Papers by Isabelle Laffont
Trials, 2021
Background After a stroke, 80% of the chronic patients have difficulties to use their paretic upp... more Background After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-week UL VRT and conventional therapy program on paretic UL function in chronic stroke. Methods The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-week in-patient rehabilitation program, which includes 13 days of VRT (...
Background In post-stroke patients it is unclear which wrist actimetry biomarkers to use to estim... more Background In post-stroke patients it is unclear which wrist actimetry biomarkers to use to estimate the degree of upper limb hemiparesis. The objective of this study was to develop a general and objective framework for monitoring hemiparetic patients in their home environment via different biomarkers based on 7 days of actimetry data. A secondary objective was to use all of these biomarkers to better understand the mechanism for potential non-use of the paretic upper limb. Methods Accelerometers were worn continuously for a period of 7 days on both wrists of 10 post-stroke hemiparetic patients as well as 6 healthy subjects. Various wrist actimetry biomarkers were calculated, including the Jerk ratio 50 (JR50, cumulative probability that the Jerk Ratio is between 0 and 0.5), absolute and relative amounts of functional use of movements of the upper limbs (FuncUse and FuncUseR) and absolute and relative velocities of the upper limbs during functional use (VUL and VULR). For each bioma...
Annals of Physical and Rehabilitation Medicine, 2018
Annals of Physical and Rehabilitation Medicine, 2018
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1-e102 e27 the behavi... more Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1-e102 e27 the behavioral/connectivity correlations were far less evident for motor deficiency. Conclusion The results of this exploratory study shed a new light on the influence of the contralesional PPC in post-stroke patients, they have to be confirmed and refined in further larger studies. Keywords Stroke; Connectivity; Posterior parietal cortex Disclosure of interest The authors have not supplied their declaration of competing interest.
Archives of Physical Medicine and Rehabilitation, 2017
Upper Limb isokinetic strengthening versus passive mobilization in patients with chronic stroke: ... more Upper Limb isokinetic strengthening versus passive mobilization in patients with chronic stroke: a randomized controlled trial,
Annals of Physical and Rehabilitation Medicine, 2016
Objective The aim of this study was to compare the analgesic effectiveness of 1 month injection a... more Objective The aim of this study was to compare the analgesic effectiveness of 1 month injection after botulinum toxin in the pectoralis major muscle or subscapularis. Material/Patients and methods In this prospective, comparative, randomized, multicenter trial, 21 patients with hemiplegic shoulder pain after a recent stroke (less 6 months) were screened at baseline, then postinjection (Botox ® 150 units pectoralis major, 100 units subscaplaris) at 1, 4 and 12 weeks. Outcomes were pain (assessed by visual analogic scale), range of motion, spasticity (Ashworth). Results Pain improve significatively in subscapularis injection since the first month (P = 0.027), but without significant difference between both groups (P = 0.50). Pain score decreases from baseline, at respectively 4 and 12 weeks, of 16.3 and 24 points in subscapularis group versus 19.2 and 7.6 points in pectoralis major group. Discussion-Conclusion Subscapularis injection offers a more linear evolution of pain and shoulder range of motion than pectoralis major injection. This study points out a role of toxin in the management hemiplegic shoulder pain. Keywords Hemiplegic; Spasticity; Shoulder pain; Botulinum toxin Disclosure of interest The authors have not supplied their declaration of competing interest. Further reading Bender L, McKenna L. Hemiplegic shoulder pain: defining the problem and its management. Disabil Rehabil 2001;23:698-705. Yelnik AP, Colle FM, Bonan IV, Vicaut E. Treatment of shoulder pain in spastic hemiplegia by reducing spasticity of the subscapular muscle: a randomised, double blind, placebo controlled study of botulinum toxin A.
PloS one, 2017
When we make rapid reaching movements, we have to trade speed for accuracy. To do so, the traject... more When we make rapid reaching movements, we have to trade speed for accuracy. To do so, the trajectory of our hand is the result of an optimal balance between feed-forward and feed-back control in the face of signal-dependant noise in the sensorimotor system. How far do these principles of trajectory formation still apply after a stroke, for persons with mild to moderate sensorimotor deficits who recovered some reaching ability? Here, we examine the accuracy of fast hand reaching movements with a focus on the information capacity of the sensorimotor system and its relation to trajectory formation in young adults, in persons who had a stroke and in age-matched control participants. We find that persons with stroke follow the same trajectory formation principles, albeit parameterized differently in the face of higher sensorimotor uncertainty. Higher directional errors after a stroke result in less feed-forward control, hence more feed-back loops responsible for segmented movements. As a...
