglobin (HHb) and total haemoglobin volume (tHb) were lower in the FSHD patients (p 0.05). The initial muscle deoxygenation time delay was shorter in the control group (FSHD: 15.1 ± 4.1 s vs.10.4 ± 2.1 s, p 0.05). Mean response time and maximal peak torque were both correlated with functional impairment (walking endurance). The results suggest that FSHD patients present an impairment in their capacity to deliver or to use oxygen.

Sustained-release fampridine (fampridine-SR) improves gait velocity and self-perceived capacities in people with multiple sclerosis (MS). However, little is known about the treatment's effect on temporospatial gait parameters, walking endurance, general fatigue, hand function and quality of life (QoL). We therefore sought to evaluate these parameters in a real-world setting: 120 consecutive, eligible patients with MS were evaluated at baseline (D0) and after two weeks (D14) of fampridine-SR. Lastly, D14 responders were again evaluated after three months (M3). Response to treatment was defined as a 15% improvement in at least one of the following tests: the Timed 25-Foot-Walk (T25FW), the 2-min walk test (2MWT) and the Multiple Sclerosis Walking Scale (MSWS-12). Eighty-three patients (74%) were found to be responders. The response rate was lower when assessed as a 20% improvement in the T25FW (50.9%), and this difference was particularly marked for fast-walking subjects (i.e. T25FW

Resume Introduction La dystonie en extension de l’hallux et/ou des petits orteils peut etre observee dans le cadre de lesions pyramidales et extrapyramidales et entrainer des douleurs des orteils concernes, spontanees ou a la marche, des difficultes et un inconfort lors de l’habillage ou le chaussage et des lesions cutanees des orteils. L’objectif de cette etude etait d’evaluer l’efficacite et la tolerance de la neurotomie des branches du nerf fibulaire profond destinees aux muscles long extenseur de l’hallux (LEH) et/ou long extenseur des orteils (LEO) dans le cadre du traitement de la dystonie en extension de l’hallux et/ou des orteils. Patients et methode Une neurotomie fibulaire profonde a ete realisee chez 20 patients ( n = 19 pour le LEH, n = 6 pour le LEO). Efficacite et tolerance du traitement ont ete analysees retrospectivement et via une entrevue telephonique permettant de mesurer l’impact subjectif sur les differentes genes du patient et son niveau de satisfaction. Resultats La dystonie avait disparu totalement dans 15 cas (75 %), elle persistait a un niveau minime chez les autres patients. Les patients rapportaient une diminution du niveau de douleurs ( p p Discussion La neurotomie des branches du nerf fibulaire profond pour le LEH et/ou le LEO semble etre un traitement efficace de l’hyperextension de l’hallux et/ou des orteils et de ses consequences chez le patient adulte neurologique. Cependant, ces resultats preliminaires encourageants doivent etre confirmes par des travaux prospectifs a plus long terme. Niveau de preuve IV.

Spatial neglect has been related to both cortical (predominantly at the temporal-parietal junction) and subcortical (predominantly of the superior longitudinal fasciculus) lesions. The objectives of this observational study were to specify the anatomical relationships of behavioral neglect in activities of daily living (N-ADLs), and the anatomical and psychometric relationships of N-ADLs on one hand and components of neglect (peripersonal neglect and personal neglect) and anosognosia on the other. Forty five patients were analyzed for behavioral difficulties in daily living (on the Catherine Bergego scale) and the main components of neglect (using conventional clinical assessments) during the first months post right hemisphere stroke. Voxel-based lesion-symptom mapping was used to identify brain areas within which lesions explained the severity of bias in each assessment (non-parametric permutation test; p

