Le vieillissement démographique français constitue un défi majeur de santé publique. Il se caractérise par des changements physiologiques pouvant provoquer des troubles moteurs. Il en résulte à plus ou moins long terme une perte d'autonomie nécessitant parfois l'institutionnalisation de la personne. L'examen des déficits posturaux se réalise en pratique clinique courante par une évaluation stabilométrique. L'enregistrement des déplacements du centre des pressions peut être analysé selon deux approches : la première, traditionnelle, analysant leur cinématique à l'aide de statistiques descriptives ; la seconde, dynamique, quantifiant leur complexité notamment en termes de régularité. Dans ce travail, nous montrons statistiquement la complémentarité de ces deux approches. Nous mettons également en évidence les intérêts cliniques de l'approche dynamique au travers de deux études : (i) une exploration de la relation entre les résultats d'un test fonctionnel validé et l'évaluation posturale chez des femmes âgées sédentaires ; (ii) une comparaison basée sur une analyse dynamique des fluctuations posturales de deux groupes de personnes âgées institutionnalisées : avec et sans antécédents de chute. / In France, aging is a major public health challenge. Specific aging-associated physiologic modifications can produce movement disorders and lead to dependency and institutionalization in nursing homes. Clinical examination of postural deficits is generally achieved by means of stabilometric evaluation. Recordings of center of pressure (COP) displacements can be analyzed in two ways : (i) a classical approach based on kinematics and descriptive statistics or (ii) a dynamical approach which provides a quantification of the complexity of COP time series in terms of regularity. In this work, we statistically show the complementarity of these two approaches. We also highlight the clinical interest of the dynamical approach with two clinical studies : (i) an exploration of the relationship between a functional test and postural evaluation in asymptomatic sedentary older women ; (ii) a comparison of institutionalized elderly non-fallers and fallers based on a dynamical analysis of COP fluctuations.

Ergonomics aims to improve worker health and enhance productivity and quality. Knowledge and practical evidence of this relationship would be instrumental for optimising organisational performance particularly in industrially developing countries where the discipline is still in its developmental stages. Therefore this thesis set out to analyse the relationship between ergonomics deficiencies and performance. A survey was first conducted to establish the severity of quality problems in the South African manufacturing industry and to determine if these were related to Ergonomic deficiencies. The results indicated that quality problems continue to plague industry, a challenge associated with huge cost implications. Furthermore organisations were not cognisant of the fact that ergonomics deficiencies such as poor workstation design and awkward or constrained working postures are a major contributing factor to poor quality and performance decrements. This demonstrates that much is yet to be done in raising awareness about the benefits of ergonomics in South Africa and other industrially developing countries. However, for this to be effective, tangible evidence of these purported benefits is required. In lieu of this, a laboratory study was then conducted to establish the relationship between awkward working postures and the performance of precision tasks. Acknowledging that the task and the worker are interrelated elements, the impact of precision task demands on the postural strain experienced by the human was also investigated. A high and low precision task quantified positional precision while a force task (combination of pushing and pulling) was utilised to assess the ability to maintain a precise force over time. These three tasks were performed in eight different postures; namely seated, standing, stooping 300 and 600, working overhead, lying supine, and twisting to either side. A combination of the tasks and postures resulted in 24 experimental conditions that were tested on forty eight healthy male and female participants. The performance related dependent variables were movement time, deviation from the centre of the target, and the trend/slope followed by the force exerted. Muscle activity of eight arm, shoulder and back muscles, iii supplemented with heart rate and local ratings of perceived exertion, were utilised to quantify the impact of the tasks and the postures on the individual. The results revealed that awkward working postures do in fact influence performance outcomes. In this regard, awkward working postures (such as overhead work and lying supine and stooping) were evidenced to significantly affect movement time, deviations from the target and the ability to maintain a constant force over time. These variables have a direct relationship with organisational priorities such as productivity and quality. Furthermore, the results indicated that high precision demands augment postural strain elicited through high muscle activity responses and may have negative implications for the precipitation of musculoskeletal disorders. Essentially, the work done on this thesis reflected the complex nature of ergonomics by drawing on both macro and micro-ergonomics approaches. In so doing, challenges perceived to be relevant to industry as reported by organisations formed the foundation for further laboratory studies. Therefore, more collaborative research and knowledge transfer between industry and ergonomics researchers is a necessity particularly in industrially developing countries where ergonomics is still in its developmental stages.

