Implications cliniques

Cette étude apporte de nouvelles connaissances sur le développement cérébral des enfants à terme et des enfants très prématurés. Le travail qui propose pour la première fois des biomarqueurs des incapacités cliniques souligne à nouveau l'importance d'une détection précoce des enfants à risque de développer des incapacités fonctionnelles à long terme. Une revue de littérature récente rappelle l'importance de diagnostiquer précocement les enfants

prématurés à risque de déficits à long terme, même mineurs, et ainsi aider à ajuster les interventions aux problèmes détectés (Arpino et al., 2010).

Ainsi, non seulement le dépistage précoce, mais également la prise en charge par des professionnels de la santé des enfants nés très prématurés ayant des déficits moteurs (même subtils), va bénéficier de résultats tels que les nôtres, dans lesquels c'est le côté dominant qui est problématique à 8 ans chez les prématurés. Il faut s'intéresser au continuum du développement de l'enfant, de son fonctionnement cérébral à ses capacités cognitivo- motrices, sans oublier les aspects de son adaptation et participation sociales. En effet, les études sur l'ajustement social des enfants prématurés à l'âge scolaire démontrent que, même en l'absence de déficience motrice ou cognitive majeure, la présence de déficits moteurs mineurs augmente le risque de retrait social et de victimisation par les pairs (Nadeau et al., 2004). La meilleure compréhension de ce continuum de développement permettra de guider l'adaptation des interventions de réadaptation physique et psychosociales auprès des enfants très prématurés.

En conclusion, l'identification d'indicateurs de fonctionnement du cerveau (incluant les aspects de développement), tels que ceux proposés par le présent travail, va permettre d'améliorer le diagnostic, le pronostic, ainsi que les interventions thérapeutiques visant à réduire les risques d'incapacités à long terme. L'augmentation du nombre de naissances prématurées signifie également l'augmentation du nombre de nouveaux-nés dont le cerveau est vulnérable (Hayden, 2010). Si le but des avancées dans les soins néonataux est la survie de ces enfants prématurés ainsi que la baisse de comorbidité pour une meilleure qualité de vie, alors la compréhension du développement de leur cerveau est cruciale pour l'établissement de nouveaux biomarqueurs. Ces derniers sont pertinents pour le suivi clinique, car ils fournissent des informations plus subtiles sur le fonctionnement cérébral que les examens en neuroanatomie. Ceci est particulièrement déterminant dans un contexte où l'identification d'anomalies de fonctionnement cérébral pendant l'enfance pourrait d'aider à prévenir les incapacités fonctionnelles des enfants à l'âge scolaire ainsi qu'à l'adolescence.

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33ffl UNIVOtSITAlIlE DE QUÉBEC cm

Le 24 août 2007

Docteur Cyril Schneider, Ph.D. Unité de recherche en neurosciences CHUL du CHUQ

OBJET: Projet 109.05.02

Contrôle cortical d'une synergie musculaire proximo-distale chez l'être humain Docteur,

La présente est en réponse à la présentation du projet en titre lors de la réunion du