Hendaye

The STIM-PRADER study aims to assess the effectiveness of auricular vagal neuromodulation therapy (aVNT) on emotional, behavioral, and cognitive domains impaired in Prader-Willi Syndrome (PWS). Currently, no treatment exists that addresses the multiple alterations associated with this rare neurodevelopmental disorder that significantly impact patients and their families. We will investigate the effects of daily, four-hour aVNT stimulation over a nine-month period on (a) emotion regulation, including assessing the persistence of effects following stimulation; (b) executive functions, including inhibition, flexibility, planning, and updating information in memory; (c) hyperphagia; (d) depression; (e) quality of life; (e) and the threshold at which effects on these dimensions can be observed. We will conduct a longitudinal multicenter parallel randomized controlled single-blind exploratory trial. Twenty-four adults with PWS and 24 caregivers will be randomly assigned to receive either active or sham stimulation under identical conditions (four hours per day, seven days per week over nine months). The primary outcome, focusing on emotional control, will be assessed every two weeks for both participants and caregivers. Secondary outcomes (executive functions, hyperphagia, depression, and quality of life) will be measured at four time points: pre-intervention, at three months, six months, and at nine months. As this is the first multicenter randomized controlled trial investigating the effects of aVNT as a treatment in PWS patients, we anticipate witnessing improved emotional regulation and reduced eating disorders, along with enhancements in executive functions and quality of life in the active stimulation group. The findings from this project could support the development of broader therapeutic approaches for other conditions in which behavioral disorders and emotional processing deficits affect patients and their caregivers.

Context Polyhandicap as a chronic complex disability condition, lead to a combination of profound intellectual disability and serious motor deficit, resulting in the extreme restriction of autonomy and communication. Due to the improvement of preventive actions and supportive care, the life expectancy of these persons is increased In order to assess the issues associated with the aging of people with polyhandicap (an emerging and underexplored phenomenon), life experiences, social representations, specific needs and expectations of familial caregivers (parents and siblings) need to be explored. It is essential to better understand these phenomenon in order to better support and assist these families. The PolyAGE project relies on an interdisciplinary approach, based on social and human sciences (social psychology of health) and public health. PolyAGE is based on a solid network including engaged and volunteer actors. Objectives The general objective of PolyAGE is to explore the life experience of familial caregivers of aging persons with polyhandicap (\>= 35 years). The investigators will question parents (objective 1) and siblings (objective 2) about the experiences, the social representations, the needs and the expectations, as well as the mechanisms associated with their choices about their children with polyhandicap. The objective 3 is to co-analyze parents' and siblings' experiences regarding the aging of their relatives with polyhandicap. Methods PolyAGE relies on the EVAL-PLH cohort, initiated in 2015, including persons with polyhandicap, familial and institutional caregivers. Eight teams are involved in PolyAGE: 2 specialized reeducation centers (Hendaye et San Salvadour), the J. Bost Foundation, the Groupe Polyhandicap France (family association), 3 university teams (CeReSS and LPS of Aix Marseille university and SantESiH of Montpellier university), 1 epidemiology team (AP-HM).The investigators propose a pluri-methodological mixt approach combining quantitative and qualitative approaches in a socio-contextual and comprehensive perspective: 1. Quantitative approach: * Evaluations using standardized self-reported questionnaires: quality of life, coping, emotional intelligence, burden. * Parents: data already available (EVAL-PLH cohort: 2 evaluation times 20151-6 and 2020-21). * Siblings: data to be collected (phone, mail). 2. Qualitative approach: * Evaluations based on interviews (parents and siblings; 1 confounding factor: participant's sex); * Combination of interviews content and interpretative phenomenological analysis. 3. Methodological triangulation: * Crossing and confrontation of quantitative and qualitative findings. Perspectives * Improvement of knowledge and identification of the specific needs/expectations of family caregivers of aging persons with polyhandicap. * Understanding the underlying reasons behind the choices made by families in terms of support for aging persons with polyhandicap in order to support the transitions related to the joint aging of persons with polyhandicap and their relatives. * Better supporting families in the aging transition (health professionals, health-decision makers).