Évaluation du contrôle sensorimoteur chez les patients ayant une scoliose idiopathique de l'adolescent : vers un biomarqueur des troubles sensorimoteur basé sur la stimulation vestibulaire galvanique

La scoliose est la pathologie déformante du rachis la plus courante de l'adolescence. Dans 80 % des cas, elle est idiopathique, signifiant qu'aucune cause n'a été associée. Les scolioses idiopathiques répondent à un modèle multifactoriel incluant des facteurs génétiques, environnementaux, neurologiques, hormonaux, biomécaniques et de croissance squelettique. Comme hypothèse neurologique, une anomalie vestibulaire provoquerait une asymétrie d'activation des voies vestibulospinales et des muscles paravertébraux commandés par cette voie, engendrant la déformation scoliotique. Certains modèles animaux permettent de reproduire ce mécanisme. De plus, des anomalies liées au système vestibulaire, comme des troubles de l'équilibre, sont observées chez les patients avec une scoliose. La stimulation vestibulaire galvanique permet d'explorer le contrôle sensorimoteur de l'équilibre puisqu'elle permet d'altérer les afférences vestibulaires. L'objectif de cette thèse est d'explorer le contrôle sensorimoteur en évaluant la réaction posturale provoquée par cette stimulation chez les patients et les participants contrôle. Dans la première étude, les patients sont plus déstabilisés que les contrôles et il n'y a pas de lien entre l'ampleur de l'instabilité et la sévérité de la scoliose. Dans la deuxième étude, à l’aide d’un modèle neuromécanique, un poids plus grand aux signaux vestibulaires a été attribué aux patients. Dans la troisième étude, un problème sensorimoteur est également observé chez les jeunes adultes ayant une scoliose, excluant ainsi que le problème soit dû à la maturation du système nerveux. Dans une étude subséquente, des patients opérés pour réduire leur déformation du rachis, montrent également une réaction posturale de plus grande amplitude à la stimulation comparativement à des participants contrôle. Ces résultats suggèrent que l’anomalie sensorimotrice ne serait pas secondaire à la déformation. Finalement, un algorithme a été développé pour identifier les patients ayant un problème sensorimoteur. Les patients montrant un contrôle sensorimoteur anormal ont également une réponse vestibulomotrice plus grande et attribuent plus de poids aux informations vestibulaires. Globalement, les résultats de cette thèse montrent qu’un déficit sensorimoteur expliquerait l’apparition de la scoliose mais pas sa progression. Le dysfonctionnement sensorimoteur n’est pas présent chez tous les patients. L’algorithme permettant une classification de la performance sensorimotrice pourrait être utile pour de futures études cliniques.Scoliosis is the most frequent spinal deformity in adolescence. In 80% of the cases, it is idiopathic, meaning that no cause has been associated with the patient's case. Idiopathic scoliosis seems to respond to a multifactorial model including genetic, environmental, neurological, hormonal, biomechanical and skeletal growth factors. A neurological assumption is that an anomaly of the vestibular system would cause asymmetrical activation of the vestibulospinal pathway and of paraspinal muscles. This cascade would generate the scoliotic deformity. Animal models have demonstrated this possibility. In addition, many vestibular related anomalies are observed in adolescents with scoliosis as vestibulo-ocular reflex abnormalities or balance control disorders. Galvanic vestibular stimulation allows exploring sensorimotor control by faltering the vestibular afferents. The objective of this thesis is to explore the sensorimotor control through vestibular-evoked postural response in patients with scoliosis and healthy controls. The results of the first study show that the vestibular-evoked postural response is larger in patients compared to controls. Moreover, the amplitude of the postural response is not scaled to the spinal deformation amplitude. In a second study, through a neuromechanical feedback control model, we demonstrate that patients assigned a larger weight to vestibular signal compared to controls. Results of the third study reveal that young adults with idiopathic scoliosis, compared to controls, have a larger postural response. This observation excludes a transient response due to the maturation of the nervous system. Then, balance control impairment seems secondary to a neurosensory phenomenon as balance control dysfunction is observed in patients who had surgery reducing spine deformation. Ultimately, an algorithm has been developed to distinguish patients with or without sensorimotor control problems compared to healthy adolescents. Remarkably, the amplitude of the feedforward vestibular response of these patients is larger and they assign a larger weight to vestibular than proprioceptive information. Overall, this thesis proposes a procedure to identify patients with scoliosis having sensorimotor control impairment. In the end, it is believed that the classification procedure may help future clinical studies as patients with sensorimotor dysfunction could be identified. Hopefully, future research will enhance this procedure and lead to an efficient biomarker

Two Neural Circuits to Point Towards Home Position After Passive Body Displacements

International audienceA challenge in motor control research is to understand the mechanisms underlying the transformation of sensory information into arm motor commands. Here, we investigated these transformation mechanisms for movements whose targets were defined by information issued from body rotations in the dark (i.e., idiothetic information). Immediately after being rotated, participants reproduced the amplitude of their perceived rotation using their arm (Experiment 1). The cortical activation during movement planning was analyzed using electroencephalography and source analyses. Task-related activities were found in regions of interest (ROIs) located in the prefrontal cortex (PFC), dorsal premotor cortex, dorsal region of the anterior cingulate cortex (ACC) and the sensorimotor cortex. Importantly, critical regions for the cognitive encoding of space did not show significant task-related activities. These results suggest that arm movements were planned using a sensorimotor-type of spatial representation. However, when a 8 s delay was introduced between body rotation and the arm movement (Experiment 2), we found that areas involved in the cognitive encoding of space [e.g., ventral premotor cortex (vPM), rostral ACC, inferior and superior posterior parietal cortex (PPC)] showed task-related activities. Overall, our results suggest that the use of a cognitive-type of representation for planning arm movement after body motion is necessary when relevant spatial information must be stored before triggering the movement

