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Master Thesis

Prise en charge rééducative précoce du membre supérieur du nourrisson après un infarctus artériel cérébral périnatal : description des pratiques professionnelles en France et élaboration d’un protocole de soins

Abstract : Introduction: perinatal arterial cerebral ischemic stroke is the most common form of the child’s stroke. The uncertain motor prognosis requires a multidisciplinary early intervention in hope of influencing an unfavourable trajectory. The main purpose of this study is to describe professional practices of early rehabilitation care of the upper limb in infants after a perinatal arterial stroke. Methods: this study was carried out according to the CHERRIES methods. It consisted of a descriptive survey of practices among physicians (pediatricians, neonatologists, neuropediatricians, rehabilitation physicians, orthopedists) and allied professionals (physiotherapists, occupational therapists, and psychomotor therapists) in France by the way of two online surveys and the elaboration of a health care protocol. Results: we obtained 220 answers: 120 medical answers and 100 paramedical answers. Eighty per cent of infants suspected of cerebral palsy were referred for specialized consultation before the age of 12 months. Less than half of them had started a rehabilitation treatment. This was mainly carried out by the liberal physiotherapists (80%), CAMSP (84%) and the psychomotor therapist (52%). The assumption period was an average of four months. The methods of rehabilitation were heterogeneous: bi-manual activities in 60% of cases; For 64% of massages and sensory stimulations; 60% of active-passive mobilizations; 40% of stretch-relaxation sessions; and 20% of the constraint-induced therapy, mainly performed in hospital. None of the paramedics used a single technique. Early orthesis of the upper limb was prescribed by 16% of physicians and used by 47% of paramedics. Injections of botulinum toxins accounted for 15% of the complementary treatments. All the professionals involved parents in the rehabilitation. Conclusion: this study shows the current heterogeneity of early rehabilitation practices. However, the concept of urgency in the diagnosis of cerebral palsy and its rehabilitation from an early age is unequivocal.
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Submitted on : Wednesday, December 18, 2019 - 4:02:52 PM
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Camille Pélissou. Prise en charge rééducative précoce du membre supérieur du nourrisson après un infarctus artériel cérébral périnatal : description des pratiques professionnelles en France et élaboration d’un protocole de soins. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02418239⟩

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