Philippe Gynécologie

Laurent Dermato-Vénérologie

Nonent Michel

Robaszkiewicz Michel

Gastroentérologie Salaun

Saraux Alain

Rhumatologie Timsit

Serge Neurologie

Walter Michel

MERVIEL

Parent's experiences of medical and rehabilitation services for children with physical disabilities during lockdown

Cet article a été soumis dans une revue à comité de relecture internationale

INTRODUCTION

The COVID-19 pandemic was an unprecedented, worldwide situation. Many countries implemented a full lockdown to limit the spread of the virus. In France, a full lockdown was applied from March 17

to May 11, 2020. All schools were closed, the possibility to go outdoors was limited, direct contact with people was not allowed, and access to medical care was restricted to emergency situations [START_REF] Cauchemez | Lockdown impact on COVID-19 epidemics in regions across metropolitan France[END_REF].

Children with physical disabilities have specific health issues that require special attention and continuous case-management. They usually attend regular medical consultations and participate in several rehabilitation sessions each week [START_REF] Roquet | From childhood to adulthood: health care use in individuals with cerebral palsy[END_REF][START_REF] Sacaze | A survey of medical and paramedical involvement in children with cerebral palsy in Britanny: preliminary results[END_REF]. The overall aim of rehabilitation is to optimize both the child's and family's quality of life and social integration through optimizing independence in activities, and optimizing their ability to adapt and respond to changes in circumstances [START_REF] Wade | Rehabilitation -a new approach. Overview and Part One: the problems[END_REF]. In many countries the setting in which rehabilitation is performed and the organization of sessions differ according to the child's needs. In France, many rehabilitation services closed during the lockdown.

The lack of rehabilitation provision was a major concern for families during this period [START_REF] Cacioppo | Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey[END_REF] and new methods of service provision had to be rapidly developed in an attempt to ensure continued care.

The lockdown thus provided the opportunity to evaluate a new model of rehabilitation provision.

We therefore set out to obtain feedback from families across France from which optimized organizational strategies could be developed and implemented to improve service provision [START_REF] Cornec | Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe)[END_REF], thus resulting in a positive outcome from this challenging situation [START_REF] Rosenbaum | Let's not go back to 'normal'! lessons from COVID-19 for professionals working in childhood disability[END_REF]. For this, it was necessary to identify the determinants of parental satisfaction with healthcare provision, and the difficulties faced by parents during the lockdown: parental satisfaction is a key indicator of the quality of pediatric healthcare [START_REF] Cornec | Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe)[END_REF][START_REF] Zastowny | Patient satisfaction and experience with health services and quality of care[END_REF]. We hypothesized that parents would be dissatisfied with the changes in medical and rehabilitation service provision during the first lockdown. We further hypothesized that the level of satisfaction would vary according to the characteristics of the children and their families, as well as the characteristics of the services they received, and that continued rehabilitation would be a major determinant of satisfaction.

The study presented here is part of the Enfant Confinement Handicap besOins (ECHO [child lockdown disability needs]) national survey, which was diffused during the first, full lockdown in France. The overall aim of the ECHO survey was to provide a real-time and macroscopic vision of the effects of the first lockdown on children with physical disabilities and their families. We published a preliminary study [START_REF] Cacioppo | Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey[END_REF] of the emerging challenges caused by the lockdown (relating to rehabilitation, daily life and family difficulties) using the first 1000 responses to the survey. The first aim of the present and novel study was to evaluate parental satisfaction with medical and rehabilitation service provision during the full lockdown in France, and to identify the determinants of satisfaction from the characteristics of the child, their family and the medical and rehabilitation services received before and during the lockdown. The second aim was to describe changes in medical consultation and rehabilitation provision during the lockdown and to report the consequent difficulties experienced by parents. French legislation (loi Jardé (n°2012-300) [START_REF] Cacioppo | Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey[END_REF]. An informed consent page was posted online before the questionnaire began. Responders could not be identified from the survey (no email or IP address) [START_REF] Eysenbach | Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES)[END_REF]. The study is reported according to STROBE and CHERRIES guidelines [START_REF] Cuschieri | The STROBE guidelines[END_REF][START_REF] Toulouse | French legal approach to clinical research[END_REF] (Supplementary Material 5).

MATERIALS AND METHODS

Questionnaire

The ECHO survey was addressed to the parents or legal guardians of children with physical disabilities (cerebral palsy, neuromuscular disease, orthopedic disease, etc.), with or without other associated impairments, aged from 0 to 18 years.

The survey was developed by a national multidisciplinary group that included parents of children with physical disabilities, family organizations, learned societies, researchers, and medical and rehabilitation professionals all experienced in disability care (see acknowledgements). The questionnaire was developed within the biopsychosocial perspective [START_REF] Wade | The biopsychosocial model of illness: a model whose time has come[END_REF] and the conceptual framework of the ICF (which describes the individual in terms of activity, participation and environment). To verify the usability of the electronic questionnaires, the survey was tested by 7 parents of children with physical disabilities prior to diffusion.

The survey was developed using an online tool, SurveyMonkey® (San Mateo, California, USA). The questionnaire was composed of 115, non-randomized and progressive questions (54 pages). The first part of the survey related to the child's characteristics. The second part of the survey related to the child's condition, medical consultations and rehabilitation received during the lockdown, and the child's daily life during the lockdown. The third part related to the parents' experience of the lockdown and organization of family life during the lockdown.

Most questions had closed answers (binary (yes/no) or multiple choice). It was not mandatory to answer all the questions (e.g. children without physiotherapy did not have to answer questions related to physiotherapy) and parents were able to review and change their answers. A completeness check was available. No financial incentive was proposed. The ECHO questionnaire is available at https://fr.surveymonkey.com/r/TESTECHO.

Participants

Snowball sampling was used. The survey was promoted nationally through parent groups, advocacy groups, learned societies and professional bodies. It was disseminated across the 13 regions of

France via email and social media (Facebook®, Linked-in® and Twitter®) to collect real-time information on the impact of the lockdown, as well as to obtain data from children with a wide range of ages and situations. Weekly reminders were sent to families, patients, learned societies, organizations etc. We aimed to obtain 1000 responses to ensure sufficient data to run robust multivariate analyses and test our hypotheses.

Questionnaires were excluded if they were not completed by the parents or legal guardians, were not finished, if the child was not living at home during the lockdown or was aged more than 18 years old.

Data collection

The present study focused on the medical and rehabilitation services that were provided during the lockdown.

The primary outcome was the client satisfaction questionnaire 8 (CSQ-8) score. This tool is a validated measure of satisfaction that consists of 8 items, each rated on a 4-point Likert scale from 1 to 4 (score ranges from 8 to 32; with higher scores denoting higher levels of satisfaction). It was used to assess parental satisfaction with both medical and rehabilitation service provision [START_REF] Attkisson | Client Satisfaction Questionnaire-8 and Service Satisfaction Scale-30. The use of psychological testing for treatment planning and outcome assessment[END_REF][START_REF] Kapp | Qualités psychométriques du Consumer satisfaction questionnaire (CSQ-8) et du Helping alliance questionnaire (HAQ)[END_REF].

The following sets of variables were used to identify determinants of satisfaction.

1/ "Child characteristics": age, sex, pathology, type of accommodation and region. Details of associated impairments and the level of dependence of the child were also requested. A custommade dependency score composed of two sub-scores was used: a prehension score based on 3 items and a mobility score based on 3 items (Supplementary Material 1). Each item was rated from 0 to 3, the two sub-scores (prehension score and mobility motor function score) from 0 to 9 and the total score from 0 to 18. Higher scores indicated greater dependence.

2/ "Service provision characteristics": maintenance of medical consultations and continuation of rehabilitation sessions during the lockdown, as well as the child's usual rehabilitation setting. We devised a three-category scale to evaluate the extent of the disruption of rehabilitation during the lockdown period: no disruption (all therapy continued), moderate disruption (at least one type of therapy stopped) and total disruption (no therapy provided at all).

3/ "Family characteristics": if a parent cared for the child alone during the lockdown and the number of children at home.

To answer the second aim, we analyzed variables relating to how medical consultations and rehabilitation sessions were adapted during the lockdown: how they were carried out (face-to-face, phone call, telerehabilitation, etc.) and by whom they were performed (professionals, parents or the children themselves). We also analyzed difficulties accessing medical consultations or pursuing rehabilitation (difficulty accessing new treatments prescribed during the lockdown, lack of rehabilitation provision, lack of equipment, lack of motivation etc.).

Statistical analysis

Descriptive statistics were performed on demographic and clinical variables. Continuous data are presented as means (standard deviation [SD]), and dichotomized and categorical data as numbers (%). When useful, 95% confidence intervals (CIs) are provided.

