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Face à l’urgence climatique, les conventions internationales se multiplient, toujours plus ambitieuses et contraignantes. Limitées par les négociations politiques, l’Union européenne décide de s’imposer comme leader d’une économie plus verte. En plus des réglementations environnementales, l’Union européenne dispose de deux principaux outils : le système d’échange de quotas d’émissions, et le futur mécanisme d’ajustement aux frontières, qui entrera en vigueur de façon transitoire dès janvier 2023. 
Dans ce travail, nous cherchons à étudier les logiques derrière ces instruments, leurs sources, mais également leur impact sur les entreprises européennes. En effet, si l’Union veut préserver sa position deuxième puissance économique mondiale, il est fondamental qu’elle parvienne à assurer la compétitivité de ses entreprises. Dans le but de favoriser une approche multidisciplinaire, ce mémoire a également recueillis, en guise d’illustrations, les positions d’entreprises et de fédérations d’entreprises directement soumises à ces instruments.

SEQE --- MACF --- Instruments de marché --- GATT --- Compétitivité des entreprises --- Droit, criminologie & sciences politiques > Droit économique & commercial

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Objectives: To review the recent literature concerning the role of visual feedback and feedforward information in reaction time, accuracy, duration, trajectory, and kinematic profiles of unimanual upper limb movements (ULMs) in typically developing children (TDC) between 4 and 18 years of age. Methods: We searched the electronic databases MEDLINE, EMBASE, Web Of Science and Cochrane Central Register of Controlled Trials for articles written in English and published between January 1980 and October 2020. Results: We included 1 longitudinal and 18 cross-sectional studies in our review. When the availability of visual information during ULMs is reduced, overall accuracy of ULMs decreases and children show shorter reaction times. For aiming movements, children have the longest movement durations when visual feedback of their arm is lacking and the shortest movement durations in complete darkness. For reach-to-grasp movements, children show longer movement durations both when visual feedback of their arm, or their arm and the target is lacking. Furthermore, when visual feedback is removed, movement trajectories are longer, more curved and less smooth, maximum grip aperture (MGA) is wider, and children reach their peak velocity and MGA earlier during the movement. Conclusion: Typically developing children between 4 and 18 years of age rely on visual feedback and feedforward information for the planning and guiding of unimanual ULMs. When children cannot rely on this visual information, they try to maintain the accuracy of their movements by reacting faster and moving more cautiously and with a larger safety margin.

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In children with unilateral cerebral palsy (CP), sensory and motor impairments are often more pronounced in the upper limb (UL) than in the lower limb, though the variability in outcome is large. This is not surprising since these children present with various brain lesions. So far, it is still unclear which neurological factors determine UL function in these children. Further research is necessary to unravel the complex neuropathophysiology underlying UL dysfunction.Magnetic resonance imaging (MRI) is the standard clinical technique to investigate brain lesions in children with CP. However, more recently developed medical imaging techniques can provide a more complete picture of the brain lesion. Diffusion tensor imaging (DTI) is found to be superior to structural MRI to identify white matter tract injury in children with CP. Limited studies using DTI have focused on the associations with UL function in children with unilateral CP presenting contradicting results on the importance of the corticospinal versus thalamocortical tracts. Recently, diffusion kurtosis imaging (DKI) was suggested as a minimal extensionof DTI as it provides a more accurate quantification of water diffusion in the brain. Until know, DKI still has not been used in the research are of CP.Furthermore, there is increasing evidence that constrained-induced movement therapy and intensive bimanual training are efficient for improving UL function in children with unilateral CP. However, until now no one treatment modality has shown to be superior. Moreover, studies reported large variability which cannot befully explained based on age or initial severity.15 Therefore, it has become an intriguing question whether the efficacy of therapy models depends on brain lesion characteristics and this requires further investigation.The overall aim of this project is to investigate which neurological factors determine UL sensorimotor outcome as well as treatment response via a clinical and biomechanical approach in children with unilateral CP. In a first study, we will try to get a betterinsight in the relation between clinical and biomechanical measures of UL function. Secondly, we will explore in how far sensorimotor function depends on white matter tract integrity (DKI) combined with brain lesioncharacteristics (MRI). Finally, we will conduct an intervention study to identify neurological predictors for treatment response.Most neuroimaging studies investigated the association between imaging findings and motor function, while we will emphasize more on identifying neurological predictors of UL function as well as treatment response. This project is, to our knowledge, the first to use DKI in children with CP also combined with the neuroanatomical characterization of the lesion and relate this to UL function. Secondly, studies using UL kinematics in combination with neuroimaging findings do not exist yet. Sothis project will provide new knowledge in this field which will help us to better understand the neuropathophysiology underlying UL dysfunction.

