Par Claire VILLEPINTE le mardi 16 Novembre 2021 à 14h Salle conférence 1er étage Pavillon Baudot CHU Purpan.
« Évaluation multidimensionnelle de la fonction du membre supérieur chez l’adulte après un accident vasculaire cérébral: Analyse des propriétés métriques de critères d’évaluation cliniques et de la performance factuelle. »
Membres du jury:
Agnès Roby-Brami – Rapporteure
Alexis Schnitzler – Rapporteur
Isabelle Bonan – Examinatrice
Philippe Marque – Examinateur
Eric Sorita – Examinateur
Pr Xavier de Boissezon Directeur de thèse
Dr. David Gasq Directeur de thèse
Stroke or cerebrovascular accident is a leading cause of disability worldwide entailing motor, sensory and psycho-cognitive impairments impacting upon quality of life. Upper-limb (UL) deficit contributes to consequences in real-life functioning across activities and participation. Present in 50 to 70 per cent of stroke survivors, somatosensory and upper motor neuron deficits impact upon normal movement, task accomplishment and adaptation to environmental demands. Measurement of UL performance is essential for judgement of change essential to rehabilitation. The International Classification for Functioning Disability and Health guides multi-faceted assessment of heterogenous UL consequences. Even if examination of outcome measurement properties is gaining increased attention, lack of standardization, linguistic issues and availability limit clinical implementation. Task and ecologically-based assessment warrants an interest for actual performance of individualized goals; yet lack of objective and quantified measures of movement quality prevails. This research aimed to examine comprehensive and standardized assessment of sensorimotor components of UL performance applicable to clinical and real-life setting. Three research axes were defined to investigate: 1) measurement properties of outcomes according to translation and cross-cultural adaptation (TCCA) and validation; 2) trends and responsiveness of kinematic and clinical measures and; 3) task and ecologically-based assessment of actual performance. First, an observational study enabled the development a somatosensory assessment according to TCCA for standardized and comprehensive assessment of somatosensory function in French based on the examination of measurement properties. Next, a systematic review and meta-analysis identified trends and responsiveness of combined kinematic and clinical measures. Finally, an exploratory study based on previous axes, enabled standardized task and ecologically-based assessment of actual performance and preliminary metrics. The overall results of this thesis supported standardized assessment and ongoing examination of measurement properties contributing to precise measurement of performance and rehabilitation. Finally, results supported standardized assessment of individualized tasks of performance in daily life in conjunction with impairment and capacity measures for comprehensive measurement of meaningful rehabilitation with ecological validity. Future studies of UL function in daily activities should investigate use of cognitive strategies for multifactorial assessment of performance.
Keywords: stroke, upper-limb, assessment, measurement properties, performance, ecological, outcome.