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Performance de marche de patients hémiplégiques après AVC : Déterminants, Réentrainement et Neuromodulation

Abstract : Stroke is a hospital emergency. Action must be taken as soon as possible to save the patient's life, limit neurological damage and reduce subsequent dysfunctions. Stroke survivors have functional limitations. Most of them walk with persistent sequelae because of the persistence of hemiparesis. The objective of this thesis was to improve the qualitative and quantitative walking ability of hemiplegic patients of vascular origin by direct current transcranial stimulation and exercise re-training. The results of the four studies provide a better understanding of the functional status of the muscle after stroke and the potential for improving hemiparetic function. The hemiparetic muscle has a performance limitation, because 12 months after ictus, there is: a loss of muscle mass (from 20 to 25%), a gain in fat mass (from 17 to 30.6%), a decrease in the size and proportion of muscle fibers (43% type I fiber) and capillary density (38%), a reduction in the ability to recruit muscle fibers with an increase in the activation time of the motor units and the persistence of rest motor activity. All these structural, biochemical and neurophysiological alterations contribute to the expression of the various motor deficiencies observed in the hemiplegic patient. The other results are related to post-stroke walking. The qualitative and quantitative improvement of walking depends on the quality of care and the socio-economic means used for rehabilitation care. With a single anodic tDCS, gains of 15% during stimulation (p = 0.360) and 25% one hour after stimulation (p = 0.038) were obtained. By combining an anodic tDCS with a 6-week exercise re-training, gains of 5% and 5.7% (p > 0.05) were reported in endurance (6MWT) and speed (10mWT) respectively.It is therefore possible to combine tDCS with the exercise re-training program with good tolerance. The results obtained give hope for improving walking performance in vascular hemiplegic patients.
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Oscar Aze. Performance de marche de patients hémiplégiques après AVC : Déterminants, Réentrainement et Neuromodulation. Médecine humaine et pathologie. Université de Lyon, 2019. Français. ⟨NNT : 2019LYSES038⟩. ⟨tel-02880851⟩



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