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The Brain-Machine Interface allows a recovery of the upper limb motricity through cerebral plasticity with the closing of the sensory-motor loop. In order to allow a grasping movement of the upper limb through the BCI, it is necessary to be able to detect properly the subject's cerebral signal, more particularly the intention to act. Material and method: a Study of the feasibility Which Described the cerebral signal in 10 healthy subjects was carried out during one year. The brain signal was analyzed using a non-invasive, EEGbased, Tmsi MCI device during global and fine upper limb grasping tasks. The main objective was to show the ability of this system to detect intention to act. Subjects performed 3 tasks: key grip, grasping and bimanual grasping, 12 Times each, and a rest phase. Results: the BCI Tmsi device made it possible to detect the intention to act, by broadening the acquisitions of the brain signal initially studied and thus allowing a combination of customized frequency bands optimizing the capabilities of the classifier in its analysis of the signal. It was not possible to include post-stroke patients due to technical issues and recruitment difficulties during the health crisis. Conclusion: the BCI Tmsi device used for our study allows the detection of the intention to act in 10 healthy subjects. It is now necessary to use this BCI to study the cerebral signal of vascular hemiplegic patients included in the EPrehension Stroke protocol, in order to use the BCI as a trigger for a finger extensor FES system.; L’Interface Cerveau-machine permet une récupération de la motricité du membre supérieur via la plasticité cérébrale grâce à une fermeture de la boucle sensori-motrice. Afin de permettre un mouvement de préhension du membre supérieur via une ICM, il est nécessaire de pouvoir détecter correctement le signal cérébral du sujet notamment l'intention d’agir. Matériel et méthode : une étude de faisabilité, descriptive du signal cérébral chez 10 sujets sains a été réalisé pendant un an. Le signal cérébral a été analysé via un dispositif d’ICM Tmsi, non invasif, basé sur l’EEG, lors de tâches de préhension globale et fine du membre supérieur. L’objectif principal était de montrer la capacité de ce système à détecter l’intention d’agir. Les sujets réalisaient 3 tâches : key grip, grasping et grasping bimanuel, avec 12 répétitions pour chacune d’entre elles, et une phase de repos. Résultats : le dispositif d’ICM Tmsi a permis de détecter l’intention d’agir, par élargissant des acquisitions du signal cérébral étudié initialement et en autorisant par ce fait une combinaison de bandes de fréquence personnalisée optimisant les capacités du classificateur dans son analyse du signal. Il a été impossible d’inclure des patients post AVC du fait de problèmes techniques rencontrés, ainsi que de difficultés de recrutement dans le contexte de crise sanitaire. Conclusion : le dispositif d’ICM Tmsi utilisé pour notre étude permet de détecter l'intention d’agir chez 10 sujets sains. Il est nécessaire maintenant d’utiliser cette ICM pour étudier le signal cérébral de patients hémiplégiques vasculaires inclus dans le protocole EPréhension Stroke, pour espérer utiliser l’ICM comme déclencheur d’un système de SEF d’extenseurs des doigts.

International audience

Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.

Coronary artery disease (CAD) are the first cause of death in high-income countries and aircrew members are also concerned by this public health problem. The last epidemiological studies about it in aerospace medicine in France date back to 1993. The aims of this study are to describe the population of crew members with a CAD, examine the tests leading to the diagnosis as well as those which enabled the rehabilitation. The data were extracted from the files of civilian and military aircrew members who were examined at the Clamart AeroMedical Center between 2010 and 2015. The studied population is composed of 120 patients including 118 males (98,3%), with a mean age of 53,15 +/- 8,94 years. The CAD was discovered for 55% of the population after an inaugural myocardial infarction (n=66), for 22,5% due to moderate symptoms (n=27), for 15,8% due to tests prescribed because of an increased cardiovascular risk (n=19) and for 6,7% on electrocardiographic abnormalities (n=8). The overall cardiovascular risk according to the SCORE scale at the moment of diagnosis was less than 1% for 39,7% cases (n=25). The coronarography revealed bitroncular lesions for 29,1% of patients and three-troncular lesions for 24,8% of them. After the cardiological assessment, 29% of patients were declared unfit. The diagnosis of CAD rarely leads to unfitness. However, a cardiological evaluation remains essential to ensure the absence of disabling sequelae in order to preserve flight safety.; Les maladies coronariennes sont la première cause de décès dans les pays à revenu élevé et les personnels navigants n’échappent pas à ce problème de santé publique. Les dernières études épidémiologiques sur ce sujet en milieu aéronautique en France datent de 1993. Les objectifs de cette étude sont de décrire la population de navigants coronariens, d’étudier les examens complémentaires ayant conduit au diagnostic ainsi que ceux ayant permis une réhabilitation. Les données ont été extraites des dossiers de personnels navigants civils et militaires coronariens ayant consulté au Centre Principal d’Expertise Médicale du Personnel Navigant de Clamart entre 2010 et 2015. La population étudiée comportait 120 sujets dont 118 de sexe masculin (98,3%), avec un âge moyen de 53,15 +/-8,94 ans. La maladie coronaire était découverte pour 55% de la population suite à un infarctus du myocarde inaugural (n=66), pour 22,5% du fait d’une symptomatologie fonctionnelle (n=27), pour 15,8% du fait d’examens de dépistage en lien avec un risque cardiovasculaire élevé (n=19) et pour 6,7% sur des anomalies électrocardiographiques (n=8). Le risque cardiovasculaire global selon l’échelle SCORE au moment du diagnostic était inférieur à 1 dans 39,7% des cas (n=25). La coronarographie a révélé une atteinte bitronculaire pour 29,1% des patients et tritronculaire pour 24,8% d’entre eux. Après évaluation cardiologique 29% des patients étaient déclarés inaptes. Un diagnostic de coronaropathie ne conduit donc pas systématiquement vers une inaptitude. Cependant, une évaluation cardiologique reste indispensable afin de s’assurer de l’absence de séquelle invalidante dans le but de préserver la sécurité des vols.

In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now become a specialized domain and needs to be introduced at all levels of the sport. A key factor in all sports injury rehabilitation protocols is injury prevention; this involves data maintenance by teams or trainers, which is still not fully developed in the Indian context. The injury and subsequent problems need to be comprehended both by athletes and their coaches. The current review is an attempt to clarify some of the issues that are important and routinely used world over, with the aim to improving rehabilitation after sports even in the underdeveloped world.