En 1789 un colon et notable français de l’Ile de France (actuel Maurice) publie un mémoire destiné aux autorités locales dans lequel il rend compte de son expérience d’entrepreneur agricole et ...forestier. Il est propriétaire et concessionnaire de plusieurs domaines agro-forestiers dans une île qui a connu 150 ans de colonisation hollandaise puis française. L’essor démographique et économique de la colonie ainsi que les besoins liés aux guerres franco-anglaises ont provoqué la régression du couvert forestier au profit des espaces agricoles. Le déséquilibre entre espace forestier et espace agricole au profit de ce dernier risque de priver la France de ressources en bois qui lui sont nécessaires dans le cas probable d’une prochaine guerre avec sa rivale. L’auteur en arrive à une réflexion plus large dans laquelle il envisage l’avenir économique de la petite colonie française en l’intégrant dans une réflexion à plusieurs échelles : île, archipel, océan Indien, monde. Il apparaît comme un précurseur du concept de développement durable.
Clinical gait analysis is widely used by different therapists working with hemiplegic patients. The purpose of this study was to assess the reliability of video-based clinical gait assessment, as ...performed by practitioners in diverse specialties.
Five neurologists, 5 physiotherapists, and 5 doctors of physical medicine and rehabilitation (physiatrists) were asked to study a videotape of 6 patients with hemiplegia in the act of walking. This activity was chosen due to the wide use of gait information for therapeutic prescription and medical decision-making during medical consultations, at conventions, or in exchanges between therapists.
Results highlighted a certain inconsistency in the use of the gait description indicators. The 15 therapists used 396 different locutions to describe the gaits of the 6 patients. These locutions yielded 60 general indicators, or gait disorders, which were grouped in 5 categories. Eleven of them were classified as "controversial" due to the significant inter-subject variability of the evaluations.
The study identified a large number of indicators that were used relatively inconsistently by the 3 specialties studied. The results of this study would appear to indicate that greater caution is needed when dealing with some of the "controversial" indicators, as well as with the "unusual" gait patterns observed in some patients.
Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The ...primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke.
Phase III, parallel, concealed allocation, randomized controlled, multicenter trial, with 12-month follow-up. Patients aged 18 to 80 years, 3 weeks to 3 months poststroke with a Fugl-Meyer Assessment score of 10 to 40 points, were randomized to the Exo or control groups. All undertook two 30-minute self-rehabilitation sessions/day, 5 days/wk for 4 weeks in addition to usual rehabilitation. The Exo group performed games-based exercises using a gravity-supported mechanical exoskeleton (Armeo Spring). The control group performed stretching plus basic active exercises. Primary outcome was change in upper extremity Fugl-Meyer Assessment score at 4 weeks.
Two hundred fifteen participants were randomly allocated to the Exo group (107) or the control group (108). Mean age (SD), 58.3 (13.6) years; mean time poststroke, 54.8 (22.1) days; and mean baseline Fugl-Meyer Assessment score, 26.1 (9.5). There was no between-group difference in mean change in Fugl-Meyer Assessment score following the intervention: 13.3 (9.0) in the Exo group and 11.8 (8.8) in the control group (P=0.22). There were no significant between-group differences in changes for any of the other outcomes at any time point (except for perception of the self-rehabilitation). There was no between-group difference in cost utility at 12 months.
In patients with moderate-to-severe impairment in the subacute phase of stroke, the purchase and use of complex devices to provide additional upper limb training may not be necessary: simply educating patients to regularly move and stretch their limbs appears sufficient.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01383512.
•Video games are not superior to conventional rehabilitation of the upper limb in sub-acute stroke.•Video games act as an additional therapy increasing the amount of rehabilitation after ...stroke.•Video game rehabilitation could be more efficient when started before 30 days post-stroke.
Few rehabilitation methods have proven their efficacy in increasing sensori-motor recovery and/or function of the upper limb (UL) after stroke. Video games (VGs) are promising tools in this indication.
To compare UL rehabilitation by using VGs and conventional rehabilitation (CR) in patients with sub-acute stroke.
Single-blind, multicentric trial, with central randomization and stratification by center.
Physical and rehabilitation medicine departments of 2 university hospitals.
Adults within 3 months after a first vascular cerebral accident, with UL Fugl Meyer Score (UL-FMS)<30/66 and without major cognitive impairment.
