.

Nahda and the Tunisian Islamic activism

Fabio Merone Ester Sigillò Damiano De Facci

This chapter deals with the dynamics of contentious politics 1 in Tunisia between 2011 and 2016. In particular, the authors focus on the transformations of Islamic activismin the aftermath of the revolutionary events of 2011. 2 The two main Islamic actors in this period have beenthe Nahda party,derived from the Muslim Brotherhood family, and the new salafist-jihadi jamaa (Islamic society) called Ansar al-Sharia (AST) and re-branded according to the new international jihadi evolution3 . The Tunisian Islamic landscape has largely developed in the country after 20114 .The explosion of the Islamic contention has different explanations. First of all, this phenomenon is mainly due to the raise in the country of a free debate on Islam and Islamism opened by the fall of the authoritarian regime; moreover, the peculiarity of the post-revolutionary period is characterized by a high level of contention and a fluid ideological landscape which have favoured framings of new types of protests. Last but not least,the explosion of the Islamic contention has been the result of a new wave of Islamic revival (sahwa) that brought many people to're-discover' religion. The combination of these three factors led to the raise of a moderate organized Islamic party, a vast Islamic public and a radical Salafist With the term Islamic activism, we refer to "the mobilization of contention to support Muslim casuses", given by Quintan Wiktorowicz. This definition seeks to be as inclusive as possible, by taking into account "the variety of contention that frequently emerges under the banner of Islam, including propagation movements, terrorist groups, collective action rooted in Islamic symbols and identity, explicitly political movements that seek to establish an Islamic state, and inward-looking groups that promote Islamic spirituality through collective efforts". Quintan Wiktorowicz, ed. Islamic activism: a social movement approach (Indiana University Press, 2004). option, which represent the backdrop of the Islamic dynamics of contention that this chapter wants to discuss.

In particular,the authors point out the transformation of Nahda by shedding the light on the dialectical dynamic between the party and the Islamic public 5 . It focuses, therefore,on the evolution of the Islamic party from 'Islamist' to conservative, a process formalized by the decisions taken during the two congresses of 2012 and 2016. While specialists on religious parties consider this switch under the lens of secularization 6 , in this chapter we stress that this change must be rather seen from the point of view of the renunciation of the Islamic politics to be transformative/revolutionary. By 2016, in fact, Nahda established itself as a democratic party that distinguishes between religious and political activities 7 . This evolution has a big impact on the way the Islamic polity is thought, because renouncing (or separating) the religious from the politics in an Islamic mindset is not only about secularizing the politic but also forgetting its social and political transformative nature 8 . The relationship between the party and the new Islamic public is particularly important in order to understand the evolution of the Tunisian Islamic activism after 2011. We call this large public the "Islamic constituency", because it is the natural Nahda's electoral basin, although it does not always share common goals with it.It deals with a variegated public, composed of people that share imagined solidarities 9 , that perceives itself as an Islamic community, regardless its specific interest into politics. This Islamic constituency contains the Nahda militants properly, other kind of Islamic militants (called by the media the Salafists of Nahda) and a larger pious public, 5

We do not take into account (if not by general reference) the important Salafist radical movement Ansar al Sharia. For a study of AST within the social movement frame, see Fabio Merone, "Between social contention and takfirism: the evolution of the Salafi-jihadi movement in Tunisia," Mediterranean Politics 22.1 (2017): 71-90 and Daveed Gartenstein-Ross, "Ansar al-Sharia Tunisia's long game: dawa, hisba, and jihad, ICCT Research Paper, May 2013," (2013): 1-25.

6 Luca Ozzano, "The many faces of the political god: a typology of religiously oriented parties," Democratization 20.5 (2013): 807-830. 7 Intissar Kherigi, "Ennahda separation of the religious and the political: a historic change or a risky maneuver?," Alsharq Forum, last accessed September 2, 2017, http://www.sharqforum.org/2016/09/08/ennahdhas- separation-of-the-religious-and-the-political-ahistoric-change-or-a-risky-maneuver/ 8 This is a similar process to that of the European socialist parties when they cut off the organic link with the working unions.

active in cultural and religious associations. Islamic activists that are the focus of this article stem from this Islamic constituency.

By providing the Tunisia case-study with new empirical data, his chapter participate to the literature which applies SMT to Islamist movements studies. This approach has the advantage of considering Islamist movements as any other movement, that behave according to resource mobilization, political opportunities and ideational framings. Thus, dynamics, processes and organization of Islamic activism can be understood as important elements of contention that transcend the specificity of 'Islam' It argued, in particular, that institutionalization is a prerequisite to obtain resources needed for mobilization and its eventual success. The second one also explicitly applied a SMT approach to Islamic movements in Egypt, by analysing how Islamists have found avenues for mobilization in the repressive environment of Mubarak's regime. Another exemplary scholar in the field is Janine Clark's; 13 she explicitly employed SMT in the analysis of Islamist networks in Egypt, Jordan and Yemen, and, at a second stage, in the investigation of alliance structures between Islamist and non-Islamist movements.

Singerman 14 applied a similar approach, though focusing on informal (horizontal) networks in Yemen. Movement Theory Approach, including contributions of several scholars mentioned above.

Therefore, by applying a 'political process approach' 15 authors analyse the transformation of Tunisian Islamic activism since the fall of the authoritarian regime.

This theoretical approach contends that movement behaviour is shaped by the broader political context (or political opportunity structure), which can facilitate or hinder collective action 16 . Moreover, the political process approach further maintains that collective action involves organizational structuring and normative framing to facilitate the mobilization of resources. In other words, organizational dynamics and cognitive processes mediate between the political environment and collective action 17 . Notably, in this chapter we refer to a political process that after 2011 is characterized by a dramatic polarization between two ideological blocs, Islamist and nationalist 18 . This has led to a double form of pressure for the Islamist camp: from outside it was demanded to prove its democratic credential, and from inside its 'Islamic' one.

The aim of this research is also to empirically contribute to the development of the analysis of Islamic mobilizations. Indeed, authors aim to fill the void in the studies aboutNahda, in the light of its interaction with other components of the Tunisian Islamic activism. As a matter of fact, so far literature hasneglected themultidimensional nature of the Islamic social movement and its impact on the party. Thus, by providing empirical evidence of an ongoing transformation of the Islamic Movementthis study contributes to the conceptualization of the notion of 'Islamic polity', itself. Indeed, the evolution of the 18 By using the category of 'nationalist', we refer to the political block that took the power after independence. In Tunisia they are also referred to as 'Bourguibist' (in reference to the founding father of the nation) or 'modernist', because they pretend that the nationalist project was a modernist one inspired by enlightenment. In this chapter, we refer to anti-Islamist or Nationalist indistinctly; both terms make reference to the essential ideological difference between those who occupied the power after independence and the most important block of opposition that appeared afterward. within the party, first of all the decision toseparate dawa(preaching, call to religion) from politics, ultimately reveal that we are dealing with a changing nature of the politics of Islamist partiesrather thanasecularization process.The decision of Nahda to abandon any reference to sharia in the constitution and its project of transformation of society led to a diffused sense of frustration and diffused protests emerging from its constituency 19 .

In the first section of this chapter,authors describe the general political process occurring in Tunisia from 2011 to 2016. In the second section wehighlight the emergence of a broad Islamic constituency in the post-revolutionary landscape. In the third and fourth section, we analysethe nature of interactions between the Nahda leadership and the new Islamic constituency, notably how the party keeps an ambiguous relation toward Islamicactivists. When the political process is infavour of the mobilization, party's leadership does not oppose social activists but it tries to co-opt it; contrarily, when the political juncture turns against them, party's leadership imposesthe end of the contention politics. The congress of 2016 will finally declare the transformation of the party. Such evolution was the consequence of the political process, the political opportunities given to different actors and the way they have reacted.

