Balance Rehabilitation With Sensory Recalibration After Stroke (AVCPOSTIM)

• The primary outcome is the deviation of the mean position of center of pressure (CP) on the mediolateral axis (mm) assessed by posturography after intervention. [ Time Frame: day 14 ] [ Designated as safety issue: No ]
  

• Evaluation of the balance [ Time Frame: day 0 ] [ Designated as safety issue: No ]
  • Postural Assessment Scale
  • Berg Balance Scale
  • Timed Up and Go

  • Measurement performed on the platform of strength:

    • surface of the center of mass displacement
    • deviation of the mean position of the center pressure on the anteroposterior axis
    • standard deviation of the average displacement of the center pressure on the mediolateral axis and the anteroposterior axis,
    • percentage of support on the hemiplegic lower limb.
  
  
• Evaluation of the balance [ Time Frame: month 3 ] [ Designated as safety issue: No ]
  • Postural Assessment Scale
  • Berg Balance Scale
  • Timed Up and Go

  • Measurement performed on the platform of strength:

    • surface of the center of mass displacement
    • deviation of the mean position of the center pressure on the anteroposterior axis
    • standard deviation of the average displacement of the center pressure on the mediolateral axis and the anteroposterior axis,
    • percentage of support on the hemiplegic lower limb.
  
  
• Evaluation of the balance [ Time Frame: month 6 ] [ Designated as safety issue: No ]
  • Postural Assessment Scale for
  • Berg Balance Scale
  • Timed Up and Go

  • Measurement performed on the platform of strength:

    • surface of the center of mass displacement
    • deviation of the mean position of the center pressure on the anteroposterior axis
    • standard deviation of the average displacement of the center pressure on the mediolateral axis and the anteroposterior axis,
    • percentage of support on the hemiplegic lower limb.
  
  
• Evaluation of functional capacity [ Time Frame: day 14 ] [ Designated as safety issue: No ]
  • Barthel Index.
  • Number of hours of help at home
  • Total Duration of hospitalization since the Cerebral Vascular Accident
  
  
• Evaluation of functional capacity [ Time Frame: month 3 ] [ Designated as safety issue: No ]
  • Barthel Index.
  • Number of hours of help at home
  • Total Duration of hospitalization since the Cerebral Vascular Accident
  
  
• Evaluation of functional capacity [ Time Frame: month 6 ] [ Designated as safety issue: No ]
  • Barthel Index.
  • Number of hours of help at home
  • Total Duration of hospitalization since the Cerebral Vascular Accident
  
  
• Evaluation of negligence [ Time Frame: day 14 ] [ Designated as safety issue: No ]
  • bell test,
  • Bisection test,
  • scale of Catherine Bergego,
  • OTA test
  • test of bodily neglect.
  
  
• Evaluation of negligence [ Time Frame: month 3 ] [ Designated as safety issue: No ]
  • bell test,
  • Bisection test,
  • scale of Catherine Bergego,
  • OTA test
  • test of bodily neglect.
  
  
• Evaluation of negligence [ Time Frame: month 6 ] [ Designated as safety issue: No ]
  • bell test,
  • Bisection test,
  • scale of Catherine Bergego,
  • OTA test
  • test of bodily neglect.
  
  
• Understanding the mechanisms of sensory manipulations [ Time Frame: day 14 ] [ Designated as safety issue: No ]
  • Measurement of spontaneous trunk inclination (by optoelectronic system)
  • start sitting when the subject is on the platform
  • Visual Vertical (by projecting a fluorescent bar in front of the patient through a computerized system).
  • haptic Straight Ahead (using a graduated table on which the subject moves his index blindfolded.
  
  
• Understanding the mechanisms of sensory manipulations [ Time Frame: month 3 ] [ Designated as safety issue: No ]
  • Measurement of spontaneous trunk inclination (by optoelectronic system)
  • start sitting when the subject is on the platform
  • Visual Vertical (by projecting a fluorescent bar in front of the patient through a computerized system).
  • haptic Straight Ahead (using a graduated table on which the subject moves his index blindfolded.
  
