La prise en charge rapide et systématique des patients en traumatologie par des protocoles tels que l’Advanced Trauma Life SupportTM maximise la survie. À l’intérieur de ces protocoles, l’examen le plus souvent proposé pour l’évaluation neurologique est l’International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). Cet outil d’évaluation des patients avec une lésion médullaire traumatique (LMT) est le plus reconnu mondialement, mais n’est pas adapté à la prise en charge initiale en traumatologie de par son exhaustivité. L’objectif principal de ce mémoire était de combler le besoin pour un outil d’évaluation neurologique adapté au patient avec une LMT en contexte aigu.La première partie de ce travail consista au développement et à la validation d’une version simplifiée de l’ISNCSCI qui a été nommée le Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Sa validation par rapport à l’ISNCSCI révéla une capacité à déterminer correctement le grade de sévérité ainsi que l’étage lésionnel de la LMT dans 100% des cas. La seconde partie de ce travail évalua la capacité du MAC-SCI à détecter les variations neurologiques périopératoires et montra qu’aucune détérioration neurologique n’était ratée. Finalement, la troisième partie de ce travail évalua l’implémentation clinique du MAC-SCI et montra des taux de complétion 2,4 fois supérieurs à ceux de l’ISNCSCI. Nous souhaitons que le MAC-SCI soit incorporé dans les protocoles de traumatologie à grande échelle dans le but d’uniformiser l’évaluation neurologique des patients en situation de traumatologie et ultimement d’améliorer les soins prodigués aux patients blessés médullaires. / Rapid and systematic management of trauma patients using protocols such as the Advanced Trauma Life SupportTM maximizes survival. Within these protocols, the tool the most often suggested for neurological assessment is the International Standards For Neurological Classification of Spinal Cord Injury (ISNCSCI). This assessment tool for patients with traumatic spinal cord injury (TSCI) is the most recognized worldwide, but is not suitable for initial trauma care due to its comprehensiveness. The main objective of this thesis was to fulfill the need for a neurological assessment tool adapted to the patient with TSCI in an acute context. The first part of this study consisted in the development and validation of a simplified version of the ISNCSCI which was named the Montreal Acute Classification of Spinal Cord Injury (MAC-SCI). Its validation against the ISNCSCI revealed an ability to correctly determine the grade of severity as well as the neurological level of injury of the TSCI in 100% of cases. The second part of this study assessed the ability of the MAC-SCI to detect perioperative neurological variations and showed that no neurological deterioration was missed. Finally, the third part of this study evaluated the clinical implementation of the MAC-SCI and showed completion rates 2.4 times higher than the ISNCSCI. We would like the MAC-SCI to be incorporated into large-scale trauma protocols in order to standardize the neurological assessment of trauma patients and ultimately improve the care provided to patients with spinal cord injuries.

Made available in DSpace on 2016-06-02T20:18:13Z (GMT). No. of bitstreams: 1 3415.pdf: 1250906 bytes, checksum: ba6707324e714954f634130cba45f223 (MD5) Previous issue date: 2010-11-12 / Universidade Federal de Minas Gerais / The palmar grasp behavior in human infants has been approached by this work. Three studies were conducted. The first study consisted of exposing the state of the art regarding the use of palmar grasp reflex (PGR) in neuropsichomotor assessment instruments and the use of PGR as a research subject in infants. The second study determined the reliability of an instrument to measure grasp strength in infants from birth to two months old. We have studied 39 healthy infants of both sexes who were allocated into three groups ("SC", "FR", "BL") according to the city from where came from . The equipment under test was called M-FLEX , which provides values of maximum grasp strength (FMAX), mean grip force (FMEAN) and grasp time (GT). The third study aimed to characterize the palmar grasp behavior of human infants , we studied 90 healthy infants of both sexes, born at term, originated from three Brazilian cities with climate and socio-cultural characteristics similars. Infants were classified into three groups according to their age. Measurements were performed on both hands face to the right side, face in the middle line and face to the left side. The variables were compared between sexes and correlated with data weight and height development. Comparisons were made of variables between the different positions of the face and between age groups. It was found that the side that the face is turned and age group are factors that affect the variables measured by M-FLEX and it is possible to measure how much asymmetry is tolerable to characterize the behavior of an infant with typical grasp. / O comportamento de preensão palmar em lactentes humanos foi abordado por este trabalho. Foram realizados 3 estudos. O estudo 1 consistiu em expor o estado da arte referente a utilização do reflexo de preensão palmar (RPP) nos instrumentos de avaliação neuropsicomotora e a utilização do RPP como objeto de pesquisa em lactente. O estudo 2 determinou a confiabilidade de um instrumento para medir a força de preensão palmar em lactentes, do nascimento aos quatro meses de idade. Foram avaliados 39 lactentes saudáveis, de ambos os sexos, compreendidos na faixa etária do nascimento aos quatro meses de vida que foram alocados em três grupos ( SC , FR , BL ) de acordo com a cidade de onde eram oriundos. O equipamento em teste denomina-se M-FLEX® o qual fornece valores de força de preensão máxima (FMAX), força de preensão média (FMED) e o tempo de preensão (TPR). O estudo 3 teve como objetivo caracterizar o comportamento de preensão palmar em lactentes humanos, para isso, foram estudados 90 lactentes saudáveis, de ambos os sexos, nascidos a termo, originados de três cidades brasileiras com características climáticas e sócio-culturais semelhantes. Os lactentes foram classificados em 3 grupos de acordo com a sua faixa etária. Foram realizadas medidas em ambas as mãos com a face voltada para o lado direito, com a face na linha média e com a face voltada para o lado esquerdo. As variáveis foram comparadas entre os sexos e correlacionadas com os dados pônderoestaturais. Foram feitas comparações das variáveis entre as diferentes posições da face e entre os grupos etários. Constatou-se que o lado que a face está virada e o grupo etário são fatores que interferem nas variáveis medidas pelo M-FLEX® e que é possível medir quanta assimetria é tolerável para caracterizar um lactente com comportamento de preensão palmar típico.