To test our first hypothesis that satisfaction with service provision during lockdown would be determined by specific factors, we first explored the effects of the three sets of variables (child, service provision and family characteristics) on CSQ-8 scores using a one-way ANOVA. To take the multiple comparisons into account, we adjusted the p-value of the univariate analysis using a Bonferroni correction, thus p was set at 0.0033 (0.05/15). Effect sizes were calculated for significant variables using the F values from the one-way ANOVA (η 2 = F* degree of freedom between/F* degree of freedom between+ degree of freedom within). The η 2 values 0.01, 0.06 and 0.14 respectively represent small, medium and large effects. Variables that were significant in the univariate analysis were included in multivariate analyses by stepwise GLM (general linear model) to further explore their relationship with satisfaction.

Unless otherwise indicated (corrections), a two-tailed p<0.05 was considered statistically significant.

All statistical analyses were performed with SPSS 24.0.

RESULTS

Sample description

During for 21•3% and in a rehabilitation center (for post-intervention rehabilitation or short-term, intensive rehabilitation to achieve a specific goal, or while waiting for a place with specialized services) for 5•9%.

Satisfaction with medical and rehabilitation service provision during the lockdown

Mean CSQ-8 score for satisfaction with medical and rehabilitation services was 18 (6) out of 32. Fiftynine percent of the ratings were below the mid score. The univariate analyses (one-way ANOVA) ( 4).

DISCUSSION

This study evaluated satisfaction with medical and rehabilitation services provided during the first lockdown in France in a large sample of parents of children with disabilities using a validated measure of satisfaction. Of the three categories of determinants considered (child, service provision and family characteristics), service provision characteristics most strongly influenced satisfaction:

the three main determinants of parental satisfaction were continued rehabilitation, rehabilitation provided by specialized services and maintained medical consultations. Care was massively interrupted: 77% of medical consultations were canceled and more than 50% of rehabilitation sessions were totally interrupted. Up to 81•7% of the remaining rehabilitation sessions were carried out by parents. The lockdown thus highlighted failures in the current model of rehabilitation provision that required professionals and families to implement new methods of service provision to ensure the children received some rehabilitation: these changes provide several keys to improve rehabilitation service provision both during and out with pandemic situations.

The results of this survey revealed a high degree of parental dissatisfaction with medical and rehabilitation services during the lockdown in France: more than the half of the respondents rated their satisfaction below the mid score. This contrasts with other studies which generally showed high levels of satisfaction with health care [START_REF] Zastowny | Patient satisfaction and experience with health services and quality of care[END_REF][START_REF] Keith | Patient satisfaction and rehabilitation services[END_REF], including a French national study of individuals with cerebral palsy performed before the pandemic in which 78% of the ratings of satisfaction with rehabilitation services were above the mid-score [START_REF] Cornec | Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe)[END_REF]. Patient satisfaction is an important indicator of quality of care [START_REF] Zastowny | Patient satisfaction and experience with health services and quality of care[END_REF]. Together with the results of other studies performed during the pandemic that revealed the large, negative impact of the lockdown on the functional capacities of children with disabilities, our results demonstrate that the insufficiency of care service provision had a negative impact on their health [START_REF] Sutter | Disrupted access to therapies and impact on well-being during the COVID-19 pandemic for children with motor impairment and their caregivers[END_REF][START_REF] Bova | Impact of COVID-19 lockdown in children with neurological disorders in Italy[END_REF][START_REF] Murphy | The Impact of the Novel Coronavirus Disease 2019 on Therapy Service Delivery for Children with Disabilities[END_REF][START_REF] Laventhal | Ethical decision-making for children with neuromuscular disorders in the COVID-19 crisis[END_REF]. Lockdowns are a high-risk situation for this vulnerable population.

Policymakers must ensure that decisions made to reduce the spread of a disease do not increase other health risks [START_REF] Cacioppo | Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey[END_REF], as recommended by nonprofit organizations such as UNICEF and the WHO, as well as EU disability strategies [20,[START_REF]Union of equality: Strategy for the rights of persons with disabilities 2021-2030 -Employment[END_REF].

The fact that continued rehabilitation was the strongest determinant of satisfaction demonstrates the importance of maintaining regular rehabilitation sessions for children with disabilities, even in a pandemic situation. The French model of care allows access to free multidisciplinary care and rehabilitation sessions, despite the low level of evidence supporting such long-term regular input [START_REF] Roquet | From childhood to adulthood: health care use in individuals with cerebral palsy[END_REF][START_REF] Sacaze | A survey of medical and paramedical involvement in children with cerebral palsy in Britanny: preliminary results[END_REF]. However, this model was not followed during the lockdown. Much research is needed to precisely document the content of the different types of therapies usually provided and to identify key ingredients for effectiveness to ensure evidence-based practice. This information could then be used to improve the quality of rehabilitation services both during and out with pandemic situations.

Parents expressed higher levels of satisfaction when their child's rehabilitation was usually carried out in a specialized center, rather than in private practice or other settings. These results support that care for children with disabilities should be provided by specialized professionals who have a good understanding of the child, their family and environment, and that an appointed person should coordinate their care. During the lockdown, such services may have been more able to respond efficiently to the situation by proposing specific family-centered solutions to support the children and their families [START_REF] Cacioppo | Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey[END_REF]. All children should receive child-centered care by professionals who know them and their families as well as their care-plan and rehabilitation goals. To facilitate the implementation of such coordinated services in France, specific missions and roles that are fully valorized by the authorities must be developed for both professionals who are employed within specialized services and those in private practice who work with children with disabilities.

Many parents had no choice but to perform their child's rehabilitation themselves during the lockdown; this was demonstrated by the results of the present study as well as those of other studies [START_REF] Kowanda | Availability of Services and Caregiver Burden: Supporting Individuals With Neurogenetic Conditions During the COVID-19 Pandemic[END_REF][START_REF] Grumi | Rehabilitation services lockdown during the COVID-19 emergency: the mental health response of caregivers of children with neurodevelopmental disabilities[END_REF]. The responses highlighted how the lack of professional input led to parents feeling overwhelmed and inadequate in their own ability to provide rehabilitation for their child. These factors could explain the high mental load found in other studies performed during the lockdown [START_REF] Cacioppo | Emerging health challenges for children with physical disabilities and their parents during the COVID-19 pandemic: The ECHO French survey[END_REF][START_REF] Grumi | Rehabilitation services lockdown during the COVID-19 emergency: the mental health response of caregivers of children with neurodevelopmental disabilities[END_REF]. The spontaneous take-over of rehabilitation by parents demonstrates the importance they attach to their child's rehabilitation, as well as their ability to be involved in rehabilitation provision.

However, they were unsatisfied with the rehabilitation they provided to their child and with the lack of professional input they received. This reiterates the importance of systematically evaluating the amount and nature of the involvement that parents desire to have in the rehabilitation process when rehabilitation is initiated and at regular intervals, even in exceptional circumstances [START_REF] Rosenbaum | Let's not go back to 'normal'! lessons from COVID-19 for professionals working in childhood disability[END_REF][START_REF] An | Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial[END_REF].

Therapists should provide education, guidance, monitoring and support for families that is in line with the family's priorities.

The lockdown provided an opportunity for the implementation and evaluation of alternative methods of care provision such as home-based therapy and telerehabilitation [START_REF] Rosenbaum | Let's not go back to 'normal'! lessons from COVID-19 for professionals working in childhood disability[END_REF][START_REF] García-Azorín | Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review[END_REF][START_REF] Fung | Rethinking "essential" and "nonessential": the developmental paediatrician's COVID-19 response[END_REF][START_REF] Patterson | Neurological telemedicine in the COVID-19 era[END_REF], which were already used in certain situations but were not widespread. Home-based therapy, either face-to-face or by telerehabilitation, allows parents to have regular contact with professionals and could counter the difficulties reported by parents relating to a lack of professional input and the feeling of not being able to provide adequate rehabilitation themselves [START_REF] An | Effects of a Collaborative Intervention Process on Parent-Therapist Interaction: A Randomized Controlled Trial[END_REF][START_REF] Beckers | Feasibility and effectiveness of home-based therapy programmes for children with cerebral palsy: a systematic review[END_REF][START_REF] Schiariti | The human rights of children with disabilities during health emergencies: the challenge of COVID-19[END_REF][START_REF] Kronberg | Early Intervention Service Delivery via Telehealth During COVID-19: A Research-Practice Partnership[END_REF]. The fact that telerehabilitation was infrequently used suggests that is more challenging to set up and perform than medical consultations provided by telehealth. If such programs are to be implemented, it is essential that they are child-friendly and that they can be performed using equipment found within the home since parents reported that their children lacked motivation and that they lacked equipment. Out with pandemic situations, such methods could facilitate continued care, and could also help to increase the child's participation in their own rehabilitation as a complement to rehabilitation provided by a therapist.

The main strengths of this study are the large sample size and the fact that respondents were from almost all regions of France. However, there are several limitations. Firstly, although snowball sampling is an effective method for sharing online surveys, it can lead to a biased sample.

Nevertheless, the survey was not designed to study a representative sample, it was designed to gather data from a large number of parents who chose to share their experiences of the lockdown in a short and real time. The fact the number of responses exceeded the number expected is testament to the importance of the issues evaluated. Specific points that should be considered in the future to improve rehabilitation services both during and out with pandemic situations were identified.

