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Evaluation multidimensionnelle dans les indications et bénéfices des injections de toxine botulique chez l’enfant paralysé cérébral

Abstract : Cerebral palsy is the most common cause of motor impairment in children, affecting 2.08 to 3.60 children/1000 births in Europe and the United States. Initial injury on an immature brain and a growing skeleton is responsible of altering body functions and structures with a limitation of activities and an impact on participation, according to the ICF. Botulinum toxin has become the standard treatment for focal spasticity in children with CP, as it is selective, reversible, safe and dose dependent. However, while it is clear that BT injections decrease tone disorders, the question of indications and benefits in terms of functional improvement still needs to be investigated. Indeed, the implementation of this treatment meets different issues, including the difficulty of the evaluation to determine the indications and benefits, because of very heterogeneous clinical presentations and the context of neurological maturation and bone growth, but also the difficulty to take into account the particular environmental dynamics between the child and his parents.In order to approach the evaluation of BT treatment in a multidimensional way, we bring with this thesis several studies contributing to a global approach to understand the different aspects of disability in UL, LL or spine, but also to understand the field of activity for the UL in terms of capacities and functional performance, and finally on the level of behavior to better understand ultimately participation. In this context, the main aim of this work is to propose a personalized analysis, using standardized tools, of the medium- and long-term consequences of treatment for a subject in growth and development.
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Submitted on : Friday, March 15, 2019 - 2:38:08 PM
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Emmanuelle Chaléat-Valayer. Evaluation multidimensionnelle dans les indications et bénéfices des injections de toxine botulique chez l’enfant paralysé cérébral. Médecine humaine et pathologie. Université de Lyon, 2018. Français. ⟨NNT : 2018LYSES016⟩. ⟨tel-02069072⟩

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