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PLASTICITE CEREBRALE ET NEUROMUSCULAIRE : Médication par l’exercice physique et récupération fonctionnelle dans la parésie spastique déformante des syndromes pyramidaux, type Accidents Vasculaires Cérébraux chez l’adulte

Abstract : Spastic deforming paresis is one of the common consequences of stroke, sometimes evident before the 15th day of injury. One of the major problems for patients is body deformity and functional limitation, discomfort and / or pain. Thus, the objective of my thesis was centred on four studies; 1) to explore first of all the phenomena limiting the total recovery of all these patients and the modus operandi of cerebral plasticity (at the neuronal level, then in correlation with the clinic), using the tools of modern imagery, and neuronal biology. Clinically observe their recovery over time. 2) Examine the microstructural behaviour of spastic muscle, compared to healthy muscle (by section imaging, then immunofluorescence and immunohistochemistry techniques), then the effectiveness of therapeutic strategies on neuromuscular plasticity, and in motor recovery of the limb higher, via a prospective, controlled and randomized study (traditional physiotherapy vs specific rehabilitation technique, targeted on antagonists and guided self-rehabilitation). In the 3rd study, in parallel with the 1st and the 2nd study, to evaluate the lower limb, the kinematic parameters compared to those of healthy subjects matched in age, and to propose effective rehabilitation techniques, in order to improve not only the perimeter, but also the quality of walking. A 4th study was also carried out in the field of Parkinson's disease, to understand the influence of rhythmic auditory stimulation on the kinematic parameters of walking in idiopathic Parkinson's disease, and to see which gait was better to improve for a safe walk. Following our results, it appears that the nervous tissue has only a limited capacity to modify, renew and repair itself. The modest recovery potential seen after brain injury is attributed to the "reorganization" of functions using remaining healthy circuitry rather than repairing damaged tissue. The main obstacles to this geminating are the “glial scar”. Nevertheless, a form known as behavioural plasticity can help increase the degree of recovery. Learning a motor skill could strengthen the circuits of the spinal interneurons that facilitate movement. We realized that learning a simple and reciprocating movement, associated with active stretching, performed several times a day on target muscles (the antagonists were more important than traditional physiotherapy) would produce an influence on the level of the spinal cord which, over time, inhibits reciprocal between the antagonistic muscles. The locometer allowed us to better understand the kinematic parameters of walking in stroke patients. The auditory stimulator can influence the rhythm of the Parkinsonism subject; when walking at very long strides, allows an increase in walking speed as great as walking at maximum safety speed, and must therefore be favored at a spontaneous or increased indexed cadence. Medication through exercise in the acute phase of stroke should not be overlooked, harming chemical drugs or medical procedures. Because, like the vital prognosis, the functional prognosis must also be requested quickly by doctors in general.
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Submitted on : Wednesday, August 11, 2021 - 11:12:47 PM
Last modification on : Saturday, August 14, 2021 - 3:25:50 AM

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  • HAL Id : tel-03317843, version 2

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Ibrahimm Npochinto Moumeni. PLASTICITE CEREBRALE ET NEUROMUSCULAIRE : Médication par l’exercice physique et récupération fonctionnelle dans la parésie spastique déformante des syndromes pyramidaux, type Accidents Vasculaires Cérébraux chez l’adulte. Neurosciences [q-bio.NC]. Sorbonne Université; Bircham International University (Espagne), 2021. Français. ⟨tel-03317843v2⟩

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