Chap. 1/ A polarized political process

An extraordinary period of political contention started in Tunisia after the ousting of the long-running president Ben Ali in 2011 20 and lasted for 4 years until the presidential and parliamentary elections of 2014/5. During this period old institutionalized actors were wiped out from the scene and new players came in, most of them framing their actions under the ideological discourse of Islamism. This period should be divided in two phases. In the first one, going from 2011 to 2013, street politics and contention prevail on the political institutionalized democratization process and the Islamic radical contention represents the main political issue. In the second phase, from Islamist forces behind the Bourguibian old leader Beji Caied Essebsi, 21 who founds a new party, Nidaa Tunis (call for Tunisia). This period is mainly characterized by strong pressures on Nahda to give up the government and, as a consequence, by a gentlemen agreement between the two main parties to build up a national unity government 22 .

Consequently, the new governments imposed the ban of radical Islamist activities and imposed a policy of 'normalization'.

The transition triggered both a process of institutionalization and a dynamic of political contention. In the period between March and October 2011, political and social forces of the country built up an institutional body with the aim to give a certain degree of legitimization to the political process. Its main purpose was to lead the country to transparent and credible elections and therefore to vote for a legislative minimum corpus 23 . While a provisional system of government was created, the political scene was dominated by unrest and social claims. Political parties participating to the government, yet at the same time hoping to maintain a revolutionary legitimacy, were obliged to keep a foot into the street politics while managing the institutional one. From the beginning of the process Nahda emerged as a key player. It played at this stage a double game. On one side it decided to be present in the Ben Achour assembly 24 and to participate in the drafting of the new electoral juridical frame, on the other it played on the ground of the grassroots Islamic politics trying to exert influence through its militants. Until the first elections, Nahda was the only organized Islamic political project.

The Islamic party won by large the elections of October 2011 and formed a coalition government with two secular parties 25 . The post-election period was characterized by an Islamic hegemony, because of the Nahda primacy in the new 21 Those are the ones that referred to Bourguiba's heritage as that of a modernist version of the Tunisian specific nationalist project (they call themselves modernists).

22

While the nationalist camp could coalesce and push the Islamist party back to the opposition, this exit was less a total victory than a political compromise. A national coalition of civil society groups (headed by the strong union UGTT) supported a compromise between the two main contenders (Nahda and Nidaa), favoring a democratic exist to the crisis. The result was a national unity government that is still holding in 2017 (although with several governmental re-shuffle).

23

Yadh Ben Achour, Tunisie: une révolution en pays d 'Islam, (Tunis:Cérès Edition, 2017).

24

The assembly created in March was also called the "Ben Achour" assembly by the name of its chair.

25

Nahda won 37% of the votes, four times more of the second party, CPR, that scored 8.7%. The parties of the governmental coalition (Nahda, CPR, Ettakatol) were the three parties that scored more at the election, totalizing toghether about 53% of the votes.

government and the development of a widespread revivalist movement in the public space. A new radical Salafist group, Ansar al-Sharia Tunisia (AST), linked ideologically to the international jihadi movement, emerged as well, organizing preaching tents and public happenings on the street 26 . All type of Islamic associations, such as zakat/alms charitable associations and/or religious studies ones, developed everywhere . In this first period, the secular elite started to be worried of the situation. An emblematic example of this fear is the broadcast of the film Persepolis on NessmaTV. The film triggered a controversial debate because depicting the image of God (forbidden in Sunni Islam) and served also as a reminder of the consequences led by the Iranian revolution of 1979 (Nessma is notoriously seen in Tunisia as the TV of the secular elite). After the movie, in fact, the TV station organized a debate in the studio showing how Islamic clerics were hijacking the political revolutionary process 27 .

In the year 2013, the situation has dramatically worsened. An escalation of events brought to the assassination of the left wing leader Choukri Belaid, in February, and to the explosion of landmines in the mountains close to the frontier with Algeria 28 . In the aftermath of Chokri Belaid's assassination, the UGTT (the main trade Union organization) organized a general strike, which degenerated into isolated attacks to Nahda headquarters throughout the country. Hammadi Jebali, the Nahda prime minister at that time, was pushed to resign. The party president refused instead to accept his resignation and denounced a masked coup d'état 29 . Until the summer 2013, the polarization of the political landscape reached its highest point. AST called Nahda for an Islamic front in order to react against who they perceived as the counter-revolutionary caciques of the old president Morsi, pushed the Nahda leadership to adopt a different political move: instead of accepting a front with the radical forces, it declared AST a terrorist organization. This move cut off any ambiguous link between Nahda and the salafi-jihadis, and it appeared as a strategical premise for a political compromise with the nationalist camp. After the approval of the new constitution, the last stage of the transition began ending up with the elections of 2014/5. Nida Tunis, the new party founded by the Bourguibian Beji Caied Essebsi, won the parliamentary and presidential elections but Nahda remained a strong political block in parliament 31 .

In 2015, after the formation of the new government of prime minister Habib Essid, the country experienced a new balance of power 32 (Boubeckeur calls it a bargained competition) . While the presidency of the republic is in the hand of Nidaa Tunis, on the level of the parliamentary life prevails the logic of a shared government between Nidaa and Nahda. This new situation meant that a de facto agreement of the moderate actors, both secular and Islamists, agreed upon the new political frame, at the prize of the exclusion of the radicals 33 . In 2014 and 2015, a rude campaign of normalization began to stop any illegal or informal organization that had been tolerated until then. In particular, the Islamic suspected organizations were shut down and all the mosques returned to official imams controlled by state institutions 34 .

In this section, we shed the light on the general frame of the political contest, pointing out to the polarization between two opposite forces. In following sections, we are going to analyze the particular nature of the Islamic dynamics of contention, in order to make sense of how it has influenced the evolution of Nahda. In particular, we will describe the rising of a new Islamic constituency and its implications on the movement. 31 Nida Tunis won 85 seats in parliament against 69 for Nahda. The Islamist party did not present a candidate for the presidential election. 32 Amel Boubekeur, "Islamists, secularists and old regime elites in Tunisia: bargained competition," Mediterranean Politics 21.1 (2016): 119 33 Amanda Kadlec, "Tunisia's paradoxical political union: Ennahda and Nidaa Tunis," The Randa bloc, last modified February 5, 2016, https://www.rand.org/blog/2016/02/tunisias-paradoxical-politicalunion-ennahda-and-nidaa.html 34 Jasmine Foundation, "Tunisia crackdown raises fears of rights rollbacks," Jasmine Foundation, last modified August 29, 2014, http://www.jasminefoundation.org/en/?p=960

Chapt. 2/ The Islamic constituency

We use the concept of Islamic constituency to describe a large Islamic public that emerged in the Tunisian public sphere after the regime fall of 2011.The interest of this category is that of defining a space of Islamic activism existing outside the party but overlapping with its militant base. This Islamic activism had an influence on Nahda's political decisions, especially in this peculiar time of contention. The existence of such a constituency is something new for the Tunisian public sphere and a central part of the post-revolutionary social and political activism 35 .Besides a more pious and personal way to express religiosity, the Islamic constituency resulted into a new political activism and social engagement that developed into two directions: the participation in charitable associations and the increase interest in religious studies 36 (a large network of associations developed as a consequence). In the following lines, we distinguish three spaces of social Islamic activism: the charitable associations, the religious schools and the new imam organizations.

First, charitable associations are the most evident forms of new Islamic activism.

Although at the beginning spontaneous, they developed and structured as an impressive social field able to mobilize thousands of people. The first moment of this mobilization was the Libyan crisis in 2011, approximately from March to October. The massive influx of refugees at the Ras Jadir border in the southern region of Medenine led to the formation of several informal groups, which provided humanitarian assistance before and after the arrival of the international aid 37 . The participation to charity activities developed as the first sign of a new Islamic activism. Apart from the effort of international Islamic 35 At the time of Ben Ali, the only 'civil society' tolerated groups were the human rights associations, mostly monopolized by the militants of the left wing movement s and partie. Larbi Sadiki, "Bin Ali's Tunisia: democracy by non-democratic means," British Journal of Middle Eastern Studies 29.1 (2002): 57-78.

