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Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke : A meta-analysis / Chih-Yang Hsu in Annals of physical and rehabilitation medicine, Vol. 63, n°6 (November 20)
[article]
Titre : Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke : A meta-analysis Type de document : texte imprimé Auteurs : Chih-Yang Hsu ; Yu-Hsuan Cheng ; Chien-Hung Lai ; Yen-Nung Lin Année de publication : 2020 Article en page(s) : p. 535-542 Note générale : doi.org/10.1016/j.rehab.2019.09.009 Langues : Anglais (eng) Mots-clés : Stroke rehabilitation Robotics Body-weight-support Treadmill Gait Résumé : Background
Technology-assisted gait training (TAGT) with body weight support (BWS) has been designed to provide high numbers of repetitions during stepping practice, but its benefits have been inconclusive.
Objective
We evaluated the superiority of TAGT over conventional overground training (COT) to judge the clinical benefits.
Methods
We searched PubMed, Embase and Web of Science databases from their earliest record to July 1, 2019 and included randomized controlled trials of TAGT with BWS, such as robot-assisted gait training and body weight-supported treadmill training, for treating walking disability in patients within 6 months after stroke. We conducted a meta-analysis of the outcomes motor impairment, mobility capacity, walking speed, endurance and fitness, balance, and activities of daily living as well as subgroup analyses of initial ambulatory ability and stroke duration.
Results
Among 14 robotics and 10 body weight-supported treadmill studies included for review, 23 studies involving 1452 participants contributed to the meta-analysis. We found no significant standardized mean differences between TAGT and COT (P > 0.05) across all outcome categories in the robotics subgroup, the body weight-supported treadmill subgroup, or both subgroups combined, for both the short and long term. Further subgroup analyses also revealed non-significant standardized mean differences (P > 0.05) across all outcomes in the subgroups initially ambulatory, non-ambulatory, or stroke duration less than 3 months.
Conclusions
TAGT with BWS was not superior to COT in improving post-stroke recovery in patients with subacute stroke. Strategies other than simply increasing the repetitions by external assistance may be considered to augment the treatment effects of TAGT.Permalink : ./index.php?lvl=notice_display&id=91466
in Annals of physical and rehabilitation medicine > Vol. 63, n°6 (November 20) . - p. 535-542[article] Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke : A meta-analysis [texte imprimé] / Chih-Yang Hsu ; Yu-Hsuan Cheng ; Chien-Hung Lai ; Yen-Nung Lin . - 2020 . - p. 535-542.
doi.org/10.1016/j.rehab.2019.09.009
Langues : Anglais (eng)
in Annals of physical and rehabilitation medicine > Vol. 63, n°6 (November 20) . - p. 535-542
Mots-clés : Stroke rehabilitation Robotics Body-weight-support Treadmill Gait Résumé : Background
Technology-assisted gait training (TAGT) with body weight support (BWS) has been designed to provide high numbers of repetitions during stepping practice, but its benefits have been inconclusive.
Objective
We evaluated the superiority of TAGT over conventional overground training (COT) to judge the clinical benefits.
Methods
We searched PubMed, Embase and Web of Science databases from their earliest record to July 1, 2019 and included randomized controlled trials of TAGT with BWS, such as robot-assisted gait training and body weight-supported treadmill training, for treating walking disability in patients within 6 months after stroke. We conducted a meta-analysis of the outcomes motor impairment, mobility capacity, walking speed, endurance and fitness, balance, and activities of daily living as well as subgroup analyses of initial ambulatory ability and stroke duration.
Results
Among 14 robotics and 10 body weight-supported treadmill studies included for review, 23 studies involving 1452 participants contributed to the meta-analysis. We found no significant standardized mean differences between TAGT and COT (P > 0.05) across all outcome categories in the robotics subgroup, the body weight-supported treadmill subgroup, or both subgroups combined, for both the short and long term. Further subgroup analyses also revealed non-significant standardized mean differences (P > 0.05) across all outcomes in the subgroups initially ambulatory, non-ambulatory, or stroke duration less than 3 months.