Secondly, the fact the survey was aimed at parents may have led to some response bias, however it highlighted the major involvement of families during this period. Furthermore, parental satisfaction is an excellent indicator of the quality of pediatric care [START_REF] Cornec | Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe)[END_REF][START_REF] Zastowny | Patient satisfaction and experience with health services and quality of care[END_REF]. Lastly the survey and results are specific to France and may not be relevant to countries with different health care systems and which responded differently to the pandemic.

CONCLUSION

During the first, full COVID-19 lockdown period, dissatisfaction with medical and rehabilitation service provision for their child with physical disabilities was frequently reported by parents.

Dissatisfaction was particularly related to the discontinuation of rehabilitation sessions and medical consultations. Satisfaction was greater when the child's care was usually managed by specialized services. The changes in medical and rehabilitation service provision during the lockdown provided an opportunity to re-evaluate the current model of service provision and to build on parents' experiences of disrupted services to achieve a positive outcome from this unprecedented, difficult situation. The determinants of satisfaction identified should help the development of new tools and means to safeguard continued care, even in exceptional circumstances. More than ever, the results of this study demonstrate the need to involve parents in processes to determine appropriate methods of rehabilitation provision both during and out with pandemic situations.

Résultats

Nous avons recruté 1377 participants qui ont répondu à l'enquête ECHO pendant le premier confinement. Le score moyen du CSQ-8 était de 18/32 (écart-type 6). Cinquante-neuf pour cent des notes étaient inférieures au score moyen. Le score de préhension était le facteur le plus fort et le seul qui affectait indépendamment la satisfaction dans le modèle multivarié des caractéristiques de l'enfant. La poursuite de la rééducation était le déterminant le plus fort, indépendamment de l'établissement et du maintien des consultations médicales : Les scores CSQ-8 pour l'absence de perturbation de la rééducation et la perturbation modérée de la rééducation étaient respectivement 6,6 (95%CI [5-8,3], p<0,001) et 3,7 (95%CI [2,5-4,9], p<0,001) fois plus élevés que les scores CSQ-8 pour une perturbation importante de la rééducation. Aucune caractéristique familiale n'a influencée la satisfaction.

Interprétation

Au cours de la première période de confinement COVID-19, les parents ont signalé des taux élevés d'insatisfaction à l'égard de la réadaptation et de la prestation de services médicaux pour les enfants atteints de handicaps physiques. Ces résultats démontrent l'importance de fournir une réadaptation régulière aux enfants en situation de handicap, même en situation de pandémie.

MOTS CLES

: COVID- 19 ;

 19 Enfants en situation de handicap moteur ; Confinement ; Réadaptation ; Satisfaction ; Parents. JURY : Président Monsieur le Professeur REMY-NERIS Olivier Membres du jury Madame le Docteur CACIOPPO Marine -Directrice Madame le Docteur PONS Christelle -Directrice Monsieur le Professeur BROCHARD Sylvain Madame le Docteur MEDEE Béatrice DATE DE SOUTENANCE : 03 Décembre 2021

Maîtres de Conférences des Universités -Praticiens Hospitaliers de 2ème Classe

	LE ROUX Pierre-Yves		Biophysique et médecine nucléaire
	LE VEN Florent Praticiens Hospitaliers Universitaires Attachée Temporaire d'Enseignement et de Recherche Cardiologie
	LIPPERT Éric MAGRO Elsa BEAURUELLE Clémence BAGACEAN Cristina GHANEM Rosy	Hématologie Neurochirurgie Bactériologie virologie Hématologie Biochimie et biologie moléculaire
	SCHICK Ulrike TALAGAS Matthieu THUILLIER Philippe Professeurs Certifiés / Agrégés du second degré Cancérologie -Radiothérapie Endocrinologie, diabète et maladies métaboliques Histologie, embryologie et cytogénétique THEREAUX Jérémie Chirurgie digestive TROADEC Marie-Bérengère Génétique MONOT Alain Français Professeur des Universités Associé RIOU Morgan Anglais
	UGUEN Arnaud LE MOIGNE Emmanuelle Professeurs Agrégés du Val-de-Grâce (Ministère des Armées) Anatomie et cytologie pathologiques Médecine interne
	Maîtres de Conférences des Universités -Praticiens Hospitaliers Hors Classe METGES Jean-Philippe Cancérologie DULOU Renaud Neurochirurgie
	JAMIN Christophe MOREL Frédéric QUERELLOU Emgan SUPLY Benoît Maîtres de Stages Universitaires -Référents (Ministère des Armées) Immunologie Médecine d'urgence Biologie et médecine du développement et de la reproduction Médecine légale
	LE COAT Anne	Médecine Générale / Urgence
	Maîtres de Conférences des Universités -Praticiens Hospitaliers de 1ère Classe Maître de Conférences des Universités Associé SCELLOS Olivia Médecine Générale
	BERROUIGUET Sofian GURIEC Nathalie BRENAUT Emilie LAVENNE-COLLOT Nathalie		Nutrition Psychiatrie d'adultes Dermato-vénéréologie Pédopsychiatrie
	DOUET-GUILBERT Nathalie GUILLOU Morgane Professeurs des Universités Associés de Médecine Générale Génétique Addictologie HILLION Sophie BARRAINE Pierre Immunologie LE GAL Solène Parasitologie et mycologie CHIRON Benoît
	LODDE Brice MIALON Philippe Maîtres de Conférences Associés de Médecine Générale Médecine et santé au travail Physiologie
	PERRIN Aurore BEURTON-COURAUD Lucas PLEE-GAUTIER Emmanuelle DERRIENNIC Jérémy QUERELLOU Solène FONSECA Jérôme ROBIN Philippe PUSZKAREK Thibault VALLET Sophie VIALA Jeanlin		Biologie et médecine du développement et de la reproduction Biochimie et biologie moléculaire Biophysique et médecine nucléaire Biophysique et médecine nucléaire Bactériologie-virologie
	Professeur des Universités
	BORDRON Anne	Biologie cellulaire
	POUGNET Richard Maîtres de Conférences des Universités	Médecine et Santé au travail
	ROPARS Juliette		Pédiatrie
	ROUE Jean-Michel		Pédiatrie
	SALIOU Philippe BERNARD Delphine		Epidémiologie, économie de la santé et prévention Biochimie et biologie moléculaire
	TROMEUR Cécile DANY Antoine		Pneumologie Epidémiologie et santé publique
	LE CORNEC Anne-Hélène Professeurs des Universités de Médecine Générale Psychologie LANCIEN Frédéric Physiologie LE FLOC'H Bernard LE CORRE Rozenn Biologie cellulaire LE RESTE Jean-Yves MIGNEN Olivier Physiologie
	Maîtres de Conférences de Médecine Générale MORIN Vincent Electronique et informatique
	BARAIS Marie
	NABBE Patrice Maîtres de Conférences des Universités Contractuels LRU
	MESQUITA Mirka		Psychologie

TABLE DES MATIERES

 DES -Liste des enseignants : pages 2 à 6 -Table des matières : page 7 -Corps de thèse : article original en anglais : pages 8 à 29

	oIntroduction : pages 9 à 10
	oMaterials and Methods : pages 10 à 12
	oResults : pages 13 à 14
	oDiscussion : pages 14 à 17
	oConclusion : page 17
	oBibliographie : pages 18 à 19
	oTableaux, figure, matériel supplémentaire : pages 20 à 29
	-Résumé : page 30
	Impact d'

un confinement complet sur le suivi médical et rééducatif des enfants en situation de handicap moteur, rapporté par les parents.

  the study period, 1954 questionnaires were completed by parents. Of these, 1377 fulfilled the eligibility criteria for the present study (Supplementary Material 2). Mothers completed 86.8% of the questionnaires. The mean age of the children was 9•5y (4•78), 54•1% were boys (Table1).

