Les enfants atteints de paralysie cérébrale unilatérale spastique ont un membre supérieur dont les mouvements sont dégradés. Un des symptômes en cause est la co-activation spastique, une activation excessive de certains muscles qui s’opposent au mouvement. En clinique, il n’existe pas d’outil pour distinguer quels muscles ont une activation pathologique. Les signaux électromyographiques, mesurés de façon non invasive, peuvent discriminer des activations musculaires pathologiques. Cependant, ils sont rarement mesurés au membre supérieur des enfants atteints de paralysie cérébrale, en raison d’obstacles méthodologiques et statistiques. Cette thèse aborde ces obstacles. Les signaux électromyographiques de muscles du membre supérieur ont été mesurés chez 63 enfants avec et sans paralysie cérébrale unilatérale spastique, dans le cadre de 5 études de recherche. Les 2 premières études ont consisté à détecter et caractériser les anomalies de commande musculaire chez les enfants avec une paralysie cérébrale, afin de cibler les paramètres électromyographiques pertinents. La 3ème étude a validé la mesure électromyographique au membre supérieur, en évaluant sa variabilité. Les 4ème et 5ème études ont appliqué la méthodologie développée à des problématiques cliniques : distinguer, pour chaque enfant, les muscles responsables des limitations de mouvements actifs ; évaluer les modifications d’activation musculaire à la suite de thérapies. Le développement méthodologique lié à ces études a permis d’évaluer la fiabilité de l’analyse électromyographique du membre supérieur, et a montré son fort potentiel pour le « diagnostic fonctionnel » des enfants atteints de paralysie cérébrale. / Children with unilateral spastic cerebral palsy have restricted movement of one upper limb.One of the symptoms responsible for this limitation is spastic co-activation, which is an excessive activation from specific muscles opposing the movement. In clinical routine, no tool can detect which muscles have a pathological activation.Electromyographic signals, measured non-invasively, can discriminate pathological muscle activations.However, they are rarely measured at the upper limb of children with cerebral palsy, due to methodological and statistical difficulties. This thesis addresses these difficulties. Electromyographic signals of upper limb muscles were measured in 63 children with and without unilateral spastic cerebral palsy, as part of 5 research studies.The first two studies consisted in detecting and characterizing abnormal muscle activations in children with cerebral palsy, in order to target relevant electromyographic parameters. The third study validated the measure of upper limb electromyography, and evaluated its variability.Fourth and fifth studies applied the developed methodology to clinical problems: the distinction, for each child, of the muscles responsible for active movement restrictions; the evaluation of muscle activation modifications following a therapy.Methodological development associated with these studies assessed the reliability of upper limb electromyography, and showed its strong potential for the “functional diagnosis” of children with cerebral palsy.

Interpretation of changes of humeral asymmetry during the Holocene period was based on the analysis of upper limb muscle activity during cereal grinding using the saddle quern and rotary quern. The aim of the diploma thesis was to test if the dominant upper limb muscle activity during cereal grinding using the saddle quern and rotary quern might be estimated by measuring the activity of musculus deltoideus (pars clavicularis), musculus infraspinatus, musculus pectoralis major and musculus triceps brachii (caput longum). Using surface electromyography, we have analyzed activity of musculus biceps brachii, musculus deltoideus (pars clavicularis), musculus deltoideus (pars acromialis), musculus deltoideus (pars spinalis), musculus pectoralis major, musculus infraspinatus, musculus triceps brachii (caput laterale) and musculus triceps brachii (caput longum) during cereal grinding using the saddle quern and rotary quern in 25 subjects. Consistent with our prediction, musculus biceps brachii was the least active muscle during saddle quern grinding and clockwise rotary grinding, therefore it is possible to exclude musculus biceps brachii from the sample of analyzed muscles. Pars clavicularis, pars acromialis and pars spinalis of musculus deltoideus were more active during rotary quern grinding than...