L’exil est un fait d’actualité qui concerne un grand nombre d’individus, il est aussi un sujet littéraire fréquent, car plusieurs auteurs l’ont vécu que ce soit par choix ou par obligation. Nous avons choisi dans cette thèse d’explorer l’enjeu de la question de l’exil dans la construction de la posture d’auteur chez Edward Said qui a fait de l’exil le thème central de sa réflexion et de son écriture. L’exil est pour Said une expérience qui mène à une condition interculturelle complexe avec une composante psychologique et une nostalgie qui génèrent une écriture tournée essentiellement vers l’élucidation des origines et la création d’un lieu d’habitat. Toutefois l’exil est un lieu de création et d’ouverture au monde qui permet d’appartenir à plusieurs univers sans être totalement d’aucun et de se positionner en « outsider ». Notre corpus d’étude est constitué, notamment de 46 essais et articles rédigés par Said entre 1965 et 2000, réunis dans son recueil Réflexions sur l’exil et autres essais. Nous avons choisi l’approche méthodologique qui considère la posture d’auteur comme un outil d’analyse permettant un double terrain d’observation : un terrain interne, avec la constitution de l’image de l’énonciateur dans le texte, et un terrain externe sur la présentation de soi qu’incarne l’auteur dans son rôle public. L’expérience de l’exil vécue et présente dans le discours et la pensée de Said l’a conduit à composer son identité auctoriale, à configurer son image d’auteur et enfin à construire sa posture d’auteur et sa singularité intellectuelle exilique. Sa posture d’auteur se définie en une multitude de postures : la posture critique et autocritique où Said s’interroge en essayiste sur lui-même et interprète son environnement sociologique, politique et culturel ; la posture humaniste où l’homme est au centre de son discours, il l’appelle à l’esprit critique et à la recherche de la vérité ; la posture anticoloniale où il défend les peuples opprimés et pourfend le colonialisme. Les postures de Said, qu’il nous a présentées et que nous avons perçues, ne sont ni contradictoires ni incohérentes, elles sont imprégnées de son statut d’exilé. / Exile is an event in which large number of individual are concerned, it is also a frequent literary subjects for several authors that lived in exile whether forced or by choice. We chose in this thesis to explore the issue of exile in the creation of the author posture, Edward Said who made exile the central theme of his reflection and writing. Exile for Said was an experience, which led him to a complex intercultural reflection, psychological and nostalgic components that was reflected on his writing and was the origin of the creation of his place in the surrounding world. However, exile creates an opening to the world and allows him to belong to several universes without being totally of any, nor feels as an “outsider” to any. Our body of study consisted particularly of 46 essays and articles that were drafted by Said between 1965 and 2000 were gathered in the collection and essays of Reflections on the exile”. We chose the methodological approach which considered the author posture as a tool of analysis allowing a double observations: an internal ground with the constitution of the image of the enunciator in the text, and an external ground on the presentation of the one whom embodies the author in his public role. The real-life and present experience of the exile in the speeches and the thoughts of Said led him to compose his auctorial identity and to configure his own image and finally to build his author posture and its intellectual exilic particularity. His author’s posture is defined in a multitude of postures: the critical posture and self-criticism where Said wonders his essay son himself and interprets his sociological, political and cultural environment; the humanistic posture where the man is in the center of his speech, he calls him the critical mind and in search of the truth; the anticolonial posture where he defend the oppressed people and assails the colonialism. The postures of Said, which he presented us and which we perceived, are neither contradictory nor inconsistent; they are filled with his exile status.