36

"After 2011 several militants created charitable and religious associations as a prosecution of their engagement into the Movement of the Islamic tendency" interview with the president of the association Nabaa al Khir, Sfax, May 2017. 37 According to the president of Tunisia Charity, 'the first-hand experience in collaborative civic engagement helped participants establish structural horizontal ties, which in turn ultimately led them to consider founding an association with a specific identity and goals' (interview with the president of Tunisia charity, Tunis, November 2015) networks, those associations developed and professionalized. The Nahda activists took an important role, often leading the process of startup. 38 The fact that Nahda's old militants occupied the role of presidents into many of these associations was a clear demonstration of the party eagerness to stay into the new process of social activism. At the same time, this quasi-hegemony of the party over associations led to some tensions. Between 2011 and 2013 this issue of Nahda's grasp on the associative world became a focus point against the party that was accused to indirectly create a system of dependency between the social aid and the political control, as the RCD (Ben Ali's party) used to do 39 . This huge network of associations developed into a system structured in few main blocs of associations, the most famous being "Marhama", "Tunisia Charity" and "Attaawn". The nature of those associations and the quality of their human actions changed over the time. They developed in fact more and more into professionalized, Western style NGOs specialized in human development. This change has occurred in parallel to the evolution of the party. The discussion of the separation between dawa and politics within the party is based on the multidimensional nature of the Islamic activism: the engagement into the civil society space, which emerged as a social and political force after 2011 and the participation to the politics 40 .

A second type of Islamic activism was that of the religious schools. As Islamic activism is the consequence of an Islamic revival (sahwa), most obviously it implies an increased interest for religious learning. The religious learning had not been a priority for Nahda since the 1970s, when the Islamic party was a jamaa 41 . The party was therefore not really engaged in this sector. Education, as a form of active spiritual renovation was since two decades the monopoly of Salafi/Wahabbi trends. The former regime used a pietistic form of Quran teachings as a form of compensation for the repression of Islamic 38 "After revolution we could choose whether to keep playing a role in the party or go for associative activities. However some were participating in both at the same time".Interview with Rachid Ali a historical Nahda militant and president of the association Nabaaal Khir,Sfax, February 2016. 39 Kaled Ammami, secular activist in associative activities, interview with the authors, Tunis, November 15, 2014 40 Ester Sigillò, "Tunisia's evolving charitable sector and its model of social mobilization," Middle East Institute, last modified, September 15, 2016. http://www.mei.edu/content/map/which-civil-societypost-revolutionary-tunisia 41 After the success of radical Salafism, many Nahda leaders complained that the party had abandoned the space of religious studies for too much of politics. Observations from the fieldwork. activist organizations 42 . After the revolution, a new wave of religious teaching invaded the public space and challenged the traditional zeitounian educational system, considered as an ideological instrument of the political power 43 . Those schools expressed a Salafist type of influence, not only in teaching but also in mobilizing the public on specific political issues 44 . According to the position of Nahda into the issues of religious teaching, it was in favor of the modernization of the Zeitouna University and style of teaching 45 . Its stand was however more intellectualistic than minded for mobilizing young Islamic activists. Islamic intellectuals such as Sami Brahami started to refer to an 'enlightened' type of reformism that had not big appeal to the majority of the new radicals 46 . That attachment to the Zeitounian allegedly enlightened tradition, was less attractive to the grassroots revivalist phenomenon of the new Islamic/salafist schools.

A third form of Islamic activism are the imams and charismatic preachers. The emergence of new leaders and activist Islamists came as the result of the action of new charismatic sheikhs. A sheikh is someone that acquires importance and respect through his charisma and factual action. He becomes a leader while preaching. This performance/preaching action can be acted in a preaching campaign in public spaces (coffee-shops or public squares), with friends, in 'liberated' minbar (preaching tribunes) of the mosques. After the fall of the regime the imams of the mosques in most cases left their places empty, leaving the space for new activists that considered that the minbar should become a place to be 'reconquered' by sincere and genuine Muslims 47 . This phenomenon was at the origin of the radical salafist trend of AST, but also paved the The Islamic constituency appears indeed as the new arena in which Nahda is only one of the players. This new public represents the political stake for the main Islamic party on the scene. The party enjoyed a privileged position in the Islamic political landscape, it had however to face a mobilized Islamic constituency ready to challenge its primacy. In the next two sections, we will see how the path of Nahda's evolution has to deal with the emergence of a new type of social Islamic movement. In particular, the activist nature of this movement was a problem for the Nahda's leadership that looked for a normalization of the political situation in order to reach a democratic deal with the nationalist front.

Chapter 3/Nahda, Dawa wa Islah and the Islamic social movement

The first of march 2011 Nahda becomes a legal party for the first time in its history. After six months and 30-years of struggle against the authoritarian state it ran for election and became the most important political party in parliament and in the country.

In this period of transition, the party had two challenges in front of it: the first was to convince the traditional non-Islamic public of its democratic credential; the second to keep a credibility in front of its public as the only valid Islamic party 48 . The Nahda leadership was aware of the potential backlash of the secular elites (in terms of backing an authoritarian restoration), if scared by radical Islamic policies. The experience of the past helped the analysis of the present 49 : only democratic established institutions could provide the guarantee for the existence of an Islamic party 50 .In order to accomplish its evolution into a democratic, liberal type of politics, however, it had to deal with a more radical and activist Islamic public. This is why the leadership of the party tried for a while to balance its policy between one of conciliation towards the Nationalists and anti- Islamic front and another of support vis à vis the grass rooted Islamic movements. A perfect balance between two opposite strategies was nevertheless very difficult to put in practice; furthermore it implied the risk of being crushed in between. If the party, for instance, chose to go too much into the direction of institutionalization, the risk would have been to lose its constituency in favor of more radical Islamic groups. If instead balanced its politics in favor of grass rooted, activist minded, radical Islamists, it would lose the trust of those hostile to the Islamist politics. As it happened in other contests (Libya for example), this second scenario could lead to a direct confrontation with uncertain outcomes.

Nahda was the Islamic party of reference for the Islamic vote until the elections of October 2011. After that, the articulation of the Islamic ideological camp developed into a variety of different trends. The position of Nahda in government, if it was the prove of its popularity, put the party in a difficult position. In particular it became problematic when trying to hold a politics of moderation in a period in which expectations for radical change were high. Nahda's government was composed of an alliance of the Islamic plus two secular parties: CPR and Ettakattol. This alliance was a tactical move in favor of a strategy of compromise 51 . Notwithstanding this move, the tension grew during the year 2012. In particular, the occupation of the public spaces by Islamic activists and preachers created a feeling of fear among segments of society such that it was impossible to remain to an equal distance between those two extremes 52 .In the following lines, we come back to some crucial events of this year 2012, showing the rising Islamic activism and the strategy of Nahda to managethe situation without renouncing to a strategy of moderation.

The first of these crucial junctures was the Islamic mobilization of March 2012 in favor of the introduction of shari'a as a reference for legislation in the constitutional draft 53 . Between February and March 2012 an intense debate developed in the country 51 Laura Guazzone, "Ennahda Islamists and the test of government in Tunisia," The International Spectator 48.4 (2013): 30-50.

52

Such events include hostile demonstrations in front of art exposition and theatre, hisba activities in working class neighborhoods and violent riots against the offense of religious symbols. Rory McCarthy, "Protecting the sacred: Tunisia's Islamists Movement Ennahdha and the challenge of free speech" British Journal of Middle Eastern Studies 42.4 (2015): 447-464.