Esta tese de Doutorado busca contribuir na formação de subsídios científicos tanto para o projeto de uma prótese antropomórfica para membros superiores, quanto para a criação de um ambiente de treinamento, ou seja, um ambiente virtual de ação e realimentação das sensações, que poderá incorporar os mecanismos, atuadores, sensores ou estimuladores desenvolvidos. Ao final desta pesquisa, foram projetados e testados os mecanismos, sensores e alguns dispositivos de realimentação que farão parte do desenvolvimento de uma prótese de mão, a Mão de São Carlos, que possuirá características antropomórficas, para reproduzir os movimentos naturais da mão humana com um controle simplificado para o paciente. A motivação principal deste trabalho é diminuir o índice de rejeição das próteses para membros superiores, facilitando seu processo de treinamento e controle / This Doctoral thesis should contribute to the gathering of scientific subsidies for the project of a multifunction anthropomorphic upper limb prosthesis, in special the artificial hand, and for the creation of a training software, i.e., a software for the sensory's action and feedback. At the end of this research, the mechanisms, sensors, actuators and some feedback devices were designed and tested, that will be part of the development of a hand prosthesis, the São Carlos Hand, which will possess anthropomorphic characteristics, a simplified control for the patient and will reproduce the natural movements of the human hand. The main motivation of this work is to reduce the rejection index of the upper limb prosthesis, facilitating training process and control

A subluxação do ombro é a complicação musculoesquelética mais comum das afecções do Sistema Nervoso Central e Periférico, que leva a diminuição do movimento, da função e aumento de dor. Um dos recursos auxiliares utilizados é a órtese que visa corrigir a deformidade, diminuir a dor e proporcionar a função. Este trabalho objetiva projetar e desenvolver o conceito de uma órtese personalizada estabilizadora de ombro. A metodologia de desenvolvimento de projeto de produto esta dividida em três fases: informacional, conceitual e projeto preliminar. Na fase informacional foi realizada pesquisa bibliográfica, de patentes e de mercado e foram entrevistados 30 prováveis usuários; coletados os dados antropométricos, força muscular manual e goniometria. Na fase conceitual, baseado na fase informacional e a partir da Metodologia TRIZ (Teoria da Resolução de Problemas Inventivos) foi proposto um desenho original de órtese híbrida, personalizada e manufaturada em tridimensional, usando estruturas rígidas e faixas de tração, que estabilizem o ombro, diminua a dor e permita a função. A fase do projeto preliminar foi composta por escaneamento tridimensional e uso de softwares que transformam uma imagem digitalizada em formato STL®. Foram realizadas sucessivas evoluções do projeto com geração de desenhos e peças prototipadas que foi avaliada por um usuário. Na fase informacional, a pesquisa de patentes e de mercado mostrou que há uma predominância dos modelos de órtese estabilizadora de ombro com material flexível onde o principal meio de tração é dado por faixas na diagonal e transversal ao tronco, tendendo a posicionar o ombro em rotação interna. Enquanto os usuários relataram expectativa de uma órtese que corrija o posicionamento, tenha melhor conforto térmico e tátil, menos cheiro e de fácil limpeza. O conceito desenvolvido foi: órtese personalizada, fácil de higienizar e de por/tirar, resistente, articulada, leve, em plástico ABS (acrilonitrila, butadieno e estireno) impressão tridimensional, com veste nos dois braços, com faixas de tração rígidas fixadas à cintura, visando à correção da subluxação do ombro com conforto, menor dor além de permitir função. O teste com usuário corroborou com o conceito, pois o protótipo preliminar apresentou bom