Etienne Allart

Lille University Hospital, university Lille Nord de France · Neurorehabilitation Unit

With about one third of adults aged 65 years and older being reported worldwide to fall each year, and an even higher prevalence with advancing age, aged-related falls and the associated disabilities and mortality are a major public health concern. In this context, identification of fall risk in healthy older adults is a key component of fall preve...

Background: In contrast to wearable tools (like in-shoe) sensors, lab-based gait assessment (using pressure-sensitive mats or cameras) only acquire data over short distances in non-ecological environments. Research question: To examine the concurrent validity of a wearable ZeroWire® footswitch system (Aurion Srl, Milan, Italy) vs. the GAITRite®...

Background: Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery - a complex procedure with potential complications. Objective: We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation prog...

Background Decompressive hemicraniectomy (DH) increases survival without severe dependency in patients with large middle cerebral artery (LMCA) infarcts. The objective was to identify predictors of 1-year outcome after DH for LMCA infarct. Methods We conducted this study in consecutive patients who underwent DH for LMCA infarcts, in a tertiary str...

The posterior parietal cortex (PPC) is a key structure for visual attention and upper limb function, two features that could be impaired after stroke, and could be implied in their recovery. If it is well established that stroke is responsible for intra- and interhemispheric connectivity troubles, little is known about those existing for the contra...

Objective: The aim of this study was to evaluate whether mutations in ERLIN2, known to cause SPG18, a recessive hereditary spastic paraplegia (SP) responsible for the degeneration of the upper motor neurons leading to weakness and spasticity restricted to the lower limbs, could contribute to amyotrophic lateral sclerosis (ALS), a distinct and more...

Background: Stroke may cause sentence comprehension disorders. Speech segmentation, i.e. the ability to detect word boundaries while listening to continuous speech, is an initial step allowing the successful identification of words and the accurate understanding of meaning within sentences. It has received little attention in people with post-strok...

Contexte La cocontraction spastique est fréquemment rencontrée chez les patients post-AVC mais l’influence de la fatigue musculaire sur ces cocontractions est mal connue. Objectifs Évaluer l’effet induit par un protocole isocinétique de fatigue du quadriceps sur le degré de cocontraction entre extenseurs de genou (droit antérieur, vastes latéral e...

Introduction: Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. Method: Eighteen experts selected on the basis of their recognized experience by the scientific committees of the Fren...

Résumé Introduction Le transfert du muscle tibialis posterior (TTP) est le traitement palliatif le plus réalisé pour pallier le déficit neurologique des releveurs du pied. S’il a été bien étudié après atteinte périphérique, il reste peu évalué en cas d’atteinte centrale, où il est souvent accusé de provoquer un effondrement de la voûte du pied. Au...

Background: Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The prim...

Parietofrontal (PF) networks link the posterior parietal cortex to premotor and prefrontal areas, and are involved in the control of many motor and cognitive behaviors in healthy humans. In recent years, electrophysiological experiments have provided a better understanding of the functional specificity and temporal involvement of the PF networks’ d...

Studies of dual-tasks (i.e. situations during which an individual performs two tasks simultaneously) and the subsequent inter-task interference have shown that locomotion and posture involves motor and cognitive components. Dual-tasks therefore constitute a promising avenue for improving the diagnosis, prevention and management of falls or cognitiv...

Introduction/Background The role of physiatrists with severe brain injured patients and intensive care unit (ICU) teams is often pointed out but remains still partly unknown. We aimed at evaluating, from ICU physicians and physiatrists’ points of view, the characteristics of interventions of physiatrists in ICU (especially concerning end-of-life de...

Introduction/Background Little is known about shoulder hypertonia in patients with brain injury. The principal aim of our study was to assess the results of spastic shoulder surgery in our team experience. Material and method Sixteen patients (18 shoulders) were retrospectively reviewed. The following were studied: etiology of hypertonia, shoulder...

Introduction/Background Patients suffering from traumatic brain injury (TBI) often present with cognitive but also posture and gait impairments. In this study, we aimed at evaluating the cost of the addition of 3 types of cognitive concurrent tasks on gait parameters, and studying the relationship between dual task cost and patient-reported percept...

