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International audience; Objective: Stroke results in limitation of active range of motion involving antagonist co-contraction. The analysis of brain-muscle connectivity can be used to deepen understanding of motor control alterations associated with the loss of motor function after stroke. This preliminary study aims to investigate the combined effects of botulinum toxin and rehabilitation on corticomuscular coherence to better understand the altered functional reorganization of the central-peripheral network.Methods: Kinematic, electromyographic and electroencephalographic data were recorded during twenty active elbow extensions in eleven chronic stroke patients and nine healthy control subjects. Active range of motion, antagonist co-contraction and corticomuscular coherence were calculated.Results: The initial increase in corticomuscular coherence in stroke patients was significantly reduced five weeks after the first botulinum toxin injection and twenty weeks away from the third injection, in both agonist and antagonist muscles, with moderate to large effect sizes, concomitantly with a decrease in antagonist co-contraction and an improvement in the active range of motion.Conclusions: This study highlights for the first time an effect of botulinum toxin injections combined with rehabilitation on corticomuscular coherence in stroke patients.Significance: Notwithstanding the relatively small sample, the results provide original evidence supporting treatment-induced effective functional reorganization of the central-peripheral network.

International audience; Objective: To report on preoperative outcomes that guide the choice of surgical techniques to correct equinovarus foot in adults with brain injury. Methods: Four databases (PubMed, MEDLINE, Cochrane, PEDro) were searched according to the PRISMA guidelines. Studies were included regardless of their level of proof, with no limitation on date of publication, and their quality was assessed with the Methodological Index for Non-Randomized Studies score. Results: We analysed 61 studies (n = 2,293 participants); 523 participants underwent neurotomy, 437 calf musculotendinous lengthening, and 888 tibialis anterior transfer or alternative anterior transfers with the flexor digitorum/hallucis longus (n = 249), the extensor hallucis longus (n = 102), the tibialis posterior (n = 41) and the peroneus longus (n = 41). Two studies were dedicated to osteoarticular surgeries (n = 12 participants). Ankle dorsiflexors motricity was assessed before 70% of neurotomies as compared with 29% before isolated calf lengthening studies, their strength being at least 3/5 in 33% and 50% of the studies concerned, respectively. Passive ankle dorsiflexion was assessed before surgery in 87% of neurotomy studies, with 62% of studies investigating non-retracted spastic equinovarus foot. Before anterior tendon transfer with the tibialis anterior or another muscle, passive ankle dorsiflexion was reported in only 20% and 46% of studies, respectively, and dynamic tibialis anterior activation during gait in 46% and 56%. Although voluntary recruitment of the tibialis anterior produced a better functional result, the presence/correction of varus justified its transfer in 60% of studies as compared with 30% in other transfers, which were justified by hyperactivity or voluntary recruitment of transferred muscle. Conclusions: This review highlights the poor level of preoperative assessment and the absence of formal criteria to indicate the different surgical approaches in the management of equinovarus foot. It reinforces the interest of a systematic standardized preoperative assessment such as selective motor block and dynamic electromyography to choose the most suitable surgical procedure.

Background After stroke, kinematic measures obtained with non-robotic and robotic devices are highly recommended to precisely quantify the sensorimotor impairments of the upper-extremity and select the most relevant therapeutic strategies. Although the ArmeoSpring exoskeleton has demonstrated its effectiveness in stroke motor rehabilitation, its interest as an assessment tool has not been sufficiently documented. The aim of this study was to investigate the psychometric properties of selected kinematic parameters obtained with the ArmeoSpring in post-stroke patients. Methods This study involved 30 post-stroke patients (mean age = 54.5 ± 16.4 years; time post-stroke = 14.7 ± 26.7 weeks; Upper-Extremity Fugl-Meyer Score (UE-FMS) = 40.7 ± 14.5/66) who participated in 3 assessment sessions, each consisting of 10 repetitions of the ‘horizontal catch’ exercise. Five kinematic parameters (task and movement time, hand path ratio, peak velocity, number of peak velocity) and a global Score were computed from raw ArmeoSpring’ data. Learning effect and retention were analyzed using a 2-way repeated-measures ANOVA, and reliability was investigated using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). Results We observed significant inter- and intra-session learning effects for most parameters except peak velocity. The measures performed in sessions 2 and 3 were significantly different from those of session 1. No additional significant difference was observed after the first 6 trials of each session and successful retention was also highlighted for all the parameters. Relative reliability was moderate to excellent for all the parameters, and MDC values expressed in percentage ranged from 42.6 to 102.8%. Conclusions After a familiarization session, the ArmeoSpring can be used to reliably and sensitively assess motor impairment and intervention effects on motor learning processes after a stroke. Trial registration The study was approved by the local hospital ethics committee in September 2016 and was registered under number 05-0916.