Dans la partie introductive de cette thèse sont illustrés le cadre théorique dans lequel se situent les études sur la reconnaissance du soi corporel. En outre, ce chapitre traite de la façon dont la reconnaissance visuelle des visages et des corps, et de la spécificité de la reconnaissance de son propre visage et de son propre corps, s’effectuent. Le deuxième chapitre décrit une étude menée chez des sujets sains, qui examine l'excitabilité du cortex moteur primaire dans le processus de reconnaissance de soi et de l’autre. Le troisième chapitre illustre l'expérience réalisé pour étudier la contribution du mouvement dans la reconnaissance du soi corporel chez des sujets neurologiquement sains et chez les patients avec lésion cérébrale de l’hémisphère droit. Le quatrième chapitre porte sur le développement du soi corporel chez les enfants avec un développement atypique, souffrant de troubles du spectre autistique à haut fonctionnement, avec une attention particulière au rôle des émotions dans la reconnaissance de postures émotionnels, propres et autrui. Enfin, le cinquième chapitre est consacré au rôle du geste dans la reconnaissance du propre corps et celui des autres / The first chapter describes the theoretical framework of self-body recognition and the processing that allow us to distinguish one’s own body and face from body and face of someone else. The second chapter will investigate motor cortex excitability during self/other recognition processing in healthy subjects. The results show an increment of motor corticospinal excitability in the right hemisphere following the presentation of self stimuli (hand and phone), at 600 and 900 ms after stimulus presentation, providing evidences about neural substrates and temporal processes underlying self-body recognition. The third chapter will describe the role of the movement in self bodily recognition in healthy subjects and in patients with right brain damage. The evidence show that patients, who did not show the advantage in the implicit recognition of self static body parts, present this advantage in the implicit recognition of self dynamic body parts. The fourth chapter focuses on the development of the bodily self in children with typical development and in children with autism, with respect to the recognition of self/other emotional body postures. First, this study shows that the advantage in bodily self processing is preserved in children with autism. Second, emotional body postures modulated self and others body processing in typically developing children, as well as in children with autism. The fifth chapter deals with the role of hand gestures in self/other bodily recognition processing, showing that the meaning of a gesture modulates the self/other processing. The processing of others’ hand is facilitated with meaningful compared to meaningless gestures

Chez les plantes, la croissance est essentielle à la régulation de la forme de tout organe en développement. A l'échelle de la cellule, la croissance résulte de la compétition entre la pression interne de la cellule et la rigidité de sa paroi. Des hétérogénéités de ces grandeurs à l'échelle du tissu mènent alors à une croissance différentielle puis à des mouvements à l'échelle de l'organe entier. Ces mouvements macroscopiques peuvent être interprétés comme une manifestation des processus de croissance microscopiques. Nous proposons de mettre à profit ce lien entre croissance et mouvements afin d'approcher la croissance d'une nouvelle manière : de l'organe à la cellule. Nos travaux portent sur les feuilles composées d'Averrhoa carambola qui montrent deux mouvements typiques des feuilles en croissance,le déroulement et la nutation. Nous montrons dans un premier temps que la forme de la feuille en croissance est régulée de manière active. Nous étudions ensuite la cinématique du déroulement et de la nutation. Ce faisant, nous mettons en évidence une relation particulière entre croissance et croissance différentielle à partir de laquelle nous construisons un modèle cinématique de nutation. Conformément à de précédents résultats, ce modèle suggère que la croissance peut s'accompagner de contractions locales. Enfin, à l'échelle du tissu, la mécanique des parois cellulaires et leur composition sont étudiées. Nos résultats révèlent des hétérogénéités spatiales de ces deux paramètres au sein de la feuille, potentiellement cohérents avec la direction du mouvement de nutation. / In plants, growth is essential to the shape regulation of developing organs. It is also the key for every plant to adapt to its environment. At the cell level, growth relies on a competition between the inner pressure of the cell and the rigidity of its cell wall. Heterogeneities of these quantities across the tissue can result in differential growth and lead to motions of the whole organ. These macroscopic motions can thus be read as an outward signal of the cellular mechanisms underlying shape regulation and growth itself. Here, we propose to take benefit from this link between growth and motions to gain a new insight on growth through a multiscale approach, from the organ to the cell wall. We focus on the compound leaves of Averrhoa carambola which display two marked motions, unfurling and nutation, widespread among developing leaves. First, we show that the shape of the leaf results from an active regulation of its macroscopic mechanical properties. The kinematics of the two latter motions are then compared to the associated growth. Doing so, we put forward the specific patterns of growth and differential growth underlying the development of the leaf. Based on these results, we build a kinematic model for nutation which, accordingly with previous findings, suggests the occurrence of local contractions during growth. At the cell wall level, our results reveal spatial heterogeneities of both its rigidity and biochemical status within the leaf. These heterogeneities might be consistent with the direction of the nutation.