53

The discussion was a key one, because at stake was the article 1 of the constitution of 1956. This article stated that Islam was the 'religion of Tunisians', keeping thus an ambiguity on the real role of Islamic law as a reference for legislation. and led to the organization of several public debates and demonstrations 54 . In the aftermath of this crisis, an Islamic public emerged as an organized social movement able to mobilize thousands of people. While the emergence of a new Islamic constituency was a fact since 2011, 55 this mobilization came as a good chance to create a more structured and unified front. The most important gathering of people was organized in front of the parliament the 16 march by a network of associations that presented themselves as a homogeneous front 56 . Some came on the front of the scene as new leaders, such as sheikh Mokhtar Jebali and Bechir Ben Hassan. Others, like Habib Ellouze and Sadok Shourou, were historical Nahda leaders and distinguished themselves as those able to make a bridge between the party and the constituency. The anti-Islamic camp labeled this front as the "Salafists of Nahda"; they were in fact an Islamic social movement that tried to put pressure on Nahda and have an influence on its transformation. In this mobilization of March, the organized front proved to be very strong. The modernist camp, voiced by the historical human rights and feminist organization (Les Femmes democrates) reacted vehemently starting a widespread debate through the media 57 . Rached Ghannouchi was under the pressure of the secular camp to renounce to any reference to shari'a. Although an extraordinary constitutive committee (majlis tassisi) 58 meeting decreed for the renunciation of demanding the introduction of shari'a putting an end to the debate 59 , the party had to deal from now on with this rising grass root movement.

The second of these crucial moments was the congress of Nahda in June 2012.The aim of this congress was double founded: on the one side it was necessary to subdue all 54 Asma Ghribi, "Role of islamic law in constitution provokes debate" Tunisia live, last modified March 22, 2012, http://www.tunisia-live.net/2012/03/22/role-of-islamic-law-in-tunisian-constitutionprovokes-debate/ 55 See section 2 of this chapter.

56

Two main organizations appeared as officially organizing the mobilization:at national level the Tunisian front of Islamic and at regional level, in Sfax, the most involved one was the so-called Imams' association.

57

Kapitalis "Des democrates tunisiennes:la charia ne doit pas etre une source de lois" Kapitalis, last modified Ocotber 9, 2011, http://www.kapitalis.com/politique/6253-des-democrates-tunisiennes-lla-chariane-doit-pas-etre-une-source-de-loir.html 58 Nahda did not have elected party organs until the 2012 congress.

59

Le Monde "Ennahda contre l'inscription de la charia dans la constitiution" Le Monde, last modified March 26, 2012, http://www.lemonde.fr/tunisie/article/2012/03/26/ennahda-contre-l-inscriptionde-la-charia-dans-la-constitution-tunisienne_1675938_1466522.html the elective charges, locally and nationally, to the militants' vote; on the other, the party had to define its own 'identity' and political strategic platform 60 . This was a party that lived most of the time of its existence underground or in exile. The political liberalization was a chance for a frank discussion within the party's militants about the signification of still being Islamist after the revolution and the role the party should play in such a key historical juncture. Such discussion was synthesized by the debate on the division in the party's activity between dawa and politics 61 . This is a debate and a key feature of transformation other Islamist parties went through . Besides the aspect of secularization of the politics that this move implies, there is one side of the issue that is properly political, in the sense that renouncing to dawa for an Islamist party is not only to renounce to religious practices but to its capacity of being an instrument of transformation of society as a whole. Such a traumatic move in this moment of radical and contentious politics had to be carefully considered; this is probably why the congress decided to delay the discussion to a further congress, while proposing to those more dawa oriented to act in civil society independently from the party politics 62 . For this purpose a new association was creat ed:Dawa wa Islah (DwI). This association had in particular the purpose of unify or coordinate the activities of the different associations grew up spontaneously in the previous period 63 . How we will see, however, this new creation became a political tool the party had in its hand to penetrate and co-opt the Islamic social movement 64 .

The association was founded in Sfax on September 2012 at the initiatives of 8 historical preachers activists (da'ya), 4 of them Nahda militants. Habib Ellouze became 60 The last congresses were held abroad and was never participated by all militants. In particular the party leadership had suffered on a relative lack of legitimacy because reduced to small groups talking to each other from Paris and London. The split between the militants from inside the country and those outside was felt as particularly problematic ( Rory Mc Carthey dissertation manuscript) 61 Kherigi, "Ennahda separation of the religious and the political",6. The association appears to be emanating from the party retrospectively. The party's double strategy of dawa/civil society activity and party co-optation of the movement appears from the interviews of both activists and party members "DwI is an association too linked to the party (Nahda): it is not able to well manage the activities and therefore does fail in its activities" (interview with the president of an Islamic charitable association. Sfax December 2015).

the president, Sadok Shourou the vice-president. The initiative of the foundation of such an association is attributed to Habib Ellouze, who has an idea of politics as being dawaminded 65 .The role of DwI as a bridge between Nahda and this movement was clear at the presentation of the association itself at the convention centre in Tunis (24 September 2012), which Nahda leaders Ghannouchi, H. Ellouze, and Shourou attended with known Salafist sheikhs such as Bechir Ben Hassan and Mokhtar Jbeli .

The important presence of Habib Ellouze as a symbol of the historical Islamic struggle against the regime and its leverage on the Islamic public in Sfax gave a certain authority to the Nahda attempt to establish its roots in the movement. Sfax is in this period the epicenter of the Islamic/salafist social movement. The association is founded here because of the existence of an active movement. In this city, the disparate dawa activities evolve around consensual and charismatic leaders such as Loukil, president of the historical Koran safeguard association and Ridha Jawedi, imam of the big mosque Lakhmi and president at the same time of the association Lakhmi Khayri and of the association of imams.

Initiatives of DwI included conferences on Islamic economy, in collaboration with the Tunisian association of Islamic economy, the Tunisian association for the zakat as well as information points (khimat) about the importance of activities such as sharing collective moments during Ramadan and helping the poor. According to the members of the association interviewed, DwI wanted to have a reformist role in order to channel those dawa initiatives into a progressive vision of Islam. Allegedly, it wished to reform the political Islamic thought and action (Islah) from below, as a process that from the grassroots would be able to inform positively the leadership of the party. The encroachment of the association into this large Islamic constituency is total for all the period between 2012 and 2013 when mobilization was at its highest peak and the party's leadership had troubles in justifying its inaction on the most controversial political crisis vis à vis its militants.

65

Habib Ellouze is the party's strong man in Sfax. In exile between 1981 and 1984, he became the president of the shura council after Ben Ali's arrival in power. He spent 15 years in prison; released for health problems, spends the time before 2011 under tight administrative control. In 2011 is elected MP in the electoral district Sfax 2; he keeps his style of preacher. Arrested in 1991, as president of the party, Sadok Chourou spends 16 years in prison, 14 of them in isolation. After the revolution, is elected MP; as much as Ellouze, he is identified inside and outside the party as a preacher more than a politician.

Finally, the third crucial moment of this 2012 year was the UGTT general strike of December against the Nahda government. In December 2012, the powerful Trade union called for a general strike against an 'illegitimate' government, and in particular after the clashes caused by the leagues for the protection of the revolution during the manifestation of the 60 th anniversary from the death of Farhat Hached . Nahda and CPR, the two biggest parties in the coalition of government, were accused to keep the power illegitimately 66 . As a response, Islamic activists triggered a campaign that ended up with a popular march in Sfax (. In particular, it was mobilized the same network of association that participated in the protests of march in front of the constitutional assembly (signatures of support for the government were gathered from 246 associations).