Resume Objectif Le reseau TC-AVC 59-62 a recu la mission d’ameliorer le suivi des personnes en situation de handicap dans les suites d’un accident vasculaire cerebral (PSH/AVC). Un etat des lieux prealable est apparu necessaire. Materiel et methodes Les medecins de 26 services de soins de suite et readaptation ont repondu a un questionnaire sur la prise en charge et le suivi des PSH/AVC, 22 services pour adultes et 4 services pediatriques. Resultats Dix-huit equipes utilisaient des echelles validees type MIF ou Barthel. Plusieurs professions etaient peu representees (psychiatres, psychologues, assistants sociaux). Pour preparer la sortie, 25 proposaient des visites a domicile, 9 des permissions le week-end. Seules 2 prenaient systematiquement contact avec le medecin traitant, et 12 si besoin. Tous envoyaient un courrier la semaine de la sortie. Concernant le suivi, 19 organisaient au moins une consultation. Les personnes demandaient une aide medicale mais davantage sociale, psychocomportementale et d’autonomisation. Treize effectuaient un suivi pendant 1 an, et 5 pendant plusieurs annees. La plupart accepteraient de consulter des PSH/AVC qui n’auraient pas ete hospitalisees en centre mais 13 n’etaient jamais sollicitees. Les medecins estimaient necessaire des recrutements de medecins, assistants sociaux, neuropsychologues et ergotherapeutes pour un suivi medico-psycho-social global. Ils jugeaient necessaire une valorisation financiere des actes associes au suivi. Conclusion Dans la region Nord Pas-de-Calais, l’evaluation et la prise en charge des troubles specifiques des PSH/AVC en centre de reeducation, la preparation de sortie et le suivi etaient insuffisants et inegaux. Cependant, les equipes etaient motivees pour ameliorer le suivi, en fonction de l’adaptation des moyens financiers.

Introduction Comfort/discomfort (C/D) is an important factor of quality of life (QoL). Brain damage is a major source of discomfort. We developed a questionnaire for assessing C/D in daily living situations and for identifying the main causes of any discomfort and presented its pilot assessment in a population of stroke patients. Methods The scale is a questionnaire of the patient or caregiver that addresses (i) comfort/discomfort in 15 situations of daily living (including getting dressed, washing, lying in bed and sitting in a chair) and (ii) the roles of physical difficulties, psychological problems and a poorly adapted environment. We analysed its metrological qualities in a group of 62 stroke patients. Results For the patients, the most uncomfortable activities were eating, dressing the lower body, urine and faeces elimination and walking, and the most significant factors of discomfort were motor impairments, fatigue, limb stiffness, joint pain, depression and anxiety. The reliability was fair for the overall score and for each C/D item and moderate for the impact of impairments on comfort/discomfort. We also found fair internal consistency and convergent validity against measures of functional status, QoL and burden of care. Sensitivity to change over a 6-week period was modest. Conclusions The scale can help to define difficulties in daily living situations and identify opportunities for intervention in stroke patients.

Introduction/Background In 1998, a research on severe traumatic brain injury (STBI) patients 3 years after onset highlighted many difficulties regarding autonomy and quality of live (QOL). Lack of follow-up and specialized infrastructures was clear. Since then, the follow-up has been organized around the Brain injuries 59/62 regional network. We aimed at comparing the evolution of autonomy and QOL and their influencing factors (IF) between the two periods. Material and method All STBI people in the same area were evaluated 3 years after onset using the European Brain Injury Society document. Autonomy and QOL IF were analysed and compared between the two periods (end of the 1990s and 2010s). Results On the 23 and 24 evaluated patients respectively in 1998 and 2016, the overall autonomy (especially in elaborated activities) and scores of QOL tended to be higher in 2016. According to the family, the average QOF has significantly improved (P = 0.023). Changes in the role in the family (P = 0.007) and the need for respite (P Factors impacting negatively on the overall autonomy, respectively in 1998 and 2016, were: coma duration (P = 0.01/0.04), length of stay in acute care (P = 0.01/0.002), severity of physical deficiencies (P = 0.00/0.04) and several cognitive disorders. In 1998 as well as in 2016, the most dependent TBI people were having significantly more physiotherapy (P = 0.06/0.006) and speech therapy cares (P = 0.04/0.01). In 2016, patients were significantly more followed by the multidisciplinary team of the network (P = 0.029) and the socio-medical teams (P = 0.003). Concerning QOL, only cognitive and psycho-behavorial impairments were found in 1998 as well as in 2016. In 2016, we also found that severity of physical impairments negatively influenced the QOL (P = 0.029). Conclusion Better support for physical, cognitive and behavioral difficulties could lead to improved autonomy and QOL in TBI patients.