Les fonctions locomotrices et posturales sont contrôlées par un ensemble de réseaux neuronaux qui doivent interagir afin de produire un comportement locomoteur optimal, adaptable aux contraintes internes et externes de l’organisme. Le maintien d’un équilibre dynamique au cours de la locomotion repose sur des processus internes de coordination entre les réseaux nerveux spinaux et supraspinaux qui commandent les différents segments du corps (membres, tête et tronc). C’est dans ce contexte que nous nous sommes intéressés aux interactions entre la fonction locomotrice et la fonction posturale, sur des préparations réduites de tronc cérébral-moelle épinière de rats nouveau-nés, au sein desquelles les CPGs locomoteurs spinaux et les noyaux vestibulaires sont intacts. Des approches combinées électrophysiologiques, pharmacologiques, neuroanatomique et lésionnelles nous ont permis de mettre en évidence une partie des mécanismes à l’origine du couplage entre les différents réseaux neuronaux étudiés. Dans cette étude nous avons montré que les réseaux locomoteurs lombaires contrôlent l’activité des réseaux thoraciques axiaux, de manière à produire une activation coordonnée des réseaux moteurs des membres et du tronc. Cette coordination est sous influence des entrées supraspinales. Les amines induisent une organisation temporelle spécifique de l’activité des réseaux thoraco-lombo-sacrés, et les informations en provenance des noyaux vestibulaires influencent le rythme locomoteur. Ces données apportent des éléments nouveaux concernant les processus neuronaux à l’origine de la coordination des réseaux moteurs et posturaux. / Locomotor and postural functions are controlled by a set of neural networks that must interact to produce optimal locomotor behavior, adaptable to internal and external constraints of the body. Maintaining a dynamic balance during locomotion is based on internal coordination processes between spinal and supraspinal neuronal networks controlling different parts of the body (limbs, head and trunk). In this context, we have interested in the interactions between locomotor and postural functions, in spinal and supraspinal networks. The experiments were conducted on isolated brainstem-spinal cord preparations from neonatal rats, in which the spinal locomotor CPGs and the vestibular nuclei are intact. Electrophysiological, pharmacological, and neuroanatomical approaches allowed us to highlight some of the mechanisms involved in the coupling of the different neural networks. In this study we showed that the lumbar locomotor networks control the activity of axial thoracic networks, in order to produce a coordinated activation of motors networks of limbs and trunk. This coordination is modulated by amines and information from the vestibular nuclei. These data provide new evidence for spinal mechanisms involved in the coordination of motor and postural networks.

Les patients présentant une pathologie rachidienne dégénérative témoignent généralement de douleurs ayant un retentissement sur leurs capacités locomotrices. L’évaluation préopératoire des individus repose actuellement sur la réalisation d’auto-questionnaire déclaratifs validés qui permettent d’approximer l’état fonctionnel. Aucun consensus sur l’analyse des résultats d’une chirurgie rachidienne n’est actuellement établi. Les capacités fonctionnelles réelles sont intéressantes pour étudier l’impact des pathologies rachidiennes. L’évaluation des capacités locomotrices et fonctionnelles de manière quantitative pourrait être utilisé afin d’améliorer la prise en charge des patients. L’objectif de cette thèse est d’utiliser l’évaluation des capacités locomotrices des patients comme marqueur des capacités fonctionnelles pour décrire une sémiologie quantifiée des patients candidats à une chirurgie du rachis.Matériels et méthodes :Mise en place du projet SPEED (Évaluation quantitative de la motricité avant et après une chirurgie du rachis chez les patients atteints de pathologie rachidienne dégénérative). Ce protocole prospectif a été mis en place en 2016 avec une période d’inclusion de 2 ans. Au total 40 patients ont été inclus dans cette étude. Les données présentées dans ce manuscrit correspondent aux études ancillaires de nos résultats. Cette thèse se compose de 4 articles principaux : évaluation quantitative clinique puis radiologique des patients, modélisation de l’équilibre sagittal permettant une quantification de l’équilibre sagittal dynamique, et méta-analyse sur la capacité discriminante de l’analyse quantifiée du mouvement au sujet du mouvement du tronc et du pelvis.Résultats :Premièrement, pour la partie clinique, nous trouvons un décalage important entre les limitations perçues et celles réelles des capacités de marche chez les patients atteints de canal lombaire étroit. L'évaluation directe de la vitesse de marche libre est plus pertinente que le périmètre de marche car elle est corrélée à l'état fonctionnel et est plus facile à mettre