Conception contemporaine de la proprioception – Évaluation et pratiques en rééducation

The term proprioception was passed down to us by Sherrington at the beginning of the last century. The definition of proprioception was discussed between this period and nowadays. During the XXth century, the prevailing view for much about limb position sense, an obvious place to look for receptors signaling position is in the joint about which the limb moves. Today, we know that this is not the case and that muscle receptors are the principal kinesthesics proprioreceptors. The topic of this article is to contribute for explaining this modification mainly due from research and publication by J. Paillard, A. Berthoz, mainly by J.P. Roll and P. Grigg - F.C. Clark. So,we have now an up-to-date definition and knowledge about the sixth sense, the muscular sense first. These new perspectives open possibilities of assessment of the muscular proprioceptives information through a recent test and proposals of educational and reeducational technics by the way of muscular proprioceptival information.     

COLHEMI : une expérience de rééducation intensive pour des enfants hémiplégiques associant la thérapie induite par la contrainte,l’entraînement bimanuel et la thérapie orientée par les buts

Being inspired by international experiments, we proposed in France, for hemiplegic children, a model of intensive care implemented in a 2 weeks-rehabilitation camp, which associated constraint-induced therapy and bimanual intensive training, but also included a time of goal-oriented therapy: COLHEMI. This program was estimated at J0, J15 (immediate exit of the program) and at 6 months, with tools assessing global capacities (EMFG, IDE), manual capacities (grip strength by E-link, Box and blocks test, Melbourne test), bimanual performance (AHA, CHEQ) and satisfaction. Six children were included in the first session of COLHEMI (2 boys, 4 girls, average age 7.5 years–min. 6 years and max. 9 years old, 6 right hemiplegias). The preliminary results show variable but real functional profits for each of 6 children, and a favorable evolution of the CHEQ. The children and the parents reported a big satisfaction regarding the quality of the program COLHEMI.     

Un nouveau regard sur la sémiologie motrice en psychiatrie : de la physiologie du mouvement moteur volontaire aux résultats d’imagerie fonctionnelle dans les troubles de conversion

Are the conversion disorders beyond medical disorders? Lived as a reality by the patient, the absence of “objectives” signs at the clinical examination have for a long time considered these conversion disorders as “pathologies without substrates”. However, if the clinic of these disorders is well known, its precise understanding remains subject to debate and the exact mechanisms that produce it are poorly understood. Does the fact that explanatory lesions in the brain are not found, exclude the possibility of functional abnormalities in this organ? It is often called these disorders “disease of the imagination or the will”, but in fact, we know little about the brain functioning of voluntary motor movement and mental representation in conversion disorders. So with this in mind, what could be the contribution of “modern” techniques of investigations such as functional imaging? Would the identification of functional abnormalities in the brain allow opening new theoretical perspectives for these patients? Functional imaging has explored more complex mechanisms considered some years ago as inaccessible (e.g. emotions, affective states, volition, mental imagery, unconscious processes), and we propose in this paper to show how, using these techniques, a pathology considered as a diagnosis of exclusion and a disorder without substrate can be approached differently through “new” neurophysiological explanation.     

La place de la compréhension des proverbes et des métaphores dans la compréhension des troubles du cours de la pensée dans la schizophrénie : apport de l’évaluation clinique,de l’imagerie cérébrale fonctionnelle et de la neurophysiologie