Introduction: À la naissance, les signatures du microbiote intestinal sont différentes entre le nourrisson né à terme et le Preterme (PT), signalant un possible explication des déficits neurodéveloppementaux chez le PT via l’axe de communication entre le cerveau et l’intestin. Cette étude vise à démontrer que le microbiote intestinal peut être un biomarqueur précoce d’une évaluation neuromotrice anormale à l’âge corrigé du terme chez les PT. Méthodes: Des échantillons fécaux ont été collectés à la naissance et à l’âge corrigé du terme dans cette cohorte de PT. L’ADN génomique a été extrait pour chaque échantillon et amplifié dans la région V3-V4 de l’ARNr 16S. L’analyse bio-informatique du microbiote a été réalisée grâce à QIIME2 (v2020.2). À l’âge corrigé du terme, l’évaluation neuromotrice sera faite à l’aide de deux tests neuromoteurs: « Amiel-Tison Test » (ENTAT) et « Global Motor Assessment » (GMA). Résultats: L’analyse PCoA a permis de délimiter l’évaluation neuromotrice anormale à l’âge corrigé du terme en utilisant l’ENTAT combiné au GMA comme évaluation neuromotrice. En utilisant l’indice de dissimilarité du Bray-Curtis comme mesure de β-diversité, la PCoA démontre une plus forte similarité au niveau des MI des PTs à évaluation neuromotrice normaux à la naissance. L’analyse corrélationnelle nous montre que l’indice Shannon de diversité-α est plus élevé à la naissance chez les PTs avec une évaluation neuromotrice normal (*P=0.56), qui continue d’augmenter à l’âge corrigé du terme, se traduisant par un gain de biodiversité dans le MI de l’enfant avec une évaluation neuromotrice normal. Les mesures d’abondance relatives de genres bactériens nous démontrent une plus forte prévalence de pathogènes opportunistes, ainsi qu’une faible présence de bactéries commensales à la naissance et à l’âge corrigé du terme dans le groupe à évaluation neuromotrice anormale. Conclusion: Les niveaux de bactéries opportunistes sont plus élevés à l’âge corrigé du terme chez les PT à évaluation neuromotrice anormal de même qu’une raréfaction de bactéries commensales. La diversité du microbiote intestinale à l’âge corrigé du terme est aussi réduite chez les PT à évaluation neuromotrice anormale. / Background: The early developmental window of the gut microbiome occurs in parallel with the nervous system development, which may be influenced by early life exposure including variation in gut microbiota colonization. Emerging evidence are now highlighting how gut microbiota signatures are distinct between term and preterm infants (PT). This study aims to explore if gut microbiota colonization, as an early biomarker, is associated with abnormal neuromotor examination at term-corrected age in infants PT. Methods: Fecal samples of thirty-four participants were collected at birth and from 26 participants at term-corrected age at term-corrected age from a longitudinal observational cohort of PT. Genomic DNA was extracted and V3-V4 region from 16S rRNA was amplified. Taxonomy abundance tables were generated from the FASTQ data obtained, using QIIME2 (v2020.2) for further analysis. At term-corrected age, two neuromotor examination were performed to evaluate neuromotor outcomes: The Amiel-Tison Test (ENTAT) and the Global Motor Assessment (GMA). Results: PCoA cluster analysis allowed to delineate abnormal neuromotor assessment at term-corrected age using ENTAT examination alone or in combination with GMA. In fact, using Bray-Curtis distance for β-diversity, PCoA shows a better clusterisation at birth of normal neuromotor examination than the abnormal neuromotor examination. Correlational analyses showed that Shannon diversity is higher at birth in PT with a normal neuromotor examination (*P=0.56), which increases at term-corrected age translating a gain in biodiversity in infant with a normal neuromotor examination. Relative abundance analysis showed a higher prevalence of opportunistic pathogens at birth and at term-corrected age in the abnormal neuromotor examination group, along with a rarefaction of commensal bacteria. Summary: Opportunistic pathogen levels are higher at term-corrected age in PT presenting an abnormal neuromotor examination along with a rarefaction of their commensal bacteria of their gut microbiota. This preliminary analysis also indicates that an early life poor bacterial diversity in the gut microbiota could be predictive of abnormal neuromotor examination at term-corrected age in infants PT.