	Responses were received from 12 of the 13 regions of France with two regions more largely
	represented (North-West 26•9% and South-East 28•7%). Most of the children had cerebral palsy
	(41•8%) and genetic diseases or congenital malformations (29%). The mean dependency score was
	9•2 (5) out of 18 with a mean mobility score of 4•9 (3•1) out of 9 and a mean prehension score of 4.3
	(2•6) out of 9. Just before the lockdown, 97•1% of the children underwent rehabilitation (86% had
	physiotherapy, 63% occupational therapy, 54% speech therapy, 60% psychomotricity and 20%

orthoptic rehabilitation). Rehabilitation was provided by specialized services (long-term, multidisciplinary care) for 61•6% of the children, in an outpatient clinic (with an individual therapist)

Table 2

 2

	pathology (η²=0.019, p<0.001), dependency score (η²=0.022, p<0.001), prehension score (η²=0.037,
	p<0.001), associated impairments (η²=0.011, p<0.001), rehabilitation setting (η²=0.05, p<0.001),
	maintained medical consultations (η²=0.017, p<0.001), and continued rehabilitation (η²=0.162,
	p<0.001). No family characteristics influenced satisfaction.
	Two multivariate models (

) showed that several child and service provision characteristics influenced satisfaction:

Table 3 )

 3 were run by stepwise GLM for child and service provision characteristics. For the "child characteristics" model, prehension score was the only factor that 95%CI [2-4•7], p=0.036). Maintained medical consultations was the third factor: CSQ-8 scores were higher when consultations were maintained than when they were cancelled (2•2, 95%CI [0•2-4•2], p=0.033).

	independently affected satisfaction. CSQ-8 score was higher for high than low prehension scores (B=
	2•5, 95%CI [0•9-4•1], p=0.028). For the "service provision characteristics" model, all 3 factors
	independently affected satisfaction. Continued rehabilitation was the strongest factor: CSQ-8 scores
	were higher for no disruption of rehabilitation and moderate disruption of rehabilitation than for

major disruption of rehabilitation (respectively B= 6•6, 95%CI [5-8•3]), p<0.001 and B=3•7, 95%CI [2•5-4•9], p<0.001). Rehabilitation setting was the second factor: CSQ-8 scores were lower for private practice and other settings than for specialized services (respectively B=2•8, 95%CI [1•2-4•3], p<0.001 and 2•4

in medical and rehabilitation service provision and difficulties reported by parents

	Of the 1377 children included, 821 (60%) had already scheduled medical consultations before the
	lockdown occurred. Of these, 187/821 (23%) were maintained and 634/821 (77%) were canceled
	(Supplementary Material 3). The consultations that were maintained were performed by telephone
	or teleconsultation in 142/187 (78%) of cases. The most frequent difficulties were the lack of
	continuity of routine consultations (35•4%) and difficulty accessing new therapies or
	treatments/equipment prescribed during the lockdown (21%) (Supplementary Material 3).
	Rehabilitation provision ceased totally for 40•3% of the children (Supplementary Material 4).

Physiotherapy, occupational therapy, speech therapy, psychomotor therapy, and orthoptic rehabilitation were totally interrupted for 50•7%, 72•6%, 67•2%, 68•2% and 86% of the children, respectively (Table

4

). The rehabilitation sessions which were maintained were carried out by the parents in 62•5% to 81•7% of cases, depending on the therapies. Rehabilitation was mostly delivered at home. Telephone guidance and telerehabilitation were used for up to 39•1% of children depending on the therapies. The most frequent difficulties reported by parents were no professional input (47•7% to 74•1%), feeling inadequate in their ability to provide rehabilitation themselves (14•7% to 36•4%), lack of motivation and cooperation from their child (7•7% to 27•4%), and a lack of equipment at home (8% to 18%) (Table

Table 1 :

 1 Characteristics of the respondents to the ECHO survey Specialized services, at home, at school or in establishment, included CAMSP (Centre d'action médico-sociale précoce [medical-social center for young children]), SESSAD (service d'éducation spéciale et de soins à domicile [special education and home health service]), IME (Institut Médico-Educatif [medical-educational institution]), IEM (Institut d'Education Motrice [educational institution for children with physical disabilities]).

	Sex
	Female

Table 2 :

 2 Determinants of satisfaction, univariate analysis Overseas: overseas departments and territories ** Specialized services, at home, at school or in establishment, included CAMSP (Centre d'action médico-sociale précoce [medical-social center for young children]), SESSAD (service d'éducation spéciale et de soins à domicile [special education and home health service]), IME (Institut Médico-Educatif [medical-educational institution]), IEM (Institut d'Education Motrice [educational institution for children with physical disabilities]).

	CSQ-8 mean (sd)	Statistic F	P-value

*

Table 3 :

 3 Determinants of satisfaction, multivariate analysis

	B	95% CI	P-value

*Specialized services, at home, at school or in establishment, included CAMSP (Centre d'action médico-sociale précoce [medical-social center for young children]), SESSAD (service d'éducation spéciale et de soins à domicile [special education and home health service]), IME (Institut Médico-Educatif [medical-educational institution]), IEM (Institut d'Education Motrice [educational institution for children with physical disabilities]). **No interaction was found between 2 variables. ***No interaction was found between 3 variables.

Table 4 :

 4 Description of rehabilitation Impact d'un confinement complet sur le suivi médical et rééducatif des enfants en situation de handicap moteur, rapporté par les parents. 7 Tables -1 Figure. Th. : Méd. : Brest 2021 RESUME :ContexteLe confinement strict a imposé un nouveau modèle de soins aux enfants présentant une situation de handicap moteur et à leurs familles. Cette étude visait à rapporter la satisfaction des parents concernant les services médicaux et de réadaptation offerts aux enfants en situation de handicap moteur lors du premier confinement strict en France, ainsi que les déterminants de la satisfaction.MéthodeL'enquête nationale ECHO (Enfant Confinement Handicap BesOins) a été adressée aux parents d'enfants en situation de handicap moteur, âgés de 0 à 18 ans, et diffusée dans toute la France pendant le premier confinement (du 17 mars au 11 mai 2020). La satisfaction des parents à l'égard des services médicaux et de réadaptation fournis à leur enfant a été évaluée à l'aide du Client Satisfaction Questionnaire (CSQ-8). Les déterminants de la satisfaction ont été recherchés parmi les caractéristiques de l'enfant, de la prestation de services et de la famille à l'aide d'analyses uni-et multivariées.

		Physiotherapy	Occupational therapy Speech therapy	Psychomotricity	Orthoptic
	Therapy before lockdown (n=1377)
	Yes	1187 (86.2%)	869 (63.1%)	741 (53.8%)	831 (60.3%)	286 (20.8%)
	No	190 (13.8%)	508 (36.9%)	636 (46.2%)	546 (39.7%)	1091 (79.2%)
	Continuation during Lockdown	n=1187	n=869	n=741	n=831	n=286
	Yes	585 (49.3%)	238 (27.4%)	243 (32.8%)	264 (31.8%)	40 (14%)
	No	602 (50.7%)	631 (72.6%)	498 (67.2%)	567 (68.2%)	246 (86%)
	Who performed the rehabilitation ?	n=585	n=238	n=243	n=264	n=40
	Usual practitioner	130 (22.2%)	68 (28.6%)	79 (32.5%)	74 (28%)	15 (37.5%)
	Relay by another professional	25 (4.3%)	2 (0.8%)	2 (0.8%)	2 (0.8%)	2 (5%)
	By parents	478 (81.7%)	180 (75.6%)	185 (76.1%)	204 (77.3%)	25 (62.5%)
	By the child himself	51 (8.7%)	24 (10.1%)	6 (2.5%)	21 (8%)	1 (2.5%)
	How was it performed ?	n=585	n=238	n=243	n=264	n=40
	At the office	50 (8.5%)	17 (7.1%)	14 (5.8%)	22 (8.3%)	10 (25%)
	At home	485 (82.9%)	166 (69.7%)	148 (60.9%)	187 (70.8%)	22 (55%)
	Phone guidance/telerehabilitation	140 (23.9%)	78 (32.7%)	99 (39.1%)	73 (27.6%)	8 (20%)
	Self-rehabilitation video protocol	53 (9.1%)	16 (6.7%)	14 (5.8%)	17 (6.4%)	0
	Written self-rehabilitation protocol	113 (19.3%)	51 (21.4%)	41 (16.9%)	36 (13.6%)	0
	Apps	14 (2.4%)	21 (8.8%)	28 (15.6%)	11 (4.2%)	3 (7.5%)
	Others	33 (5.6%)	3 (1.3%)	5 (2.1%)	6 (2.3%)	5 (12.5%)
	Difficulties	n=1187	n=869	n=741	n=831	n=286
	No professional input	566 (47.7%)	510 (58.7%)	445 (60.1%)	510 (61.4%)	212 (74.1%)
	Frequency of sessions	141 (11.9%)	49 (5.6%)	45 (6.1%)	48 (5.8%)	8 (2.8%)
	Duration of sessions	66 (5.6%)	23 (2.6%)	13 (1.8%)	25 (3%)	2 (0.7%)
	Lack of time	138 (11.6%)	73 (8.4%)	52 (7.2%)	65 (7.8%)	12 (4.2%)
	Unsuitable space at home	174 (14.7%)	61 (7%)	23 (3.1%)	88 (10.6%)	7 (2.4%)
	Lack of equipment	214 (18%)	118 (13.6%)	79 (10.7%)	137 (16.5%)	23 (8%)
	Inappropriate content	43 (3.6%)	38 (4.4%)	31 (4.2%)	24 (2.9%)	7 (2.4%)
	Motivation-cooperation of the child	325 (27.4%)	155 (17.8%)	139 (18.8%)	145 (17.4%)	22 (7.7%)
	Parents felt inadequate	432 (36.4%)	212 (24.4%)	179 (24.2%)	204 (24.5%)	42 (14.7%)
	None	130 (11%)	108 (12.4%)	81 (10.9%)	90 (10.8%)	32 (11.2%)
	Others	89 (7.5%)	47 (5.4%)	50 (6.7%)	48 (5.8%)	16 (5.6%)