International audience; Stroke is known to cause widespread activation and connectivity changes resulting in different levels of functional impairment. Recovery of motor functions is thought to rely mainly on reorganizations within the sensorimotor cortex, but increasing attention is being paid to other cerebral regions. To investigate the motor taskrelated functional connectivity (FC) of the ipsilesional premotor cortex (PMC) and its relation to residual motor output after stroke in a population of mostly poorly recoverd patients. Twenty-four stroke patients (23 right handed, mean age = 52.4-12.6 years) with varying levels of motor deficits underwent functional magnetic resonance imaging while performing different motor tasks (passive mobilization, motor execution, and motor imagery of an extension movement of the unaffected hand [UH] or affected hand [AH]). For the different motor tasks, analyses of cerebral activation and task-related FC of the ipsilesional lateral sensorimotor network (SMN), and particularly the premotor cortex (PMC), were performed. Compared with UH data, FC of the ipsilesional lateral SMN during the passive or active motor tasks involving the AH was decreased with regions of the ipsilesional SMN and was increased with regions of the bilateral frontal and the ipsilesional posterior parietal cortices such as the precuneus (Pcu). During passive wrist mobilization, FC between the ipsilesional PMC and the contralesional SMN was negatively correlated with residual motor function, whereas that with nonmotor regions such as the bilateral Pcu and the contralesional dorsolateral prefrontal cortex was positively correlated with the residual motor function. Cross-modal FC of the ipsilesional PMC may reflect compensation strategies after stroke. The results emphasize the importance of the PMC and other nonmotor regions as prominent nodes involved in reorganization processes after a stroke.

Objective Spastic co-contraction is a motor-disabling form of muscle overactivity occurring after a stroke, contributing to a limitation in active movement and a certain level of motor impairment. The cortical mechanisms underlying spastic co-contraction remain to be more fully elucidated, the present study aimed to investigate the role of the cortical beta oscillations in spastic co-contraction after a stroke. Method We recruited fifteen post-stroke participants and nine healthy controls. The participants were asked to perform active elbow extensions. In the study, multimodal analysis was performed to combine the evaluation of three-dimensional elbow kinematics, the elbow muscles electromyographic activations, and the cortical oscillatory activity. Results The movement-related beta desynchronization was significantly decreased in post-stroke participants compared to healthy participants. We found a significant correlation between the movement-related beta desynchronization and the elbow flexors activation during the active elbow extension in post-stroke participants. When compared to healthy participants, post-stroke participants exhibited significant alterations in the elbow kinematics and greater muscle activation levels. Conclusions Cortical beta oscillation alterations may reflect an important neural mechanism underlying spastic co-contraction after a stroke. Significance Measuring the cortical oscillatory activity could be useful to further characterize neuromuscular plasticity induced by recovery or therapeutic interventions.

