Multisensory immersion for intensive sensorimotor rehabilitation – iSMRehab

Stroke is one of the main causes of chronic disability in the world. Patients recover spontaneously, but most often retain after-effects that can be reduced by rapid implementation of appropriate rehabilitation. Optimizing rehabilitation to maximize autonomy is therefore a major public health issue. One of the means is to develop devices allowing an optimal and early rehabilitation. The objective of iSMRehab is to develop and validate medical devices allowing an early sensorimotor rehabilitation to (re)activate the sensorimotor neural networks and recover the altered motor functions. Functional recovery depends on the ability of the central nervous system to adapt and reorganize itself after an injury (neuroplasticity). The Vibramoov system proposes an innovative sensorimotor rehabilitation, unique in the world, based on muscle-tendon vibration programs whose frequency, amplitude and sequence make it possible to reproduce the sensory inputs during complex intentional movements such as walking, to activate the corresponding sensorimotor networks and to produce an illusion of this movement. However, the level of evidence for the efficacy of Vibramoov, like all currently recommended rehabilitative practices (manual or instrumented), is overall low due to the lack of randomized controlled trials and because neuroplasticity is not evaluated. Objective 1 is to provide experimental evidence (electrophysiology, neuroimaging) of neuroplasticity by Vibramoov and its neuroprotective effect in post-stroke patients in the sub-acute phase i.e., when recovery is optimal. Experimental data will be correlated with clinically assessed motor performances (neurological assessment, functional tests and scales) and their modifications during rehabilitation. Objective 2 is to bring technological developments to the current Vibramoov system by synchronizing functional vibrations with stimulations of other sensory modalities (touch, vision and hearing) in virtual reality. Multisensory immersion in an enriched environment is indeed known to improve post-stroke functional recovery but no device exists to date despite the potential interest of immersing patients with no or little ability, to move in a virtual environment t. Finally, objective 3 is to implement a proof-of-concept study on naive and expert participants to evaluate the new device (acceptability, appetence, usability). We will take advantage of this study to also evaluate brain activity with ecological electrophysiological recordings in order to compare the effectiveness of the current device and the new device on brain integrative processes. The expected results are objective evidence of the neuroplasticity and neuroprotective effect of the Vibramoov and of a new, even more innovative therapeutic device, addressing early rehabilitation needs. The project is focused on gait disorders after a stroke because i) gait recovery is a major issue in rehabilitation as stroke sequelae greatly limit autonomy and socio-professional links and ii) stroke is the main cause of chronic disability. However, the devices will allow to generate programs mimicking other movements involving the lower and/or upper limbs. Moreover, the therapy can be proposed to all patients presenting a motor handicap, whether it is linked to neurological lesions of traumatic, vascular, neurodegenerative or viral origin (COVID), or consecutive to an orthopedic trauma requiring immobilization; patients for whom a sensorimotor rehabilitation is required for the recovery and/or the maintenance of the motor functions.