Introduction/Background The posterior parietal cortex (PPC) is a key structure for visual attention and upper limb function, two features that could be impaired after stroke, and could be implied in their recovery. If it is well established that stroke is responsible for intra- and interhemispheric connectivity troubles, little is known about those...

Introduction/Background In 1998, a research on severe traumatic brain injury (STBI) patients 3 years after onset highlighted many difficulties regarding autonomy and quality of live (QOL). Lack of follow-up and specialized infrastructures was clear. Since then, the follow-up has been organized around the Brain injuries 59/62 regional network. We ai...

Les ténotomies percutanées connaissent un intérêt grandissant dans le panel thérapeutique utilisé chez le sujet spastique. Les gestes tendineux percutanés à l’aiguille, en plus de pouvoir être proposés sous anesthésie locale, permettent un gain de temps dans le programme opératoire, souvent long, réalisé chez les patients spastiques. L’objectif de...

Introduction La négligence personnelle (corporelle) tient un rôle important dans les difficultés rencontrées par les patients, mais son évaluation est souvent centrée sur la sphère du visage et/ou relève de tests à faible dimension écologique. L’objectif de cette étude était de développer un outil d’évaluation répondant à ces deux écueils. Patient...

Introduction Les patients traumatisés crâniens (TC) présentent souvent des troubles cognitifs et des troubles multimodaux de la posture et de la marche. L’objectif principal de ce travail était de mesurer le cout de l’ajout de 3 types de tâches cognitives sur les paramètres de marche. Patients et méthode Les paramètres spatiotemporels de marche on...

Le cortex pariétal postérieur (PPC) est une structure clé de l’intégration sensori-motrice qui forme, avec les structures frontales auxquelles il est connecté, des réseaux pariéto-frontaux aux fonctions spécifiques. Il est ainsi impliqué dans la planification et le contrôle des mouvements de préhension visuo-guidés mais aussi dans le contrôle de l’...

Objective To describe the characteristics of brain-injured patients who were referred to a simulator-based driving evaluation, evaluate the different components of driving assessment and to search for factor of success on the driving simulator assessment. Material/patients and methods We retrospectively analyzed data of brain-injured patients (205...

Objective In 1998, a research on severe traumatic brain injury (TBI) patients in Lille conurbation 3 years after TBI highlighted many difficulties regarding autonomy and quality of family, social and professional lives. Lack of follow-up and infrastructures was clear. Since then, follow-up has organized itself around the TBI and Stroke 59/62 networ...

Objective The GAITRite® system, according to the published data, appears to be an easy to use and validated device for gait analysis. However, it only allows acquisitions on short distances in a nonecological environment. In addition to this device, it could be interesting to use new embarked evaluation tools. The main aim of this study was to exam...

Objective To assess the contralesional connectivity between the posterior parietal cortex (PPC) and the motor cortex (M1) in stroke patients, and to probe putative relationships with spatial neglect and motor impairment. Material/patients and methods In 12 right-side stroke patients and 12 age-matched healthy controls, we used paired-pulse transcr...

Objective Previous reports identified a spatial bias in patients with hemianopia to explain why they tended to bisect a line toward their blind, contralateral visual field. According to them, a perceptual distortion resulting from expansion of the central region of visual space could be involve in their performance. Aims of our study were to confir...

Les réseaux pariétofrontaux, reliant le cortex pariétal postérieur (CPP) aux aires prémotrices puis au cortex moteur (M1) via le faisceau longitudinal supérieur, jouent un rôle majeur dans la planification et le contrôle des mouvements intentionnels du membre supérieur et plus largement dans l’intégration sensorimotrice. Longtemps étudiée chez l’an...

Objectives: To assess the contralesional connectivity between the posterior parietal cortex (PPC) and the motor cortex (M1) in stroke patients, and to probe putative relationships with spatial neglect and motor impairment. Methods: In 12 right-side stroke patients and 12 age-matched healthy controls, we used paired-pulse transcranial magnetic st...

La qualite de vie liee a la sante (preferable au terme plus generique de qualite de vie) s’est imposee comme un indicateur important de mesure de l’etat d’une population et des resultats de diverses approches therapeutiques ; il participe par ailleurs de plus en plus aux processus d’evaluation medico-economique en sante en y faisant entrer l’evalua...