Line Cottegnies Katherine Philips's French Translations: Between Mediation and Appropriation

While Katherine Philips's translations from Corneille, especially her Pompey, have attracted substantial scholarly attention in recent years, her other translations from the French have been relatively neglected. Yet these shorter translations are key to understanding the kind of niche as a social, fashionable author Philips was attempting to create for herself in the latter part of her career. The French poems she chose to translate or imitate are indicative of the forms of poetry she was trying to promote in the early 1660s, as she looked towards France for inspiration and sought to make an impact in British literary and musical life by emulating French models. Her interest in the French court air and ballet also sheds light on her aims in composing her songs between the acts in Pompey. Philips's French poems testify to her interest in contemporary French musical and literary culture, as well as in a more highbrow pastoral literature that she was trying to adapt for an English audience. Her translation of Saint-Amant's "Solitude" in particular represents an ambitious attempt to make an intervention in the contemporary debate about neo-Epicureanism, while also reflecting her literary flair for identifying popular poems. Katherine Philips's translations of Corneille have attracted a great deal of critical attention in recent years, especially her version of La Mort de Pompée-slightly less so her incomplete translation of Horace. 1 Her other translations from the French, a corpus of four poems, have been relatively neglected, however, as have the two songs she adapted from French court airs. [START_REF] Roberts | English Language Notes 1 (1963-4): 191-6, and "The Dating of Orinda's French Translations[END_REF] Yet these poems are of vital importance to understand the kind of niche Philips was trying to create for herself in what turned out to be the latter part of her career, especially around her Irish year, a period of intense activity for her. In fact, the French influence on Philips's oeuvre has often been commented on in passing, but has perhaps not been given its full due. After all, the title-page to the 1667 Poems, although not authorial, advertises the strongly French flavour of the collection, by singling out the translations: POEMS ... To which is added Monsieur Corneille's POMPEY & HORACE, Tragedies. With several other Translations out of FRENCH. [START_REF]the most deservedly Admired Mrs. Katherine Philips, the matchless Orinda[END_REF] The editor of the posthumous 1667 edition thought so highly of Philips's achievement as a translator that he even chose to reproduce the French version of Saint-Amant's poem next to her translation. The French poems Philips chose to translate or imitate are in fact highly meaningful for the kind of poetry she was trying to promote, and also shed light on her translation of Pompée, including the songs she wrote for the interludes between the acts. [START_REF] Russell | Katherine Philips as Political Playwright: 'The Songs Between the Acts' in Pompey[END_REF] Philips's French poems manifest her interest in the musical and literary culture fashionable on the continent at the time. In the early 1660s, it seems that Philips was looking towards France for inspiration. Sadly, her untimely death prevented her from pursuing this work, but her translations from the French did make some impact on Restoration culture. [START_REF] Maguire | For a study of Philips's reputation in the Restoration and eighteenth century, see Paula Loscocco[END_REF] Pompey and Horace were instrumental in shaping Restoration heroic drama, and her French poems were also of considerable literary significance. Her translation of Saint-Amant, in particular, remained popular through the eighteenth century, and was often reprinted anonymously in Dryden's and other miscellanies through to 1780. [START_REF] Roberts | Saint-Amant". 7 For the circumstances around the production of Pompey in Dublin in 1663 which this article will not deal with, see for instance Christopher Morash[END_REF] The following essay first aims at highlighting the pervasive influence of French contemporary poetry in Philips's poetry, as exemplified by the French "songs" that she translated or imitated, which give us an insight into what she was reading as she embarked on her translation of Pompée for her Dublin patrons. 7 I will then more particularly focus on Philips's strategy in "La Solitude de St Amant", one of the more ambitious poems she translated. Philips can be described as a subtle mediator between French poetry and English interregnum and early Restoration poetry, with wide-ranging ambitions, as her treatment of the Epicurean subtext of Saint-Amant shows.

Katherine Philips, who grew up in the 1630s and during the revolutionary period, developed an interest in French literature fairly early in her career, partly because it was part of a royalist culture that she nostalgically looked back on. In the 1640s and 1650s, royalists were indebted to the long-term influence of the court of the French Queen Henrietta Maria, who had promoted a form of préciosité and tried to acclimatize the continental pastoral in the 1620s and 1630s. [START_REF]For a study of drama at the court of Henrietta Maria and its relationship to préciosité, see most particularly Karen Britland, Drama at the Courts of Queen Henrietta Maria[END_REF] The code names that Philips chose to celebrate her coterie friends and her interest in friendship as a topic echo, for instance, the neoplatonic cult of friendship that was popularized in France by Scudéry among others and was emulated at Henrietta Maria's court before the revolution. [START_REF]On Philips and friendship, see for instance Penelope Anderson, Friendship's Shadows: Women's Friendship and the Politics of Betrayal in England, 1640-1705[END_REF] They also testify to Philips's taste for French romance, which is confirmed by John Davies's dedication to her of his translation of one tome of La Calprenède's Cleopatra in 1659. [START_REF]Books IX and X of La Calprenède's Cleopatra were translated as Hymen's praeludia, or, Loves master-piece being the ninth, and tenth part of that so much admir'd romance intituled Cleopatra[END_REF] Her coterie also included known Francophiles: her friend Charles Cotterell, for instance, translated another of La Calprenède's works, Cassandre, in the early 1650s. [START_REF]La Calprenède, Cassandra the fam'd romance: the whole work in five parts[END_REF] When Philips translated Corneille's Pompée for her Irish patrons in 1662-3, she was blazing a trail. The early 1660s, with the return of the monarchy, were years of intense interest in French contemporary literature in England, also fuelled by the recent continental exile of many royalists, and by the new King's love for French theatre, music, and dance. [START_REF]See for instance Gesa Stedman[END_REF] By responding to the invitation of Roger Boyle, earl of Orrery, to translate Pompée while in Dublin, Philips was responding to a new cultural moment; but she was also, to a certain extent, serving the political and cultural programme of the Restoration aristocracy in Ireland, who wanted to emulate London court life and promote Dublin as a cultural centre while simultaneously paying homage to the new King. [START_REF]On Orrery's complex politics, see Gray[END_REF] Corneille had been extremely popular in France in the 1640s and 1650s, and was well known to the generation of royalists who had been in exile there. His early tragicomedies of the 1630s had appealed to the Caroline court; his later tragedies offered the new British stage a novel idiom, the heroic tragedy. [START_REF]For Corneille's cultural importance for Philips[END_REF] Philips's Pompey represents a cultural milestone as the first translation of a French neoclassical tragedy to appear on the stage in Britain or Ireland, "inaugurating the discourse of English translation as an act of cultural supremacy", as Hero Chalmers puts it. [START_REF] Mambretti | See my "K. Philips and Corneille: Of the Importance of Being a Translator[END_REF] It is no mean paradox that this discourse of cultural supremacy should have been initiated by a woman. Even if translation, as an allegedly ancillary activity, had always been seen as more acceptable, and more appropriate for women than the publication of more personal works, Philips clearly turns it here into an instrument of empowerment-and potentially of social advancement-as it concerns a text and an occasion (the performance of Pompey, in Dublin, in February 1663) that appeared as highly fashionable and desirable in the Irish context. [START_REF] Clarke | The Politics of Translation and Gender in the Countess of Pembroke's Antonie[END_REF] Social prestige is here inseparable from cultural and literary prestige. Translation from French into English, in a century when many gentlewomen were taught and read French but were discouraged from writing and publishing original works, can also be problematized in gender terms. While there were of course many well-regarded male translators, it is also the case that translation could constitute a "soft" entry into literature for early modern literary-minded women. As Bill Overton has recently claimed, translation was far from being considered a second-rate activity during the Restoration; yet there was still a significant difference, a "status-gap", between translating from the classical languages and from the vernacular. [START_REF] Overton | From French Verse to English: Behn's Version of Tallemant's Le Voyage De L'isle D'amour (1663)[END_REF] In terms of prestige, women translators suffered from the fact that many of their vernacular source texts were also comparatively recent, and thus had not yet gained the status of classics. Yet women translators such as Katherine Philips and, later, Aphra Behn turned this contemporary, topical form of translation into a prestigious, statusgiving activity-perhaps even a fairly lucrative one, in the case of Behn. [START_REF]For Behn as a translator, see Overton, as well as my "Aphra Behn's French Translations[END_REF] Philips's interest in French literature was not confined to drama but extended also to poetry. The influence of French poetry is reflected, for instance, in the titles of some of her original poems, such as "L'Accord du bien" or "La Grandeur d'esprit", although the sources for these titles have not been identified. In addition, Philips was responsible for four direct translations of French poetry: "La Solitude de Saint Amant", "Tendres désirs", "A Pastoral of Mons. de Scudéry's in the first volume of Almahide", and "Translation of Thomas a Kempis into verse, out of Mons. Corneille". 19 These four poems seem almost strategically chosen to represent different, fashionable genres, which originally aimed at potentially different readerships: they comprise a libertine pastoral, a love ditty, a pastoral (from a highly fashionable romance), and a religious meditation. She also wrote two original songs after French airs: "Song to the tune of Sommes nous pas trop heureux" and "Song to the tune of Adieu Phillis." 20 Philips's poetic translations per se belong to the last few years of her short career. As Elizabeth Hageman and Andrea Sununu point out, none of these translations was included in the surreptitious edition of her poetry published in early 1664. [START_REF] Hageman | New Manuscript Texts and Katherine Philips, the 'Matchless Orinda[END_REF] Furthermore, as William Roberts noted in 1970, most of the poems translated by Philips had been printed in France relatively recently. [START_REF] Roberts | The Dating of Orinda's French Translations". The exception, Saint-Amant's "Solitude[END_REF] Although Corneille's Imitatio Christi had been published several times from 1651 onwards, Book 3-from which Philips's translation is drawn-appeared only in the 1654 edition. 23 The first part of Scudéry's romance Almahide was published in 1660. [START_REF]John Philips's 1677 translation of the novel (Almahide, or, The captive queen an excellent new romance, never before in English) does not include the song. 25 Hymen's praeludia sig[END_REF] John Davies's praise of Philips's "curiosity to look into these things [i.e. contemporary French poetry] before they have hardlie taken English aire" was evidently well judged. 25 The source of the very short poem "Tendres desirs", identified by Hageman and Sununu, also points towards a translation date in the early 1660s. From an annotation in the Rosania manuscript in the National Library of Wales, Hageman and Sununu were able to locate the French source in the third (1660) volume of a popular compilation of short anonymous prose romances published in five volumes between 1659 and 1663 by Charles de Sercy as Recueil de pièces en prose, les plus agréables de ce temps. Composées par divers Autheurs. 26 The original poem is a song sung by the young hero, Alcippe (who was originally a character in Honoré d'Urfé's L'Astrée), in the story entitled "Le Voyage d'Alcippe", a piece almost certainly written by Donneau de Visé: [START_REF] Denis | [END_REF] Tendres desirs, doux enfans de l'Amour, Allez, saisissez-vous de l'esprit de Silvie, Et soyez dans le mien promptement de retour. C'est là le seul moyen de conserver ma vie. Mais si vous ne pouvez enflâmer ses appas, Abandonnez mon coeur, & n'y revenez pas. 28 Philips's first stanza is a fairly literal translation-in decasyllabic couplets, like her sourceexcept for a few instances where she departs from the French. The sensuality of the original is nevertheless extenuated-most visibly in the line "si vous ne pouvez enflâmer ses appas" (literally "if you cannot fire her up", my translation), translated as "if you miss her brest whom I adore": Go soft desires, Love's gentle Progeny, And on y e heart of charming Silvia seize, Then quickly back again return to me, Since that's y e only cure for my disease.