According to Bleuler (1911), language impairments were indicative of thought disorders, a fundamental feature of schizophrenia. The objectives of the present review are twofold: (1) to present the clinical interest of the use of the tests of proverbs and metaphors comprehension for the evaluation of the characteristics of thought disorders in schizophrenia, and to highlight the heterogeneity of the forms of their interpretations; (2) to present the results from neuroimaging and neurophysiological studies of metaphor comprehension in order to identify the neurocognitive mechanisms underlying metaphorical language comprehension of patients with schizophrenic disorders. Results from the reviewed clinical applications of proverbs tests showed that thought disorders in individuals with schizophrenia are illustrated by different forms of proverb interpretations: literal, concrete, idiosyncratic, over-inclusiveness and unconventional. Results from the reviewed brain imaging and neurophysiological studies showed that these different forms of figurative misinterpretations may be related to different neurocognitive mechanisms: concreteness appears to be related to the dysfunction of the left inferior frontal gyrus and inverted brain lateralization during metaphor processing in individuals with schizophrenia compared to healthy individuals. During novel metaphor comprehension, which is highly effortful, individuals with schizophrenia, relative to controls, demonstrate increased activation of the right precuneus, a region that mediates complex and highly integrated functions including retrieval of episodic memory and mental imagery. These results may suggest that individuals with schizophrenia use mental imagery to support comprehension of both literal and metaphoric language. Furthermore, it was demonstrated that over-inclusive thinking, which is exhibited by individuals with schizophrenia during figurative language comprehension, could be related to very early right hemispheric hyper-activation (when a left early activation is expected) and to reduced bilateral brain activity during semantic processing. Such as reversed brain activation may explain why the individuals with schizophrenia are relatively over reliant on early-stage coarse or large semantic processing and may be prone to form meanings that are idiosyncratic and highly unconventional.     

Le bassin,premier cube de la tour : applications en rééducation et dans les installations

The anatomical position of the pelvis, a relay between the trunk and the lower limbs, makes it an essential platform in determining the erect, static and dynamic posture. The antigravity and environmental constraints linked to the support of the body areas in support interfere with the pelvic posture. The cerebromotor context of cerebral palsy strongly constrains all of these physiological devices. In our practice of rehabilitation and in the design of the facilities of our subjects, we apply ourselves to integrate these different elements, to make an impact analysis and to deduce a specification, integrating the personal aspects specific to the subject, to help improve their quality of life.     

Les accidents vasculaires cérébraux et la prise en charge psychologique à domicile des personnes qui en sont victimes

Stroke is a major public health issue with a high priority. Prevention plays an important role in reducing the impact of the disease. Although quick health intervention reduces death, it results in an increased number of disabled people. The handicap is not always visible, and requires appropriate strategies for the patient. Such approaches aim to allow patients to stay at home, reducing their time spent in the hospital. However, transitioning from the hospital is always a tricky time, as efforts are necessary to adapt and reorganize around the new everyday life of the affected people. In this context, neuropsychology offers interesting perspectives. In-home care not only allows the patient and their family to better deal with a new perception of the body, but also enables personalized support by bringing care within the intimate environment where they live. Post-stroke cognitive impairment decreases the autonomy and introspective capacities of patients. In Limousin, a trained team of itinerant healthcare professionals (HEMIPASS) was founded in 2010 to support patients and their relatives at home. Psychologists Michèle Chazot-Balcon, Elise Henry and the neurologist Jean-Yves Salle from the University Hospital in Limoges, discuss the semiology of stroke, its possible psychological effects, and how to deal with them from the patient's home.     

Impact du handicap physique et des troubles émotionnels concomitants sur la qualité de vie en post-AVC

Introduction

The physical and/or psycho-cognitive changes after stroke may lead to a decline in the quality of life (QOL) of patients. The aims of our study were to evaluate the QOL of stroke survivors and to investigate its relationships with the physical disability degree and the emotional disorders (anxiety and depression).

Évaluation de l’intérêt de la plateforme de stabilométrie pour les bilans et la rééducation des transferts d’appui des enfants paralysés cérébraux marchants après chirurgie multisites

Single event multi-level surgery can be proposed to cerebral palsy children in order to improve their gait. Rehabilitation is essential to the success of such procedure helping the children to plainly exploit his new orthopedic potential. One of the early aims of the rehabilitation is to restore good weight transfer capacities during locomotion. Biofeedback with posturographic forceplates may be of help to reach this purpose. This study presents a specific training protocol. An assessment procedure of this biofeedback effect is detailed. Feasibility of the procedure is tested on 13 subjects. The effect of the rehabilitation is illustrated by one detailed case. The results of this pre-study are discussed and a future randomized controlled trial is introduced.