The mobilizations of 2012 was a process of political contention organized by an Islamic constituency that perceived itself as 'revolutionary'. In a post-revolutionary politics, it is normal that new discourses are framed and new forces emerge . The fulfillment of a revolutionary program however creates inevitably a polarization where those new ideas can be supported by one side and ostracized by the other. This was the case of the political context in Tunisia, where a mobilized Islamic public of different trends could have pushed the country into a revolutionary accomplished action. Nahda found itself in the middle of this process and the way it reacted was to use all means for channeling this Islamic movement into its politics without losing ground in terms of trustful partnership for democratization. The dynamics of contention grew stronger in the next year 67 , 2013, and the Islamic party risked to be crushed into the middle of a zero sum confrontation between the two extremist opposites.

The position of Nahda was most difficult in 2012 to become untenable in 2013 after the assassination of the left wing leader Choukri Belaid. In April-May 2013, DwI organized a spectacular preaching campaign around the country, inviting preachers from the gulf states 68 while at the same time the salafi-jihadi organization AST tried to 66 According to the opposition, Nahda engaged to stay in government only one year. Nahda, instead, claimed that never agreed for a limited schedule rather engaged in giving up the power as soon as the assembly would vote for a new constitution.

67

Nahda was also contested by its constituency and not only on religious matters. The critics within the Islamic constituency argued against that the loss of the party's 'revolutionary spirit' and its unwillingness to push the change in topics such as the transitional justice and measures of support for unemployed.

68

DwI came under the spotlight in the spring of 2013 during the successful Egyptian sheikh Mohammed Hassan series of lectures. The tour was a success, with significant media coverage and the organize a congress in Kairouan. However, the time for tolerance was now over and the Interior Minister reacted by banning all public religious activities 'non-authorized' . This action was aimed especially against Ansar al-Sharia, (whose congress was erupted by force) 69 but was generalized to all those considered 'salafist' activities and suspected to share the same constituency as the radical salafist-jihadis. Nahda came under high pressure. In the aftermath of Belaid's assassination, groups of Islamic activists spontaneously organized neighborhood patrols to 'protect' the people against what they saw as an attempt of coup d'état. AST called for an Islamic front against the secular 'counter-revolution' 70 while on the mountains at the border with Algeria the first armed attacks against military patrols occurred. For Nahda it was a dramatic moment of transformation in which the political choices were decisive for the future of the party.

The security apparatus (backed by the traditional anti-Islamist elites and the nationalist block) of the state came back on the scene and it no more tolerated any forms of religious/political practices. On the other side, the social Islamic movement got stronger and radicalized. The strategy of the party to co-opt constituency's activists eventually failed: members of DwI were pushed to the radical camp. On the grassroots level, many thought to form a large Islamic front with the inclusion of the radical salafists camp. These events could have turned into the Libyan scenario, where a potential civil war could have exploded and the moderation strategy of Nahda evaporated. The following events proved however a different development. The pressure against Nahda reached its highest point during the large demonstration in front of the parliament in the summer of 2013 during which protesters demanded the resignation of the government 73 . While Nahda refused to leave power, it accepted however to outlaw Ansar al-sharia, made many concessions on the constitutional draft and handed over the power to a technocratic caretaker government in January 2014 74 .

In January 2014 the constitution was approved by all the parties, while at the same time Nahda handed power to a technocratic caretaker government. In November/December of the same year, the parliamentary elections were held according to the new constitutional system. Nidaa Tunis succeed to coalesce the entire anti-Islamist front and gained the elections. A 'secret' meeting in Paris before the election between the leaders of the two main parties (Essebsi and Ghannouchi) established however a new deal between the two biggest national political forces. This gave born to a period of several governments supported by a national union parliamentary majority75 .

The period of democratic transition (2011-14) finally ended with a new power system, the inclusion of Nahda, and the normalization of the country (i.e. the end of social and political mobilization). The relationship between Nahda and its constituency evolved during this period. Nahda had the strength to impose a normalization to its own constituency. By playing the role of the 'responsible' party, keen to keep the national 71 Mohammed Brahmi, a Nasserist MP, was assassinated on July 25, 2013 with the same type of action as that of Belaid.

72

Tamarrod is the name young Egyptian activists gave to the signature collection campaign that led to the huge demonstrations in Egypt against Morsi. After the Egyptian campaign, a group of left wing activists in Tunisia tried to do the same, but failed to coalesced the anti-Nahda block with street mobilization, Reuters, "New Tunisian protest to mirror Egypt'e Tamarrod campaign" Reuters, last modified, July 3, 2013 http://english.ahram.org.eg/NewsContent/2/8/75627/World/Region/New-Tunisianprotest-movement-to-mirror-Egypts-Tam.aspx 73 BBC news, "Tunisia crisis: tens of thousands join protest" BBC news, last modified, August 7, 2013. http://www.bbc.com/news/world-africa-23597308 74 Monica Marks, "Tunisia's Ennahda: Rethinking Islamism in the context of ISIS and the Egyptian coup," Rethinking Political Islam Series (2015). unity government, and defender of the new democratic institutions, the Nahda leadership was able to re-gain its hegemony on the Islamist scene, all the more so that no other credible Islamist alternative was able to challenge it 76 . The evolution of Nahda became manifest in the way it dealt with the Islamic associations. In 2014, the government triggered a campaign of repression against illegal imams and Islamic associations . While Nahda tried to operate a mediation to avoid the worst, it also exploited the situation and pushed the activist for a change in the way they dealt with charitable associations in order to evolve into professionalized Ong, human development style. In particular, the transformation of charitable associationsbecame evident after January 2014when the state hardened coercive policies against Islamic charities with the accusation of opacity and lack of professionalization. This juncture was now favorable to the Nahda leadership that could feel stronger to impose to its militants the separation between dawa and politics.

The last moment of the social movement's resilience to the policy of normalization was the famous Jawadi case in Sfax in 2015. Sheikh Jawadi was a central figure of the Tunisian Islamic activism, indeed he was not only the imam of the central mosque Lakhmi, but also the president of Lakhmi khairiya, the vice-president of the Imams'association and president of the associative network Attaawanou in Sfax.

During the campaign against the no-authorized imams, Jawadi was asked to leave the place of the mosque for an imam chosen by the minister of religious affair. The attendants of the mosque (his public, more specifically) protested and claimed that he was a popular imam, chosen by the public of the faithful. In particular, protests were addressed against the government which was accused to violate freedom of worship 77 .The mobilization of the Jawadi public became the focalized resistance of all the Islamic social movement. Jawadi was ousted on 15th September 2015.: The new imam was Abdelaziz Loukhil, an old nahdha militant highly respected in Sfax. This solution eventually led to the exclusion of young cheikhs who had been proclaimed imam "from below" after the revolution, and was the beginning of a new phase where final decisions were taken by the party's leadership "from the top". Nahda was now the Islamic spoiler of the situation: it 76 With the exception of AST of course that was however outlawed in August 2013. 77 Kapitalis "Mosqué Sidi Lakhmi: la prièe du vendredi de nouveau empeché", Kapitalis, last modified November 6, 2015, http://kapitalis.com/tunisie/2015/11/06/mosquee-sidi-lakhmi-la-priere-duvendredi-de-nouveau-empechee/ could claim the win of its political strategy, both by presenting itself in front of the Islamic public as the only credible Islamic player and in front of the nationalist front as the guarantee for the success of the democratic transition.

In June 2016 the Xth congress of the party took finally place. Nahda claimed to have chosen for liberal democracy and pluralism without any ambiguity 78 . It also declared not to be an Islamist party anymore. Nahda perceived itself now as a conservative party with Islam as its ethical reference, similar to the European Christian parties 79 . This change implied the end of the debate on the separation between dawa and politics. It was now a matter of fact and those who felt more oriented to reform religion and make it the base for a new social system should do it on civil society by engaging in associative activities. The associations became thus agents of development rather then traditional charitable associations (at least in theory). As a consequence, several party militants left the executive committees of Islamic associations. Abdessalem Khammari for instance left the association Dar al Khair once he was elected in the choura (general counsel of party).