Objective Beside the posterior leg compartment, spasticity of the hemiplegic patient can involve other muscle groups in the leg. Spasticity of the lateral compartment is responsible of a vertical clonus that may be confused with the clonus of the triceps surae (long fibular) or a transverse clonus (short fibular), and by the liveliness of the tendo...

Objective The majority of toe claws in spastic patients are of extrinsic origin, by hypertonia and/or retraction of the long flexor muscles; they are treated by a partial neurotomy (hyponeurotization) of the branches of the tibial nerve [1] or by lengthening their tendon. A minority is related to a hypertonia and/or retraction of the intrinsic musc...

Objective In the spectrum of spatial neglect, personal neglect (body neglect) plays an important role in the difficulties encountered by patients, but its assessment is often centered on the sphere of the face and/or involves tests that have no ecological value. The objective of this study was to develop an assessment tool adressing these two pitfa...

Objective The spastic hemiplegic patient often presents dystonia of extensor hallucis longus (EHL) and, more rarely, extensor digitorum longus (EDL). This dystonia is difficult to treat by tendon lengthening, because its primum movens is purely neurological without retraction musculo-tendinous. A hyponeurotisation by partial section of the branches...

Objective Management of tracheotomy is a key point of the coma arousal phase. Tracheal lesions can interfere with the decannulation of the patient. The objectives of our study were to determine the incidence of post-tracheotomy tracheal lesions in patients with brain injury, identify their associated factors and to specify their impact on rehabilit...

Objective: To evaluate the objective and subjective functional effectiveness of tibial nerve neurotomy (TNN) in post-stroke spastic equinovarus foot (SEF). Methods: In an open study, 23 hemiplegic patients were assessed immediately before TNN and then 5months after TNN. The main outcome measure was the Lower Limb Function Assessment Scale (LL-FA...

Objective Distal lower limb deformities are frequent after a central nervous system lesion, and have a significant impact on posture, gait and activity. This study aimed at analyse neuro-orthopaedics procedures performed in such indications, considering their timing, their main functional objectives and their global efficacy on gait and walking con...

Many conditions can cause foot drop, which makes walking difficult because the foot easily bumps into obstacles, or the knee must be kept more flexed than usual during the swing phase of gait, especially when going up stairs. Several techniques that have been described to correct foot drop rely on bone procedures or tendon transfer, with or without...

Tibialis posterior transfer in central palsy of foot levators: a propos of 17 cases. Aim To evaluate, in spastic patients with a lack of tibialis anterior spontaneous contraction, the efficiency of the tibialis posterior transfer and the occurrence of adverse effects on the static foot posture. Patients and methods Seventeen patients were evaluat...

Objectives The main objective of this study was to describe the population of patients hospitalized in awareness recovery units [AE1], since the occurrence of brain-injury until their discharge. Secondary objectives were to know which criteria could influence length of stay in awakening centers and to judge evolution of patients’ autonomy. Patient...

Introduction Posture and gait are frequently disturbed in patients suffering from diseases affecting central nervous system. Whatever the origin of these troubles (neuromotors, sensory, coordination or cognitive deficiencies), they can lead to major impact on activities, participation and quality of life. Thus they represent an important rehabilita...

Sustained-release fampridine (fampridine-SR) improves gait velocity and self-perceived capacities in people with multiple sclerosis (MS). However, little is known about the treatment’s effect on temporospatial gait parameters, walking endurance, general fatigue, hand function and quality of life (QoL). We therefore sought to evaluate these paramet...

Résumé Introduction La dystonie en extension de l’hallux et/ou des petits orteils peut être observée dans le cadre de lésions pyramidales et extrapyramidales et entraîner des douleurs des orteils concernés, spontanées ou à la marche, des difficultés et un inconfort lors de l’habillage ou le chaussage et des lésions cutanées des orteils. L’objectif...

Normative data on gait is essential for clinical practice - especially in children whose gait pattern changes over time. Sets of normative gait data in healthy children vary significantly from one country to another. We decided to generate a specific reference database of gait parameters for French children. Three hundred and eighty-two children (2...

Dystonia in extensor hallucis and/or digitorum muscles can be observed in pyramidal and extrapyramidal lesions and results in pain in these toes, spontaneous or when walking, problems and discomfort when putting on shoes and socks, and cutaneous lesions on the toes. The objective of this study was to assess the efficacy and safety of deep fibular n...

