Notre objectif était de rechercher une méthode d’évaluation musculaire afin de déterminer des facteurs de non réponse tissulaire à une injection de toxine botulique (TB) dans un muscle spastique, chez l’adulte post AVC et chez l’enfant paralysé cérébral (PC). Une étude de reproductibilité et 3 revues systématiques de la littérature ont été réalisées. Les mesures échographiques de l’épaisseur et de l’angle des pennation des fibres du muscle gastrocnémien médial en 2D sont reproductibles. La mesure du module d’élasticité par Shear Wave Ultrasound Elastography délivre une information fiable sur la rigidité du muscle gastrocnémien médial spastique au repos.L’analyse du devenir du muscle post-injection rapporte que la TB participe au remodelage du muscle spastique avec une atrophie persistante, répétition d’injections dépendante.L’étude de l’impact des traitements adjuvants à la TB chez l’enfant PC montre que le renforcement musculaire intensif, y compris des muscles injectés, permet de lutter contre l’atrophie sans renforcer la spasticité. Les plâtres d’allongement permettent d’optimiser le fonctionnement articulaire mais les preuves sur la diminution de la raideur musculaire restent faibles. Dans la description des facteurs pronostics d’efficacité, plus de la moitié des patients identifiés comme secondairement non-répondeurs à la TB dans la spasticité des membres ne sont pas immunisés contre la TB. Les anticorps neutralisants ne sont donc pas la principale cause de non-réponse secondaire. Une évaluation de la qualité musculaire échographique comme facteur pronostic de réponse à la TB et pour mesurer l’impact des traitements adjuvants devrait être réalisée régulièrement afin de déterminer à quel moment ces traitements ne sont plus favorables au système musculaire. / The aim was to investigate a muscle evaluation method to determine tissue factors leading to non-responsiveness to an injection of botulinum toxin (BTX) into a spastic muscle in adult post stroke and children with cerebral palsy (CP). A reproducibility study and 3 systematic literature reviews were carried out. 2D ultrasound measurements of thickness and pennation angle of medialis gastrocnemius muscle fibers are reproducible. Measurement of the modulus of elasticity by shear wave ultrasound elastography provides a reliable information about the rigidity of the spastic medial gastrocnemius muscle at rest.Analysis of the post-injection muscle fate found that BTX participates in the remodeling of the spastic muscle with persistent atrophy that is dependent on the repetition of the injections.Analysis of the impact of BTX adjuvant therapies in CP children showed that intensive muscle strengthening, including of the injected muscles, may help combat atrophy without increasing spasticity. Stretching casts are used to optimize joint function, but there is little evidence for a reduction in muscle stiffness. In the description of prognostic efficacy factors, more than half of patients identified as secondariy non-responders to BTX in limb spasticity tests were not immunized against BTX. Neutralizing antibodies were therefore not the main cause for secondary non-responsiveness. An ultrasound evaluation of muscle quality as a prognostic factor for BTX response and to measure the impact of adjuvant treatments must be regularly performed to determine when these treatments are no longer favourable for the muscle system.

This dissertation presents a new 2D ultrasound-based visual servoing method. The main goal is to automatically guide a robotized 2D ultrasound probe held by a medical robot in order to reach a desired cross-section ultrasound image of an object of interest. This method allows to control both the in-plane and out-of-plane motions of a 2D ultrasound probe. It makes direct use of the 2D ultrasound image in the visual servo scheme, where the feed-back visual features are combinations of image moments. To build the servo scheme, we develop the analytical form of the interaction matrix that relates the image moments time variation to the probe velocity. That modeling is theoretically verified on simple shapes like spherical and cylindrical objects. In order to be able to automatically position the 2D ultrasound probe with respect to an observed object, we propose six relevant independent visual features to control the 6 degrees of freedom of the robotic system. Then, the system is endowed with the capability of automatically interacting with objects without any prior information about their shape, 3D parameters, nor 3D location. To do so, we develop on-line estimation methods that identify the parameters involved in the built visual servo scheme. We conducted both simulation and experimental trials respectively on simulated volumetric objects, and on both objects and soft tissues immersed in a water-filled tank. Successful results have been obtained, which show the validity of the developed methods and their robustness to different errors and perturbations especially those inherent to the ultrasound modality. Keywords: Medical robotics, visual servoing, 2D ultrasound imaging, kinematics modeling, model-free servoing.

The work deals with design and implementation of 2D ultrasound simulation. Applications of the ultrasound simulation can be found in medicine, biophysic or image reconstruction. As an example of using the ultrasound simulation we can mention High Intensity Focused Ultrasound that is used for diagnosing and treating cancer. The program is part of the k-Wave toolbox designed for supercomputer systems, specifically for machines with shared memory architecture. The program is implemented in the C++ language and using OpenMP acceleration.  Using the designed solution, it is possible to solve large-scale simulations in 2D space. The work also deals with merging and unification of the 2D and 3D simulation using modern C++. A realistic example of use is ultrasound simulation in transcranial neuromodulation and neurostimulation in large domains, which have more than 16384x16384 grid points. Simulation of such size may take several days if we use the original MATLAB 2D k-Wave. Speedup of the new implementation is up to 8 on the Anselm and Salomon supercomputers.