acoplamento ao tronco, tração satisfatória e possibilidade de realizar um maior número de atividades diárias com menos dor e sensação de cansaço. / The shoulder subluxation is the most common musculoskeletal complication of Central and Peripheral Nervous System disorders, which leads to a decrease in movement, function and increase in pain. One of the resources used to help with this issue is the orthosis that aims to correct the deformity, decrease the pain and provide function. This work aims to design and develop the concept of a personalized shoulder stabilizing orthosis. The methodology used on the product design is divided into three phases: informational, conceptual and preliminary design. In the informational phase, bibliographic, patent and market research were carried out and 30 potential users were interviewed; anthropometric data, manual muscle strength and goniometry were collected. In the conceptual phase, based on the informational data and using TRIZ Methodology (Theory of Inventive Problem Solving), an original concept design of a hybrid orthosis, personalized and manufactured three-dimensional, using rigid structures and traction bands, was proposed to stabilize the shoulder, reduce pain and allow function. The preliminary design phase consisted of tridimensional scanning and the use of software that transformed a scanned image into STL®. Successive evaluations of the project were carried out with generation of designs and prototyped parts - which the user has evaluated. During the informational phase, the patent and market research demonstrated a predominance of the stabilizing orthosis models using flexible material where the main form of traction was given by diagonal and transverse bands to the trunk, tending to position the shoulder in internal rotation. Users have reported the expectation that this orthosis could correct the shoulder positioning and that it has a better thermal and tactile comfort, less smell and easier to clean. The concept developed was: a personalized orthosis, easy to sanitize and to put on/take off, resistant, articulated, lightweight, in ABS (Acrylonitrile butadiene styrene), three-dimensional printing, with a vest in both arms, rigid traction bands fixed to the waist, aiming to correct the shoulder subluxation with comfort, less pain while allowing function. The user test corroborated with the concept, as the preliminary prototype presented good trunk coupling, satisfactory traction and the possibility to perform a greater number of daily activities with less pain and less fatigue caused by limb weight.

Introduction: Multiple sclerosis is a chronic autoimmune neurodegenerative affection of the central nervous system with various neurological symptoms. Disability of upper extremities with other symptoms leads to impaired ability to work and ADL-activities of daily living. The purpose of the pilot study was to evaluate the effect of hand training with the Hand Tutor® rehabilitation system. Methods: The study involved 9 probands, completed 6 probands (2 females and 4 males) at an average age of 36 (SD 4), with a mean disease duration of 13 years (SD 4). Patients received a series of 10 Hand Tutor® therapies, 1-2 times a week. The effect of the therapy was evaluated using the Nine Hole Peg Test (9HPT), the Modified Frenchay Scale and the subjective evaluation of the probands. Results: Before the therapies, the average performance in the 9HPT test was 85 seconds and 83 points in the Modified Frenchay scale. After the therapies, the average 9HPT performance was 67 seconds and 86 points in the Modified Frenchay scale. According to the subjective evaluation of probands, the therapy had a positive effect on the tremor of the upper limb and on the use of the upper limb in the ADL. Conclusion: Therapy with a special rehabilitation system provides patients with MS with more intensive hand training using...

