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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. The aim of this systematic review was to evaluate the general effectiveness of adjunct therapies regardless of their nature in children with spasticity. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Focus on the different therapeutic patient education (TPE) programs for stroke survivors found in the literature. Verify their content and efficacy. Method: A literature review was conducted by searching for entries from 1966 to 2011 in the Medline and Cochrane Library databases. The references for the accepted articles were taken into consideration and the articles corresponding to the criteria inclusion but not present within the initial search were selected. The keywords used were “self care”, “self management”, “patient education” and “stroke”. Given the multiplicity of symptoms that may be addressed in TPE programs, and following expert advice, the symptoms were grouped after expanding the bibliographic search using the following, additional keywords: “dysphagia”; “swallowing disorder”; “urinary incontinence”; “caregiver”; “fall prevention”; “falling”; “injury”; “shoulder pain”; “physical activity”; “exercise”; “aphasia” and “cognitive impairment”. Results: We found 30 article abstracts. In the end, we only accepted seven articles on general TPE programs that were well structured and detailed enough. The TPE programs found in the literature were often of questionable methodological quality. The multiplicity of symptoms led to very general TPE programs that covered all possible stroke after-effects. The purpose of these programs was to reduce stress and anxiety, to improve quality of life and to alleviate psychosocial after-effects. A change in caregiver and patient behavior was observed at times. We expanded the bibliographic search to include scientific arguments that could help implement TPE programs for more specific targets. Conclusion: TPE programs for stroke survivors could be improved by standardizing and assessing programs that focus on a specific problem caused by the various possible after-effects of strokes. In order to promote education for stroke survivors, specific training for health care professionals and appropriate funding are necessary. [Copyright &y& Elsevier]

Abstract: Objectives: To observe whether medical complications, the evolution of neurological disorders and dependence and/or the discharge destinations are different for patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery compared to patients treated medically for severe or malignant cerebral infarction in the same cerebral territory, during their hospitalization in a physical medicine and rehabilitation department. Patients and methods: This retrospective study compared patients treated by craniectomy for malignant cerebral infarction in the middle cerebral artery and patients treated medically for severe or malignant cerebral infarction in the same cerebral territory. Patients were paired according to age, lesion side and hospitalization period. Results: Twelve patients treated by craniectomy (age 43±10.44) were paired with 12 patients treated medically (age 49±7.66). The two groups were comparable in terms of general undesirable medical events. The medical events related to craniectomy are described. The evolution of patient deficiencies, the length of the hospital stay (194±118.93 days vs 152±94.64 days), the Functional Independence Measure at discharge (87±21.28 vs 95±22.19) and the number of direct home discharges (7 vs 9) did not significantly differ between groups. Discussion and conclusion: No more medical problems were observed in the patients treated by craniectomy than in the patients treated medically, except for the medical events specifically related to craniectomy, which extended the hospital stay but had no major repercussions. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 < 0.0001), and had lower BMI (23.8 vs. 28 years, P = 0.0002). The method of bladder emptying was spontaneous voiding, clean intermittent catheterization and transileal cutaneous ureterostomy in 47.1% vs. 29.3%; 47.1% vs. 59.4% and 5.7% vs. 11.2% of CD and OD patients respectively ( P = 0.01). The prevalence of urinary incontinence did not differ significantly between the two groups (44.7% vs. 53.5%), as well as the mean Qualiveen score (76.6 vs. 81.7). The main medical concern was NLUTD in 26% of patients with CD and in 27.8% of patients with OD ( P = 0.73). Surgery (augmentation cystoplasty, artificial urinary sphincter, continent cystostomy) was more common in patients with OD ( P < 0.01). 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 ( Figs. 2 and 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Right brain damage (RBD) involves postural asymmetry and spatial frames disorders. In acute RBD patients, postural asymmetry is immediately reduced after one single session of prism adaptation (PA), without assessment of effects on spatial frames (Tilikete et al., 2001). Aim To assess long-term effects of PA on posture and spatial frames in chronic RBD patients, without neglect. Method Six chronic RBD patients without neglect (mean delay: 45 months) were included. Each patient sustained 10 PA sessions of 20 minutes during 2 weeks. Outcome measures were: (i) posturographic analysis (mediolateral position of center of pressure (X cop ), (ii) subjective straight ahead (SSA) and perception of longitudinal body axis (LBA), (iii) the Scale for Controversive Pushing (SCP). Each parameter was assessed by 3 pre-tests and 3 post-tests (+2 h, Day + 3 and Day + 7). Moreover, the score of BBS, PASS, TUG and Barthel were measured. Results In pre-tests, all patients showed a shift of the X cop toward the right and a shift of SSA (4 toward the left and 2 toward the right). Four patients showed a shift of LBA (2 toward the right and 2 toward the left). The functional balance and the independence were decreased in all patients. In post-tests, results displayed (i) a significant reduction of mediolateral postural asymmetry at D + 7; (ii) a significant left deviation of SSA at D + 3 and enduring at D + 7; (iii) no significant modification of LBA and (iv) a significant increase of SCP at D + 3 and D + 7. Moreover, results showed a significant increase of PASS and BBS at D + 7. The mean curves of X cop and SSA between pre- and post-tests were similar. Conclusions PA involves persistent reduction of postural asymmetry in RBD patients without neglect. These findings were obtained at a chronic stage. This new effect cannot be explained by reduction of spatial attentional shift. Improvement may be explained by a better calibration of extra-personal space frames used for posture, without effect on personal space frame. Findings argue in favour of a bottom-up effect of PA on mechanisms underlying spatial cognition. [ABSTRACT FROM AUTHOR]

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