Annals of Physical and Rehabilitation Medicine, 2016
Stroke / Annals of Physical and Rehabilitation Medicine 59S (2016) e67-e79 measures were poor pre... more Stroke / Annals of Physical and Rehabilitation Medicine 59S (2016) e67-e79 measures were poor predictors of change in FM scores after training. Discussion-Conclusion The results suggested that pre-therapy motor impairments, motion kinematic measures and associated cognitive deficits might not be reliable predictors of motor outcomes after an intensive rehabilitation program for the upper limb in severe stroke patients 2 months after onset. Intensive upper limb interventions could contribute to enhance motor recovery, especially in severe subacute stroke patients.
Annals of Physical and Rehabilitation Medicine, 2016
therefore suggests a more functional rehabilitation, according to the concept of task-oriented tr... more therefore suggests a more functional rehabilitation, according to the concept of task-oriented training: rehabilitate gait by gait.
Annals of Physical and Rehabilitation Medicine, 2016
Robotics and virtual reality / Annals of Physical and Rehabilitation Medicine 59S (2016) e87-e89 ... more Robotics and virtual reality / Annals of Physical and Rehabilitation Medicine 59S (2016) e87-e89 REAplan allows assessing muscle force by an isometric and isokinetic evaluation (18 cm/s) in three directions. Finally, the kinematic was assessed by a pointing task to 30 targets evenly distribute in the REAplan working space. Results The isometric force assessed with REAplan is highly correlated with the one assessed with the dynamometer for flexor muscles (r = 0.8 and P < 0.001) and is moderate for extensor muscles (r = 0.61 and P < 0.001). The isokinetic force assessment showed that children developed a higher force when their upper limb was mobilized in a trajectory in front of them compared to trajectories angled 45 • C in diagonal. This is true for elbow flexor and extensor muscles (P < 0.001). For the kinematic assessment, straightness, averaged speed and speed metric improve when the distance to reach a target is longer (P < 0.05). Finally, all assessment tasks showed a very good reproducibility (ICC > 0.82 and P < 0.001) and this study allowed to establish norms for each age group. Discussion/Conclusion This study allowed validating, establishing norms and evaluating the reproducibility of motor performance assessment tasks in healthy children using REAplan. This method can now be used to assess brain-damaged children. Some of these results will be illustrated during the congress.
Annals of Physical and Rehabilitation Medicine, 2014
Upper limb function / Annals of Physical and Rehabilitation Medicine 57S (2014) e178-e180 graspin... more Upper limb function / Annals of Physical and Rehabilitation Medicine 57S (2014) e178-e180 grasping and manipulation strategies in hemiparetic patients and complement assessment using standard clinical scales. Project supported by Labex SMART (supported by ANR within the "Investissements d'Avenir programme" ANR-11-IDEX-0004-02).
Annals of physical and rehabilitation medicine, Jan 7, 2015
The idea of using brain computer interfaces (BCI) for rehabilitation emerged relatively recently.... more The idea of using brain computer interfaces (BCI) for rehabilitation emerged relatively recently. Basically, BCI for neurorehabilitation involves the recording and decoding of local brain signals generated by the patient, as he/her tries to perform a particular task (even if imperfect), or during a mental imagery task. The main objective is to promote the recruitment of selected brain areas involved and to facilitate neural plasticity. The recorded signal can be used in several ways: (i) to objectify and strengthen motor imagery-based training, by providing the patient feedback on the imagined motor task, for example, in a virtual environment; (ii) to generate a desired motor task via functional electrical stimulation or rehabilitative robotic orthoses attached to the patient's limb - encouraging and optimizing task execution as well as "closing" the disrupted sensorimotor loop by giving the patient the appropriate sensory feedback; (iii) to understand cerebral reorgan...
Neurorehabilitation and Neural Repair, 2013
Background. Kinematic assessment of upper limb motor recovery after stroke may be related to clin... more Background. Kinematic assessment of upper limb motor recovery after stroke may be related to clinical scores while being more sensitive and reliable than clinical evaluation alone. Objective. To identify the potential of kinematics in assessing upper limb recovery early poststroke. Methods. Thirteen patients were included within 1 month poststroke and evaluated once a week for 6 weeks and at 3 months with ( a) the Fugl-Meyer Assessment (FMA) and ( b) kinematic analysis of reach-to-grasp movements. The link between clinical and kinematic data was identified using mixed model with random coefficient analysis. Results. Movement time, trajectory length, directness, smoothness, mean and maximum velocity of the hand were sensitive to change over time and distinguished between movements of paretic, nonparetic, and healthy control limbs. The FMA score increased with movement smoothness over time, explaining 62.5% of FMA variability. Conclusion. Kinematic analysis of reach-to-grasp movements...