Several members of the shura, in turn, left the party to focus on the activities of their associations and decided to be engaged exclusively in "civil society." This is the case of Habib Ellouze, president of DwI, and also the case of Jendoubi who left the party to focus on its new association OTDS (Organisation Tunisienne pour le Developpement Social), that heir of Marhama. 80 Concerning the religious studies, instead, the congress praised for a reform, not in the sense of the salafist/wahhabi trends but in tune with the modernist, specific Tunisian/Zeitunian tradition. Nahda would therefore be a national party, engaged in democratization and the modernization of Islam. Islam remains a key part of the identity of the country as a factor of modernization 81 .

The outcome of the process of dialectical confrontation between Nahda and the Islamic social movement was indeed in favor of the Nahda leadership, in particular of its more reformist wing. The transformation of the party into this direction is certain the consequence of a long historical process and of the theoretical elaboration of its more 'enlightened' leaders. The outcome of the political process of democratization, however, was key to determine the frame for this outcome.

Conclusion

This chapter participate to the general book issue by showing the importance of the political process and political opportunities in determining the direction of the historical political process. We have in particular highlighted the evolution of the Islamic political landscape in Tunisia. With the exclusion of the important radical salafist group of AST, analyzed elsewhere by one of the authors, we showed the importance of Islamist actors in the politics of opposition and contention of the post-2011 politics in Tunisia.

This contribution aims to stress the importance of the political process factor upon the transformations of the new Islamic social movements that emerged in the postrevolutionary period. The transformation of Nahda from 'Islamist' to an Islamic conservative party is here considered under the lenses of the historical renunciation of the Tunisian Ikhwani party to its politics of social transformation. By renouncing to dawa activities, in fact, Nahda renounces to radically transform society. This transformation implies indeed a transformation of the Islamist polity. However, the Islamic party, in order to keep its hegemony over the Islamic scene, it cannot completely cut all the links to its constituency. Thus, Nahda's strategy appears rather 'ambiguous', as it maintains a repertoire of contention. The evolution of the political transition, however starts to reverse its direction in 2013. This time the moderate strategy of the Nahda's leadership is best suitable to manage the political transition. The return on power of old nationalist (anti-Islamist) elites, has represented the final stage of Nahdha's transformation, as it could have potentially pushed the Islamist party back underground. The Nahda leadership, strong of its historical experience with the Ben Ali regime, was able this time to play differently and to use the changing political context to impose the transformation of the party to the most radical and activist minded part of its constituency. This is the end of the story and the apparently successful epilogue of the Tunisian democratic transition. History is however not written in advance and the political evolution cannot be applied according to a standardized models. The democratic deal implied, as we explained, a political compromise 'between moderates'. This left out any political space for more radical politics. In this scenario, however, we cannot exclude the possible emergence of new radical options which can become better suited than moderated solutions provided by the strategy of Nahda.

1

  Doug McAdam, Sidney Tarrow and Charles Tilly, Dynamics of contention (Cambridge University Press, 2001).

  2

  as a system of meaning, identity and basis of collective action 10 Since the early 2000s, there have been a number of attempts combining the study of Islamist mobilization and social movements. The first examples are the academic contributions of Wiktorowicz 11 and Wickham 12 . The first one applied theResource Mobilization Theory to Salafist and Muslim Brotherhood Islamist mobilization in Jordan.

  2013/14 to 2015/16, we observe a backlash; the Nationalist camp coalesces all the anti-19 Interview with Mohamed Rachid, imam of Kasserine, Tunis, April 2016. 20 Sami Zemni, "The extraordinary politics of the Tunisian revolution: the process of constitution making," Mediterranean Politics 20.1 (2015): 1-17.

  regime 30 . The events occurred in Egypt in July 2014, and the violent overthrow of the MB 26 Fabio Merone and Francesco Cavatorta, "Salafist movement and sheikh-ism in the Tunisian democratic transition," Middle East Law and Governance 5.3 (2013): 308-330. 27 BBC, "Protesters attack TV station over film Persepolis" BBC, last modified October 9, 2011, http://www.bbc.com/news/world-africa-15233442 28 Tristan Dreisbach, "Three landmines explode around Mount Chaambi this week" Tunisia live, last modified November 20, 2013, http://www.tunisia-live.net/2013/11/20/three-landmines-explode-onchaambi-mountain-this-week/ 29 BBC "Tunisia prime minister Hamadi Jebali resigns" BBC, last modified February 19, 2013, http://www.bbc.com/news/world-africa-21508498 30 Fabio Merone, "Between social contention and takfirism: the evolution of the Salafi-jihadi movement in Tunisia," Mediterranean Politics 22.1 (2017): 71-90.

42

  Rikke Hostrup Haugbølle and Francesco Cavatorta, "Islamism in Tunisia before and after the Arab Spring," Popular Protest in the New Middle East: Islamism and Post-Islamist Politics 147 (2014): 31. 43 Sheikh Mohammed Ali, 2013, interview with the authors. 44 The school Ibn Malik is one important case. Founded by Sheikh Mohammed Ali, became one important reference point for new sheikhs and Islamic leaders that emerged in 2011 and 2012. International clerics like the famous Ahmed Mazid Shanquity also belonged to the scientific committee of the association.https://www.youtube.com/watch?v=7bG3GVAv33M. Last view 12 January 2017. 45 Zeitouna director, Tunis, 24 June 2013, interview with the authors. 46 Sami Brahami, Religion and politics. Between the fluttering seculars and the inability of the Islamists (translated from Arabic) (Tunis: Manshurat Karm al-Sharif, 2012), 199. 47 Abu al Mouwahed, AST leader, 8 December 2012, Douar Hisher interview with the authors ground for different types of activism. As we will see in the next two sections, it gave birth to a specific Islamic social movement whose center became the city of Sfax.

48

  Kasper Ly Netterstrøm, "The Islamists' Compromise in Tunisia," Journal ofDemocracy 26.4 (2015): 119. 49 At the end of the 1980s, in fact, the ben Ali's regime initially opened the political field until Nahda emerged as the biggest opposition party. As a consequence, the Islamist militants reacted on the street giving the regime the excuse for a campaign of total eradication. 50 Rached Ghannouchi, interview with the authors, Tunis, 20 March 2013.

62

  Interview with Daimi, Nahda leader, Tunis 5 August 2012.63"Before 2012, the dawa's activities were scattered. Each working individually with its own association. DwI wants now unify all the dawa's activities" (interview with DwI's secretary general. Sfax December 2015).

  64

Chapt 4 /

 4 Nahda, democratization and the end of contention participation of thousands of people in both the two stops in Tunis (al-Menzah theater, 30 April) and Sfax (Lakhmi mosque, 4 may. "Thousands participate to the preacher Mohammed Hassan event at the "Coupole" (translated from Arabic)" YouTube video, posted by Shems Fm April 30, 2013 https://tunisie14.tn/videos/detail/la-coupole-affiche-complet-pour-la-visite-du-predicateur-mohamedhassen.69Alice Fordham "Tunisia's moderates lost patience with Ansar al Sharia" The National, last modified May 21, 2013, https://www.thenational.ae/world/mena/tunisia-s-moderates-lose-patience-withansar-al-sharia-1.655866 70 Fabio Merone, "Between social contention and takfirism"71-90.The year 2013-2014 was the turning point of democratization in Tunisia. After the ousting of the Egyptian president in July 2013 and the second political assassination 71 , a group of left wing activists wanted to imitate the Egyptians anti-Morsi mobilization by organizing a tamarrod campaign with the aim of getting rid of the Nahda government 72 .

78Kherigi"

  Ennahda separation of the religious and the political",10 79 Kherigi "Ennahda separation of the religious and the political", 12. 80 Interview with the vice-president of OTDS. Tunis, December 2016. 81 Kherigi "Ennahda separation of the religious and the political", 11-12.