International audience; Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

International audience; Electromyographic (EMG) raw signals are sensitive to intrinsic and extrinsic factors. Consequently, EMG normalization is required to draw proper interpretations of standardized data. Specific recommendations are needed regarding a relevant EMG normalization method for participants who show atypical EMG patterns, such as poststroke subjects. This study compared three EMG normalization methods ("isometric MVC", "isokinetic MVC", "isokinetic MVC kinematic-related") on muscle activations and the antagonist-agonist co-contraction index. Fifteen post-stroke subjects and fifteen healthy controls performed active elbow extensions, followed by isometric and isokinetic maximum voluntary contractions (MVC). Muscle activations were obtained by normalizing EMG envelopes during active movement using a reference value determined for each EMG normalization method. The results showed no significant difference between the three EMG normalization methods in poststroke subjects on muscle activation and the antagonist-agonist co-contraction index. We highlighted that the antagonist-agonist co-contraction index could underestimate the antagonist co-contraction in the presence of atypical EMG patterns. Based on its practicality and feasibility, we recommend the use of isometric MVC as a relevant procedure for EMG normalization in post-stroke subjects. We suggest combined analysis of the antagonist-agonist co-contraction index and agonist and antagonist activations to properly investigate antagonist co-contraction in the presence of atypical EMG patterns during movement.

BACKGROUND: Kinematic analysis and clinical outcome measures with established responsiveness contribute to the quantified assessment of post-stroke upper-limb function, the selection of interventions and the differentiation of motor recovery patterns.OBJECTIVE: This systematic review and meta-analysis aimed to report trends in use and compare the responsiveness of kinematic and clinical measures in studies measuring the effectiveness of constraint-induced movement, trunk restraint and bilateral arm therapies for upper-limb function after stroke.METHODS: In this systematic review, randomised controlled trials implementing kinematic analysis and clinical outcome measures to evaluate the effects of therapies in post-stroke adults were eligible. We searched 8 electronic databases (MEDLINE, EMBASE, Web of Science, Scopus, CINAHL, CENTRAL, OTseeker and Pedro). Risk of bias was assessed according to the Cochrane Risk of Bias domains. A meta-analysis was conducted for repeated design measures of pre- and post-test data providing estimated standardised mean differences (SMDs).RESULTS: We included reports of 12 studies (191 participants) reporting kinematic smoothness, movement duration and efficiency, trunk and shoulder range of motion, control strategy and velocity variables in conjunction with assessment by Motor Activity Log, Fugl-Meyer Assessment and Wolf Motor Function Test. Responsiveness was higher (i.e., non-overlap of 95% confidence intervals [CIs]) for Motor Activity Log score (SMD for amount of use 1.0, 95% CI 0.75-1.25, pCONCLUSION: These results are consistent with current literature supporting the use of combined kinematic and clinical measures for comprehensive and accurate evaluation of post-stroke upper-limb function. Future research should include other design trials and rehabilitation types to confirm these findings, focusing on subgroup analysis of type of rehabilitation intervention and functional levels.

International audience; Background: Botuloscope is a cohort study supported by a French public grant and aiming to evaluate a 1year treatment of the post-stroke spastic upper limb with botulinum toxin type A (BoNT-A) in terms of individual satisfaction with respect to personalized goals and quality of life. Methods: This was an open-label prospective, multicentric study (11 French centres) that followed 330 adults [mean (SD) age 53.7 (13.7) years] over 1 year; participants had ranked 5 therapeutic goals at inclusion [mean (SD) 5.1 (7.3) years post-stroke], had severe hemiparesis [median motricity index (MI) 40 (Q1-Q3 24 to 60)], and were assessed at inclusion (M0) and at month 3 (M3) and M12. Outcome criteria were: spasticity, range of motion, pain [visual analog scale (VAS)], motor function [Modified Ashworth Scale (MAS)] and activities (MI; Frenchay Arm Test), and overall satisfaction with the achievement of each goal (VAS) and quality of life (Reintegration to Normal Life Index). Criteria at M0 and M12 were compared. Adverse effects were also collected, as were medication changes. Results: The primary goal was comfort and activities for 63% of participants and motor function for 36%. Participants underwent a mean of 2.4 injection sessions, 19% causing adverse effects. The greatest spasticity attenuation occurred with wrist flexors (median decrease in MAS À2 [Q1-Q3; À2 to À1], P < 10 À3). Fewer individuals took oral anti-spastic drugs (56% at M12 vs 50% at M0; P < 10 À2). Range of motion increased by 168, on average (13 to 19; P < 10 À3) for wrist extension. Pain prevalence decreases at rest (29% at M0 vs. 19% at M12; P < 10 À4) and during mobilization (64% vs. 43%; P < 10 À4), and fewer participants took analgesics (25% vs. 17%; P < 10 À3). Satisfaction was high for the goals ''hand hygiene'' and ''pain release'' and moderate for ''improvement in upper limb function''. However, function was more improved for participants who selected this goal as the first priority than others (P < 10 À2). Overall, 22% had the goal ''improving gait and balance'', which was reasonably achieved at M12. Quality of life improved markedly [median 8 (4 to 11) vs. 6 (3 to 10); P < 10 À4 ]. Prevalence of complete dissatisfaction with the first objective was 10% to 15%. Conclusion: This is the first long-term follow-up of BoNT-A treatment for upper limb spasticity involving a large cohort independent of industry. Quality of life was improved by treating upper limb spasticity with BoNT-A, even at 5 years post-stroke. Personalizing objectives of the treatment amplified its efficacy. BoNT-A was a powerful analgesic when pain was spasticity-related. Treating the spastic upper limb also improved balance and gait abilities.