Background Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The primary objective of this study was to assess the impact on foot alignment of TPT in patients with central foot drop. The secondary objective was to determine whether TPT combined with other surgical procedures improved gait. Hypothesis TTP can induce flattening of the medial arch of the foot. Patients and Methods We retrospectively identified 13 patients managed with TPT (1 foot per patient). Mean follow-up was 65 months (range, 12–108 months). The causes were stroke (n = 5), head injury (n = 3), spinal cord injury (n = 2), cervical spondylotic myelopathy (n = 1), cerebral palsy (n = 1), and a brain tumour (n = 1). The clinical assessment focused chiefly on forefoot alignment and footprint parameters. The following variables were collected from weight-bearing radiographs: Djian-Annonier angle, Meary-Tomeno angle, lateral arch angle, and calcaneal pitch angle in the sagittal plane; talo-metatarsal angle in the transverse plane; and rearfoot valgus angle in the coronal plane. Results Of the 13 feet, 6 had normal footprint parameters and 7 pes cavus. There were no cases of flatfoot. Pronation deformities and supination deformities were each found in 2 patients. Comparing the radiographic parameters between the two feet in each patient identified differences only for the lateral arch angle and calcaneal pitch angle, which indicated pes cavus on the operated side (operated side: 142.7° [range, 136°–156°], p = 0.041; and 24° [range, 14°–33°], p = 0.028, respectively). Discussion In contrast to the working hypothesis, we found no evidence of progression to valgus flatfoot after TPT transfer performed to treat central foot drop. Level of evidence IV, retrospective study with no control group.

Objectives To assess the contralesional connectivity between the posterior parietal cortex (PPC) and the motor cortex (M1) in stroke patients, and to probe putative relationships with spatial neglect and motor impairment. Methods In 12 right-side stroke patients and 12 age-matched healthy controls, we used paired-pulse transcranial magnetic stimulation to assess the contralesional connectivity between three left-side PPC sites (the anterior intraparietal sulcus (aIPS), the posterior intraparietal sulcus and the superior parieto-occipital cortex (SPOC)) and M1. The interstimulus interval (ISI) was set to 4 or 6 ms. Results Although there were no differences between the stroke patient group and the controls, a subgroup analysis showed that stimulation over the SPOC with an ISI of 6 ms facilitated motor-evoked potential responses in patients with neglect (and especially those with severe peripersonal neglect), relative to non-neglect patients. With an ISI of 4 ms, the aIPS exerted an inhibitory influence on M1 in all subjects. The severity of motor impairment was not associated with PPC-M1 connectivity. Conclusions aIPS-M1 connectivity seems to be unaffected in stroke patients, whereas connectivity from the most posterior parts of the parietal cortex depends on the patient’s neglect status. Significance These results provide insight into post-stroke changes in contralesional PPC-M1 connectivity.