en œuvre dans la pratique.Deuxièmement, concernant l’analyse radiologique, nous trouvons une amélioration de l'équilibre sagittal et de la lordose lombaire après une chirurgie de décompression lombaire postérieure sans fusion. Cette amélioration est surtout retrouvée chez des patients qui présentent des troubles posturaux antalgiques liée à la sténose lombaire. Cette compensation antalgique est difficile à différencier des troubles statiques avec nos outils de mesure actuels.Troisièmement, concernant l’analyse du mouvement, nous avons réalisé la première étude montrant que les paramètres de mouvement 3D peuvent estimer correctement la « sagittal vertical axis » calculée sur l'imagerie. De plus, cette estimation pourrait être utilisé lors de l'analyse de la marche et nous pensons qu'un tel type d'analyse permettrait de mieux caractériser les déficiences des patients.Quatrièmement, concernant l’analyse quantifiée tronc/pelvis, nous confirmons que les patients lombalgiques présentent une coordination tronc/pelvis différente dans le plan transverse au cours de la marche. De plus, notre méta-analyse confirme et révèle cette différence significative en montrant une coordination plus en phase pour les patients lombalgiques par rapport aux sujets en bonne santé pendant la marche. La coordination entre ces mouvements est plus rigide en présence de lombalgie et refléterait les adaptations neuromusculaires nécessaires pour adopter un comportement de protection sans douleur pendant la marche. / IntroductionPatients with degenerative spinal pathology generally report pain that affects their locomotor abilities. The preoperative assessment is currently based on the completion of validated self-questionnaire declarations that allow to approximate the functional state. No consensus on analyzing the results of spinal surgery is currently established. The actual functional capacities are interesting to study the impact of spinal pathologies. The evaluation of locomotor and functional capacities in a quantitative way could be used to improve the management of patients. The aim of this thesis is to use the evaluation of patients' locomotor capacities as a marker of functional abilities to describe a quantified semiology of patients who are candidates for spine surgery.Materials and methods:Implementation of the SPEED project (Quantitative motor capacities evaluation before and after spinal surgery in patients with degenerative spinal pathology). This prospective protocol was implemented in 2016 with an inclusion period of 2 years. 40 patients were included in this study. The data presented in this manuscript correspond to the preliminary studies of our results. This thesis is composed with 4 main researches: clinical and radiological quantitative evaluation of the patients, sagittal equilibrium modeling allowing a quantification of the dynamic sagittal equilibrium, and meta-analysis on the discriminant capacity of the quantified analysis of the movement about the movement of the trunk and pelvis.Results:First, for the clinical part, we find a significant gap between perceived and actual limitations of walking ability in patients with lumbar spinal stenosis. The direct evaluation of the comfortable walking speed is more relevant than the walking perimeter because it correlates to the functional state and is easier to implement in practice.Second, concerning radiological analysis, we find an improvement in sagittal balance and lumbar lordosis after posterior lumbar decompression without fusion. This improvement is mostly found in patients with postural analgesic disorders related to lumbar stenosis. This analgesic compensation is difficult to distinguish from static disorders with our current measurement tools.Third, regarding motion analysis, we performed the first study showing that 3D motion parameters can correctly estimate the sagittal vertical axis computed on imaging. In addition, this estimate could be used during the gait analysis and we believe that such a type of analysis would better characterize patients' impairments during walking.Fourth, concerning the quantified trunk / pelvis analysis, we confirm that low back pain patients have different trunk / pelvis coordination in the transverse plane during walking. In addition, our meta-analysis confirms and reveals this significant difference by showing more in-phase coordination for low back pain patients compared to healthy subjects during walking. The coordination between these movements is more rigid in the presence of low back pain and reflects the neuromuscular adaptations necessary to adopt a painless protection behavior during walking.Conclusion:Quantitative analysis of function and locomotion through the use of different functional and dynamic measures provides a better assessment of patients. This analysis can be done through complementary walk tests that are easy to implement in our daily practice, but also by new technologies using motion analysis.