Le réseau TC-AVC 59-62 a reçu la mission d’améliorer le suivi des personnes en situation de handicap dans les suites d’un accident vasculaire cérébral (PSH/AVC). Un état des lieux préalable est apparu nécessaire.

Background: Stroke often leads to upright standing and walking impairments. Clinical assessments do not sufficiently address ecological aspects and the patient's subjective evaluation of function. Objective: To perform a pilot assessment of the psychometric properties of the Lower Limb-Function Assessment Scale (LL-FAS). Methods: The LL-FAS in...

Background: Hemiplegic patients with supraspinal spasticity can present with a flexor pattern at the hip and knee that hampers both passive and active functions. Objective: To investigate the efficacy of OnabotulinumtoxinA injections on this flexor scheme. Methods: This open-label observational study included eleven patients who had suffered a...

Background Malnutrition is common in the first few months after stroke and contributes to a poor overall outcome. We analyzed long-term weight changes and their predictive factors. Methods A total of 71 first-ever stroke patients were included in the study and examined (1) their weight on admission to the acute stroke unit (usual weight [UW]), on...

Introduction: In a 12--year old girl suffering from autosomal recessive axonal Charcot--Marie--Tooth neuropathy, pes cavovarus was treated with botulinum toxin injection in the tibialis posterior. Case report: The patient underwent a clinical evaluation, video analysis of spatiotemporal gait parameters and dynamic foot plantar pressure assessment b...

Comfort/discomfort (C/D) is an important factor of quality of life (QoL). Brain damage is a major source of discomfort. We developed a questionnaire for assessing C/D in daily living situations and for identifying the main causes of any discomfort and presented its pilot assessment in a population of stroke patients. The scale is a questionnaire of...

Rééducation neurologique. Guide pratique de réédu-cation des affections neurologiques. 3 e édition. Sous la direction de A. Chantraine. Éditions Arnette (2013). Le Pr Alex Chantraine, entouré de nombreux collabora-teurs francophones internationaux, nous propose une troi-sième édition revue et enrichie du « Guide pratique de rééducation des affectio...

Publication of abstracts presented at a scientific meeting is a measure of the latter's scientific quality. To evaluate the publication rate for abstracts presented at the 2008 congress of the French Physical and Rehabilitation Medicine Society (SOFMER) and to identify (i) factors that were predictive of publication and (ii) the main reasons for no...

Un essai thérapeutique sur les effets préventifs de stimulations proprioceptives plantaires sur l’atrophie des muscles du mollet est mené au CHRU de Lille. L’évaluation de la perte de force se fait au moyen de la dynamométrie isocinétique des fléchisseurs plantaires de cheville sur le dynamomètre CON-TREX® chez des sujets opérés d’une arthroplastie...

Several authors have reported alterations in vasodilation during effort in patients with dystrophinopathies, in which a lack of neuronal NO synthase is thought to lead to functional muscle ischemia. In order to determine changes in muscle oxygenation during effort in patients with Becker muscular dystrophy (BMD) and assess the parameters' links wit...

Annals of Physical and Rehabilitation Medicine 54S (2011) e149–e160 associations were identified for MICE group. When compared to MICE, HIIT induced a significantly higher decrease in weight (−4.85 vs. −2.1 kg, P < 0.05), body mass index (−1.72 vs. −0.81 kg/m 2), and waist circumference (−5.4 vs. −0.5 cm, P < 0.05). Conclusion.– Long-term HIIT exer...

ECIM et EIHI, respectivement), ainsi que le profil lipidique. Les variations du QTd étaient corrélées à celles des capacités d'exercice (r = −0,21, p < 0,03), du taux de triglycérides (r = 0,27, p < 0,02) et du ratio triglycérides/HDL-cholestérol (r = 0,21, p < 0,03), dans le groupe EIHI uniquement. Les patients du groupe HIIT avait une diminution...

Objectif : Le présent article vise à revoir la documentation scientifique concernant le traitement de la dépression dans la maladie de Parkinson. Méthodologie : Une revue de la littérature a été effectuée au moyen d'une recherche dans Medline avec les mots clés suivants : maladie de Parkinson, dépression, antidépresseurs, traitement et désordres ps...