Intensité et rééducation motrice dans la parésie spastique

Meimoun, M.; Bayle, N.; Baude, Mathilde

doi:10.1016/j.neurol.2014.09.011

Cited by 18 publications

(22 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many studies investigated the effects of conventional rehabilitation and/or non-intensive therapies on upper limb motor recovery in subacute stroke [ 29 , 30 , 46 ]. However, it is accepted that augmented rehabilitation programs using exercises at high intensity and focused on the repetition of numerous specific active movements, are effective on motor outcomes in subacute or even chronic patients [ 7 , 11 , 16 , 47 – 52 ]; of note, two recent trials using semi-intensive programs (3 sessions a week) for short periods of time (8–10 weeks) produced negative results [ 53 , 54 ]. In the first study, time per session was described without details regarding the number of movements achieved and the modalities used to perform movement.…”

Section: Discussionmentioning

confidence: 99%

“…The recovery of motor function results in part from neural re-organization, which is facilitated by early onset of rehabilitation care [ 6 ] and high intensity of training programs [ 7 , 8 ]. High intensity may relate to extended program durations, increased frequencies of rehabilitation sessions or to an increased number of specific movements or tasks achieved per session [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Pila

Duret²,

Laborne

et al. 2017

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

BackgroundWhen exploring changes in upper limb kinematics and motor impairment associated with motor recovery in subacute post stroke during intensive therapies involving robot-assisted training, it is not known whether trained joints improve before non-trained joints and whether target reaching capacity improves before movement accuracy.MethodsTwenty-two subacute stroke patients (mean delay post-stroke at program onset 63 ± 29 days, M2) underwent 50 ± 17 (mean ± SD) 45-min sessions of robot-assisted (InMotion™) shoulder/elbow training over 3 months, in addition to conventional occupational therapy. Monthly evaluations (M2 to M5) included Fugl-Meyer Assessment (FM), with subscores per joint, and four robot-based kinematic measures: mean target distance covered, mean velocity, direction accuracy (inverse of root mean square error from straight line) and movement smoothness (inverse of mean number of zero-crossings in the velocity profile). We assessed delays to reach statistically significant improvement for each outcome measure.ResultsAt M5, all clinical and kinematic parameters had markedly improved: Fugl-Meyer, +65% (median); distance covered, +87%; mean velocity, +101%; accuracy, +134%; and smoothness, +96%. Delays to reach statistical significance were M3 for the shoulder/elbow Fugl-Meyer subscore (+43%), M4 for the hand (+80%) and M5 for the wrist (+133%) subscores. For kinematic parameters, delays to significant improvements were M3 for distance (+68%), velocity (+65%) and smoothness (+50%), and M5 for accuracy (+134%).ConclusionsAn intensive rehabilitation program combining robot-assisted shoulder/elbow training and conventional occupational therapy was associated with improvement in shoulder and elbow movements first, which suggests focal behavior-related brain plasticity. Findings also suggested that recovery of movement quantity related parameters (range of motion, velocity and smoothness) might precede that of movement quality (accuracy).Trial registrationEudraCT 2016–005121-36. Date of Registration: 2016–12-20. Date of enrolment of the first participant to the trial: 2009–11-24 (retrospective data).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Pila

Duret²,

Laborne

et al. 2017

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

show abstract

“…Others benefit from reinduction periods, prescribed according to subjective or ill-defined criteria. It has not been demonstrated that this conventional rehabilitation system now fits current knowledge on behavior-induced brain plasticity and on the potential for motor recovery in chronic spastic paresis [16–18]. Indeed, a significant body of evidence demonstrates that high intensity of rehabilitation (the opposite of “maintenance therapy”) correlates with motor function improvement in chronic stages [16, 19, 20].…”

