Fondation Hopale

CPLAY is a novel serious-game platform combining miniaturized, instrumented building bricks with a tablet interface and AI-driven activity recognition to deliver personalized, gamified upper-limb rehabilitation for children with Developmental Coordination Disorder or Cerebral Palsy. Developed through a co-design process with therapists, engineers, parents and children, two IMU-equipped brick form factors transmit 70 Hz motion data via Bluetooth to a tablet hosting fifteen progressively challenging 3D assembly tasks enriched with rewards and audiovisual feedback. In a clinical feasibility trial, 30 children (mean age 9.1 ± 1.0 years) performed each model twice under supervision; synchronized motion and video data were annotated to train signal-processing routines and deep-learning classifiers. Signal processing detected all 36 movement and fall events (one false positive), while the Transformer model outperformed other approaches, achieving 86.0% multi-class accuracy and 85–96% binary accuracy across activity labels. These results demonstrate CPLAY's ability to objectively detect and classify key rehabilitation movements, paving the way for adaptive, AI-driven therapy, with future work focused on embedding a recommendation engine, scaling trials and refining AI models. • A co-design approach ensuring holistic development of a novel rehabilitation tool. • Gamification boosts engagement, attention, and motivation during therapy sessions. • Data from instrumented bricks trains AI to detect rehabilitation events in real time. • Collects cognitive and motor data to enable personalized rehabilitation plans.

Context: A clinical trial was recently conducted to compare the efficacy of pain neuroscience education (PNE) with spinal physiology and ergonomics education as part of a short multidisciplinary rehabilitation program (MRP) in patients with persistent low back pain (LBP). A qualitative study could provide additional context for these results. Objective: To explore change in understanding and coping strategies in participants with persistent LBP who received PNE as part of a one-week MRP. Methods: Four medical residents conducted semi-structured interviews of 12 patients with PLBP and who had participated in a one-week multidisciplinary rehabilitation program including a PNE component. Audio recordings were analyzed thematically by three physiotherapists. Results: The prespecified themes of understanding and coping were present in the data and analyzed with regard to change. Other themes – other forms of learning, other barriers to change, satisfaction and criticisms – also emerged. Pain reconceptualization was frequently associated with new adaptive coping strategies. However conceptual change was found in only half of the participants and does not always appear to be sufficient to lead to changes in coping strategies for pain. Other forms of learning (e.g. experiential learning) and non-educational factors (e.g. motivational ones) also seem to influence conceptual and coping change. Satisfactions (e.g. innovative nature of the approach) and criticisms (e.g. lack of interaction and insufficient connection to everyday life) were reported by certain some participants. Conclusion: Strategies that promote conceptual change, safety perception, and behavioral change are likely to improve the outcomes of PNE within an MRP.

BackgroundTo describe the key findings and lessons learned from an international pilot study that surveyed spinal cord injury programs in acute and rehabilitation facilities to understand the status of spinal cord injury care.MethodsAn online survey with two questionnaires, a 74-item for acute care and a 51-item for rehabilitation, was used. A subset of survey items relevant to the themes of specialized care, timeliness, patient-centeredness, and evidence-based care were operationalized as structure or process indicators. Percentages of facilities reporting the structure or process to be present, and percentages of indicators met by each facility were calculated and reported separately for facilities from high-income countries (HIC) and from low and middle-income countries (LMIC) to identify “hard to meet” indicators defined as those met by less than two-thirds of facilities and to describe performance level.ResultsA total of 26 acute and 26 rehabilitation facilities from 25 countries participated in the study. The comparison of the facilities based on the country income level revealed three general observations: 1) some indicators were met equally well by both HIC and LMIC, such as 24-hour access to CT scanners in acute care and out-patient services at rehabilitation facilities; 2) some indicators were hard to meet for LMIC but not for HIC, such as having a multidisciplinary team for both acute and rehabilitation settings; and 3) some indicators were hard to meet by both HIC and LMIC, including having peer counselling programs. Variability was also observed for the same indicator between acute and rehabilitation facilities, and a wide range in the total number of indicators met among HIC facilities (acute 59–100%; rehabilitation 36–100%) and among LMIC facilities (acute: 41–82%; rehabilitation: 36–93%) was reported.ConclusionsResults from this international pilot study found that the participating acute and rehabilitation facilities on average adhered to 74% of the selected indicators, suggesting that the structure and processes to provide ideal traumatic spinal cord injury care were broadly available. Recruiting a representative sample of SCI facilities and incorporating regional attributes in future surveys will be helpful to examine factors affecting adherence to indicators.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Keywords: rectus femoris transferclinical gait analysispropensity score matchingorthopaedic surgerycerebral palsy

Retrospective. The objective of the study was to describe the type of ejaculation in patients with cauda equina (CE) and conus medullaris (CM) lesions, and to analyse sperm quality. France. One hundred sixty-six patients with CE and CM lesions were included. Diagnosis was based on clinical (no motor responses, sensation or sacral reflexes) and urodynamic assessments (no detrusor activity). Vibromassage (VM) was used to induce ejaculation according to the recommendations for patients with spinal cord injury. If ejaculation did not occur, oral midodrine was administered in progressive doses. Retrograde ejaculation was systematically sought. Sperm parameters were analysed according to World Health Organisation recommendations (2010). Eighty-nine patients were included. Eleven ejaculated on the first VM trial (four anterograde (AE), six retrograde (RE) and one antero-retrograde (ARE)). Five patients continued trials of VM alone, two of whom ejaculated following a mean 1.9 trials (one RE, one ARE). Twenty-six patients underwent trials of VM+ midodrine, 18 of whom ejaculated following a mean 4.4 trials with a mean dose of 22.5 g of midodrine (2 AE, 13 RE and 5 ARE). Fifty-three ejaculates from 26 patients were analysed. Sperm concentration was low in 90.6% of samples; total necrospermia was found in 65% and asthenospermia in 95% of samples. Ejaculation is difficult to induce using VM in patients with CE and CM lesions, and requires high doses of midodrine. Sperm counts were generally low, and asthenospermia and necrospermia were found in the majority of specimens. Cryopreservation of sperm should be systematic in case of medically assisted procreation.