International audience; Spasticity and spastic co-contraction are expressions of muscle overactivity that occur in spastic paresis syndrome after a brain injury. The objective of the present pilot study was to improve our understanding of the respective adverse consequences of spasticity and spastic co-contraction on motor disability. In contrary to spasticity, spastic co-contraction is strongly associated with motor impairment in subjects with brain injury. Therapies should be directed toward reducing spastic co-contraction in order to improve motor function. Objective: To elucidate the adverse consequences of spasticity and spastic co-contraction of elbow flexors on motor impairment and upper limb functional limitation. Design: A pilot case-controlled prospective observational study. Subjects: Ten brain-injured adults, and 10 healthy controls. Methods: The co-contraction index was computed from electromyographic recordings of elbow flexors during sub-maximal (25% Maximal Voluntary Contraction) isometric elbow extension. Spasticity was assessed with the Tardieu scale, upper limb limitation using a goniometer during active elbow extension, motor selectivity with the Fugl-Meyer Assessment for the upper limb, and motor function with the Action Research Arm Test. Results: Greater co-contraction occurred in patients with brain injury compared with controls. In contrast to spasticity, strong associations were found between the co-contraction index, the limitation of active elbow extension, the Fugl-Meyer Assessment, and the Action Research Arm Test. Conclusion: This pilot study suggests that spastic co-contraction rather than spasticity is an important factor in altered upper limb motricity in subjects with brain injury, leading to abnormal restricting arm movement patterns in subjects with more severe motor impairment. Practical applications directly concern the pre-and post-therapeutic evaluation of treatments aimed at improving motor skills in subjects with brain injury.

International audience; Background: Somatosensory impairment of the upper limb (UL) occurs in approximately 50% of adults post-stroke, associated with loss of hand motor function, activity and participation. Measurement of UL sensory impairment is a component of rehabilitation contributing to the selection of sensorimotor techniques optimizing recovery and providing a prognostic estimate of UL function. To date, no standardized official French version of a measure of somatosensory impairment has been established.Objective: To develop and validate a French version of the Erasmus modified Nottingham Sensory Assessment somatosensory (EmNSA-SS) and stereognosis (EmNSA-ST) component for evaluating the UL among adults with stroke.Methods: This study is a single-center observational cross-sectional study. A French version of the EmNSA for UL was developed by forward-backward translation and cross-cultural adaptation. Fifty stroke patients were recruited to establish concurrent-criterion-related validity, internal consistency, intra- and inter-rater reproducibility with intracorrelation coefficients (ICCs) for reliability and the minimal detectable change with 95% confidence interval (MDC95) for agreement, as well as ceiling and floor effects. Criterion validity was assessed against the Fugl-Meyer Assessment-Sensory (FMA-S) for the UL.Results: The median (range) EmNSA-SS score was 41.5 (1-44). The Spearman rank correlation coefficient between EmNSA-SS and FMA-S total scores was moderate (rho=0.74, P