But if you miss her brest whom I adore, Then take your flight & visit mine no more. 29 Philips's interest in song, in English as well as French, is well documented. Henry Lawes set a number of her poems to music, and she also wrote original songs for inclusion in Pompey. [START_REF]One poem was published with its score in Lawes's Second Book of Ayres and Dialogues (London, 1655). See Joan Applegate[END_REF] Both she and Lawes were interested in French airs, which epitomized a French coterie atmosphere. In the case of "Tendres désirs", however, it is quite possible that Philips drew inspiration from a whole set of French songs and airs rather than a single air. (This would explain at least some of the variants in her English version.) She may have had the Sercy collection of prose stories at hand, but she might also have come across another popular collection of airs compiled by Bertrand de Bacilly and first published in 1661 under the title Recueil des plus beaux vers qui ont été mis en chant. 31 Another venture of the successful bookseller Charles de Sercy, this Recueil was an anthology of songs which, for the most part, had already been in circulation. The songs were listed in alphabetical order of first lines, and included the authors' names but not the music. The Bacilly compilation includes a number of songs or airs that are very close in wording to "Tendres Désirs". In fact, this kind of amorous poesy was commonplace to the point of being almost generic. Philips's English version is perfectly in line with this glib, popular French idiom and her poem seems to contain multiple echoes of songs by minor authors of the period, reproduced in the same collection, like this one by the Marquess of Mauleurier: Allez, allez, tendres soupirs, Allez déclarer mes désirs A la Beauté que j'aime; Faites-luy si bien vostre cour, Qu'elle connoisse mon amour, Sans luy dire moy-même. Allez jusqu'au fonds de son coeur. [START_REF]Recueil des plus beaux vers 21[END_REF] Derivation from Mauleurier's poem could explain, for instance, Philips's substitution of the lady's "heart" for her "esprit" (mind) in the source identified by Hageman and Sununu. As for the name "Silvie", it had been commonplace in many French poems of the period at least since Théophile de Viau, and it is mentioned for instance in the same collection in another song written by Bouillon: Allez soûpirs, allez trouver Silvie, Pour luy découvrir mes langueurs; Dites-lui qu'enfin je me meurs, Et qu'au moment qu'elle m'oste la vie, J'ay pour ses yeux tant de crainte & d'amour, Qu'elle y perdra quand je perdray le jour. 33 These songs were meant to be performed to the lute in salons and at court and circulated among a coterie of readers. In recent years, music historians such as Anne-Madeleine Goulet have started studying how these airs and songs circulated (both words and music). [START_REF]La Fabrique des paroles de musique en France à l'Age classique[END_REF] By choosing to echo this contemporary trend, Philips positions herself as a mediator between continental Europe and England. She shows her interest in the musical culture of her time, and in the continental air as a highly contemporary, even fashionable genre that was meant for circulation among a social and cultural elite. This bias can be seen again in her choice of sources for the poems, "Song to the tune of Adieu Phillis" and "Song to the tune of Sommes nous pas trop heureux". I was recently able to show that the former was based on a court song which, in all likelihood, circulated in manuscript, but was published in 1673 in one of the volumes of an anthology of airs, gathered and published by the bookseller Robert Ballard between 1670 and 1699. [START_REF]), an air in C major for two voices: "Adieu, belle Phillis, je vais loin de tes charmes, / Passer mes tristes jours, / Et mourir de langueur:/ Je n'auray plus du moins, ces mortelles alarmes / Que tes yeux donnoient à mon coeur[END_REF] As for the latter song, it was tentatively linked by Elizabeth Hageman and Andrea Sununu with a cluster of French satires of the early 1660s-although they assumed that the original source might be a love poem for which they found a later manuscript transcription at the National Library of Wales. 36 The original, on which the above-mentioned satires are based, is in fact a serenade from a royal Ballet written by Benserade (text), and Lully ( music) and entitled Ballet de l'Impatience. The Ballet was first performed in February 1660/61. [START_REF]The libretto was published as Ballet Royal De l'Impatience. Dansé par sa Majesté le 19[END_REF] It was a very public event, performed three times at court in February 1661, with participants including the young King Louis XIV himself. The song in question is a serenade that a "Lord", impersonated by the King, offers his mistress, for whom he dances. (Louis even danced at least on one occasion in front of Henrietta Maria and her followers.) 38 The libretto must have somehow found its way into Philips's hands in the months following its publication. It was published without the score, although Philips may have had access to the latter as well. There were in fact constant exchanges between France and England in the early 1660s, and there are many ways she could have heard about the song. [START_REF]For speculation about the networks involved, see[END_REF] The Bibliothèque nationale de France has a later manuscript transcript of the air by musician and royal music librarian André Philidor, dated 1691, and later transcripts have emerged, testifying to different forms of circulation. 40 It is a serenade in G minor for one voice (a countertenor) and a "concert" of 29 instruments, with a base for the accompaniment. The song was then reproduced in isolation in volumes of airs and songs, most probably to be sung to the lute: Sommes nous pas trop heureux, Belle Iris, que vous en semble? Nous voicy tous deux ensemble, Et nous nous parlons tous deux. La nuict de ses sombres voiles Couvre nos desirs ardens, Et l'Amour & les Estoiles Sont nos secrets confidens. [START_REF]Accompagné d'un Concert de plusieurs instruments[END_REF] The serenade is included, for instance, in the Bacilly compilation of songs and court airs cited above, with minor textual variants. [START_REF]Suite de la Troisiesme partie du Recueil des plus beaux vers qui ont esté mis en chant, 3 e partie (Paris: Robert Ballard, n.d.) 205[END_REF] The French song, in B flat minor, depicts a serene, nocturnal love scene, as is typical of a serenade. The lovers, alone at night, converse happily, but the French song mentions their hidden "ardent desires", although these are held in check. Philips's transposition is a more tame love song, where desires are toned down: How prodigious is my Fate, Since I can't determine clearly, Whether you'll doe more severely Giving me your love or Hate. 43 The French song's balance between desire and nocturnal languor is completely absent from Philips's version. This elimination of sensuality is characteristic of her strategy as a translator.

