{"id":7369,"date":"2025-12-30T16:21:48","date_gmt":"2025-12-30T15:21:48","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=7369"},"modified":"2025-12-30T17:49:14","modified_gmt":"2025-12-30T16:49:14","slug":"sep-prise-en-charge","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=7369","title":{"rendered":"SEP prise en charge"},"content":{"rendered":"\n<h3 id=\"principes\" class=\"wp-block-heading\">Principes <\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fractionnement :<\/strong> Respecter l&rsquo;alternance effort\/repos. La r\u00e8gle est souvent \u00ab\u00a0autant de temps de repos que de travail\u00a0\u00bb avant et entre les exercices.<\/li>\n\n\n\n<li><strong>Thermosensibilit\u00e9 (Ph\u00e9nom\u00e8ne d&rsquo;Uhthoff) :<\/strong> La chaleur majore les sympt\u00f4mes et la fatigue (ralentissement de la conduction nerveuse). Il faut \u00e9viter la pratique en conditions chaudes et privil\u00e9gier la <strong>cryoth\u00e9rapie<\/strong> (douche ou bain frais) avant l&rsquo;effort.<\/li>\n\n\n\n<li><strong>Fatigabilit\u00e9 :<\/strong> Distinguer la fatigue per\u00e7ue de la fatigabilit\u00e9 musculaire objective. Il faut freiner le patient pour \u00e9viter une fatigue trop intense avant d&rsquo;atteindre son seuil de rupture.<\/li>\n<\/ul>\n\n\n\n<h3 id=\"la-reeducation-est-adaptee-selon-le-score-edss\" class=\"wp-block-heading\"><strong>La r\u00e9\u00e9ducation est adapt\u00e9e selon le score EDSS.<\/strong><\/h3>\n\n\n\n<h4 id=\"patient-avec-atteinte-fruste-edss-0-45\" class=\"wp-block-heading\">Patient avec atteinte fruste (EDSS 0 &#8211; 4.5)<\/h4>\n\n\n\n<p><\/p>\n\n\n\n<p>Objectifs : entretien, pr\u00e9vention, a\u00e9robie<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>R\u00e9entra\u00eenement \u00e0 l&rsquo;effort :<\/strong> Travail en a\u00e9robie (v\u00e9lo, tapis, elliptique) pour augmenter le seuil de fatigabilit\u00e9. Recommandation HAS : 2x\/semaine.<\/li>\n\n\n\n<li><strong>Renforcement Musculaire&nbsp;<\/strong>\n<ul class=\"wp-block-list\">\n<li>Global ou analytique, isocin\u00e9tique.<\/li>\n\n\n\n<li><em>Contre la spasticit\u00e9 :<\/em> Travail excentrique des antagonistes (ex: releveurs).<\/li>\n\n\n\n<li><em>Muscles cl\u00e9s :<\/em> Grand fessier, Moyen fessier, Ischio-jambiers (pour freiner le recurvatum), Abdominaux\/Spinaux.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>\u00c9quilibre et Coordination :<\/strong> S\u00e9quences de redressement, plan instable (Freeman), unipodal, double t\u00e2che.<\/li>\n\n\n\n<li><strong>\u00c9tirements :<\/strong> Polyarticulaires et auto-\u00e9tirements quotidiens.<\/li>\n<\/ul>\n\n\n\n<h4 id=\"patient-avec-atteinte-intermediaire-edss-45-7\" class=\"wp-block-heading\"> Patient avec atteinte interm\u00e9diaire (EDSS 4.5 &#8211; 7)<\/h4>\n\n\n\n<p>Objectif : Maintien de l&rsquo;autonomie, s\u00e9curit\u00e9 \u00e0 la marche, transferts.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Marche :<\/strong>\n<ul class=\"wp-block-list\">\n<li>Correction des boiteries : travail du transfert d&rsquo;appui, contr\u00f4le du recurvatum (feedback visuel\/auditif), passage d&rsquo;obstacles pour la triple flexion .<\/li>\n\n\n\n<li>Aides techniques : Canne, releveur de pied, orth\u00e8ses, stimulation \u00e9lectrique fonctionnelle (SEF).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Transferts :<\/strong> Apprentissage du <strong>relev\u00e9 du sol<\/strong> (d\u00e9composer le mouvement, passer par le chevalier servant) pour g\u00e9rer les chutes.