Quelle articulation entre les pôles de compétitivité et les tissus productifs régionaux ?: Une mise en perspective de quatre pôles en Provence-Alpes-Côte d'Azur

L'objectif de ce travail de recherche était de mettre en lumière les conditions de mise en œuvre et les bénéfices attendus de quatre pôles de compétitivité de la région PACA (Solutions communicantes sécurisées ; Mer, sécurité et sûreté, Développement durable ; Fruits et légumes ; Parfums, arômes, senteurs, saveurs). Le questionnement e a été décliné suivant deux axes : 1/ quelle est la capacité réelle de ces dispositifs à produire, diffuser et utiliser des ressources scientifiques et techniques ? Les pôles de compétitivité ont en charge de produire de nouvelles ressources dans des tissus productifs préexistants. Comment s'articulent ces nouvelles ressources avec celles déjà existantes ? Sont-elles susceptibles de se féconder mutuellement ? Mais dans le même temps, n'y a-t-il pas des risques de polarisation de l'activité et de ce fait, des risques d'exclusion ? 2/ quelle est la capacité réelle du nouveau dispositif à susciter et installer durablement la coopération nécessaire à la création des ressources attendues

Restitution des propositions et synthèse

National audienc

Restitution des propositions et synthèse

National audienc

Une approche dynamique des déficits posturaux : Exemple de l’hémiplégie vasculaire

Dans cet article, nous proposons quelques arguments en faveur de l’utilisation de la théorie des systèmes dynamiques pour l’étude de la posture pathologique. Dans le cas de l’hémiplégie, la majorité des travaux traitant des déficits posturaux utilise des méthodes « indirectes » basées principalement sur l’utilisation de la stabilométrie pour l’observation des déplacements du centre des pressions. Ce type d’analyse permet de quantifier le niveau de déficience posturale et présente un certain pouvoir pronostique, mais s’avère peu concluant pour le développement de protocoles de rééducation efficaces. Nous présentons ici la synthèse de quelques études récentes visant une étude plus « directe » de l’organisation spatio-temporelle du système postural à travers l’étude de la dynamique des coordinations hanche-cheville chez le patient hémiplégique. Les résultats de ces investigations attestent de l’intérêt de cette approche pour la quantification et la compréhension des déficits posturaux en termes d’anomalies spatio-temporelles des patrons fonctionnels de mouvements. De plus, une réflexion quant à l’implication de l’approche dynamique dans le développement de futures thérapies physiques est envisagée concrètement. Mots clés : Approche dynamique / déficits posturaux / hémiplégie / coordination hanche-cheville / apprentissage / biofeedback

Neurolytic blockade of the obturator nerve for intractable spasticity of adductor thigh muscles.

International audienceNeurolytic blockade is one of the therapeutic possibilities to treat spasticity of various muscles. In patients with spasticity of the adductor thigh muscles, a percutaneous approach to the obturator nerve is often difficult. We describe a new approach to the obturator nerve and we examine its feasibility. The second objective was to assess the efficacy of obturator neurolysis for the management of adductor thigh muscle pain and spasticity associated with hemiplegia or paraplegia. Nerve blocks were performed via a combined approach using fluoroscopy and nerve stimulation to identify the obturator nerve. Neurolysis was performed by injection of 65% ethanol. We performed 27 blocks in 23 patients. Technical evaluation was achieved in terms of number of attempted needle insertions, time to accurate location of the nerve and success rate. The efficacy of the block was assessed using four scores: degree of alleviation of muscle spasm and triple flexion of the lower limb, improvement of gait and facilitation of hygienic care. Success rate of the technique was 100% with a time to accurate nerve location of 130+/-35 s. Compared with scores measured immediately before the block, all studied parameters were significantly improved. Efficiency was significant on adductor muscle spasticity (p<0.001 at 1 day and p<0.01 at 60 and 120 months). Triple flexion was also significantly improved (p<0.05 from 1 to 120 days), as well as gait (p<0.02) and hygiene (p<0.01) scores. No complications occurred. The combined approach of the obturator nerve represents a new technique which proved to be accurate, fast, simple, highly successful and reproducible. Obturator neurolysis was confirmed as an efficient and cost-effective technique to reduce adductor muscle spasm and related pain and to improve gait and hygienic care in patients with neurological sequelae of stroke, head trauma or any lesion of the motor neurone

Sensitivity to change of two depression rating scales for stroke patients.