Purpose: 1, to determine effect of education and exercise on neck pain, disability, cervical posture and muscle function in office workers with sub-clinical neck symptoms; 2, to determine differences in forward head posture in preferred and standardized posture, and 3, to explore the influence of time on work posture in a sub-group of office workers. Subjects: Sixty-six office workers with sub-clinical neck symptoms who utilize computers at least 4 hours per day participated. A sub-group of 27 were videotaped to assess posture over a workday. Methods: Videotaping was performed 15 minutes of the first and last hour of the workday for analysis of the craniovertebral angle. Cervical posture using the CROM was measured on all subjects in standardized and preferred positioning of the trunk and lower extremities. Subjects were randomly assigned to one of three groups: education only (EOG), education and exercise (EEG), or control (CG). Pre and post-test measurements of pain (Visual Analog Scale), disability (NeckDisability Index), forward head posture (FHP), and deep cervical flexor muscle function (Craniocervical Flexion Test and Short Neck Flexor Endurance Test) were assessed for change within group as well as differences between groups over the 8 week period. Results: No difference was found for FHP over 8 hours in the subgroup. FHP was greater in preferred position compared to standardized by 7.59 mm (95% CI 6.27-8.92, p<.001). Median and mean scores improved for all 3 groups on pain and disability with greater improvement in intervention groups. FHP was unchanged/slightly worse in the CG and EOG, and improved in the EEG. Muscle function improved for the EEG. Statistical significance was not found for change scores between groups. Posttest scores were statistically significant for the NDI between EEG (20.45) and the CG (34.47), p=.042, and between the EEG and the EOG (34.59), p=.023 using Kruskall Wallis with adjusted significance for pairwise comparisons. Discussion/Conclusions: Posture over the workday did not change, differences were found based on preferred and standardized positions. Exercise and education intervention for those with sub-clinical neck symptoms show promise but did not demonstrate significance improvement over controls in this study.

Cette thèse se propose de comprendre la réception de Maurice Barrès (1862-1923) des premières années de sa carrière au lendemain de la Seconde Guerre mondiale, en insistant sur différents « moments » de cette réception. Il s’agit d’abord de comprendre comment se constitue son autorité d’écrivain, dans le contexte des milieux symbolistes des années 1890. Nous étudions notamment les rapports de Barrès avec les rédacteurs de La Revue blanche – des rapports qui définissent l’identité même de la revue – jusqu’à la rupture de l’affaire Dreyfus. Nous nous intéressons ensuite à sa réception au sein de La NRF, à travers les lectures – à la fois critiques et fascinées – qu’en font trois figures majeures de la revue : André Gide, Albert Thibaudet et Jacques Rivière. De même, nous tentons de comprendre comment les surréalistes ont gardé un lien ambigu avec cet écrivain au cours des années 1920, en étudiant de plus près le procès Barrès (mai 1921) et la réception particulière que fait Louis Aragon de cette figure, dans sa phase surréaliste, mais aussi dans la suite de sa carrière. Enfin, nous terminons par étudier le cas particulier de Joseph Delteil, écrivain proche du surréalisme, mais dont la position est tiraillée entre ancrage régionaliste et avant-garde, et qui trouve dans l’exemple barrésien un modèle (provisoire) de résolution de ces contradictions. L’étude de cette réception, à travers les exemples cités, se donne ainsi pour but de comprendre comment une posture d’auteur a pu essaimer dans des milieux idéologiques et esthétiques opposés au traditionalisme, et à travers des manifestations ambiguës de fidélité littéraire. / The purpose of this Dissertation is to understand the reception of Maurice Barrès (1862-1923), going from the first years of his career to the aftermath of the Second World War, while insisting on specific “moments” of this reception. This will firstly be done by comprehending how a writer’s authority is shaped, in the context of 1890’s Symbolist milieu. Consequently, we will analyse the relationships between Barrès and the copywriters of the La Revue blanche going till the clash caused by the Dreyfus affair. We will then take interest in his reception within the La NRF, through the interpretation that made three major figures of the review: André Gide, Albert Thibaudet and Jacques Rivière – readers that were both critic to the nationalist writer as fascinated by his auctorial posture. At the same time, we will try to understand how the Surrealists have kept an ambiguous tie with this writer during the 1920’s, by closely studying Barrès’s trial (May 1921) and the particular welcome that Louis Aragon gave to this figure, during his surrealist phase, but also during the rest of his career. Finally, we will finish by analysing the particular case of Joseph Delteil, a writer close to Surrealism but whose position was torn between his regionalist grounding and an avant-garde one, and who finds through Barrès a model of resolution of these contradictions. The study of Barrès’s reception, by means of the quoted cases, is thus made in the purpose of understanding how an author’s posture was able to dispense, in the ideologist and esthetical milieu opposed to traditionalism, as well as among the ambiguous manifestations of the literary loyalty.