Introduction Les patients traumatises crâniens (TC) presentent souvent des troubles cognitifs et des troubles multimodaux de la posture et de la marche. L’objectif principal de ce travail etait de mesurer le cout de l’ajout de 3 types de tâches cognitives sur les parametres de marche. Patients et methode Les parametres spatiotemporels de marche ont ete evalues a l’aide d’un tapis Gaitrite chez 22 sujets victimes d’un traumatisme crânien modere a severe et 26 sujets controles apparies en âge. L’ajout des 3 tâches cognitives (back task, compte a rebours, parler en marchant) a ete mesure lors d’une tâche de marche sur terrain plat et de franchissement d’obstacle. Nous avons egalement mesure les liens entre le cout de la double tâche de locomotion et les performances dans un autre type de double tâche motrice (double tâche de Baddeley) et la confiance percus par le patient dans l’equilibre et la marche en vie quotidienne (ABCscale). Resultats Les resultats preliminaires montrent que le cout cognitif etait plus important dans le groupe TC pour la tâche de marche sur terrain plat et les tâches de comptage et de conversation avec l’examinateur. La reduction de la vitesse de marche portait a la fois sur la cadence et la longueur des pas. Par ailleurs, le cout de la double tâche de locomotion etait correle a celui de la double tâche de Baddeley (r = −0,420 ; p = 0,003), mais pas au score total de l’ABCscale. Discussion Le retentissement sur la marche de l’ajout d’une tâche cognitive intercurrente est facilement mesurable et pourrait sensibiliser l’analyse des consequences des troubles cognitifs dans la vie quotidienne. Cependant, la perception de la confiance dans les activites de marche semble impliquer d’autres facteurs.

Introduction/Background Patients suffering from traumatic brain injury (TBI) often present with cognitive but also posture and gait impairments. In this study, we aimed at evaluating the cost of the addition of 3 types of cognitive concurrent tasks on gait parameters, and studying the relationship between dual task cost and patient-reported perception of their confidence in balance and gait in daily living. Material and method Spatiotemporal gait parameters were assessed using a GAITRITE mat in 22 moderate-to-severe TBI patients and 26 age-matched healthy controls. The addition of 3 cognitive tasks (letter back-task, substractions by 3, talking when walking) was studied during unobstructed walking and stepping over an obstacle. We also evaluated the relationship between dual task cost during gait and (1) cost in another motor task (Baddeley) and (2) patient perceived confidence in dynamic balance and gait in daily living (ABC scale). Results Dual task cost during gait was higher in TBI patients compared to healthy controls when walking unobstructed and in the subtraction and talking concurrent tasks. Alteration of gait speed was primarily due to a decrease of step length more than of gait cadence. TBI patients tended to prioritize the cognitive task. Dual task cost during gait was correlated with the Baddeley dual task performance (r = −0.420; P = 0.003) but not with the ABC scale score. Conclusion TBI patients exhibit difficulties in dual task gait conditions, which can be easily assessed and should be addressed in rehabilitation. The dual task cost could be not specific to locomotor activities. Finally, other factors seem to explain the alteration in confidence in gait and balance in daily living.

Introduction/Background Little is known about shoulder hypertonia in patients with brain injury. The principal aim of our study was to assess the results of spastic shoulder surgery in our team experience. Material and method Sixteen patients (18 shoulders) were retrospectively reviewed. The following were studied: etiology of hypertonia, shoulder deformation schemes, initial aims of surgery, shoulder pre- and postoperative mobility, impact of surgery on limb function when possible. None limb was functional preoperatively. Spontaneously, shoulders were all in a medial rotation, in adduction in 15 cases, in abduction in 3 cases. One had spontaneous retroposition. Therapeutic aim was hygienic in all and pain-relief in 6. Ten neurotomies of the lateral pectoral nerve (LPN), 8 intramuscular lengthening of the latissimus dorsi (LD), 9 percutaneous tenotomies of the pectoralis major (PM), one neurotomy of the motor nerve for the long head of triceps brachii (LHTB) and one intramuscular lengthening of the teres major (TM) were performed. Results Mean age at surgery was 52.1 (24–73). Etiology was vascular in 11, anoxic in 2, one had traumatic brain injury, one multiple sclerosis, one cervicarthrosic myelopathy. Preoperatively, the mean results for passive abduction of the shoulder was 50.6° (10–90) and for the passive lateral rotation was −5° (−70; 20). Postoperatively, there were respectively improved at 87.7° (60–160) and 6.7° (−20; 20). Only 3 muscles presented with residual tightness (two PM and 1TM) in patients where an isolated neurotomy of the lateral pectoral nerve (LPN) had been achieved. All of the initial objectives of the surgery were satisfied. One patient recovered a partial functionnal limb thanks to a recovered active shoulder flexion. Conclusion In classical medial rotation-adduction deformation schemes, surgery performed on the 3 main involved muscles (PM, LD, TM) offers good results in term of passive mobility of the shoulder and pain-relief.