Conclusions
TAGT with BWS was not superior to COT in improving post-stroke recovery in patients with subacute stroke. Strategies other than simply increasing the repetitions by external assistance may be considered to augment the treatment effects of TAGT.Permalink : ./index.php?lvl=notice_display&id=91466 Exemplaires (1)
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Exclu du prêtClinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial / Marianna Capecci in Annals of physical and rehabilitation medicine, Vol. 62, n°5 (Septembre 2019)
[article]
Titre : Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial Type de document : texte imprimé Auteurs : Marianna Capecci ; Sanaz Pournajaf ; Daniele Galafate ; Patrizio Sale ; Domenica Le Pera ; Michela Goffredo ; Maria Francesca De Pandis ; Marco Franceschini Année de publication : 2019 Article en page(s) : p. 303-312 Note générale : doi.org/10.1016/j.rehab.2019.06.016 Langues : Anglais (eng) Mots-clés : Gait Robotics Parkinson disease Rehabilitation Freezing Résumé : Background
Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms.
Objective
We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life.
Methods
Outpatients with Parkinson disease (Hoehn and Yahr stage ≥ 2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1).
Results
We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction.
Conclusions
Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait – related disability.Permalink : ./index.php?lvl=notice_display&id=84139
in Annals of physical and rehabilitation medicine > Vol. 62, n°5 (Septembre 2019) . - p. 303-312[article] Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial [texte imprimé] / Marianna Capecci ; Sanaz Pournajaf ; Daniele Galafate ; Patrizio Sale ; Domenica Le Pera ; Michela Goffredo ; Maria Francesca De Pandis ; Marco Franceschini . - 2019 . - p. 303-312.
doi.org/10.1016/j.rehab.2019.06.016
Langues : Anglais (eng)
in Annals of physical and rehabilitation medicine > Vol. 62, n°5 (Septembre 2019) . - p. 303-312
Mots-clés : Gait Robotics Parkinson disease Rehabilitation Freezing Résumé : Background
Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms.
Objective
We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life.
Methods
Outpatients with Parkinson disease (Hoehn and Yahr stage ≥ 2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1).
Results
We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction.
Conclusions
Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait – related disability.Permalink : ./index.php?lvl=notice_display&id=84139 Exemplaires (1)
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Exclu du prêtEffectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial / Stéphanie Dehem in Annals of physical and rehabilitation medicine, Vol. 62, n°5 (Septembre 2019)
[article]
Titre : Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial Type de document : texte imprimé Auteurs : Stéphanie Dehem ; Maxime Gilliaux ; Gaëtan G. Stoquart ; Christine Detrembleur ; Géraldine Jacquemin ; Sara Palumbo ; Anne Frederick ; Thierry Lejeune Année de publication : 2019 Article en page(s) : p. 313-320 Note générale : doi.org/10.1016/j.rehab.2019.04.002 Langues : Anglais (eng) Mots-clés : Stroke Upper extremity Robotics Rehabilitation Recovery of function Résumé : Background
Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).
Objective
This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.
Methods
We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n = 22, and RAT, n = 23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.
Results
In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P = 0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P = 0.02) and patient social participation (Stroke Impact Scale +18%; P = 0.01). Participants’ abilities to perform manual activities and activities of daily living improved similarly in both groups.
Conclusion
For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.Permalink : ./index.php?lvl=notice_display&id=84140
in Annals of physical and rehabilitation medicine > Vol. 62, n°5 (Septembre 2019) . - p. 313-320[article] Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial [texte imprimé] / Stéphanie Dehem ; Maxime Gilliaux ; Gaëtan G. Stoquart ; Christine Detrembleur ; Géraldine Jacquemin ; Sara Palumbo ; Anne Frederick ; Thierry Lejeune . - 2019 . - p. 313-320.
doi.org/10.1016/j.rehab.2019.04.002
Langues : Anglais (eng)
in Annals of physical and rehabilitation medicine > Vol. 62, n°5 (Septembre 2019) . - p. 313-320
Mots-clés : Stroke Upper extremity Robotics Rehabilitation Recovery of function Résumé : Background
Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).
Objective
This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.
Methods
We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n = 22, and RAT, n = 23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.
Results
In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P = 0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P = 0.02) and patient social participation (Stroke Impact Scale +18%; P = 0.01). Participants’ abilities to perform manual activities and activities of daily living improved similarly in both groups.
Conclusion
For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.Permalink : ./index.php?lvl=notice_display&id=84140 Exemplaires (1)
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Exclu du prêtImproving Quality of Life and Depression After Stroke Through Telerehabilitation / Susan M. Linder in American Journal of Occupational Therapy, Vol. 69/2 (Mars/Avril 2015)
[article]
Titre : Improving Quality of Life and Depression After Stroke Through Telerehabilitation Type de document : texte imprimé Auteurs : Susan M. Linder, Auteur ; Anson B. Rosenfeldt, Auteur ; R. Curtis Bay, Auteur Année de publication : 2015 Article en page(s) : p.1-10 Langues : Anglais (eng) Mots-clés : Accident cérébrovasculaire Etat dépressif Qualité vie Robotique Télé médecineDepression Exercise therapy Quality of life Robotics Stroke Telemedicine Résumé : OBJECTIVE. The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke.
