La stimulation magnétique transcrânienne et la stimulation électrique fonctionnelle : des outils émergents au secours des cliniciens

Travail d'intégration présenté à Dorothy Barthélemy en vue de l’obtention du grade de Maîtrise professionnelle en physiothérapieProblématique : Les accidents vasculaires cérébraux (AVC) et les lésions médullaires (LM) sont une cause d’incapacités fonctionnelles majeures, dont la compréhension et le traitement demeurent limités. Parmi les techniques émergentes pouvant améliorer la récupération fonctionnelle des patients, la stimulation magnétique transcrânienne (TMS) et la stimulation électrique fonctionnelle (FES) semblent prometteuses. Objectifs : Décrire la TMS et la FES. Démontrer leur application clinique potentielle. Méthode : Revue de littérature : PubMed, MEDline et PEDro. Résultats : Lors de l’évaluation neurologique, l’utilisation de la TMS permettrait une mesure objective des déficits et une appréciation du pronostic de récupération motrice. Plusieurs études sont en cours pour démontrer la validité et la fiabilité des techniques de stimulation à choc unique et à double choc. Lors du traitement des lésions touchant la voie corticospinale, la TMS permet de moduler l’excitabilité corticale selon deux modes : répétitif ou associée à une stimulation périphérique. Ces paradigmes, combinés au traitement traditionnel, permettraient d’optimiser la récupération motrice et de diminuer la spasticité. Cependant, les résultats des études sont contradictoires quant à l’efficacité de ces approches. Une atteinte de la voie corticospinale peut induire un pied tombant. La FES, déjà utilisée en clinique, adresse ce déficit et permet une augmentation de la vitesse et une diminution de l’effort de marche. Cependant, l’effet thérapeutique de la FES (durée des effets, signification clinique) n’est pas toujours établi. Conclusion : La TMS et la FES représentent des approches nouvelles et prometteuses en réadaptation neurologique qui nécessitent plus d’études pour démontrer leur efficacité thérapeutique

Active training and driving-specific feedback improve older drivers' visual search prior to lane changes

<p>Abstract</p> <p>Background</p> <p>Driving retraining classes may offer an opportunity to attenuate some effects of aging that may alter driving skills. Unfortunately, there is evidence that classroom programs (driving refresher courses) do not improve the driving performance of older drivers. The aim of the current study was to evaluate if simulator training sessions with video-based feedback can modify visual search behaviors of older drivers while changing lanes in urban driving.</p> <p>Methods</p> <p>In order to evaluate the effectiveness of the video-based feedback training, 10 older drivers who received a driving refresher course and feedback about their driving performance were tested with an on-road standardized evaluation before and after participating to a simulator training program (Feedback group). Their results were compared to a Control group (12 older drivers) who received the same refresher course and in-simulator active practice as the Feedback group without receiving driving-specific feedback.</p> <p>Results</p> <p>After attending the training program, the Control group showed no increase in the frequency of the visual inspection of three regions of interests (rear view and left side mirrors, and blind spot). In contrast, for the Feedback group, combining active training and driving-specific feedbacks increased the frequency of blind spot inspection by 100% (32.3 to 64.9% of verification before changing lanes).</p> <p>Conclusions</p> <p>These results suggest that simulator training combined with driving-specific feedbacks helped older drivers to improve their visual inspection strategies, and that in-simulator training transferred positively to on-road driving. In order to be effective, it is claimed that driving programs should include active practice sessions with driving-specific feedbacks. Simulators offer a unique environment for developing such programs adapted to older drivers' needs.</p

Multiple Exposition to a Driving Simulator Reduces Simulator Symptoms for Elderly Drivers

This study examines how older drivers responded to repeated exposures to a driver simulator. Older active and fit drivers participated in 5 simulator sessions within a 14-day period. For each session, simulator sickness symptoms were measured with the Simulator Sickness Questionnaire at baseline and post-session. In addition, participants completed a 10-cm visual analog scale (0= no symptom, 10= mild nausea) at baseline and after a familiarization scenario and post-session. Overall, older adults adapted to the driving simulator and by the fourth session, they showed no difference in sickness scores between the baseline and the post-session measurements. Increasing the exposure duration at session 5 yielded an increase in the sickness symptoms. These results suggest that shorterduration multiple exposures could reduce simulator sickness symptoms in elderly drivers and allow a more effective use of simulators for training by preventing early withdrawal of participants

Multiple-Session Simulator Training for Older Drivers and On-Road Transfer of Learning

