e138 Abstracts / Annals of Physical and Rehabilitation Medicine 54S (2011) e131–e147 was shown between the two groups for gait velocity, step length, step width, or simple support time. Conclusion.– It seems that quantified gait parameters are not relevant evaluation criteria to assess the efficiency of a treatment with botulinum toxin type A. This evaluation must be done using satisfaction scales fulfilled by the patient, linked with therapeutic objectives that are well specified before the treatment, with the PRM doctor. doi:10.1016/j.rehab.2011.07.567 CO22-001–EN Neurophysiological features of motor imagery with applications in motor rehabilitation C. Collet a,∗ , M. Grangeon b , A. Guillot b , P.O. Sancho c , M. Picot c , P. Revol c , G. Rode c a CRIS-performance motrice, mentale et du matériel, université Claude-Bernard-Lyon 1-EA 647, UFR STAPS, 27 et 29, boulevard du 11-Novembre-1918, 69621 Villeurbanne cedex, France b Université Claude-Bernard-Lyon 1-EA 647, Villeurbanne cedex, France c Service de rééducation neurologique, hôpital Henri-Gabrielle, hospices civils de Lyon, Saint-Genis-Laval, France ∗ Corresponding author. Keywords: Motor imagery; Quadiplegia; Grasping; Motor rehabilitation; Tenodesis Introduction.– Motor imagery is the mental representation of a movement without any concomitant execution. One of the main features of motor ima- gery is to share the same properties with actual execution, in particular, the principle of isochrony. Therefore, the aim of this presentation is to describe how motor imagery can be incorporated into the rehabilitation process of patients with tetraplegia. For over 10 years, the literature describes significant advances in the rehabilitation of motor functions through motor imagery, whether concerning central (brain, spinal cord) or peripheral lesions. Comments.– We focus on grasping illustrated by two clinical cases where motor imagery was integrated into conventional physiotherapy and occupational the- rapy management. The first patient had a level C6-C7 lesion and was able to re-learn to grasp objects with the tenodesis effect. The motor imagery work was mainly focused on motor function of daily life. We showed an improvement in movement time, precision and range of motion. The second patient exhibited a C5-C6 spinal cord lesion, leading to the impossibility of arm extension. After surgery, i.e. the transfer of the distal insertion of the biceps tendon on the triceps, the rehabilitation of the extension of the forearm on the arm and the seizure of an object by tenodesis effect was undertaken with a protocol comparable to the first patient. We observed an improvement in kinematic parameters with decreased movement times and reduced variability of arm trajectory. Progress remained stable during a retention test at 1 month. Discussion.– The role of motor imagery is beneficial in addition to conventional rehabilitation. It strengthens motor programs through brain plasticity and also helps to learn new ones. Physical workload could thus be reduced, especially when eliciting fatigue and pain. The quality of the imagery work remains to be evaluated. A set of tests is used to evaluate the vividness of the mental image, the maintenance of attention during the work session and a level of physiological arousal consistent with a sustained mental work. We currently work on a larger population and study cortical reorganization induced by motor imagery, using magnetoencephalographic recordings. doi:10.1016/j.rehab.2011.07.568 CO22-002–EN Constraint induced therapy and functional imaging J. Luauté ∗ , S. Bellaiche , D. Boisson Plate-forme mouvement et handicap, centre de recherche en neuroscience de Lyon, équipe IMPACT, CHU de Lyon, Hôpital Henry-Gabrielle, Lyon, France ∗ Corresponding author. Keywords: Stroke; Constraint induced movement therapy (CIMT); Functional imaging After a stroke, constraint induced movement therapy (CIMT) improves upper- limb motor performances of selected hemiparetic patients. What is the neural substrate of this therapeutic effect in terms of brain plasticity? Using functional imaging, equivocal results have been reported regarding the implication of motor areas from both hemispheres [2,4–7]. Lesion topography could play a key role to explain these apparent contradictory results. Schaechter et al. (2002) showed a decrease of brain damaged motor cortex activity after CIMT for the two patients who sustained a cortical lesion and an increased CIMT-related activity in the ipsilesional motor cortex for the two other patients who sustained a sub-cortical lesion. In another study performed in 6 hemiparetic patients included at a chronical stage, Hamzei et al. (2006) suggested that an intact cortico-spinal tract, improves synaptic efficiency of the ipsilesional sensori-motor cortex. Otherwise, motor improvement requires the involvement of motor associated areas of the damaged hemisphere or motor regions of the intact hemisphere. It is also possible that intensive rehabilitation and constraint—the two compo- nents of CIMT—elicit specific and distinct brain plasticity mechanisms. We studied this hypothesis using fMRI in a case-control study (Bellaiche 2009). Results showed that constraint of the less affected hand favored a lateralized pattern of activation towards the ipsilesional motor cortex. Additional impro- vement after intensive rehabilitation was correlated with a bilateral increased activity of the pre-motor cortex and the cerebellum. References [1] Bellaiche et al. Poster 1806 EFNS 2009 [2] Dong et al. Stroke 2006;37:1552–55 [3] Hamzei et al. NeuroImage 2006; 31: 710–20 [4] Johansen-Berg et al. Brain 2002; 125:2731–42 [5] Lin et al. Am J Phys Med Rehabil 2010;89:177–85 [6] Schaechter et al. Neurorehabil Neural Repair 2002; 16:326–38 [7] Wittenberg et al. Neurorehabil Neural Repair 2003; 17:48–57. doi:10.1016/j.rehab.2011.07.569 CO22-003–EN Isokinetic program in stroke survivors with chronic upper limb hemiparesis F. Coroian a,∗ , M. Julia a , N. Hammami b , D. Mottet b , C. Hérisson a , I. Laffont a a Fédération hospitalo universitaire de MPR Montpellier-Nîmes, université Montpellier-1, CHRU Montpellier/Mouvement to Health, EA 2991, Euromov, 371, boulevard du Doyen-Gaston-Giraud, 34295 Montpellier, France b Mouvement to Health, EA 2991, Euromov, université Montpellier-1, Montpellier, France ∗ Corresponding author. Keywords: Stroke; Chronic hemiparesis; Isokinetic muscular strengthening; Upper limb Purpose.– To evaluate the effects of isokinetic strength training combined with conventional rehabilitation on hemiparetic arm motor function in patients with chronic stroke. Patients and methods.– Eight patients with persistent hemiparesis 6 months after stroke were included in a 6 weeks rehabilitation program. Rehabilitation sessions occurred 3 times a week during 6 weeks. The program involved isokinetic muscle strengthening in CPM mode of flexor and extensor muscles of the elbow and wrist, associated with a conventional neurological rehabilitation of the affected upper limb. The evaluation was made before and just after the program (18 sessions) bearing on 3 points: clinical evaluation, isokinetic test and functional evaluation (Fugl-Meyer upper limb scale [FMS] and Block and Box test [BBT]). Results.– At the beginning of the study, the isokinetic evaluation highlighted a speed-dependent muscular deficit on the muscular groups tested. After 18 rehabilitation sessions we noted a significant increase in FMS upper limb scale (+18%, P < 0.01) and in BBT score, an increase in muscle strength without any increase in upper arm spasticity. Discussion.– The loss of strength is considered as a major limiting contribu- tor to disability after stroke (Canning, 2004). Some studies present arguments in favour of an isokinetic training of the paretic upper limb, by highlighting deteriorations of the characteristics of the muscular contraction. It is expec- ted that isokinetic training could improve both magnitude and time-dependent