Load and speed effects on the cervical flexion relaxation phenomenon

<p>Abstract</p> <p>Background</p> <p>The flexion relaxation phenomenon (FRP) represents a well-studied neuromuscular response that occurs in the lumbar and cervical spine. However, the cervical spine FRP has not been investigated extensively, and the speed of movement and loading effects remains to be characterized. The objectives of the present study were to evaluate the influence of load and speed on cervical FRP electromyographic (EMG) and kinematic parameters and to assess the measurement of cervical FRP kinematic and EMG parameter repeatability.</p> <p>Methods</p> <p>Eighteen healthy adults (6 women and 12 men), aged 20 to 39 years, participated in this study. They undertook 2 sessions in which they had to perform a standardized cervical flexion/extension movement in 3 phases: complete cervical flexion; the static period in complete cervical flexion; and extension with return to the initial position. Two different rhythm conditions and 3 different loading conditions were applied to assess load and speed effects. Kinematic and EMG data were collected, and dependent variables included angles corresponding to the onset and cessation of myoelectric silence as well as the root mean square (RMS) values of EMG signals. Repeatability was examined in the first session and between the 2 sessions.</p> <p>Results</p> <p>Statistical analyses revealed a significant load effect (P < 0.001). An augmented load led to increased FRP onset and cessation angles. No load × speed interaction effect was detected in the kinematics data. A significant load effect (P < 0.001) was observed on RMS values in all phases of movement, while a significant speed effect (P < 0.001) could be seen only during the extension phase. Load × speed interaction effect was noted in the extension phase, where higher loads and faster rhythm generated significantly greater muscle activation. Intra-session and inter-session repeatability was good for the EMG and kinematic parameters.</p> <p>Conclusions</p> <p>The load increase evoked augmented FRP onset and cessation angles as well as heightened muscle activation. Such increments may reflect the need to enhance spinal stability under loading conditions. The kinematic and EMG parameters showed promising repeatability. Further studies are needed to assess kinematic and EMG differences between healthy subjects and patients with neck pain.</p

On the dynamics of spatial updating

Abstract Most of our knowledge on the human neural bases of spatial updating comes from fMRI studies in which recumbent participants moved in virtual environments. As a result, little is known about the dynamic of spatial updating during real body motion. Here, we exploited the high temporal resolution of electroencephalography (EEG) to investigate the dynamics of cortical activation in a spatial updating task where participants had to remember their initial orientation while they were passively rotated about their vertical axis in the dark. After the rotations, the participants pointed towards their initial orientation. We contrasted the EEG signals with those recorded in a control condition in which participants had no cognitive task to perform during body rotations. We found that the amplitude of the P 1 N 1 complex of the rotation-evoked potential (RotEPs) (recorded over the vertex) was significantly greater in the Updating task. The analyses of the cortical current in the source space revealed that the main significant task-related cortical activities started during the N 1 P 2 interval (136-303 ms after rotation onset). They were essentially localised in the temporal and frontal (supplementary motor complex, dorsolateral prefrontal cortex, anterior prefrontal cortex) regions. During this time-window, the right superior posterior parietal cortex (PPC) also showed significant task-related activities. The increased activation of the PPC became bilateral over the P 2 N 2 component (303-470 ms after rotation onset). In this late interval, the cuneus and precuneus started to show significant task-related activities. Together, the present results are consistent with the general scheme that the first task-related cortical activities during spatial updating are related to the encoding of spatial goals and to the storing of spatial information in working memory. These activities would precede those involved in higher order processes also relevant for updating body orientation during rotations linked to the egocentric and visual representations of the environment

Is abnormal vestibulomotor responses related to idiopathic scoliosis onset or severity?

International audienceno abstrac

The Vestibular-Evoked Postural Response of Adolescents with Idiopathic Scoliosis Is Altered.

Adolescent idiopathic scoliosis is a multifactorial disorder including neurological factors. A dysfunction of the sensorimotor networks processing vestibular information could be related to spine deformation. This study investigates whether feed-forward vestibulomotor control or sensory reweighting mechanisms are impaired in adolescent scoliosis patients. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation while participants stood with their eyes closed and head facing forward. Lateral forces under each foot and lateral displacement of the upper body of adolescents with mild (n = 20) or severe (n = 16) spine deformation were compared to those of healthy control adolescents (n = 16). Adolescent idiopathic scoliosis patients demonstrated greater lateral displacement and net lateral forces than controls both during and immediately after vestibular stimulation. Altered sensory reweighting of vestibular and proprioceptive information changed balance control of AIS patients during and after vestibular stimulation. Therefore, scoliosis onset could be related to abnormal sensory reweighting, leading to altered sensorimotor processes

Group mean time-series for C7 horizontal displacement along the frontal plane for left and right vestibular stimulation (left and right upper panels, respectively).

<p>Group mean time-series for the net lateral force for left and right vestibular stimulation (left and right lower panels, respectively). The grey areas show the interval of vestibular stimulation. To ease comparison for both GVS directions, the polarity of the time-series is made the same.</p