<\/li>\n\n\n\n<li><strong>\u00c9quilibre :<\/strong> Assis et debout, r\u00e9actions parachutes.<\/li>\n<\/ul>\n\n\n\n<h4 id=\"patient-avec-atteinte-severe-edss-gt-7\" class=\"wp-block-heading\"> Patient avec atteinte s\u00e9v\u00e8re (EDSS &gt; 7)<\/h4>\n\n\n\n<p>Objectif : Confort, pr\u00e9vention des complications, autonomie au fauteuil.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Verticalisation :<\/strong> Lutte contre l&rsquo;ost\u00e9oporose et la spasticit\u00e9, entretien orthop\u00e9dique (cheville \u00e0 90\u00b0). Utilisation de standing ou fauteuil verticalisateur<\/li>\n\n\n\n<li><strong>Respiratoire :<\/strong> Renforcement des muscles expirateurs (souvent d\u00e9ficitaires), entretien de l&rsquo;ampliation thoracique, spirom\u00e9trie incitative<\/li>\n\n\n\n<li><strong>Orthop\u00e9dique\/Cutan\u00e9 :<\/strong> Mobilisations passives, postures, pr\u00e9vention des escarres (installation, coussins)<\/li>\n\n\n\n<li><strong>Fauteuil Roulant :<\/strong> Apprentissage du maniement et des transferts (push-up, planche de transfert)&nbsp;<\/li>\n<\/ul>\n\n\n\n<h4 id=\"reeducation-specifique-par-syndrome\" class=\"wp-block-heading\"> R\u00e9\u00e9ducation Sp\u00e9cifique par Syndrome<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Spasticit\u00e9 :<\/strong> \u00e9tirements lents et prolong\u00e9s, postures d&rsquo;inhibition<\/li>\n\n\n\n<li><strong>Ataxie C\u00e9r\u00e9belleuse :<\/strong>\n<ul class=\"wp-block-list\">\n<li>Utiliser des charges (lests aux chevilles\/poignets) pour r\u00e9duire l&rsquo;hyperm\u00e9trie<\/li>\n\n\n\n<li>Traiter dans le calme (concentration), contr\u00f4le visuel, d\u00e9composition du mouvement .<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Ataxie Proprioceptive :<\/strong>\n<ul class=\"wp-block-list\">\n<li>Utilisation du biofeedback visuel (miroir), travail sur diff\u00e9rentes textures (Perfetti), compression articulaire&nbsp;<\/li>\n\n\n\n<li>Compensation par la vue et l&rsquo;audition<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Vestibulaire :<\/strong>\n<ul class=\"wp-block-list\">\n<li>Travail de la poursuite oculaire, stabilisation du regard t\u00eate mobile, stimulation optocin\u00e9tique .<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Principes La r\u00e9\u00e9ducation est adapt\u00e9e selon le score EDSS. Patient avec atteinte fruste (EDSS 0 &#8211; 4.5) Objectifs : entretien, pr\u00e9vention, a\u00e9robie Patient avec atteinte interm\u00e9diaire (EDSS 4.5 &#8211; 7) Objectif : Maintien de l&rsquo;autonomie,&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=7369\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0SEP prise en charge\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":5,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[403],"tags":[],"class_list":["post-7369","post","type-post","status-publish","format-standard","hentry","category-champ-neuro-sep"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.7 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>SEP prise en charge - wikine<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kineaphp.fr\/?p=7369\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"SEP prise en charge - wikine\" \/>\n<meta property=\"og:description\" content=\"Principes La r\u00e9\u00e9ducation est adapt\u00e9e selon le score EDSS. 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