| Étude de la perception du corps dans l’espace chez des patients post AVC droit : une étude transversale (Study of the perception of the body in space in right post-stroke patients: a cross-sectional study) Painchaud, Solène - (2023-07-04) / Universite de Rennes - Étude de la perception du corps dans l’espace chez des patients post AVC droit : une étude transversale
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Langue : Français Directeur(s) de thèse: Leplaideur, Stéphanie Discipline : Médecine physique et de réadaptation Classification : Médecine et santé Mots-clés : AVC, équilibre, marche, autonomie, Représentation spatiale, SSA, LBA
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Résumé : La perception du corps dans l’espace peut être perturbée après un accident vasculaire cérébral (AVC). Le but de cette étude est de rechercher une relation entre ces troubles de la perception et la posture, l’équilibre et l’autonomie. Le biais et l’incertitude du longitudinal body axis (LBA) et ceux du subjective straight ahead (SSA) évalués à l’inclusion, puis à J14, J90 et J180, ont été mis en relation avec les tests de posture (scale contraversive pushing (SCP)), d’équilibre (Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), Timed Up and Go (TUG)) et l’autonomie (Indice de Barthel) au sein d’une base de données comprenant 89 patients post AVC droit subaigus issus d’une étude prospective multicentrique. Le biais du LBA était associé au PASS, au BBS et au Barthel (p < 0.001). Le biais du SSA était associé à l’indice de Barthel (p < 0.001). La mauvaise perception du corps dans l’espace était associée à un trouble l’équilibre et à une moins bonne autonomie. Le LBA est plus fortement associé à l’équilibre. L’évaluation du LBA et du SSA pourraient être intéressant afin de proposer des programmes de rééducation spécifique des troubles de la cognition spatiale et ainsi améliorer la récupération fonctionnelle de ces patients. Abstract : Background: The subjective straight ahead and the longitudinal body axis can be disturbed after a stroke. However, their link with balance and recovery are not yet well explained. Aim: To evaluate the association of LBA and SSA perturbations on balance and autonomy recovery after stroke. Methods: We used the AVC postim database and analyzed 80 patients within 9 months of a first right hemisphere lesion. Given the primary objective of balance asymmetry assessment, patients were included when they could stand for at least 30 seconds without any assistance. LBA and SSA perceptions were tested at the inclusion time, with the balance tests and the autonomy questionnaire. They were then all collected at D14, D90 and D180. To perform the LBA, the patient was lying down in the dark with a luminous line placed in front of the patient. The patient was instructed to indicate when the strip crossed the axis of his/her body: on the line joining the middle between their shoulders and the middle between their ankles. To perform the SSA, the patient was seated in front of a graduated table, blindfolded. The patient was asked to indicate the straight ahead with his index finger of his right arm. Mean deviation and uncertainty, defined as the standard deviation of the LBA or the SSA, were calculated for 6 trials. Balance was assessed by the Postural Assessment Scale for Stroke (PASS), the Berg Balance Scale (BBS), the Scale Contraversive Pushing (SCP) and the Time Up and Go Test (TUG). Functional outcome was also assessed by the Barthel index. Results: The scores for balance and Barthel index were associated to LBA value, regardless of the time: PASS (Beta = - 0.35 [-0.5; -0.2], p < 0.001), BBS (Beta = - 0.9 [-1.35 ; - 0.45], p < 0.001), Barthel (Beta = - 1.52 [-2.2 ; -0.83], p < 0.001). It was also associated to the uncertainty value: PASS (Beta = - 0.47 [-0.67; -0.26], p < 0.001), la BBS (Beta = - 1.24 [-1.86; -0.61], p < 0.001), Barthel (Beta = - 1.94 [-2.95; -0.93], p < 0.001). The scores for the Barthel index were related to SSA value, regardless of the time: Barthel (Beta = - 0.86 [-1.33; -0.39], p < 0.001). It was also associated to the uncertainty value for the Barthel index (Beta = - 0.85 [-1.25; - 0.45], p < 0.001). Conclusions: After a right stroke, the misperception of the LBA was associated with a poor score of all balance and autonomy scales. The misperception of the SSA was associated with a poor score of autonomy scales only. Rehabilitation programs should better consider the poor body’s perception in space. Indeed, it seems to be an important factor in postural balance and thus independence. | |||