A 45-min additional session of conventional occupational therapy (OT) or a VG-based OT session as add-on therapy to usual rehabilitation programs, 5 days/week for 6 weeks.
Primary outcome: UL-FMS. Secondary outcome: Box and Block Test (BBT), Wolf Motor Function test (WMFT), Motor Activity Log (MAL), Barthel Index and quality of life (SF-36).
We included 51 patients (20 women) at a mean (SD) of 27.2 (19.4) days post-stroke (mean age 58 years range 24–83), 26 in the CR group and 25 in the VG group (23 in each group at 6-month follow-up). The mean duration of the additional rehabilitation session was similar in both groups: 29.3 (4.3) vs 28.0 (4.4) min in CR and VG groups. Shoulder pain occurred in 4 patients in the VG group versus 7 in the CR group. At day 45, gain in UL-FMS did not significantly differ between the groups (CR mean 17.8 14.6 vs VG 24.1 14.8; P=0.10), whereas gain in BBT was doubled in the VG group (CR 7.4 12.2 vs VG 15.7 16.3; P=0.02). At 6-month follow-up, the study was inconclusive about between-group differences in UL-FMS, BBT and other criteria. Post-hoc analysis showed that gains in UL-FMS or BBT were significantly higher in the VG than CR group for patients included within 30 days post-stroke.
In general, we cannot conclude that video gaming and conventional OT led to different long-term sensorimotor recovery of the UL after sub-acute stroke. However, when applied within the first month after stroke, video gaming was more efficient than conventional rehabilitation on both sensorimotor recovery and gross grasping function.
ClinicalTrials.gov (NCT01554449).
The acute phase of stroke is accompanied by functional changes and interplay of both hemispheres. However little is known on how the time course of functional motor recovery is related to the ...progression of symmetry in the motor areas of the brain. This study aimed to assess the time course of both hemodynamic patterns of cortical motor areas using functional near infrared spectroscopy (fNIRS) and functional recovery during the first months after stroke. Unaffected upper limb movements-related contralateral motor areas activity showed no significant changes.
Eight right-handed first ischemic/hemorrhagic stroke patients (60±8 yrs, 3 female and 5 men) with mild to severe hemiparesis were examined with fNIRS measurements and functional motor recovery (Fugl-Meyer score) tests every two weeks during two months (five sessions). We investigated hemodynamic changes over the contralateral and ipsilateral motor areas with a 2×8-channel fNIRS system (Oxymon MkIII®) during a unilateral intermittent isometric forearm task (1Hz) at self-selected submaximal force levels. Laterality index (LI) was computed to evaluate the asymmetry of hemodynamic changes from the two hemispheres.
Affected upper limb movements were associated early with a bilateral cortical activity before shifting to contralateral patterns (P<0.01). Progressive lateralization was observed with LI increases over the first 4 sessions (from −0.24±0.18 to 0.36±0.27, P<0.05) prior to level off (session 5, 0.25±0.39), as did the Fugl-Meyer score.
These findings suggest that cortical reorganization monitoring with fNIRS during the first weeks after stroke should be considered further when assessing functional motor recovery in stroke rehabilitation services.
No pain scale is available for stroke patients due to the presence of language or cognitive disorders. However, the Faces Pain Scale (FPS), which was initially developed for children, has been used ...with success in adults with cognitive impairments. The aim of this study is to test whether the FPS could be used in left or right hemispheric stroke patients (LHSP, RHSP). One hundred twenty-seven stoke patients and 21 controls were recruited in 2 rehabilitation units. Construct validity of FPS was assessed by rating and ranking facial expressions. FPS was correlated to a Visual Analog Scale (VAS) and to a Verbal Rating Scale (VRS) for the assessment of shoulder pain. Reliability was determined by test-retest procedures. Performances of RHSP in the ranking and rating procedures were very poor compared to LHSP and to controls. However, in the assessment of patients' shoulder pain, FPS scores were highly correlated with VAS and VRS in both stroke groups (r=0.65-0.82, p<10(-3)). FPS was more reliable in LHSP than in RHSP. It was preferred to VAS and VRS in LHSP, while in RHSP VAS was the preferred scale. The present study provides preliminary support for the validity and the reliability of FPS in LHSP. However, we do not recommend its sole use in stroke patients. Further studies are needed to determine whether FPS can be used in stroke patients for assessing changes in severity of pain over time.
PDF
