Centre National de Reéducation Fonctionnelle & de Réadaptation

This trial is part of the spastiCRYO clinical research project. The primary objective of this clinical trial is to test the hypothesis: "Upper limb nerve cryoneurolysis is non inferior to the usual care and has therapeutic add value in dealing with shoulder pain and functional problems caused by spasticity and motor impairment".
It is a non-inferiority study on the referred topic, comparing the therapeutic effect (improvement in function and pain) of cryoneurolysis of selected nerves (lateral pectoral nerve and thoracodorsal nerve) with the usual care: intramuscular botulinum neurotoxin type A (BoNT-A) injection of pectoralis major, teres major and subscapularis muscles. The hypothesis is that cryoneurolysis is not inferior to the usual care in terms of magnitude of the therapeutic effect and might have a therapeutic add-value in terms of duration of that effect.
Two secondary hypotheses are firstly, that cryoneurolysis is a safe procedure that can be deployed in a rehabilitation hospital setting with minimum requirements to perform mini-invasive procedures and secondly that selecting patients who might benefit from this treatment is straightforward.
To test these hypotheses, the research team will gather, analyse and compare outcome measures data from the endpoints which are the changes along the trial duration in shoulder pain, upper limb function, involved muscles spasticity, shoulder range of motion (abduction and external rotation) level of impairment, and follow-up of potential adverse effects in two independent and equivalent groups of participants who have shoulder pain and functional limitations caused by spasticity and are in a stable phase of their condition. Participants in one group (cryoneurolysis arm) have one session of selected nerves ultrasound and neurostimulation guided cryoneurolysis and participants in the other group (BoNT-A arm) have one session of ultrasound and neurostimulation guided injection of BoNT-A in the pectoralis major, teres major and subscapularis.
The participants of the two groups follow an upper limb analogous rehabilitation program for 24 weeks after each intervention. Longitudinal follow-up in the trial will take 24 weeks. In a real-world scenario, within 24 weeks the effect of Bont-A intramuscular injection has already waned, and the procedure should be repeated.
Secondary objectives are to compare changes in upper limb sensory function and electroneuromyographic parameters with the intention to understand the cryoneurolysis mechanism of action and the reversibility of this mini-invasive intervention. Changes in quality-of-life dimension of participants is a secondary endpoint as well.

Functional, independent mobility is essential for everyone (Fasciglione, 2017). It determines everyone's ability to engage in activities of daily living and contributes to maintaining health and well-being (Fasciglione, 2017).
However, the number of people with mobility limitations is increasing. Indeed, due to the aging of the population and the growing number of people with chronic diseases, the prevalence of people experiencing mobility-related limitations is increasing rapidly (Berardi et al., 2021); in addition to this health problems (such as osteoarticular, muscular, neurological diseases) and accidents are the cause of 23.6% and 42% of mobility-related limitation situations respectively (Camirand & Institut de la statistique du Québec, 2011).
To overcome these limitations, some people require the use of a manual wheelchair to enable mobility. Globally, wheelchair mobility (manual or motorized) refers to "the ability to move independently with a wheelchair, and to overcome obstacles encountered in carrying out activities of daily living or social roles" (Routhier et al., 2003, p. 20). This definition emphasizes that the use of a wheelchair enables independent movement.
In the past, the wheelchairs available were limited, expensive and rudimentary. Recent technological advances have given people access to a wide range of devices, adaptable to the majority of motor impairments and enabling movement in a wider variety of environments. Today's manual wheelchairs are increasingly sophisticated. However, they have no braking system other than the immobilizer that locks the wheels. Users have no choice but to use their hands as brake pads when gripping the handrail to slow down and stop.
A preliminary survey conducted by EPPUR among 164 manual wheelchair users, between March and May 2020, has shown that 75% of manual wheelchair users express difficulty braking with their wheelchair or resort to assistance from a third party (EPPUR). Worryingly, 50% of survey respondents reported having lost control of their wheelchair on a slope or ramp. Finally, in their daily lives, 85% of respondents reported having already changed their route to avoid a slope. For wheelchair users, negotiating sloping streets means constant braking.
The Dreeft® system was developed on the basis of these observations. No other system for braking manual wheelchairs is currently available. As described in the previous sections, the technology developed is based on the design of the hub which integrates the braking system, operating by back-pedaling. The manual wheelchair user benefits from improved responsiveness and manoeuvrability, with no friction on the hands. Adapted to manual wheelchairs, this innovative braking system is a potential revolution for users.
In order to confirm the benefits and functional contribution of the Dreeft® device in real life, a clinical study will be carried out.

Brief Summary
This prospective, monocentric national study aims to establish normative reference data for the Ker-EGI (Kerpape Gait Index), a novel gait quantification index based on muscle activation profiles of the lower limbs in children. The objective is to determine both the mean activation profile and its variability in a healthy pediatric population.
Participants are healthy children and adolescents, aged 3 to 15 years, recruited outside of the Kerpape Rehabilitation Center and specifically attending the Kerpape gait laboratory for this study. A total of 120 subjects are expected. Each participant and their parent(s)/legal guardian provide informed consent prior to enrollment.
Study Procedure:
Each child is accompanied by at least one parent and participates in a single session lasting approximately one hour. After skin preparation (shaving if necessary and cleaning with alcohol), 28 surface electrodes (ECG type) are placed bilaterally on seven lower limb muscles (tibialis anterior, soleus, gastrocnemius medialis, rectus femoris, vastus medialis, semitendinosus, and gluteus medius). Anatomical landmarks are marked with a dermographic pencil. For younger children, a doll is used to facilitate explanation of electrode placement.
The gait analysis is performed with the child in underwear from the time of electrode placement. Each participant completes 10 walking trials (five round trips of 10 meters) at self-selected comfortable speed, following demonstration or a test trial if necessary. Gait is recorded using synchronized cameras and video recordings are anonymized daily.
Data Collection:
Collected data include participant demographics (name, age, sex, height, weight, leg length), electrode signals, and video recordings. Following the session, electrodes are removed, and children are invited to get dressed.
Constraints and Risks:
The study involves a minimal deviation from routine conditions: a single one-hour session including electrode placement, walking assessment, and filming. No invasive procedures or therapeutic interventions are conducted.
Sample Size:
120 healthy children and adolescents, aged 3 to 15 years.