I. Bonan

Motor strategies of postural control after hemispheric stroke

After stroke, the causes of balance disorders include motor disorders, sensory loss, perceptual deficits and altered spatial cognition. This review focuses on motor strategies for postural control after stroke. Weight-bearing asymmetry, smaller surface of stability, increased sway, body tilting and sometimes pushing syndrome are observed. Weakness and sensory impairments account only for some of these disturbances; altered postural reactions and anticipated postural adjustments as well as abnormal synergistic muscular activation play an important part. These disorders are often linked to cognitive impairments (visuospatial analysis, perception of verticality, use of sensory information, attention, etc.), which explain the preeminent disorders of postural control seen with right rather than left-hemisphere lesions. Most of the motor changes are due to an impaired central nervous system but some could be considered adaptive behaviors. These changes have consequences for rehabilitation and need further studies for building customized programs based on the motor comportment of a given patient.

Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review

Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele.

Volumetric definition of shoulder range of motion and its correlation with clinical signs of shoulder hyperlaxity. A motion capture study

BACKGROUND Shoulder hyperlaxity (SHL) is assessed with clinical signs. Quantification of SHL remains difficult, however, because no quantitative definition has yet been described. With use of a motion capture system (MCS), the aim of this study was to categorize SHL through a volumetric MCS-based definition and to compare this volume with clinical signs used for SHL diagnosis. METHOD Twenty-three subjects were examined with passive and active measurement of their shoulder range of motion (SROM) and then with an MCS protocol, allowing computation of the shoulder configuration space volume (SCSV). Clinical data of SHL were assessed by the sulcus sign, external rotation with the arm at the side (ER1) >85° in a standing position, external rotation >90° in a lying position, and Beighton score for general joint laxity. Active and passive ER1, EIR2 (sum of external and internal rotation at 90° of abduction), flexion-extension, and abduction were also measured and correlated to SCSV. RESULTS Except for the sulcus sign, SCSV was significantly correlated with all clinical signs used for SHL. Passive examination of the different SROMs was better correlated to SCSV than active examination. In passive examination, the worst SROM was ER1 (R = 0.36; P = .09), whereas EIR2, flexion, and abduction were highly correlated to SCSV (P < .01). CONCLUSION SCSV appears to be an appealing tool for evaluation of SHL regarding its correlation with clinical signs used for SHL diagnosis. The sulcus sign and ER1 >85° in a standing position appear less discriminating and should be replaced by EIR2 measurement for SHL diagnosis.

Development of a novel index of shoulder's mobility based on the configuration space volume and its link to mono-axial amplitudes

At first sight, shoulder mobility is frequently evaluated through mono-axial amplitude. Interestingly, for diagnosing shoulder hyperlaxity or frozen shoulder, external rotation of the arm whilst at the side (ER1) is commonly used. However, by definition, a mono-axial amplitude does not fully reflect shoulder global mobility. Our goal was to propose a novel index for measuring shoulder global mobility and secondly to evaluate the link between main mono-axial amplitudes and this new index. Twenty-eight female subjects (mean age 24.8 years) without upper limb pathology participated in the study. The movements of their right dominant arm were measured with an opto-electronic motion capture system. They performed 5 mono-axial maximal amplitude motions (axial rotations in three different postures, flexion/extension and abduction from rest) and a global range of motion exploring all the reachable space around the three axes of rotation. From this, we computed the correlation coefficient between the volume of the reachable space and each possible linear combination of the 5 mono-axial amplitudes. Even though ER1 is often chosen to assess global mobility, it demonstrated the lowest correlation with measured joint mobility. To assess shoulder global mobility, clinical routine examination should more take into account external/internal rotation with the shoulder abducted, then abduction and finally flexion/extension. However, further clinical testing in other populations has to be done to evaluate the potential generalization of this result.

Effect of sensorial stimulations on postural disturbances related to spatial cognition disorders after stroke

Balance disorders related to disturbances in perception of spatial reference systems are common especially after right hemispheric stroke. Mental misrepresentation of bodily orientation in space is then often superimposed upon other factors affecting imbalance such as motor and sensory impairments. Traditional rehabilitation for balance recovery has not been specifically designed to improve balance disorders related to spatial cognition. The traditional approach, consisting of stimulating the conscious perception of body orientation in space, is demanding and laborious. The approach based on sensorial stimulation is completely different. The relevance of this method lies in the fact that, firstly it is specifically active in the cognitive component of balance disorders; and secondly, it can passively be applied with minimal patient participation, which is of particular importance for this patient group characterized by disorders of attention and concentration. These techniques, such as proprioceptive, visual or vestibular stimulation, have been found to correct spatial neglect but also postural bias. Clinical and data from functional neuro-imaging suggest a direct central action on cortical structures involved in the elaboration of spatial representation. These are promising techniques for the rehabilitation of postural disturbances related to spatial cognition disorders but are as yet at the stage of preliminary results.

Kinematic motion abnormalities and bimanual performance in children with unilateral cerebral palsy

To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance.

Effect of neck muscles vibration on postural balance and spatial frame of reference: A systematic scoping review

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.

New insights into posture and locomotion.

This issue of NCCN combines review articles and original contributions by speakers who participated in the 2014 and 2015 SOFPEL congresses. As always, these SOFPEL congresses bring together different professionals interested in balance and gait disorders, ranging from physiology to treatment and rehabilitation, including physicians (mainly neurologists and rehabilitation medicine specialists), physiologists, physical therapists and podiatrists. During the 2014 congress held in Rennes, the main topics addressed by the invited speakers were: balance in cerebral palsy (Olivier Remy-Neris); vision and hearing in gait (Benoit Bardy), freezing in Parkinsonism (Arnaud Delval); and biomechanics of standing (Armel Cretual). In the 2015 congress to be held in Paris, cortical aspects of balance control (Alfredo Bronstein), the role of the mesencephalon (Carine Karachi), walking exoskeletons (Jacques Kerdraon) and use of Tai chi for balance control (Luce Condamine) will be the topics of the main conferences, along with current scientific communications.

Stratégie de coordination hanche-cheville de l’hémiplégique lors d’un évitement dynamique

dure et mousse. Une évaluation posturographique (plateforme-SPS, Synapsys) et subjective de l’équilibre (Dizziness Handicap Inventory) a été effectuée sans l’appareil, avant, puis quatre heures et deux semaines après la thérapie. Résultats.— L’effet de la thérapie sur les scores posturographiques a été : — significative dans les deux groupes d’âge ; — plus marqué dans le groupe > 65 ; — inversement proportionnel à la quantité de l’information sensorielle disponible lors des tests posturographiques. Les scores subjectifs ont montré une diminution significative du handicap ressenti par les patients au quotidien. Discussion et conclusion.— Le vieillissement ne restreint pas le bénéfice de cette thérapie, qui améliore l’équilibre des patients vestibulaires au-delà des limites traditionnelles. L’électrostimulation linguale (biofeedback et neuromodulation) potentialiserait l’effet des exercices ciblés. Des études avec une utilisation prolongée de BrainPort sont nécessaires pour évaluer l’efficacité à long-terme de cette approche rééducative.