  Hafez applied the Political Process Approach (PPA) to Islamist radicalization in Algeria.To be sure, the most consistent contribution which apply SMT to Islamist movements is the edited volume by Wiktorowicz: Islamic Activism: a Social Islam, charity, and activism: Middle-class networks and social welfare in Egypt, Jordan, and Yemen (Indiana University Press, 2004); Janine Clark, "The conditions of Islamist moderation: Unpacking Cross-Ideological cooperation in Jordan," International Journal of Middle East Studies 38.04 (2006):539-560.

	10 Press, 2004), 3. Quintan Wiktorowicz, ed. Islamic activism: a social movement approach (Indiana University 11 Quintan Wiktorowicz, "Civil society as social control: State power in Jordan," Comparative politics (2000): 43-61. 12 Carrie Rosefsky Wickham, Mobilizing Islam: Religion, activism and political change in Egypt (Columbia University Press, 2005).

13

Janine Clark, 14

Diane Singerman, "The networked world of Islamist social movements" in Islamic activism: a social movement approach (Indiana University

Press, 2004), 143-163.

  Tunisian Islamist movement from jamaa to party and the consequent transformations 15 Mohammed Hafez, Why Muslims rebel: Repression and resistance in the Islamic world(Lynne Rienner Publishers, 2003).

	16	Mohammed Hafez, "From Marginalization to Massacres: A Political Process Explanation of GIA
	Violence in Algeria" in Islamic activism: a social movement approach (Indiana University Press, 2004),
	39.
	17	Doug McAdam, "Micromobilization contexts and recruitment to activism," International Social
	Movement Research 1.1 (1988): 125-154. Doug McAdam, Sidney Tarrow and Charles Tilly, Dynamics of
	contention (Cambridge University Press, 2001).

Dominique Thomas, Générations jihadistes. Al-Qaida-Etat Islamique, histoire d'une lutte fratricide (Paris: Michalon Editeur, 2016).

Anne Wolf, "An Islamist 'renaissance'? Religion and politics in post-revolutionary Tunisia," The Journal of North African Studies 18.4 (2013):

560-573.

Sharan Grewal, "From Islamists to Muslim Democrats: How Living in Secular Democracies Shaped Tunisia's Ennahda," (2017).


PT, MSc Dominique Vincent-Genod
email: dominique.vincent-genod@chu-lyon.fr

PhD Pascal Rippert

PhD Justine Coton

MD Laure Le Goff

OT Aurélie Barriere

PT Anne Berruyer

PT Marjorie Bernard

PT Camille Garde

PT Marta Gutierrez-Garcia

PT Stéphanie Gilabert

PT Adriana Gomes-Lisboade-Souza

PhD Aurore Daron

MD Laurent Servais

PhD Guillaume Thomann

PhD Carole Vuillerot

Berruyer, Bernard, Garde Vincent-Genod Barriere

Scoring People With Spinal Muscular Atrophy on the Motor Function Measure Using the Microsoft Kinect

Keywords: data display, motor function, outcome assessment, spinal muscular atrophies of childhood, task performance and analysis

Purpose: Assess the ability of the Kinect to capture movement and posture of people with spinal muscular atrophy (SMA) during completion of 14 items of the Motor Function Measure, a validated functional rating scale for people with neuromuscular diseases. Methods: Multicenter feasibility study in which Motor Function Measure items were scored as usual by the participant's therapist during the completion (Score-T) while another therapist scored items based only on the visualization of digital data collected using the Kinect (Score-D). Agreement and disagreement were investigated. Results: Twenty people with SMA type 2 or 3 were participants; 142 items were recorded and analyzed. There was 31.7% agreement between Score-T and Score-D for participants with SMA type 2, and 76.2% for those with SMA type 3. Conclusions: The results prevent us from considering the use of Kinect capture to deduce an automated scoring, but this device may be of interest to highlight potential compensations. (

INTRODUCTION

Spinal muscular atrophy (SMA) is an inherited autosomal recessive neuromuscular disorder caused by a homozygous absence or loss of function mutation of the SMN1 gene. [START_REF] Verhaart | A multi-source approach to determine SMA incidence and research ready population[END_REF] It is characterized by the degeneration of motor neurons of the anterior horn of the spinal cord, resulting in muscle weakness according to the age and stage of motor development acquired at the onset of the disease. [START_REF] Munsat | International SMA consortium meeting (26-28[END_REF][START_REF] Lunn | Spinal muscular atrophy[END_REF][START_REF] Finkel | 209th ENMC International Workshop: outcome measures and clinical trial readiness in spinal muscular atrophy 7-9 November 2014, Heemskerk, The Netherlands[END_REF] Authors have defined different types of SMA according to the ability of affected people to sit or walk; those with type 1 do not acquire autonomous sitting position, those with type 2 do not acquire independent walking, and those with type 3 have difficulty running, climbing stairs, or getting up from a chair.

With the advancements in molecular genetics and the better understanding of the pathogenesis and natural history of SMA, new therapeutic approaches have been developed and approved by the Food and Drug Administration and the European Medicines Agency. [START_REF] Messina | New treatments in spinal muscular atrophy: positive results and new challenges[END_REF][START_REF] Kirschner | European ad-hoc consensus statement on gene replacement therapy for spinal muscular atrophy[END_REF][START_REF] Iftikhar | Current and emerging therapies for Duchenne muscular dystrophy and spinal muscular atrophy[END_REF] To evaluate the effects of therapeutics on people, valid and sensitive assessment tools are needed. In SMA, the Motor Function Measure (MFM) [START_REF] Bérard | A motor function measure for neuromuscular diseases. Construction and validation study[END_REF][START_REF] De Lattre | Motor function measure: validation of a short form for young children with neuromuscular diseases[END_REF] is a validated tool that is reliable and sensitive to change [START_REF] Jacqmin | Mathematical disease progression modeling in type 2/3 spinal muscular atrophy[END_REF][START_REF] Vuillerot | Responsiveness of the motor function measure in patients with spinal muscular atrophy[END_REF] and has been used as a primary outcome measure in clinical trials or observational studies (eg, study ClinicalTrials.gov numbers: NCT02628743, NCT00774423, NCT02908685).

Training of therapists in MFM completion is essential and maintains good to excellent interrater reproducibility for all items [START_REF] Bérard | A motor function measure for neuromuscular diseases. Construction and validation study[END_REF][START_REF] De Lattre | Motor function measure: validation of a short form for young children with neuromuscular diseases[END_REF] ; however, despite standardized MFM training sessions, there is interrater variability in the item-scoring procedure. This is mainly dependent on the intrinsic qualities of the participants and therapists such as mood or motivation. These factors are difficult to control. [START_REF] Servais | Video games to measure outcome for children with neuromuscular disorders[END_REF] The use of easy-to-use markerless motion capture and analysis technologies could be a method to enhance MFM reliability. Use of motion capture technology may allow the completion of a functional rating scale such as the MFM in a playful environment that could promote optimal participation from participants. It could also provide automatic item scores based on digital data from capture of participant movements.

Among the many sensors available in video games, the optical sensor system Kinect (Microsoft, Redmond, Washington) provides good representation of human kinematics [START_REF] Rocha | System for automatic gait analysis based on a single RGB-D camera[END_REF][START_REF] Bonnechère | 3D analysis of upper limbs motion during rehabilitation exercises using the KinectTM sensor: development, laboratory validation and clinical application[END_REF][START_REF] Lopez | Statistical validation for clinical measures: repeatability and agreement of Kinect TM -based software[END_REF][START_REF] Clark | 3-dimensional cameras and skeleton pose tracking for physical function assessment: a review of uses, validity, current developments and Kinect alternatives[END_REF][START_REF] Cai | Validity and reliability of upper limb functional assessment using the Microsoft Kinect V2 sensor[END_REF][START_REF] Scano | Kinect V2 implementation and testing of the reaching performance scale for motor evaluation of patients with neurological impairment[END_REF][START_REF] Hondori | A review on technical and clinical impact of Microsoft Kinect on physical therapy and rehabilitation[END_REF] and has potential to be used for completion of MFM. To be able to develop algorithms allowing automatic item scoring, it is necessary to first verify the ability of the sensor to capture the requested movement of participants. The aim of the present feasibility study was to assess the ability of Kinect used during the completion of 14 of the 32 items of the MFM to capture the movements and postures of people with SMA with sufficient accuracy to provide appropriate item scoring.