Philips's choice of source for "Song to the tune of Sommes nous pas trop heureux" is indicative of her interest in contemporary French court culture. The Ballet de l'Impatience was a royal ballet, with music composed by the most prominent musician of the times, Lully, while the text was by a fashionable author, Benserade. The song later found its way into compilations and became an air, meant to be performed to the lute among a coterie or at court. For Philips, who was trying in the early 1660s to make a contribution to the new Irish court culture at the time, this was just the new thing that needed to be emulated. It can be argued, then, that, like Henrietta Maria, who acted as cultural ambassador for France in England, Philips played her part in mediating French taste for the aristocratic elites in both England and Ireland. 44 Philips's role as a mediator of French literary culture is nowhere more obvious than in her impressive translation of Saint-Amant, which shows the serious kind of impact she aspired to as a poet. "La Solitude" was a very successful poem, often imitated and copied by seventeenth-century English poets. It is a likely influence on poems such as Milton's "Il Penseroso", Cowley's "Ode to retirement", and Marvell's "The Garden" and "Upon Appleton House", as well as on Philips's own poems about retirement and solitude. [START_REF] Kastner | For Saint-Amant's influence on English poets[END_REF] Its fortunes in England were later enhanced when Henry Purcell set the first two stanzas of Philips's translation of "Solitude" to music in 1684; his setting remained very popular until the turn of the century. Given the popularity of the poem, Philips's decision to translate it in full is a mark of her growing literary ambition.

Saint-Amant had visited England twice on diplomatic missions, first in 1631 as the emissary of Bassompierre, then in 1643-4 with the Comte d'Harcourt, who had been sent over to offer French mediation in English affairs relating to the civil wars. He apparently spoke English, which would have singled him out among French travellers. 46 After his second English visit, he wrote a scathing satirical poem, Albion, in which he sympathized with the plight of Queen Henrietta Maria, but the poem was not published until 1969. [START_REF] Didier | Le Poète Saint-Amant (1594-1661[END_REF] Several of his poems were translated into English in the mid-seventeenth century. Thomas Fairfax also translated "La Solitude"; his version, which remained in manuscript until the nineteenth century, may have been known to Marvell. [START_REF]The Poems of Thomas Lord Fairfax[END_REF] Two other poems by Saint-Amant-"La Jouissance" and "La Débauche"-were Englished by Thomas Stanley, while Edward Sherburne translated three poems ("La Métamorphose de Lyrian et de Sylvie", "Le Soleil levant", "Plainte sur la mort de Sylvie"). [START_REF] Stanley | [END_REF] Such evidence suggests that Saint-Amant was one of the best-known French poets in England at this time.

Saint-Amant's "Solitude" is one of two pastoral poems translated by Philips, alongside Scudéry's "song" from Almahide. These two poems represent two very different kinds of pastoral. Scudéry's song was more in tune with the high-minded amorous pastorals of fashionable romance, whereas Saint-Amant's "Solitude" is a more complex, hybrid poem. Philips, who lived in Wales in a rural environment, was drawn to the theme of stoic pastoral retirement for both personal reasons and because of its political connotations. [START_REF] Prescott | That private shade, wherein my Muse was bred': Katherine Philips and the Poetic Spaces of Welsh Retirement[END_REF] But it is an indication of her flair that with Saint-Amant's "Solitude" she chose a poem that in some respects went against the grain of her own stylistic leanings. A dark, baroque poem, built on jarring contrasts and antitheses which are meant to surprise and unsettle, "Solitude" is poles apart from the sense of elegance and decorum that one usually associates with Philips's poetry. The poem is based on a series of antitheses which express, through the recurrent trope of discordia concors, the pleasure in displeasure felt by the persona who celebrates his beloved solitude ("O! que j'aime la Solitude") amidst a nature alternatively described as a refuge and as a harsh, inhospitable milieu. [START_REF]The poem is cited from the 1667 edition of Philips's Poems[END_REF] The poem is thus both a pastoral and an antipastoral. The speaker's perception and apprehension of the world is based on a series of paradoxes: nature is savage and peaceful; the speaker loves to look down into precipices from which suicides have jumped (stanza 2); he feels intense pleasure at feeling "disquiet". The sight of ruined castles conjures up hellish visions of goblins and skeletons, but also creates an intense sense of aesthetic pleasure (it is not surprising that this poem should have been read as pre-Gothic and as an anticipation of the sublime). [START_REF] Lévy | Le Roman gothique anglais[END_REF] To sum up, the poet finds pleasure in the aesthetic contemplation of wilderness.

"Solitude" can in fact be read as a landscape poem, which revisits the classical convention of the locus amoenus as the poem takes the form of an ekphrasis: "This Landskip though fantastick, take, / Which I have coppy'd from y e life" (CW3 101). It is a capriccio, shown in a chiaroscuro reminiscent of Salvatore Rosa's near-contemporary visual landscapes. [START_REF] Rosa | 1670), or Witches at Their Incantations, National Gallery (c. 1646) for two complementary aspects of Rosa's gloomy imagination[END_REF] Nature is depicted as a postlapsarian world, inhabited by serpents and other evil, threatening creatures, and retaining only distant echoes of the garden of Eden or the locus amoenus of the tradition-whose ghostly presence is encapsulated in the "squelette horrible" ("horrible skeleton", CW3 227) of the "poor lover who hanged himself for the love of a cruel shepherdess". 54 As will be argued later, Philips's translation slightly extenuates the violence of the French with the "Carcass, which did once belong / To one that hang'd himself, for Love / Of a fayr Nimph that did him wrong" (CW3 97). This nature is wild, with its ragged rocks, its horrifying ("effroyable", CW3 229) tempests, its fierce torrents which devastate the wild vales they scar-a devastation that the speaker finds "doux" (sweet), in a characteristic oxymoron. [START_REF]Que je trouve doux le ravage[END_REF] It is an adequate setting for the human, fallen world: the ruins evoke visions of sabbaths, of ghosts and skeletons dangling in the wind (stanza 9); and yet this world can also offer a mitigated, paradisiacal refuge, free of danger, away from predators-for mankind is alternatively a culprit and a victim in "Solitude": Lâ, cent mille oyseaux aquatiques, Vivent sans craindre en leur repos, Le Giboyeur fin & dispos, Avec ses mortelles pratiques.

Philips's translation reads:

Here, water-fowle repose enjoy, Without y e interrupting care, Least fortune should their bliss destroy, By y e malicious Fowler's snare. 56 The passage unmistakably evokes Marvell's Mower of the "Mower poems", or the "skilful gard'ner" of "The Garden", whether the latter poem predates Philips's version of "Solitude" or not-Marvell obviously knew Saint-Amant's poem too. Philips makes more explicit the symbolism of the "malicious Fowler" by associating him with Fortune, where Saint-Amant had been less specific with the mysterious "Giboyeur", a rare word in French for a game hunter. (The word "Fowler" may be a pun on Philips's maiden name, although if so the implications are puzzling.) In this passage, Saint-Amant describes a pastoral land of plenty (the hyperbole of "[cent] mille oyseaux", one hundred thousand birds), which is threatened by the presence of the mysterious hunter and his mortal snares ("ses mortelles pratiques"). In the French poem it is not an allegorical Fortune that is hovering about, but this alert hunter ("fin et dispos" -clever and eager, or ready). The passage can be read as a parable, that of a postlapsarian world in which man has become a universal predator, using all his skill and wit to destroy and kill, without even giving it a second thought. If this ghostly presence of a blind, superior power randomly dispensing death is to be interpreted as an image of the presence of the divine in Saint-Amant's poem, then it is a conception of a transcendence which seems to echo Lucretius's depiction of the gods as indifferent to men in De Rerum Natura. Saint-Amant, however, appears to go one step further by emphasizing the actual (if callous) intervention of the hunter in the natural landscape, in contradistinction from the complete indifference to men of the Lucretian gods. In his version, however, the hunter is not described as malicious, contrary to Philips's interpretation which moralizes the fowler by turning him into a personification of evil agency; in her version, the fowler becomes an equivalent of the serpent lurking about the garden of Eden, ready to smite at random. Her only concession to Saint-Amant's more Lucretian version of the hunter is perhaps her addition of the term "fortune", in the sense of chance (absent in the original). This nuance may be interpreted as a sign of her alertness to the potentially Epicurean subtext of the poem (to which I shall return), in spite of a rather moralistic reading of the evil fowler. Formally, Philips tried to remain close to the original text, with lines of eight syllables and comparable rhyme schemes, but she made stylistic choices which reveal a consistent toning down of the original text. One aspect of this strategy is a tendency to smooth out what was irregular either morally or aesthetically. She thus occasionally substitutes commonplaces for the original images. When Saint-Amant describes spring as being in love with a blossoming thorn ("Espine fleurie", CW3 224), Philips replaces the actual bush with a mythological reference to the goddess Flora, a more mannerist, even mannered image: "this Thorn / So curiously by Flora drest" (CW3 95). Philips thus substitutes Saint-Amant's paean to natural vegetation (even though spring is personified by being granted feeling) with what is a perception of nature mediated through more conventional, mythological references. Similarly, she personifies the sea by describing it as smiling in stanza 17-a personification completely absent from the original. When Saint-Amant mentions cyphers carved on trees in stanza 11 ("Des chiffres taillés sur les arbres", CW3 227), a passing allusion to an easilyrecognizable, conventional petrarchan trope, Philips unfolds the image to make it more explicit: "What Lovers carv'd on every Tree" (CW3 98)-the cliché, implicit in Saint-Amant, is here spelled out. Philips's version also tends to tone down the sensuality and the passionate associations of the original (as already noted with respect to her songs). In one characteristic example (where many could be mentioned), the nightingale, Philomel, is described in Saint-Amant's poem as having un "chant langoureux" (a "languorous song"), which suggests, of course, the languor of love; for Philips, however, Philomela sings "in melting notes" (CW3 224, 95). Substituting "melting" for "langoureux", Philips somewhat misses what was in fact in Saint-Amant a slight departure from the conventional image of Philomela's traditionally melodious notes.