Tyrimo tikslas: ištirti viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų gyvenimo kokybę ir jos pokyčius ambulatorinio gydymo metu. Tyrimo uždaviniai: 1. Nustatyti viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų pagrindinius slaugos poreikius ir jų kaitą vieno mėnesio laikotarpiu nuo patirtos traumos. 2. Ištirti viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų gyvenimo kokybę ir jos kaitą vieno mėnesio laikotarpiu nuo patirtos traumos. 3. Nustatyti veiksnius, turinčius įtakos viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų gyvenimo kokybei. Tyrimo kontingentas ir metodai. Tyrime dalyvavo 112 viršutinių galūnių lūžius patyrusių pagyvenusio amžiaus pacientų, gydytų ambulatoriškai VšĮ Kauno Klinikinės ligoninės priėmimo – skubios pagalbos ir traumų skyriuje – poliklinikoje 2013m. rugsėjo mėn. – 2014m. vasario mėn. Buvo atlikta anoniminė anketinė apklausa, kurią sudarė sociodemografiniai duomenys, slaugos poreikių klausimynas pagal gyvybines veiklas bei SF – 36 gyvenimo kokybės klausimynas, traumos dieną ir praėjus mėnesiui po jos. Tyrimui atlikti 2013-10-01 gautas Lietuvos Sveikatos Mokslų Universiteto Bioetikos centro leidimas (BEC – KS (M) – 16). Rezultatai: Po mėnesio nuo viršutinių galūnių lūžių pagyvenusio amžiaus asmenų savarankiškumas gamintis maistą, klotis lovą, valgyti, vartytis, prakaitavimas, karščiavimas, judėjimą ribojantis skausmas, sumažėjęs fizinis aktyvumas, nuskausminamųjų vartojimas, nemiga... [toliau žr. visą tekstą] / Research aim: to research the quality of life and its changes of the elderly patients with upper limb fractures during out-patient treatment. Research goals 1. To identify the main nursing needs and their changes for the elderly patients with upper limb fracture in a month since incurred trauma. 2. To research the quality of life and its changes of the elderly patients with upper limb fractures in a month since incurred trauma. 3. To determine factors influencing the quality of life of the elderly patients with upper limb fractures. Research contingent and methods. There were 112 elderly patients with upper limb fractures on out-patient treatment in the reception – emergency and trauma department at VŠĮ ( public institution) Kaunas Clinical hospital participating in the research from September 2013 to February 2014. An anonymous questionnaire was conducted, including sociodemographic data, questionnaire on nursing needs according to vital activities and SF-36 health related quality of life questionnaire on the trauma day and in a month it incurred. A permission (BEC-KS(M)-16) of 01-10-2013 to conduct a research was given by the center of Bioethics at Lithuanian University of Health Sciences Results: In a month since the elderly patients incurred upper limb fractures, their independence to prepare meals, make the bed, eat, turn over, perspiration, fever, pain restricting movements, taking anesthetics, insomnia, need of other persons help in order to comb, take a bath, change... [to full text]

Made available in DSpace on 2016-06-02T20:44:09Z (GMT). No. of bitstreams: 1 4123.pdf: 1813947 bytes, checksum: 4753a26b5a422cbd5d905496a47cfbec (MD5) Previous issue date: 2012-01-12 / Breast cancer is the most common malignancy among women in Brazil. In recent years there has been significant progress involving surgical techniques, and a corresponding increase in the number of breast-conserving surgical procedures. However, in terms of function complications and pain, post-operative morbidities still represent a clinical problem. These sequelae and complications have a strong impact on the daily lives, occupational performance and the quality of life of breast cancer patients. The objective of this study was to verify if there is a relationship between late upper limb complications and health-related quality of life in women who have undergone breast cancer surgery. Eighty-one women who had breast surgery between 1 and 5 years previous participated in the study. It was also carried out a survey of the complaints brought by patients regarding the upper limb and the application of the Disabilities of the Arm, Shoulder, and Hand (DASH) and the European Organization for Research and Treatment of Cancer (EORTC QLQC-30 and BR23) questionnaires. The main complaints reported by the patients were as follows: numbness (67.9%); muscle weakness (49.4%); pain (45.7%); lymphedema (22.2%); neck pain (9.9%); and range of motion limitation (6.2%). There was a statistically significant correlation between the morbidity reported by patients with upper limb dysfunction assessed using the DASH and the quality of life related to health. It was concluded that late function complications in women who have undergone breast cancer surgery present a significant impact on the upper limb, in daily life and the health-related quality of life. To invest in occupational therapy can improve functionality not only the upper limb, but also the future perspective, social and emotional function. / O câncer de mama é a neoplasia