Section: Introductionmentioning

confidence: 99%

Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial

et al. 2019

View full text Add to dashboard Cite

BackgroundAfter discharge from hospital following a stroke, prescriptions of community-based rehabilitation are often downgraded to “maintenance” rehabilitation or discontinued. This classic therapeutic behavior stems from persistent confusion between lesion-induced plasticity, which lasts for the first 6 months essentially, and behavior-induced plasticity, of indefinite duration, through which intense rehabilitation might remain effective. This prospective, randomized, multicenter, single-blind study in subjects with chronic stroke-induced hemiparesis evaluates changes in active function with a Guided Self-rehabilitation Contract vs conventional therapy alone, pursued for a year.MethodsOne hundred and twenty four adult subjects with chronic hemiparesis (> 1 year since first stroke) will be included in six tertiary rehabilitation centers. For each patient, two treatments will be compared over a 1-year period, preceded and followed by an observational 6-month phase of conventional rehabilitation. In the experimental group, the therapist will implement the diary-based and antagonist-targeting Guided Self-rehabilitation Contract method using two monthly home visits. The method involves: i) prescribing a daily antagonist-targeting self-rehabilitation program, ii) teaching the techniques involved in the program, iii) motivating and guiding the patient over time, by requesting a diary of the work achieved to be brought back by the patient at each visit. In the control group, participants will benefit from conventional therapy only, as per their physician’s prescription.The two co-primary outcome measures are the maximal ambulation speed barefoot over 10 m for the lower limb, and the Modified Frenchay Scale for the upper limb. Secondary outcome measures include total cost of care from the medical insurance point of view, physiological cost index in the 2-min walking test, quality of life (SF 36) and measures of the psychological impact of the two treatment modalities. Participants will be evaluated every 6 months (D1/M6/M12/M18/M24) by a blinded investigator, the experimental period being between M6 and M18. Each patient will be allowed to receive any medications deemed necessary to their attending physician, including botulinum toxin injections.DiscussionThis study will increase the level of knowledge on the effects of Guided Self-rehabilitation Contracts in patients with chronic stroke-induced hemiparesis.Trial registrationClinicalTrials.gov: NCT02202954, July 29, 2014.

show abstract

“…The process of rehabilitation after a stroke needs a long-term commitment and requires dedicated time every day in order to improve outcomes and escape the potentially vicious cycle. 45,[86][87][88] In most cases, more than an hour of rehabilitation is needed daily.…”

Section: Guided Self-rehabilitation Contractsmentioning

confidence: 99%

How Can We Improve Current Practice in Spastic Paresis?

Fheodoroff¹,

Jacinto²,

Geurts³

et al. 2016

European Neurological Review

View full text Add to dashboard Cite

Spastic paresis can arise from a variety of conditions, including stroke, spinal cord injury, multiple sclerosis, cerebral palsy, traumatic brain injury and hereditary spastic paraplegia. It is associated with muscle contracture, stiffness and pain, and can lead to segmental deformity. The positive, negative and biomechanical symptoms associated with spastic paresis can significantly affect patients℉ quality of life, by affecting their ability to perform normal activities. This paper – based on the content of a global spasticity interdisciplinary masterclass presented by the authors for healthcare practitioners working in the field of spastic paresis – proposes a multidisciplinary approach to care involving not only healthcare practitioners, but also the patient and their family members/carers, and improvement of the transition between specialist care and community services. The suggested treatment pathway comprises assessment of the severity of spastic paresis, early access to neurorehabilitation and physiotherapy and treatment with botulinum toxin and new technologies, where appropriate. To address the challenge of maintaining patients℉ motivation over the long term, tailored guided self-rehabilitation contracts can be used to set and monitor therapeutic goals. Current global consensus guidelines may have to be updated, to include a clinical care pathway related to the encompassing management of spastic paresis.

show abstract

Intensité et rééducation motrice dans la parésie spastique

Cited by 18 publications

References 99 publications

Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Pattern of improvement in upper limb pointing task kinematics after a 3-month training program with robotic assistance in stroke

Guided Self-rehabilitation Contract vs conventional therapy in chronic stroke-induced hemiparesis: NEURORESTORE, a multicenter randomized controlled trial

How Can We Improve Current Practice in Spastic Paresis?

Contact Info

Product

Resources

About