Effects of Hand Configuration on the Grasping, Holding, and Placement of an Instrumented Object in Patients With Hemiparesis

Objective: Limitations with manual dexterity are an important problem for patients suffering from hemiparesis post stroke. Sensorimotor deficits, compensatory strategies and the use of alternative grasping configurations may influence the efficiency of prehensile motor behavior. The aim of the present study is to examine how different grasp configurations affect patient ability to regulate both grip forces and object orientation when lifting, holding and placing an object.Methods: Twelve stroke patients with mild to moderate hemiparesis were recruited. Each was required to lift, hold and replace an instrumented object. Four different grasp configurations were tested on both the hemiparetic and less affected arms. Load cells from each of the 6 faces of the instrumented object and an integrated inertial measurement unit were used to extract data regarding the timing of unloading/loading phases, regulation of grip forces, and object orientation throughout the task.Results: Grip forces were greatest when using a palmar-digital grasp and lowest when using a top grasp. The time delay between peak acceleration and maximum grip force was also greatest for palmar-digital grasp and lowest for the top grasp. Use of the hemiparetic arm was associated with increased duration of the unloading phase and greater difficulty with maintaining the vertical orientation of the object at the transitions to object lifting and object placement. The occurrence of touch and push errors at the onset of grasp varied according to both grasp configuration and use of the hemiparetic arm.Conclusion: Stroke patients exhibit impairments in the scale and temporal precision of grip force adjustments and reduced ability to maintain object orientation with various grasp configurations using the hemiparetic arm. Nonetheless, the timing and magnitude of grip force adjustments may be facilitated using a top grasp configuration. Conversely, whole hand prehension strategies compound difficulties with grip force scaling and inhibit the synchrony of grasp onset and object release

Lawsuit and Traumatic Brain Injury: The Relationship Between Long-Lasting Sequelae and Financial Compensation in Litigants. Results From the PariS-TBI Study

Purpose: People with traumatic brain injury are frequently involved in a litigation because another person was at fault for causing the accident. A compensation amount will often be settled to compensate the victim for the past, present, future damages and losses suffered. We report descriptive data about the full and final personal compensation amount and investigated its association with patient's outcomes.Methods: We used a longitudinal prospective study of severe TBI patients injured in 2005–2007 (PariS-TBI). Questions regarding involvement in a litigation were asked concurrently with 4 and 8-year outcomes.Results: Among 160 participants assessed 4 and/or 8 years post-injury, a total of 67 persons declared being involved in a litigation, among which 38 people reported a compensation amount of a mean €292,653 (standard deviation = 436,334; interquartile 25–50–75 = 37,000–100,000–500,000; minimum = 1,500-maximum = 2,000,000). A higher compensation amount was associated with more severe disability and cognitive impairment in patients, and with more informal care time provided by caregivers. However, no significant association related to patient's gender, age, years of education, motor/balance impairment, return to work status, mood and related to caregiver's subjective burden was found.Conclusion: Financial compensation was related to victims' long-term severity of impairment, although some extreme cases with severe disability were granted very poor compensation

Accident vasculaire cérébral et reprise du travail

L'accident vasculaire cérébral (AVC) est une maladie fréquente. Le pourcentage de reprise du travail pour ces patients est de, suivant les études, 11 à 85%. Nous avons suivi une cohorte de 34 patients consécutifs hospitalisés au moins un mois en Rééducation au CHU de la Pitié-Salpêtrière et étudié le taux et les conditions de leur réinsertion professionnelle. Nous avons inclus les patients de moins de 60 ans, ayant des séquelles d'un AVC. La moyenne d'âge est de 47 ans, la durée moyenne d'hospitalisation de 6 mois et la durée moyenne de suivi de 3 ans. A la date de point, deux patients avaient repris, avec difficultés, une activité professionnelle. Pour le reste, aucune démarche en ce sens n'avait été faite. L'importance des séquelles physiques et neuro-psychologiques, le manque de contact entre les médecins de MPR et les médecins du travail, la réticence des employeurs et l'absence de formation adaptée en sont les principaux obstacles.Stroke is a fairly common disease. The work resumption rate for these patients vary from 11 % to 85 % according to different surveys. We followed a cohort of 34 patients in Rehabilitation Center for least a month in CHU Pitié Salpêtrière and we studied their professional rehabilitation rate and conditions. Patients under age sixty and with cerebral vascular accident after effects were included. The median age for patients is 47 years, the average figure for hospital treatment 6 month and for the follw-up 3 years. At the checking date, two patients were professionally rehabilitated with difficulties. Nothing had been done for the others. The main hindrances of this plan are the magnitude of the physical and neuropsychological after effects, the lack of contacts between rehabilitation and occupational physicians, the employers's unwillingness and the lack of suitable training.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation de la négligence spatiale unilatérale chez l'enfant et des troubles des fonctions exécutives dans la vie quotidienne chez l' adulte après lésion cérébrale acquise