Aim To evaluate efficiency of the tibialis posterior muscle transfer in patients with peripheral palsy of foot levators, and to determine occurrence of adverse effects on the static foot posture. Patients and methods Fifteen patients were evaluated retrospectively at a median 90 months follow-up (8–219). Eight patients had truncal paralysis (femoral fracture, knee sprain, total hip arthroplasty), 5 radicular (spinal trauma, disk hernia, lumbar surgery) and 2 neuropathic paralysis. The tibialis posterior was transferred on the tibialis anterior in 9 cases, on the second cuneiform twice, three times on the peroneus brevis and once on the navicular. None was associated to a Lambrinudi hind foot osteotomy. Collected data concerned (a) function: orthotics need, walking distance, and a satisfaction score (/4) (b) deficiencies: amplitude of active dorsiflexion, dorsiflexion strength and plantar footprint and (c) radiographic analysis, Djian angle and hindfoot alignment. Results The eleven patients wearing orthotics were completely weaned from it. Following the procedure, only one patient had a limited walking distance (50–200 m). The mean satisfaction score was 2/4 (−3/4). Maximum dorsiflexion meanly reached the neutral position (−20 to 15); the arc of movement averaged 11°(0–36) during analytic testing and 4,5°(0–10) when walking. Dorsiflexion strength averaged 2,75 (0–5). Eleven patients had a normal plantar footprint and 4 a cavus foot. Djian angle averaged 122 (111–130) and the hindfoot alignment angle was 5,3°valgus. The Djian angle was the only angle to be significantly different from the contralateral non operated foot (P = 0,015), with a trend to cavus foot. Discussion Tibialis posterior muscle is effective in foot-drop due to peripheral paralysis. A flat valgus foot does not appear to be a long-term complication of this procedure. On the contrary, we found a trend to cavus foot.

Objective The aims of this study were to determine the prevalence of pituitary dysfunction in patients presenting with cognitive and/or mood complaints and/or fatigability late after a mild traumatic brain injury (TBI), and to analyse the relations of endocrine abnormalities with population characteristics, imagery and autonomy. Methods We studied 38 patients: 25 men, mean age 36 (range 21–60 years), at a mean of 23 months (range 9–40) post-event; 44.7% were GOS 1, 47.4% GOS 2 (moderate disability) and 7.9% GOS 3 (severe disability). 15 patients were active. For each patient, we collected data on initial CT scan, MRI lesions, late Glasgow Outcome Scale (GOS), autonomy (EBIS questionnaire) and pituitary functions (static and dynamic tests). Results No patient showed any posterior pituitary dysfunction. One (2.6%) showed a hyperprolactinemia, two (5.3%) a gonadotropin deficiency, seven (18.4%) a TSH deficiency. Nine patients (23.7%) had partial ACTH deficiency (diagnosed by ITT or metyrapone test). Severe GH deficiency (GHD) was diagnosed in nine patients (23.7%) (ITT or arginine + GHRH test) and was isolated in 39% of cases. Twenty-three patients (60.5%) showed at least one anterior pituitary deficiency requiring a substitutive treatment. Hypopituitarism was only related to age (positive correlation, P = 0.01) and the presence of a cerebral oedema on initial CT scan ( P = 0.044). We didn’t find any association with autonomy in activities, GOS score and MRI data. Conclusions In mild TBI patients with persistent cognitive disorders, fatigability or mood disorder, the risk of anterior pituitary deficiency is high and justifies a systematic pituitary assessment with specific reference tests.