Tonally, Philips also tends to neutralize the striking strangeness, and power, of the original, as when the "terrifying verdict" ("sentence épouvantable", my translation) that was passed by heaven on the cruel shepherdess simply becomes a "mighty pain" (CW3 227, 98). In stanza 19 she resorts again to a cliché, that of "flame" to describe the poet's inspiration, as a rather tame version of Saint-Amant's "Demon" (CW3 101, 231)-in the Greek sense of the term as the genius of inspiration. Elizabeth Scott-Baumann comments on Philips's word choice, which she sees as a desire for restraint. 57 These stylistic choices indeed tend to neutralize the striking violence of the original. A final example will be sufficient to prove this point. In a characteristic passage, Saint-Amant emphasizes the antithetical feelings conjured up by the frightful spectacle of the wild torrents: "Que je trouve doux le ravage / De ces fiers torrens vagabonds" (CW3 224). [START_REF]How sweet seems to me the devastation / Wrought by these fierce, vagabond torrents[END_REF] In the version of the poem preserved in the Rosania manuscript, held at the National Library of Wales, the violent strangeness of the French paradox and antithesis is attenuated, as the destruction wrought by the wild torrents is simply described as "pleasant", a term perhaps more aesthetic than the paradoxical French adjective "doux" (sweet): "What pleasant desolations make / These torrents vagabond, & fierce" (CW3 95). 59 The effect is radically amplified in the text of the 1667 Poems, where the adjective "pretty" is substituted for "pleasant". It is highly possible that the 1667 editor intervened here, thinking he was thus "improving" the poem. [START_REF]Producing Women's Poetry[END_REF] Does this overall strategy also apply to Philips's treatment of the Epicurean subtext of the poem? It is not completely clear how far she was aware of Saint-Amant's underlying philosophical agenda, although the consistency with which she subtly tones down the radicalism of the original shows an awareness of sorts. The most obvious argument in favour of an Epicurean reading of the French poem is the association of the theme of the philosopher's retreat from an active life with the topos of the garden. In several instances, the speaker rejoices at the spectacle of the dangers of a busy life, an unmistakable reference to the famous opening of Book 2 of Lucretius's De Rerum Natura:

How highly is my fancy pleas'd

To be upon y e Ocean's shore, When she begins to be appeas'd, And her fierce billows cease to roare. 61 This attitude of detachment is fundamentally anti-Christian in Saint-Amant, as it rejects notions of sympathy with and pity for other human beings: the thoughts of the lover who died for love and of the suicide who killed himself out of despair merely contribute to the speaker's sense of tranquillity by contrast. Besides this, the focus in the poem on the notion of pleasure naturally also points to an Epicurean subtext, as does the insistence on a sensual apprehension of nature-the repetition of terms referring to sight and vision, but also to hearing, present in the birds' songs as well as in the music the speaker plays on his lute in stanza 13. Finally, the celebration of friendship in stanzas 18 to 20 completes the Epicurean paradigm. Again the conspicuous absence of society in the poem points to an underlying anti-Christian motif. Civilization and society seem to have disintegrated here, as the speaker wanders about ruins, skeletons and rotting carcasses, in a world described as totally material and devoid of any spirituality. The only form of afterlife mentioned in "Solitude" is the ghost of the cruel shepherdess, who comes back to mourn for her fate. In fact, mankind seems to be out to destroy itself, as despair and self-inflicted death take their toll (in stanzas 3 and 10). In stanza 17, the poem depicts a beautiful seascape which could have impious implications. In Philips's version, the sea is personified:

Sometimes, so gently she does smile, A floating mirrour she might be, And you would fancy all that while, New heavens in her face to see. The Sun himself is drawn so well, Where there he does his Picture view, That our Ey can hardly tell, Which is y e false Sun, which y e true. And least we give our Sence y e ly, We think hee's fallen from ye Sky. 62 The comparison between the sky and the surface of the water suggests the symbolic creation of an alternative "heaven", or "new heavens", which go together with the fall of the Sun/Son. [START_REF]Saint-Amant's use of "les cieux", or heaven, does suggest here a religious subtext. 64[END_REF] The symbolism of this subversive displacement is particularly significant in this poem. In fact, the passage sounds, for once, more impious in English than in French, because of the traditional pun on "sun"/"son" in English, which does not work in French, but is perfectly adequate in what is clearly an impious context.

That Philips was aware of this anti-Christian and Epicurean subtext seems obvious in her treatment of some of the material she had to translate. She seems to have been uneasy, for instance, about Saint-Amant's use of "Mon Dieu" as a familiar interjection: "O! que j'aime la Solitude! ... Mon Dieu! que mes yeux sont contens / De voir ces Bois" (stanza 1, CW3 223). In her version, the more neutral "heavens" does not exactly have the same connotation, and slightly tones down the potential irreverence of the French: "O! heavens! what content is mine!" (CW3 94) The very beginning of the poem is also interesting for the way it presents nature as being already present. In the original text, the phrase "A la nativité du temps" (at the beginning of time) implicitly contradicts the biblical narrative of the Creation: "que mes yeux sont contens / De voir ces Bois, qui se trouverent / A la nativité du Temps". 64 Philips completely changes the focus of this argument by using a different preposition: "what content is mine! / To see these Trees which have appear'd / From y e nativity of Time" (CW3 94, my emphasis). In her version, nature belongs to creation, it was not there first. Philips seems aware here of the potential impiety of the original. In another instance, which reinforces this point, she fails to translate the word "désespoir" (despair; stanza 3), perhaps because despair was considered a capital sin, by omitting the line in which the word occurred and loosely paraphrasing the original instead with the word "Sorrows" (CW3 95, 224). To conclude, even though Philips offers a sensitive and competent translation of "Solitude", it seems that she was aware of its potential radicalism, and purges the text of some of the most visible impieties.

All the French poems Philips chose to translate share one characteristic-their popularity in contemporary French polite and courtly circles. They manifest her desire both to experiment with continental genres and also to discover exciting new texts in the context of intense transnational cultural exchanges on the one hand, and of a revival of aristocratic and court culture in England and Ireland on the other. Her rapport with French literature therefore must also be understood as strategic from the perspective of her ambitions as an author, in literary as well as social terms. As Pompey gained her access to the Dublin aristocracy, and was likely to have also advanced her in London, had she lived longer, her shorter translations show her trying her hand at various continental genres, including the court air and two different forms of pastoral: all genres that had been fashionable in France at court and in salons for quite some time. [START_REF]The posthumous staging of Philips's Horace clearly shows that she had drawn the attention of some of the literati at court. Line Cottegnies is Professor of English Literature at the Université Sorbonne Nouvelle-Paris 3. She is the author of a monograph on the politics and poetics of wonder in Caroline poetry, L'Eclipse du regard: la poésie anglaise du baroque au classicisme[END_REF] They also bear witness to her knowledge of, and interest in, music, especially the social air or song; her involvement with the musical milieu of her time is a promising area for future research. Finally, her choice of Saint-Amant as a source shows an interesting hiatus between her own literary style, and a slightly older, popular French text which had already reached the status of a classic in France. It is also a text whose radical implications open up an intriguing perspective on Philips: she was obviously aware of the radicalism of this ambitious poem, and shows some anxiety about its most extreme aspects. This poem should perhaps be read as engaging with the Epicurean revival of the 1650s, which, for instance, prompted Lucy Hutchinson to translate Lucretius in the same years; as such, it sheds an intriguing light on Philips's oeuvre as a whole. By translating "Solitude", Philips showed versatility, boldness and literary flair. She also showed that she was not intimidated by the potentially radical (blithely unchristian) implications of the original French poem, although she slightly attenuates its most extreme aspects. Her interest in French poetry as a whole testifies to her wide-ranging interests in contemporary literature as well as to her intellectual and literary ambition.

NOTES

See Pompey. A Tragoedy (Dublin, 1663). For a study of the impact of Philips's dramatic translations, see for instance Peter Beal, In Praise of Scribes; Manuscripts and their Makers in Seventeenth-Century England (Oxford: Oxford UP, 1998) 147-91; Hero Chalmers,