Neurorehabilitation and Neural Repair, 2012
Background. Better understanding of how bimanual coordination changes over the first weeks of rec... more Background. Better understanding of how bimanual coordination changes over the first weeks of recovery after stroke is required to address the potential utility for bimanual rehabilitation. Three-dimensional kinematic analysis can provide quantitative assessment of unimanual and bimanual movements. Objective. To assess the natural evolution of reaching kinematics during standard poststroke rehabilitation, focusing on bimanual coordination. Methods. A total of 12 hemiparetic, moderately impaired patients were included within 30 days after a first unilateral ischemic/hemorrhagic stroke; 7 kinematic assessments were performed once a week for 6 weeks and at 3 months after inclusion. The reach-to-grasp task was performed in 3 different conditions: unimanual with the healthy limb (UN), unimanual with the paretic limb (UP), and bimanual (BN/BP). Results. For the paretic limb, movement fluency (number of movement units and total movement time) was lower for bimanual reaching compared with u...
HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific re... more HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt età la diffusion de documents scientifiques de niveau recherche, publiés ou non, emanant desétablissements d'enseignement et de recherche français ouétrangers, des laboratoires publics ou privés.
Journal of the Neurological Sciences, 2013
7), seizures (n = 4), papilledema (n = 8), visual impairment (n = 8), visual field defects (n = 5... more 7), seizures (n = 4), papilledema (n = 8), visual impairment (n = 8), visual field defects (n = 5), bilateral 3,4 and 6th cranial nerve palsy (n = 5), LMN facial palsy (n = 4), bilateral 6th nerve palsy (n = 3) and radiculopathy (n = 4). None had focal deficits. CSF pressure ranged from 235 to 400 mm of Hg. Superior sagittal sinus and transverse sinus thrombosis were the commonest sites of thrombosis by MR venography. Treatment included anti-oedema measures, methyl prednisolone (n = 4) and 5000 IU subcutaneous heparin 6th hourly followed by acenocoumarol. Optic nerve fenestration (n = 3) followed by thecoperitoneal shunt (n = 4) was undertaken in those with significant vision loss and headache, though the outcome remained poor. Conclusion: Cerebral venous thrombosis can have diverse presentations. CVT with vision loss and cranial nerve palsy may be misdiagnosed as chronic meningitis, pachymeningitis or vasculitis.
People post-stroke perceive movement fluency in virtual reality
Experimental Brain Research, 2012
We investigated the visual perception of biological movement by people post-stroke, using minimal... more We investigated the visual perception of biological movement by people post-stroke, using minimal kinematic displays. A group of twenty patients and a group of twelve age-matched healthy controls were asked to judge movement fluency. The movements to judge were either displayed as an end-point dot or as a stick-figure of the arm and trunk. It was found that the perception of movement fluency was preserved post-stroke, however, with an increase in the variability of judgment. Moreover, the end-point dot representation ameliorated what was perceived and judged, presumably by directing attention to the important kinematic cues: smoothness and directness of the trajectory. We conclude that, despite perception of actions is influenced by the ability of the observer to execute the observed movement, hemiparesis has a mild effect on the perception of biological movement. Yet, a valuable virtual learning environment for upper-limb rehabilitation should be implemented to provide the observer with neither too much, nor too little information to maximize learning.
Motor Recovery of the Ipsilesional Upper Limb in Subacute Stroke
Archives of Physical Medicine and Rehabilitation, 2013
To investigate the time-related changes in motor performance of the ipsilesional upper limb in su... more To investigate the time-related changes in motor performance of the ipsilesional upper limb in subacute poststroke patients by using clinical and kinematic assessments. Observational, longitudinal, prospective, monocentric study. Physical medicine and rehabilitation department. Stroke patients (n=19; mean age, 62.9y) were included less than 30 days after a first unilateral ischemic/hemorrhagic stroke. The control group was composed of age-matched, healthy volunteers (n=9; mean age, 63.1y). Clinical and kinematic assessments were conducted once a week during 6 weeks and 3 months after inclusion. Clinical measures consisted of Fugl-Meyer Assessment, Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Barthel Index. We used a 3-dimensional motion recording system during a reach-to-grasp task to analyze movement smoothness, movement time, and peak velocity of the hand. Healthy controls performed both clinical (BBT and 9HPT) and kinematic evaluation within a single session. BBT and 9HPT. Recovery of ipsilesional upper arm capacities increased over time and leveled off after a 6-week period of rehabilitation, corresponding to 9 weeks poststroke. At study discharge, patients demonstrated similar ipsilesional clinical scores to controls but exhibited less smooth reaching movements. We found no effect of the hemispheric side of the lesion on ipsilesional motor deficits. Our findings provide evidence that ipsilesional motor capacities remain impaired at least 3 months after stroke, even if clinical tests fail to detect the impairment. Focusing on this lasting ipsilesional impairment through a more detailed kinematic analysis could be of interest to understand the specific neural network underlying ipsilesional upper-limb impairment.
Annals of Physical and Rehabilitation Medicine, 2012
Para-ostéoarthropathies neurogènes de localisations inhabituelles chez le traumatisé crânien
Annals of Physical and Rehabilitation Medicine, 2012
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Papers by Isabelle Laffont