International audienceOBJECTIVE: To assess the sensitivity to change of two depression scales for stroke patients: the Aphasic Depression Rating Scale (ADRS), which is a 9-item external assessment, and the Visual Analog Mood Scale (VAMS), which is a visual self-assessment scale. PATIENTS: Forty-nine stroke patients admitted to two rehabilitation units. METHODS: Symptoms of depression were assessed twice at a one-month interval (D0-D30) using the ADRS, the VAMS, and by a trained psychologist (PSY). Sensitivity to change was assessed by effect size and standardized response mean. A one-way ANOVA on ranks was performed to determine if the scales distinguished between deteriorated, stable and improved patient status. Spearman's correlation coefficient (r) was used to assess the relationship between changes in PSY and changes in the ADRS and the VAMS between D0 and D30. RESULTS: Mean depression scores at D0 and D30 were 2.6 +/- 1.8 and 2.4 +/- 1.7 (ADRS/10), 3.1 +/- 2.9 and 3.0 +/- 3.2 (VAMS/10), 2.9 +/- 2.3 and 2.4 +/- 2.4 (PSY/10). Percentages of deteriorated, stable and improved patient status were 22%, 45% and 33% (ADRS); 41%, 22% and 37% (VAMS); and 20%, 41% and 39% (PSY). Changes in PSY correlated with the ADRS (r = 0.72, P<10( -6)) and the VAMS (r = 0.41, P<10(- 2)). The ADRS was better than the VAMS in terms of effect size, standardized response mean and ability to discriminate between deteriorated, stable and improved patient status. This result was partly due to the difficulty encountered by nine (19%) patients in understanding directions to complete the VAMS. CONCLUSIONS: The ADRS is more sensitive than the VAMS for detecting changes in post-stroke depression. The VAMS is less appropriate in very cognitively impaired stroke patients

Contribution of each lower limb to upright standing in stroke patients.

International audienceBACKGROUND AND PURPOSE: To analyze the postural behavior of standing stroke patients: (1) To differentiate between postural impairment attributable to the neurological condition (deficits attributable to the cerebral lesion) and postural impairment attributable to new mechanical constraints caused by body weight asymmetry; (2) To assess the involvement of each limb in the postural impairment; (3) To better understand which clinical deficits underlie the postural impairment. METHODS: The posturographic characteristics of each limb in 41 stroke patients (first hemispheric stroke: 16 left, 25 right cerebral lesions) required to stand in their preferred posture were compared to those in 40 matched healthy individuals required to stand asymmetrically. RESULTS: Compared to normal individuals in a similar asymmetrical posture, stroke patients were more unstable. The weight bearing asymmetry and the lateral postural instability were mainly related to spatial neglect. The paretic limb was unable to bring into play a normal longitudinal pattern of the center of pressure, which reflects an impaired stabilization control. Overall postural instability occurred when the strong limb was unable to compensate for the postural impairment of the paretic limb. CONCLUSIONS: The weight bearing asymmetry of standing stroke patients is not the primary cause of their postural imbalance, which is rather the consequence of impaired control of postural stabilization involving both limbs. Weight bearing asymmetry may not be the principle target of rehabilitation programs aiming at restoring standing balance after stroke. Instead it is suggested that more account should be taken of the compensatory role of the strong limb

Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: a prospective study

International audienceOBJECTIVE: To evaluate clinical prognostic factors of complex regional pain syndrome type I (CRPS I) in patients with stroke in an attempt to improve the Perrigot score, which does not include shoulder subluxation, unilateral neglect, or depression. DESIGN: This was a prospective study. The initial clinical data (first month) included motor index, Ashworth scale, de Bats score for shoulder subluxation, Montgomery-Asberg Depression Rating Scale, and sensory disorders evaluation. The prognosis of CRPS I was evaluated from the Perrigot score. A score of CRPS I severity was measured on entry and 3 mo later. RESULTS: Of the 71 patients with hemiplegia who were included, 34.8% had a CRPS I. The five main clinical factors in the prognosis of CRPS I were motor deficit, spasticity, sensory deficits, and initial coma. The prognostic score of Perrigot was strongly correlated with the CRPS I severity and was predictive of subsequent progression. CONCLUSION: Shoulder subluxation, unilateral neglect, and depression did not seem to be determinant predictive factors of CRPS I severity