Introduction: The Modified Mallampati Tongue score is a quick and reliable method commonly used in anesthesiology to assess airway patency and predict the ease of intubation. Modified Mallampati Tongue scores range from I – IV with higher Mallampati scores being associated with more difficult intubations as well as increased sleep-disordered breathing, such as obstructive sleep apnea. The Mallampati Tongue score is determined by visibility of the oropharynx when the mouth is opened as wide as possible with the tongue maximally protruded and is directly affected by the position of the tongue. The tongue is an influential muscle to the craniofacial complex; it plays an essential role in the development of the dentoalveolar structures, and its position affects airway volume which influences natural head posture, which influences craniofacial growth. Objective: The primary aims of this study were to identify if any associations exist between Modified Mallampati Tongue scores (I-IV) and 1) craniofacial sagittal and vertical relationships of the jaws and 2) craniofacial head posture (including the postural relationships of the cervical vertebrae, hyoid bone, cranium, and tongue). A secondary aim was to identify if any associations exist between Modified Mallampati Tongue score and age, sex, or race/ethnicity. Methods: This retrospective study included 400 subjects from the Temple University Kornberg School of Dentistry Department of orthodontics who had pre-orthodontic treatment diagnostic records obtained from June 1st 2020 through September 1st 2021. Each patient’s Modified Mallampati Tongue score (I-IV) was recorded in an intraoral photograph of maximum mouth opening with tongue protrusion. All lateral cephalograms were traced in Dolphin Imaging and Amira Morphometrics Software by two examiners tracing 200 subjects each. The craniofacial morphological features were analyzed through the Steiner, Wits, and McNamara analyses for assessment of the sagittal relationships of the maxilla and mandible and by the Jarabak analysis for assessment of the vertical relationships and divergence. Craniofacial head posture was assessed through an analysis that represents the postural relationships of the cervical vertebrae, cranium, length/height of the tongue, and position of the hyoid bone. For statistical analysis, One-way ANOVA, Pearson’s correlation, and Chi-square tests were conducted. Probability values of <0.05 were considered significant. Results: Overall, this study included 400 subjects with ages ranging from 7-73 years old (mean age of 17.99 years), of which there were 288 females (72%) and 112 males (28%). Of the 400 subjects, 60% (241) were African American, 32% (127) Hispanic, 7% (26) Caucasian, and 2% (6) Asian. The most prevalent Modified Mallampati Tongue Score was III (142 subjects, 36%). Out of all of the craniofacial morphology and head posture variables compared against Modified Mallampati Tongue scores (I-IV), significant findings from the one-way ANOVA tests included vertical position of the hyoid bone to the neck, vertical position of the hyoid bone to the mandible, ANB, and Wits values. Higher Mallampati Tongue scores were associated with higher ANB and higher Wits values. Greater Mallampati scores were associated with increased vertical distance of the hyoid bone to the mandible and to the neck, meaning a lower position of the hyoid bone. In addition, correlations that were statistically significant given a 95% confidence interval, included significant positive correlations between Mallampati Tongue score and increased ANB, Wits, and distance of the hyoid to the mandible and to the neck. Pearson’s Correlation Index also showed a significant negative correlation between Mallampati Tongue scores and craniofacial morphology values for SNB and pogonion to nasion-perpendicular, showing that increased Modified Mallampati Tongue scores correlate with more retrognathic mandibles. When evaluating the results of the Chi-Square analyses, there were no significant differences between Modified Mallampati Tongue score and race/ethnicity or age, but there was a significant difference between genders showing that women were more likely to have lower Mallampati Tongue scores than men. Inter-examiner and intra-examiner reliability for the craniofacial head posture measurements, craniofacial morphology measurements, and Modified Mallampati Tongue scores were excellent (correlation coefficients: 0.84 – 0.99). Conclusions: This study reveals that a higher Modified Mallampati Tongue score correlates with higher ANB and Wits values, meaning that higher Modified Mallampati Tongue scores are associated with a Skeletal Class II relationship of the jaws, which could be due to retrognathic mandibular growth. In addition, a higher Modified Mallampati Tongue score is significantly associated with increased distance of the hyoid bone to the mandible and to the neck. This study also found women more likely to have lower Modified Mallampati Tongue scores than men. The results of this study allude to the potential for Mallampati Tongue scores to be used as predictors of Class II skeletal sagittal growth which would ultimately help with orthodontic treatment planning decisions and enhance overall treatment outcomes. / Oral Biology