Driving retraining classes may offer an opportunity to attenuate some of the aging manifestation that may alter driving skills. Unfortunately, there are suggestions that classroom programs do not allow to improve the driving performance of elderly drivers. The aim of this study was to evaluate if specific simulator training sessions with video-based feedback can modify on-road behaviors of elderly drivers. In order to evaluate the effectiveness of the training, 10 elderly drivers who received feedback were tested before and after the training program with an on-road standardized evaluation. A control group (12 older drivers) also participated. Participants in this group received a classroom training program and similar exposure to driving in a simulator but without drivingspecific feedback. After attending the training program, the control group showed no modification of their driving performance (on-road score, frequency of successful turning maneuvers and frequency blind spot verification before lane change maneuvers). On the other hand, participants in the feedback group improved their driving skills for all maneuvers that were evaluated. These results suggest that simulator training transferred effectively to on-road performance. In order to be effective, driving programs should include active practice sessions with driving specific feedback

Alternative avenues in the assessment of driving capacities in older drivers and implications for training

The population aging, combined with the overrepresentation of older drivers in car crashes, engendered a whole body of research destined at finding simple and efficient assessment methods of driving capacities. However, this quest is little more than a utopian dream, given that car crashes and unsafe driving behaviours can result from a plethora of interacting factors. This review highlights the main problems of the current assessment methods and training programs, and presents theoretical and empirical arguments justifying the need of reorienting the research focus. Our discussion is elaborated in light of the fundamental principle of specificity in learning and practice. We also identify overlooked variables that are deterministic when assessing, and training, a complex ability like driving. We especially focus on the role of the sensorimotor transformation process. Finally, we propose alternative methods that are in-line with the recent trends in educational programs that use virtual reality and simulation technologies

Remote sensing of aerosols at night with the CoSQM sky brightness data

Aerosol optical depth is an important indicator of aerosol particle properties and their associated radiative impacts. AOD determination is very important to achieve relevant climate modelling. Most remote sensing techniques to retrieve aerosol optical depth are applicable to daytime given the high level of light available. The night represents half of the time but in such conditions only a few remote sensing methods are available. Among these approaches, the most reliable are moon photometers and star photometers. In this paper, we attempt to fill gaps in the aerosol detection performed with the aforementioned techniques using night sky brightness measurements during moonless nights with the novel CoSQM, a portable, low-cost and open-source multispectral photometer. In this paper, we present an innovative method for estimating the aerosol optical depth using an empirical relationship between the zenith night sky brightness measured at night with the CoSQM and the aerosol optical depth retrieved during daytime from the AErosol Robotic NETwork

Aging yields a smaller number of fixations and a reduced gaze amplitude when driving in a simulator

With the increasing number of elderly drivers, it is important to better understand if strategies for capturing visual information are affected by age and by the complexity of the driving contexts. Ten young (aged 21-31 years) and older (aged 65-75 years) active drivers drove through a continuous simulated scenario (STISIM, v2.0). The scenario included drinving on open roads (less demanding), stopping at intersections and passing maneuvers (more demanding). Eye movements were recorded with an oculometer (ASL, model 510). Compared to younger drivers, older drivers showed a smaller horizontal amplitude between fixations and a smaller variance in the amplitude of the eye movements. They also showed a smaller number of fixations/sec for the more complex driving maneuvers that were analyzed (passing maneuvers). Overall, this may reveal a "tunnel effect" (or perceptual narrowing) phenomenon when the driving context increases in complexity

Visual inspections made by young and elderly drivers before lane changing

Lane changing is a complex driving maneuver that could challenge elderly drivers. The aim of this study was to evaluate eye glances of young and elderly active drivers when engaging lane change maneuvers. Young (21-31 years) and older (65-75 years) active drivers drove through a continuous simulated environment (STISIM v2.0). The scenario included 16 events where the driver needed to glance at three regions of interest (ROI):1) the rear-view mirror, 2)the left-side mirror, and 3) the left blind spot to ensure secure lane change. The lane change maneuvers were necessary to avoid a static object that was partially of completely blocking the lane or for overtaking a slower moving vehicle. Comparend with younger drivers, older drivers showed a constant frequency of glances across the two types of driving maneuvers (i.e., avoiding a static object and overtaking a slower vehicle), the younger drivers generally showed a higher frequency of glances and this frequency increased when overtaking a slower vehicle. A better knowledge of the elderly drivers' behavior could be beneficial in identifying at-risk behaviors and to retrain older drivers to adopt safer behaviors