maligna mais freqüente na população feminina brasileira. Nos últimos anos houve grande evolução das técnicas cirúrgicas e aumento do número de cirurgias conservadoras da mama, entretanto a morbidade imediata ou tardia após a cirurgia, sob a forma de comprometimento funcional e dor ainda é um significativo problema clínico. Essa condição tardia pode interferir na realização das atividades da vida cotidiana, no desempenho ocupacional e na qualidade de vida das mulheres que foram submetidas à cirurgia do câncer de mama. O objetivo deste estudo foi verificar a relação entre o comprometimento funcional tardio do membro superior e a qualidade de vida relacionada à saúde de mulheres submetidas à cirurgia do câncer de mama. Participaram da pesquisa 81 mulheres com tempo decorrido de cirurgia do câncer de mama variando entre 1 a 5 anos. Foi realizado levantamento das queixas referidas pelas pacientes em relação ao membro superior e aplicado os questionários Disabilities of the Arm, Shoulder and Hand (DASH) e European Organization for Research and Treatment of Cancer (EORTC QLQC-30 e BR23). As principais queixas relatadas pela pacientes foram: dormência (67,9%), fraqueza muscular (49,4%), dor (45,7%), linfedema (22,2%), cervicalgia (9,9%) e limitação da amplitude de movimentos (6,2%). Houve correlação estatística significante entre as morbidades referidas pelas pacientes com a disfunção do membro superior avaliada através do DASH e com a qualidade de vida relacionada à saúde. Concluiu-se que o comprometimento funcional tardio apresenta impacto significativo na função do membro superior, na vida cotidiana e na qualidade de vida relacionada à saúde das mulheres que foram submetidas à cirurgia do câncer de mama, apontando que investir nas ações de terapia ocupacional pode melhorar não apenas a funcionalidade do membro superior, mas também a perspectiva de futuro, a função social e emocional.

Après un accident vasculaire cérébral (AVC), l’utilisation de stratégies compensatoires dans les activités de la vie quotidienne peut freiner la récupération motrice du membre supérieur parétique. En effet, lors d’une tâche d’atteinte, les individus post-AVC présentant un déficit sévère limitant les mouvements épaule-coude, doivent utiliser la flexion du tronc afin de réaliser une tâche d’atteinte. Dans ce cas, il s’agit d’une compensation obligatoire-adaptative. D’autre part, certains individus post-AVC ayant suffisamment récupéré la motricité épaule-coude, continuent de solliciter une flexion du tronc, et cette compensation non-obligatoire du tronc est dite maladaptative car elle reflète la non-utilisation épaule–coude (proximal arm non-use - PANU) ayant pour effet d’entraver la récupération du bras parétique.Dans la première étude, 45 sujets post-AVC et 45 sujets contrôles sains appariés en âge ont effectué une tâche d’atteinte, le tronc libre (utilisation spontanée du bras) et le tronc auto-fixé (utilisation maximale du bras). L’analyse a montré que les scores PANU des sujets post-AVC étaient compris entre 1,9% et 40,7% avec une médiane à 11,7%. La mesure du score PANU est reproductible, valide et représente la réserve motrice épaule-coude. Le seuil significatif du PANU a été fixé à 6,5% (limite supérieure chez les sujets sains). Enfin, le score PANU est complémentaire aux tests usuels de déficience et de fonction du membre supérieur (Box and Block test, Fugl-Meyer)La deuxième étude a montré la possibilité d’utiliser un système Kinect dans l’obtention du score PANU. Des mesures ont été effectuées simultanément avec les deux systèmes (Kinect et Zebris-CMS20s) chez 19 sujets post-AVC. Cette étude a montré que le score PANU mesuré avec la Kinect pourrait être utilisé comme un outil de diagnostic qui permettrait de proposer aux sujets post-AVC une rééducation spécifique d’utilisation forcée du bras par tronc bloqué ou bien par feedback.La troisième étude est une revue de la littérature sur les technologies innovantes appliquées à la rééducation sensorimotrice post-AVC suggérant que le score PANU puisse être intégré dans un traitement rééducatif par réalité virtuelle.En conclusion, ces travaux démontrent que quantifier objectivement la non-utilisation épaule-coude (score PANU) lors d’une tâche d’atteinte est possible et reproductible. Les scores PANU peuvent être déterminés également par un système très accessible (Kinect) ce qui permettrait d’intégrer le score PANU dans un jeu de rééducation par réalité virtuelle. / The use of compensatory strategies to perform activities of daily living after a stroke can reduce the upper limb recovery. In fact, post-stroke individuals with severe upper limb impairment that limits shoulder-elbow motion, have to use trunk compensation to achieve a reaching task within arms’ length, which is a form of mandatory/adaptive compensation strategy. Whereas, post-stroke individuals having adequately recovered shoulder-elbow motion, continue to use the trunk when they could use the proximal arm to achieve the reach; and this non-mandatory trunk