  
• Understanding the mechanisms of sensory manipulations [ Time Frame: month 6 ] [ Designated as safety issue: No ]
  • Measurement of spontaneous trunk inclination (by optoelectronic system)
  • start sitting when the subject is on the platform
  • Visual Vertical (by projecting a fluorescent bar in front of the patient through a computerized system).
  • haptic Straight Ahead (using a graduated table on which the subject moves his index blindfolded.
  
  

• Time since stroke [ Time Frame: day 0 ] [ Designated as safety issue: No ]
  
• Extent of the injury and localization of brain injury [ Time Frame: month 2 ] [ Designated as safety issue: No ]
  by morphological MRI with sequences DT1, TSE T2 and flair to achieve a morphological analysis of the lesion. The MRI will be read back by central Rennes.
  
  
• Presence of negligence [ Time Frame: day 0 ] [ Designated as safety issue: No ]
  battery of five tests
  
  
• Severity of hemiplegia [ Time Frame: day 0 ] [ Designated as safety issue: No ]
  motility index, Barthel
  
  
• study the effect of vibratory stimulation by studying changes in brain activity in particular areas of interest involved in the representation of the body [ Time Frame: day 0 ] [ Designated as safety issue: No ]
  functional MRI analysis in patients included in the coordinating centre
  
  
• study the effect of vibratory stimulation by studying changes in brain activity in particular areas of interest involved in the representation of the body [ Time Frame: day 14 ] [ Designated as safety issue: No ]
  functional MRI analysis in patients included in the coordinating centre
  
  

Imbalance is particularly severe after a Cerebral Vascular Accident because they not only limit the capacity of transfer and are a source of falls but also represent an obstacle to the acquisition of autonomy.

When the brain lesion is located in the right hemisphere, the prognosis in terms of equilibrium is worse probably because of the presence of disorders of spatial cognition. These disorders of spatial cognition are manifested by a distortion of the mental representation of space and body in space that probably cause a deviation of the position of the center of pression on platform. This component of balance disorders secondary to disruption of spatial cognition, do not benefit at present from specific rehabilitative treatment despite the severity of the consequences.

But the application of sensory manipulations has proven its effectiveness on visuospatial neglect that is another disorder of spatial cognition closed to the pathophysiology of balance disorders after right brain lesion. Sensory manipulations decrease the distortion of internal representations of the body in space by restoring the symmetry of sensory inputs. Some of these manipulations (visual manipulation by wearing prisms and proprioceptive manipulations) are also effective on the immediate correction of postural imbalances on force platform and disorders of spatial perception.

We therefore believe that the approach by repeated sensory manipulation is a new promising way of research for the rehabilitative treatment of balance disorders secondary to disorders of spatial cognition. As the mechanisms of action and the structures involved during proprioceptive vibration of neck muscles and during visual prism adaptation are different, we believe that the combination of these two types of sensory manipulations will permit to obtain a greater and longer lasting effect than a lonely manipulation. The concomitant evaluation of the bias on postural platform and the perception of the body axis will allow us to assess the impact of such rehabilitation on the disorders of spatial representation and so better understand the mechanisms of action of sensory manipulations.

The main objective of this study is to test the effectiveness of a rehabilitation program with cervical vibration (V) and / or prism adaptation (P) in patients with left hemiplegia on balance at the end of the intervention (day14).

Secondary objectives are to test:

• The immediate effect (day 0) on force platform evaluation of balance,
• Maintaining the gain at 3 months and 6 months on balance,
• Effectiveness at day 14 on negligence
• Maintaining the gain at 3 months and 6 months on neglect,
• Effectiveness at day 14 on functional abilities,
• Maintaining the gain at 3 months and 6 months on functional abilities,
• Understanding the mechanisms of action of each of the sensory manipulations by assessing changes in perceptions of space, after rehabilitation programs (day 14) and at 3 months and 6 months.
• To evaluate the evolution of motility, sensitivity and spasticity in the various assessments.