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Doelstelling: Het doel van deze systematische review was om te achterhalen wat de functionele uitkomst is na een chirurgische transpositie van de musculus flexor carpi ulnaris in de pols bij kinderen met unilaterale cerebrale parese. Methode: Een systematische zoektocht werd uitgevoerd via verschillende elektronische databanken, waaronder MEDLINE, COCHRANE, EMBASE en CINAHL alsook in referentielijsten van de weerhouden artikels. De artikels werden methodologisch geanalyseerd met behulp van de Physiotherapy Evidence Database (PEDro) schaal. Informatie over het studietype, het aantal deelnemers, de kenmerken van de patiënten, de behandeling, de uitkomstmaten en de resultaten werden verzameld. Resultaten: Een totaal van 319 artikels werd geïdentificeerd, waarvan slechts zes werden geïncludeerd in deze systematische analyse. De interne kwaliteit van deze zes studies was laag, aangezien het geen gerandomiseerde gecontroleerde studies zijn. De rustpositie van de pols en de functionaliteit, waaronder het actieve bewegingsbereik en de knijpkracht van de pols, verbeterde postoperatief bij elk kind en geen enkel kind verloor mobiliteit in de pols. Dit gold eveneens voor de esthetiek van de pols. Conclusie: Deze review toont aan dat de rustpositie van de pols na een peestranspositie verandert naar een meer neutrale positie, wat een positieve invloed heeft op de functionaliteit en de esthetiek van de pols. Verder kan een flexor carpi ulnaris transpositie zorgen voor een beter actief bewegingsbereik en een betere knijpkracht. Op hogere evidentie gebaseerde studies zijn echter schaars. Verder onderzoek met betrekking tot de postoperatieve functionaliteit van de pols is noodzakelijk en dit op basis van systematisch gebruik van dezelfde primaire uitkomstmaten.

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Background: Robotic-assisted therapy (RAT) is a relatively new technology used in the treatment of children with cerebral palsy (CP). RAT has the main advantage of offering an attractive environment, better maintaining the motivation of the child during therapy. Also, it offers the possibility of a repetitive, intensive and frequent practice. In children with unilateral CP, RAT has been increasingly used to improve the function of the upper limb. Chen et al. (2013) concluded with their systematic review that RAT appears to be promising, though mainly case studies were included. Objective: This review aims to provide an overview of the more recent literature that examined the effectiveness of RAT in the rehabilitation of the upper limb function in children with unilateral CP. Methods: A literature search in Pubmed, Cinahl, Cochrane, Embase, and Web of Science was conducted systematically from July 2013 up to November 2018. Studies including children with unilateral CP, aged 1 until 18 years, were included when the effectiveness of RAT on upper limb function was examined. Results: The search resulted in seven studies, including four case studies, two randomized controlled trials, and one randomized cross-over study. Five different robotic systems were used across these studies. The total dosage of therapy varied between 5 and 40 hours, with a duration of 1-12 week(s). The results indicate that RAT leads to improvements on each level of the International Classification of Functioning, Disability and Health. Conclusion: This review indicates that the use of RAT in the rehabilitation of the upper limb function is beneficial and is better compared to conventional therapy. However, studies of higher quality, including larger sample sizes and with a longer follow-up are needed to confirm the results of this review.