La première partie concerne l évaluation de la négligence spatiale unilatérale de l enfant, au moyen d une étude rétrospective, d une étude prospective, et du développement et de la normalisation d un test de barrage spécifique. Nous rapportons 19 cas d'enfants négligents, âgés de 7 mois à 14 ans. Nos résultats indiquent que les tâches spatiales impliqueraient les deux hémisphères à un stade précoce du développement, et que la prédominance hémisphérique droite pour ces tâches résulterait de la maturation cérébrale. La deuxième partie concerne l évaluation des troubles des fonctions exécutives dans une situation de la vie quotidienne impliquant la gestion de multi-tâches (tâche de cuisine). Les patients cérébro-lésés présentant un syndrome dysexécutif faisaient significativement plus d erreurs que les sujets contrôles. Cette tâche est très sensible. Les erreurs étaient expliquées par les troubles des fonctions exécutives, notamment par un défaut de contrôle du déroulement de l action.PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Négligence spatiale unilatérale à la phase aiguë de l'accident vasculaire cérébral

REIMS-BU Santé (514542104) / SudocSudocFranceF

EXECUTION VERSUS GENERATION DE SCRIPTS (UNE APPROCHE ECOLOGIQUE DU SYNDROME DYSEXECUTIF (DES MEDECINE PHYSIQUE ET READAPTATION))

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation par une batterie écologique du maniement des données chiffrées chez les patients aphasiques vasculaires

Les patients aphasiques après lésion vasculaire cérébrale présentent souvent des troubles de la manipulation des chiffres. Néanmoins, leur dépistage est mal validé et leur retentissement au quotidien rarement recherché. Nous avons évalué les capacités numériques chez des patients aphasiques post-AVC hémisphérique gauche, par une échelle écologique, la BENQ (Batterie d Evaluation des Nombres au Quotidien), comparativement à une batterie analytique du calcul, le TLC2 (Test Lillois du Calcul). Douze patients droitiers bénéficièrent d une évaluation neurologique, orthophonique (batterie de Ducarne) et d une imagerie cérébrale. Après être rentrés au domicile, ils passèrent le TLC2 puis la BENQ : ce test écologique récemment normalisé en population témoin comportait 11 épreuves manipulant des données chiffrées en situation de vie quotidienne (prise de RDV, paiement avec billets ou pièces de monnaie...). L âge moyen des patients était de 44 ans. Neuf avaient un score de Barthel supérieur à 95. 75% se plaignaient d une gêne importante dans la manipulation des données chiffrées au quotidien. La passation de la BENQ durait en moyenne 55 minutes. Neuf eurent des résultats pathologiques à la BENQ. La BENQ dépiste de façon rapide les troubles de manipulation des données chiffrées chez des patients aphasiques de sévérité variable. La corrélation entre certains scores du TLC2 et de la BENQ (transcodage des chiffres et remplissage d'un chèque, lecture de nombres et lecture de l heure...), révèle à la fois une déficience et une incapacité. Le dépistage de ce handicap par cette batterie écologique permet une prise en charge spécifique en rééducation.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Seeing and imagining the "same" objects in unilateral neglect.

International audienceDissociations between perceptual and imaginal neglect are typically investigated by using very different tasks (e.g. visual target cancellation vs. place descriptions). Here we report patients' performance on imaginal and perceptual tasks which shared identical stimuli and procedure, except for the modality of stimulus presentation. In different tasks, participants either saw towns/regions on a map of France or heard their names, and pressed one of two keys according to the stimulus location (left or right of Paris). Neglect patients as a group were less accurate for left-sided stimuli in both modalities, but on single-case analysis only one patient with perceptual neglect had asymmetrical imaginal accuracy. These results confirmed that imaginal neglect is relatively rare, and is usually associated with perceptual neglect. Perceptual neglect resulted more frequent and severe than imaginal neglect, also when assessed using strictly comparable tests, consistent with the exogenous orienting bias typically observed in these patients

Neurological sequelae after cerebral anoxia.

International audiencePRIMARY OBJECTIVE: Cardiac arrest can cause neurological impairment. The aim of this study is to confirm the disability and the predominant part of executive and behavioural impairments after cardiac arrest. RESEARCH DESIGN: A retrospective study is proposed. METHODS AND PROCEDURES: All consecutive patients admitted to the Department of Rehabilitation for Neurological Impairments following cerebral anoxia after cardiac arrest between 1995-2007 were included. Clinical and neuropsychological assessment was proposed. MAIN OUTCOMES AND RESULTS: Thirty patients, 19 men, were examined. Ages ranged from 16-58 (mean = 39.5). Fourteen patients presented with severe disability and 16 patients presented with moderate disability. In the first group (severe disability) no patients were autonomous for daily life activities. They presented with dysexecutive syndrome and behavioural disorders associated with amnesia syndrome; 64% of them presented with motor disorders. In the second group, patients with moderate disability were autonomous in daily life but not for the complex activities or functioning. They had no motor impairment but suffered from executive and memory impairments. Behavioural changes were noted. Medical history or demographic data did not differ between the two groups. CONCLUSION: The study confirms the predominant part of executive, memory and behavioural impairments after cardiac arrest. This retrospective study cannot provide prognosis factors and further prognosis studies are needed