International audience; BACKGROUND: Stroke patients have impaired postural balance that increases the risk of falls and impairs their mobility. Assessment of postural balance is commonly carried out by recording centre of pressure (CoP) displacements, but the lack of data concerning reliability of these measures compromises their interpretation. The purpose of this study was to investigate the between-day reliability of six CoP-based variables, in order to provide i) reliability data for monitoring postural sway and weight-bearing asymmetry of stroke patients in clinical practice and ii) consistent assessment method of measurement error for applications in physical medicine and rehabilitation. METHODS: Postural balance of 20 stroke patients was assessed in quiet standing on a force platform, in two sessions, 7 days apart. Six CoP-based variables were collected in eyes open and eyes closed conditions: postural sway was assessed with mean and standart deviation of CoP-velocity, CoP-velocity along the mediolateral and anteroposterior axes, and confidence ellipse area (CE(AREA)); weight-bearing asymmetry was assessed with mean CoP position along the mediolateral axis (CoP(ML)). The intraclass correlation coefficient (ICC) was used to determine the level of agreement between test-retest. Small real difference (SRD), corresponding to the smallest change that indicates a real improvement for a single individual, was used to determine the extent of measurement error. RESULTS: ICCs were satisfactory (>0.9) for all CoP-based variables, except for CE(AREA) in eyes open condition and CoP(ML) (

International audience; Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of poststroke rehabilitation to stimulate recovery, but the concepts of empirical methods originally proposed by therapists to rehabilitate these patients have not withstood clinical analysis. Functional neuroimaging and animal models have unveiled the mechanisms underlying functional recovery and helped teams understand its limitations and improvement modalities. These neuroscience discoveries constitute the grounds needed to understand the emergence of new technologies: robotics and virtual reality. The objective of this review of the literature was to select key works in this field to better understand current therapeutic possibilities.

Background We studied the possible development of valgus flat foot after transfer of the posterior tibial tendon to the lateral cuneiform, used for surgical restoration of dorsiflexion in brain-damaged adult patients with spastic equinovarus foot. Methods Twenty hemiplegic patients were reviewed with a mean postoperative follow-up of 57.9 months. Weightbearing radiographs, static baropodometry analysis and functional evaluation were used to assess postoperatively outcomes. Results On the operated side, weightbearing radiographs showed an absence of medial arch collapse and a symmetrical and physiological hindfoot valgus; static baropodometric analysis showed a reduced plantar contact surface with a pes cavus appearance. The surgical procedure yielded good functional results. Nineteen patients were satisfied with the outcome of their surgery. Conclusions Our findings support that transfer of the posterior tibial tendon does not lead to valgus flat foot in the spastic brain-damaged adult, and is still a current surgical alternative for management of spastic equinovarus foot.

International audience; Purpose Lower urinary tract dysfunction is common in multiple sclerosis (MS). The purpose of this study was to prospectively evaluate the impact of intermittent catheterization (IC) on the quality of life of patients affected by MS. Methods Between 2007 and 2009, we admitted 23 patients to teach them the technique of IC. Their quality of life was evaluated before and more than 6 months after the beginning of learning the technique, when the urinary situation was stable. Two questionnaires were used: one specific for urinary disorders (QUALIVEEN Ò) and one general (SF-36 Ò). Results Twenty-two patients followed this different way of bladder emptying. More than 6 months (9.3 ± 3 months on average) after first learning to use IC, the impact of urinary disorders explored by Qualiveen Ò had significantly decreased (the overall quality of life; bother with limitation; fears; feelings; Wilcoxon's test, respectively p = 0.004; 0.007; 0.02; 0.02) while the quality of life was not diminished. Conclusion Intermittent catheterization (IC) in association with overall urinary management, among patients affected by MS, is well accepted and reduces the impact of urinary dysfunction on their quality of life.