Objective Distal lower limb deformities are frequent after a central nervous system lesion, and have a significant impact on posture, gait and activity. This study aimed at analyse neuro-orthopaedics procedures performed in such indications, considering their timing, their main functional objectives and their global efficacy on gait and walking conditions. Methods One hundred sixty-one adult patients were assessed at the spasticity multidisciplinary consultation of Lille University hospital and then operated on in 2012 and 2013. Data were analysed retrospectively and included disease history, main functional objectives, nature of surgical procedures and their timing of realization and finally a qualitative analysis of analytic and functional results at the end of the treatment (with a one year post-surgery period). Results Patients presented with consequences of stroke (57.8%), traumatic brain injury (11.8%), cerebral palsy (9.3%); median post-lesion period was 3.5 years. The objective for patients was an improvement of gait (94.4%) and transfer (7,5%), and a reduction in walking aids (6.8%). Ninety-six patients (59.6%) were operated on twice; in this case, the first surgical phase consisted most of time in neurotomies, the second one in tendinous and articular procedures. At the end of the treatment, goals were totally reached in 2/3 of patients and at least in part in 30% of them. Kinematic abnormalities during gait (equinus, varus, valgus, toe claws) were clearly improved. Finally, the need of assistance when walking or making transfers and the need for orthotics were significantly reduced. Discussion This study confirms the efficacy of neuro-orthopaedic treatment of distal lower limb spastic deformities on gait and walking conditions. Efficacy on activities, participation and quality of life remains to be studied.

Objective Beside the posterior leg compartment, spasticity of the hemiplegic patient can involve other muscle groups in the leg. Spasticity of the lateral compartment is responsible of a vertical clonus that may be confused with the clonus of the triceps surae (long fibular) or a transverse clonus (short fibular), and by the liveliness of the tendon reflex when striking their tendon. Beside recurrent botulinum toxin injections, this spasticity may be treated by a hyponeurotisation by partial section of the branches of the superficial fibular nerve to the muscle(s) concerned. Its technique has never been described. Material/patients and methods Twelve legs of formalin corpses have been dissected. The number of branches to PL and PB, their level of emergence from the common and deep fibular nerves, and their entry point into the muscle have been measured from the lateral femoral-tibial articular space (LTF). Results There was always a common trunk to the EDL and the EHL, arisen on average at 10.3 cm (8.2–13.6) from the LTF line. Six times out of 10 in addition to this common one (3), two (2) or three (1) additional branches to the EDL, arisen between 4.6 and 12 cm downstream the LTF line. Six times out of 10 in addition to this common trunk existed one (4) or two (2) additional branches to the EHL, arisen between 13 and 26 cm downstream the LTF line. Discussion–conclusion This first study allow establishing the surgical technique of the hyponeurotisation of PL and PB muscles. The first results are presented.

Objective In the spectrum of spatial neglect, personal neglect (body neglect) plays an important role in the difficulties encountered by patients, but its assessment is often centered on the sphere of the face and/or involves tests that have no ecological value. The objective of this study was to develop an assessment tool adressing these two pitfalls. Material/Patients and methods The scale includes seven items assessing personal neglect on the entire body (face, but also upper and lower parts of the body). The ordinal rating (0-3) made by the examiner focuses on the patient's ability to explore and be aware of the contralesional body side when simulating activities of daily life. The validation study focused on inter- and intra-observer reliability, criterion validity (Fluff test, neuroanatomical correlates), construct validity (line bisection test, Catherine Bergego scale) and internal consistency. Results Twenty-three neglect patients (N + ) and 20 non-neglect patients (N-) have been included. The total score of the scale was correlated with the Fluff test score ( r = −0.566; P = 0.009), but not with assessments of the other features of neglect. Intraclass correlation coefficients (ICCintra = 0.924; ICCinter = 0.858) and the distribution on the Bland-Altman diagrams showed good reliability properties of the total score. Reliability of the items was moderate to good (kappa > 0.5) except for one item. Internal consistency of the tool was moderate (α = 0.56). The results concerning the neuroanatomical correlates are being processed. Discussion - Conclusion The assessment scale of personal neglect showed good psychometric properties. It allows the evaluation of personal neglect on the entire body with an ecological value. Future works are needed to precize validity of the scale and particularly its responsiveness.