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Master Thesis

Suivi à long terme en MPR des personnes ayant présenté un AVC : revue de la littérature

Abstract : Introduction: Stroke is the main cause of acquired motor disability in adults. Of the 800,000 French people affected today, 75% are suffering from sequelae and will benefit from PRM treatment. We found many studies about interventions in the acute phase of a stroke, but studies on chronic phase follow-up are lacking. The aim of this work is to carry out an overview on the long-term follow-up in PRM on impairments, activity limitations and participation restrictions following stroke. Methods: We included reviews and controlled trials, published between 2006 and 2017 gathered through the databases of the Cochrane Library, Medline and PEDro referring to the PRM's follow-up on deficiencies, activity limitations and participation restrictions after stroke. The International Classification of Functioning of Disability and Health (ICF) enabled us to define the different functions that can be altered following a stroke and to look for interventions that can be proposed. Main results: Precocity, intensity, continuity, repetitiveness and task oriented exercises are recommended. Walking: The use of mechanized systems seems more relevant for patients who have not yet acquired walking. Botulinum toxin has a positive effect, potentiated when associated with stretching or walking. Grip: constraint-induced therapy, robotics and mirror therapy have promising effects on functional recovery of the upper limb. Language: Five sessions of 45 minutes per week are recommended. Language disorders are improved by intensive work, constraint-induced therapy, and group therapies. Spatial Neglect: Prism adaptations, visual scanning, virtual reality, sensory stimulation improve performance tests, but their effects in the actions of daily life remain weak. Swallowing: Postural and swallowing exercises, dietetic modifications, stimulations of the buccofacial praxis are recommended. Sphincteric disorders: Current recommendations combine biofeedback and rehabilitation of the pelvic floor. Conclusion: It is not possible to recommend a single rehabilitation technique. A personalized program including a combination of several methods, adapted to each patient and his multiple deficits seems to be the most effective. Rehabilitation has a beneficial effect on functional recovery after a stroke compared with no treatment and this effect was noted as persistent beyond the intervention period. Precocity, intensity, continuity, repetitiveness and task oriented exercises are recommended in order to promote brain plasticity.
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https://dumas.ccsd.cnrs.fr/dumas-01877178
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Submitted on : Wednesday, September 19, 2018 - 2:15:52 PM
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Joséphine Vogel. Suivi à long terme en MPR des personnes ayant présenté un AVC : revue de la littérature. Sciences du Vivant [q-bio]. 2017. ⟨dumas-01877178⟩

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