compensation is considered maladaptive because it reflects proximal arm non-use or PANU, which is detrimental to true recovery of the paretic arm.In the first study, 45 post-stroke individuals and 45 age matched healthy controls performed a seated reaching task within arm’s length with the trunk free to move (spontaneous use) and trunk restrained (maximal use) to measure their PANU score. The analysis showed that PANU scores for the post-stroke individuals ranged between 1,9% and 40,7% with a median of 11,7%, and these PANU scores were a reliable and reproducible measure of the functional reserve of the upper limb. The PANU score threshold for clinical significance was set as 6.5% (upper limit in healthy subjects). The PANU score seems pertinent as a complement to usual clinical assessments of upper limb function and impairment (Box and Block test, Fugl-Meyer).The second study explored the applicability of the Kinect system to measure PANU scores in 19 post stroke individuals in comparison to the standard Zebris-CMS20s method. The analysis showed that the PANU score measured by the Kinect was valid and reliable, and therefore should be used as a tool to classify patients in order to propose specific upper limb rehabilitation with arm-forced use by trunk restraint or feedback.Study three was a review of innovative technologies applied to sensorimotor rehabilitation after a stroke suggesting that PANU scores could be implemented in virtual reality rehabilitation and be used as a tool to determine the efficacy of the specialised treatment.In conclusion, this thesis showed that i) objectively quantifying the proximal arm non-use (PANU score) during a reaching task using a 3D motion capture system is feasible and reliable, and ii) PANU scores are accurately determined also using a more widely available and less expensive Kinect-based motion sensor with the future aim of PANU being integrated in a Kinect-based upper limb virtual reality rehabilitation.

Les progrès de la mécatronique ont permis d’améliorer les prothèses du membre supérieur en augmentant le catalogue des mouvements prothétiques. Cependant, un fossé se creuse entre les capacités technologiques de la prothèse et leur méthode de contrôle. La commande myoélectrique, qui est la méthode la plus répandue, reste complexe, notamment pour les personnes amputées au niveau trans-huméral qui peuvent avoir un coude actif en plus de la main et du poignet motorisés. Une approche intéressante consiste à utiliser la mobilité du membre résiduel, présente chez la plupart des amputés trans-huméraux, pour contrôler des articulations prothétiques distales comme le coude. Les mouvements du coude sont couplés aux mouvements du membre résiduel selon un modèle de coordination épaule/coude saine. Cette thèse étudie une stratégie de commande d’un coude prothétique utilisant les mouvements du membre résiduel, mesuré par des centrales inertielles, et nos connaissances du contrôle moteur humain. Pour cela, un modèle de la coordination épaule/coude a été construit à partir d’enregistrements de gestes sains de préhension. Ce modèle, implémenté sur un prototype de prothèse, a été testé par 10 individus sains équipés du prototype afin de valider le concept, puis par 6 personnes amputées. Ces dernières ont aussi réalisé la tâche avec une commande myoélectrique conventionnelle afin de comparer les résultats. La commande couplant automatiquement les mouvements de l’épaule et du coude s’est montrée satisfaisante en termes de facilité d’utilisation et de réduction des stratégies de compensation. / Progress in mechatronics has enabled the improvement of upper limb prosthetics increasing the grasps catalog. However, a gap has been growing between the prosthesis technological possibilities and the methods to control it. Indeed, common myoelectric control strategy remains complex, especially for transhumeral amputees who can have an active elbow in addition to a prosthetic wrist and hand. Since most transhumeral amputees have a mobile residual limb, an interesting approach aims at utilizing this mobility to control intermediate prosthetic joints, like the elbow, based on the shoulder/elbow coordination observed in healthy movements. This thesis investigates the possibility of controlling an active prosthetic elbow using the residual limb motion, measured with inertial measurement units, and knowledge of the human motor control. A primary focus has been targeting the reaching movement for which a model has been built using regression tools and kinematic data from several healthy individuals. The model, implemented on a prosthesis prototype, has been tested with 10 healthy participants wearing the prototype to validate the concept, and with 6 amputated individuals. These participants also performed the task with a conventional myoelectric control strategy for comparison purpose. The results show that the inter-joint coordination-based control strategy is satisfying in terms of intuitiveness and reduction of the compensatory strategies.