METHOD. A multisite randomized controlled clinical trial was completed with 99 people <6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy + home exercise program, and participated in an 8-wk home intervention.
RESULTS. We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups.
CONCLUSION. A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke.Permalink : ./index.php?lvl=notice_display&id=35876
in American Journal of Occupational Therapy > Vol. 69/2 (Mars/Avril 2015) . - p.1-10[article] Improving Quality of Life and Depression After Stroke Through Telerehabilitation [texte imprimé] / Susan M. Linder, Auteur ; Anson B. Rosenfeldt, Auteur ; R. Curtis Bay, Auteur . - 2015 . - p.1-10.
Langues : Anglais (eng)
in American Journal of Occupational Therapy > Vol. 69/2 (Mars/Avril 2015) . - p.1-10
Mots-clés : Accident cérébrovasculaire Etat dépressif Qualité vie Robotique Télé médecineDepression Exercise therapy Quality of life Robotics Stroke Telemedicine Résumé : OBJECTIVE. The aim of this study was to determine the effects of home-based robot-assisted rehabilitation coupled with a home exercise program compared with a home exercise program alone on depression and quality of life in people after stroke.
METHOD. A multisite randomized controlled clinical trial was completed with 99 people <6 mo after stroke who had limited access to formal therapy. Participants were randomized into one of two groups, (1) a home exercise program or (2) a robot-assisted therapy + home exercise program, and participated in an 8-wk home intervention.
RESULTS. We observed statistically significant changes in all but one domain on the Stroke Impact Scale and the Center for Epidemiologic Studies Depression Scale for both groups.
CONCLUSION. A robot-assisted intervention coupled with a home exercise program and a home exercise program alone administered using a telerehabilitation model may be valuable approaches to improving quality of life and depression in people after stroke.Permalink : ./index.php?lvl=notice_display&id=35876 Exemplaires (1)
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Exclu du prêtInnovative technologies applied to sensorimotor rehabilitation after stroke / I. LAFFONT in Annals of physical and rehabilitation medicine, Vol. 57, n°8 (Novembre 2014)
[article]
Titre : Innovative technologies applied to sensorimotor rehabilitation after stroke Titre original : Technologies nouvelles appliquées à la rééducation sensori-motrice après AVC Type de document : texte imprimé Auteurs : I. LAFFONT, Auteur ; Karima Bakhti, Auteur Année de publication : 2014 Article en page(s) : p.543-551 Langues : Français (fre) Mots-clés : Stroke Rehabilitation New technologies Robotics Virtual reality Brain stimulation Accident vasculaire cérébral Rééducation Technologies nouvelles Robotique Réalité virtuelle Stimulation cérébrale Résumé : Innovative technologies for sensorimotor rehabilitation after stroke have dramatically increased these past 20 years. Based on a review of the literature on “Medline” and “Web of Science” between 1990 and 2013, we offer an overview of available tools and their current level of validation. Neuromuscular electric stimulation and/or functional electric stimulation are widely used and highly suspected of being effective in upper or lower limb stroke rehabilitation. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for the upper limb. Its effectiveness in gait training is more controversial. Virtual reality is widely used in the rehabilitation of cognitive and motor impairments, as well as posture, with admitted benefits. Non-invasive brain stimulation (rTMS and TDCS) are promising in this indication but clinical evidence of their effectiveness is still lacking. In the same manner, these past five years, neurofeedback techniques based on brain signal recordings have emerged with a special focus on their therapeutic relevance in rehabilitation. Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and “real use” of those devices is still an issue since most of them are not easily available in current practice.
