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Interactions posturo-vestibulaires : Intégration des informations vestibulaires dans le contrôle postural statique et dynamique

Abstract : In humans, balance control is a plurimodal function based on multisensory information (visual, somatosensory and vestibular cues). In case of pathological dysfunction of the vestibular sensor, the orientation and stabilization of the head and body are altered. This leads to postural control abnormalities reflecting the integration of erroneous information by the central nervous system. In this framework, we investigated the effects of three levels of impairment of vestibular function (transient imbalance, labyrinthine intrusion and surgical removal) on static and dynamic postural control. First, we quantified the involvement of vestibular information in the dynamic control of posture (locomotion) in a context of stimulation of the semicircular canals on asymptomatic participants. Next, we determined the influence of deafness and cochlear implantation on postural control as well as the physiological integrity of the vestibular system. Finally, in the case of the development of a vestibular schwannoma and its surgical removal, we quantified the effects of preoperative vestibular solicitation by physiotherapy. It appears that the involvement of vestibular information in postural control differs according to the type of alteration. A transient imbalance of vestibular tone seems to be inhibited during a run task, without causing any change in muscular synergies during walking and running. While in a labyrinthine break-in postural control seems robust despite a change in vestibular pattern (normoreflexia → hyporeflexia) coupled to a modification of the visual perception of gravity. Finally, preoperative vestibular rehabilitation removes the deleterious effects of surgical removal on the balance control and allows the shortening of balance recovery. The discussion is structured around the adaptive processes of the central nervous system to compensate for these different levels of vestibular dysfunction on postural control. Finally, these works open clinical perspectives by improving patient care, especially during the vestibular rehabilitation.
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Dimitri Fabre. Interactions posturo-vestibulaires : Intégration des informations vestibulaires dans le contrôle postural statique et dynamique. Médecine humaine et pathologie. Université de Lorraine, 2019. Français. ⟨NNT : 2019LORR0197⟩. ⟨tel-02529049⟩



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