Alors que de nombreux exosquelettes destinés à la rééducation neuromotrice ont été développés ces dernières années, ces dispositifs n'ont pas encore permis de vrai progrès dans la prise en charge des patients cérébrolésés. Une des clés pour améliorer les faibles résultats thérapeutiques obtenus serait de constamment adapter la thérapie robotisée en fonction de l'évolution du patient et de sa récupération, en adaptant l'assistance fournie par le robot pour maximiser l'engagement du patient. L'objectif de cette thèse est donc de comprendre les processus d'adaptations réciproques dans un contexte d'interaction physique Homme-Exosquelette. Dans un premier temps nous avons donc développé un nouveau type de contrôleur adaptatif qui assiste le sujet "au besoin", en modulant l'assistance fournie; et évalué différent signaux pour piloter cette adaptation afin de suivre au mieux la récupération du patient. Dans un deuxième temps, nous avons étudié l'adaptation de sujets sains à l'application de champs de forces distribués par un exosquelette sur leur bras durant la réalisation de mouvements dans l'espace. En effet, lors d'une interaction physique homme-robot, le sujet adapte aussi son comportement aux contraintes exercées par le robot. D'importantes différences inter-individuelles ont été observées, avec une adaptation à la contrainte imposée chez seulement 21% des sujets, mais avec des effets à-posteriori persistants mesurés chez 85% d'entre eux; ainsi qu'une généralisation dans l'espace de ces effets et un transfert à des contextes différents (hors du robot). Ces premiers résultats devraient permettre à terme d'améliorer la rééducation neuromotrice robotisée. / While many robotic exoskeletons have been developed for stroke rehabilitation in recent years, there were not yet improvements to the traditional therapy. A key to unleash the potentiality of robotics is to adapt the assistance provided by the robot in order to maximize the subject engagement and effort, by having the robotic therapy evolving with the patient recovery. For this reason, we aim at better understanding the process of reciprocal adaptation in a context of physical Human-Robot Interaction (pHRI). We first developed a new adaptive controller, which assists the subject "as-needed", by regulating its interaction to maximize the human involvement. We further compared different signals driving this adaptation, to better following the functional recovery level of the patients. While the control is performed by the robot, the subject is also adapting his movements, and this adaptation has not yet been studied when dealing with 3D movements and exoskeletons. Therefore, we exposed human motions to distributed force fields, generated by the exoskeleton at the joint level, to produce specific inter-joint coordination and to analyse the effects of this exposition. With healthy participants, we observed important inter-individual difference, with adaptation to the fields in 21% of the participants, but post-effects and persisting retention of these in time in 85% of the subjects, together with spatial generalization, and, preliminarily, transfer of the effects outside of the exoskeleton context. This work towards understanding pHRI could provide insights on innovative ways to develop new controllers for improving stroke motor recovery with exoskeletons.