Les technologies innovantes appliquées à la rééducation sensori-motrice dans les suites d’un accident vasculaire cérébral se sont multipliées ces 20 dernières années. À partir d’une revue de la littérature sur « Medline » et « Web of Science » entre 1990 et 2013, nous proposons une synthèse des outils disponibles et de leur niveau de validation actuel. La stimulation électrique neuromusculaire et/ou fonctionnelle a une efficacité admise dans cette indication. La robotique de rééducation a été diversement appréciée dans la littérature. Il semble qu’elle ait une certaine efficacité sur les capacités fonctionnelles lorsqu’elle est utilisée pour le membre supérieur. Son efficacité dans la rééducation à la marche est plus controversée. La réalité virtuelle est utilisée par de nombreuses équipes dans la rééducation de la motricité ou de la posture, avec un bénéfice maintenant admis. Les techniques de stimulations cérébrales non invasives (rTMS et TDCS) sont encore exploratoires dans cette indication, de la même façon que les techniques de neuro-feedback visant à utiliser l’enregistrement du signal cérébral pour agir sur la plasticité cérébrale. L’avènement de ces technologies appliquées à la rééducation est en train de révolutionner nos pratiques. Elles reposent sur les progrès des neurosciences qui nous permettent de mieux comprendre les phénomènes de plasticité neurale qui sous-tendent l’efficacité de la rééducation. L’appropriation de ces outils par les patients et les thérapeutes est une nécessité. Ces dispositifs doivent se mettre au service de la relation entre le patient et son rééducateur mais ne peuvent se substituer à ce dernier.Permalink : ./index.php?lvl=notice_display&id=34538
in Annals of physical and rehabilitation medicine > Vol. 57, n°8 (Novembre 2014) . - p.543-551[article] Innovative technologies applied to sensorimotor rehabilitation after stroke = Technologies nouvelles appliquées à la rééducation sensori-motrice après AVC [texte imprimé] / I. LAFFONT, Auteur ; Karima Bakhti, Auteur . - 2014 . - p.543-551.
Langues : Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 57, n°8 (Novembre 2014) . - p.543-551
Mots-clés : Stroke Rehabilitation New technologies Robotics Virtual reality Brain stimulation Accident vasculaire cérébral Rééducation Technologies nouvelles Robotique Réalité virtuelle Stimulation cérébrale Résumé : Innovative technologies for sensorimotor rehabilitation after stroke have dramatically increased these past 20 years. Based on a review of the literature on “Medline” and “Web of Science” between 1990 and 2013, we offer an overview of available tools and their current level of validation. Neuromuscular electric stimulation and/or functional electric stimulation are widely used and highly suspected of being effective in upper or lower limb stroke rehabilitation. Robotic rehabilitation has yielded various results in the literature. It seems to have some effect on functional capacities when used for the upper limb. Its effectiveness in gait training is more controversial. Virtual reality is widely used in the rehabilitation of cognitive and motor impairments, as well as posture, with admitted benefits. Non-invasive brain stimulation (rTMS and TDCS) are promising in this indication but clinical evidence of their effectiveness is still lacking. In the same manner, these past five years, neurofeedback techniques based on brain signal recordings have emerged with a special focus on their therapeutic relevance in rehabilitation. Technological devices applied to rehabilitation are revolutionizing our clinical practices. Most of them are based on advances in neurosciences allowing us to better understand the phenomenon of brain plasticity, which underlies the effectiveness of rehabilitation. The acceptation and “real use” of those devices is still an issue since most of them are not easily available in current practice.
Les technologies innovantes appliquées à la rééducation sensori-motrice dans les suites d’un accident vasculaire cérébral se sont multipliées ces 20 dernières années. À partir d’une revue de la littérature sur « Medline » et « Web of Science » entre 1990 et 2013, nous proposons une synthèse des outils disponibles et de leur niveau de validation actuel. La stimulation électrique neuromusculaire et/ou fonctionnelle a une efficacité admise dans cette indication. La robotique de rééducation a été diversement appréciée dans la littérature. Il semble qu’elle ait une certaine efficacité sur les capacités fonctionnelles lorsqu’elle est utilisée pour le membre supérieur. Son efficacité dans la rééducation à la marche est plus controversée. La réalité virtuelle est utilisée par de nombreuses équipes dans la rééducation de la motricité ou de la posture, avec un bénéfice maintenant admis. Les techniques de stimulations cérébrales non invasives (rTMS et TDCS) sont encore exploratoires dans cette indication, de la même façon que les techniques de neuro-feedback visant à utiliser l’enregistrement du signal cérébral pour agir sur la plasticité cérébrale. L’avènement de ces technologies appliquées à la rééducation est en train de révolutionner nos pratiques. Elles reposent sur les progrès des neurosciences qui nous permettent de mieux comprendre les phénomènes de plasticité neurale qui sous-tendent l’efficacité de la rééducation. L’appropriation de ces outils par les patients et les thérapeutes est une nécessité. Ces dispositifs doivent se mettre au service de la relation entre le patient et son rééducateur mais ne peuvent se substituer à ce dernier.Permalink : ./index.php?lvl=notice_display&id=34538 Exemplaires (1)
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Exclu du prêt