METHODS

Study Design

This multicenter, prospective, noninterventional feasibility study was approved by the French ethics committee "Comité de protection des Personnes Sud est II " (#IRB 11236) and the Belgium ethics committee "Comité éthique du Centre Hospitalier Régional la Citadelle de Liège " (#ID RCB: 2014-A01 263-44).

Participants and Study Setting

Participants included in the study were enrolled between September 2015 and September 2017 in the Pediatric Neuro-Muscular Diseases reference center in Lyon (France), I-Motion Institute (Paris, France) and Neuro-Muscular Diseases reference center in Liege (Belgium). The inclusion criteria were people with genetically confirmed SMA type 2 or 3, and those between 2 years of age and older and 30 years of age and younger. Participants could be part of the SMA natural history study (NatHis-SMA, NCT02391831). [START_REF] Chabanon | Prospective and longitudinal natural history study of patients with type 2 and 3 spinal muscular atrophy: baseline data NatHis-SMA study[END_REF] All therapists involved in the study had been previously trained and certified for MFM completion.

Motor Function Measure

Motor Function Measure consists of 32 items that evaluate 3 functional domains: D1, standing and transfers; D2, axial and proximal motor function; and D3, distal motor function. For each item, the scoring system uses a 4-point Likert scale based on the participants' increasing ability to perform each task: 0 = cannot initiate the exercise or maintain the starting position; 1 = performs the task partially; 2 = performs the movement incompletely or completely but imperfectly, and 3 = performs the task fully and "normally."

The proportion of the maximal score in each domain (D1, D2, and D3) is calculated, as is the proportion of the maximal score. 8

Kinect

The Kinect V2 sensor (Microsoft, Redmond, Washington) was used. It is a markerless infrared-based motion capture and analysis system that tracks a digital skeleton composed of 25 points of the human body at a frame rate up to 30 frames per second. No marker placed on the person' s body and no calibration of measurements is required for recording movements.

Development of Motion Display Software KiMe2

The KiMe2 software was developed by the G-SCOP laboratory (Grenoble, France) to display movement captured by the Kinect. This records the positions of the joints in 3 dimensions (3D) and records the persons' movements over time. It includes modules to facilitate the initial positioning of the person with respect to the camera' s field of capture. The 3D reconstruction module of the digital skeleton enables the digital visualization of the person in both real time and retrospectively. Kinematic curves and digital skeleton 3D reconstruction are shown in Figure 1; see Supplemental Digital Content Video 1, available at: http://links.lww.com/PPT/A414.

Because of technical limitations, not all 32 items are suitable for the recording of the data using a Kinect sensor during completion of MFM. The KiMe2 software was developed to record data from 14 items of the MFM, items 9, 10, 11, 12, 13, 14, 15, 16, 24, 25, 26, 27, 31, and 32 (see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A415).

Conduct of the Study

Motor Function Measure was completed according to the MFM user' s manual (see http://www.mfm-nmd.org). Participants were positioned at a distance of 1.5 to 2.5 m in front of the Kinect, facing and centered in the field of capture. For participants not involved in the NatHis-SMA study, the Kinect was at the height of his or her pelvis; for those involved in the NatHis-SMA study, the height of the Kinect was 1.50 m from the ground because of the ACTIVE-seated test that was part of the protocol. [START_REF] Lowes | Proof of concept of the ability of the Kinect to quantify upper extremity function in dystrophinopathy[END_REF][START_REF] Lowes | Reliability and validity of activeseated: an outcome in dystrophinopathy[END_REF] During the completion of the 14 items suitable for recording by the Kinect, therapists recorded participants' movements with the Kinect by triggering and stopping the recording using a press button in the KiMe2 software. At the beginning of the capture, the screen was checked to verify that the system was working correctly. The therapist and/or the caregiver(s) accompanying the participant could be present in the Kinect field of capture without altering the capture of participant movements.

Data Collected

The day of MFM completion, participant demographic characteristics (gender, age), disease type (SMA type 2 or 3), walking ability (walking participants were those able to walk a 10-m distance indoors without assistance), and each score of the 32 MFM items given by the participant' s therapist in real-time during the MFM completion (Score-T) were collected.

Based only on analyses of digital data presented by the KiMe2 software in the form of a 3D skeleton reconstruction and kinetic and kinematic curves (Figure 1; see Supplemental Digital Content Video 1, available at: http://links.lww.com/PPT/A414), recordings of completed items by the Kinect were further scored by a physiotherapist assisted by an engineer, masked to the participant' s therapist score, giving a Score-D. Two MFM per participant could be collected provided there was at least 6-month interval between the 2 MFM.

Statistical Analysis

Quantitative variables were described as median, interquartile range. Categorical variables were described as frequencies or percentages.

The strength of agreement between items scores provided by the participant' s therapist (Score-T) and from digital data (Score-D) was assessed by the proportion of agreement and disagreement for each item.

RESULTS

Twenty participants aged from 4 to 29 years were included, 10 of whom also participated in the Nathis-SMA study. Ten participants had SMA type 2 and 10 had SMA type 3. Thirteen, including 3 with SMA type 3, could not walk (Table 1).

MFM Completion and Item Recording

Sixteen participants completed only 1 MFM; 2 participants with SMA type 2 and 2 participants who were not walking and with SMA type 3 completed 2 MFM 6 months apart. For 4 MFM completions, participants completed items with a sitting starting position (items 14, 15, 16, and 24) in their electric wheelchair, instead of a chair of standardized height, as authorized by the MFM user' s manual. In 184 items, the starting position could not be achieved by the participants (score 0 for these items) preventing the completion of the items and their recording. For 10 items, items were not recorded because the participant' s therapist forgot to start recording or there was a technical problem; 142 item recordings were therefore obtained and analyzed (Figure 2).

Agreement and Disagreement Between Scores From Therapist (Score-T) and Scores Based on Digital Data (Score-D)

Table 2 lists the distributions of agreement and disagreement among the 4 levels of MFM item scoring (0, 1, 2, and 3). Among the 142 items recording included in the analysis, there were 23 with a significant deformation of the skeleton (Table 2; see Supplemental Digital Content 2, available at: http://links. lww.com/PPT/A416), preventing item scoring based on digital data (Score-D). Such significant deformation of the skeleton often occurred when the participant was leaning over or by capturing interference between the ground and extremities. When a Score-D was available, there were 29 disagreements; there was a difference of 1 point between Score-T and Score-D in all disagreements (Table 2).

There was agreement between Score-T and Score-D for 90 of 142 items (63.4%; Table 2). According to individual items, with the exception of item 13 "Maintain the seated position," better agreements were in SMA type 3 than in type 2; overall, agreement was in 31.7% of recordings for SMA type 2 and 76.2% for SMA type 3 (Table 3).

For items 14 "raising the head" and 25 "standing straight," disagreement (73.7% and 71.4%, respectively) was more Abbreviation: NK, not known. a The scoring system uses a 4-point Likert scale (0-3) for each item, from score 0 when participant cannot initiate the task to score 3 when participant performs the task fully with a controlled movement. b A Score-D could not be determined on the basis of digital data because of a significant deformation of the skeleton during the course of the item completion (see Supplemental Digital Content 2, available at: http://links. lww.com/PPT/A416).

frequent than agreement. For these items, a lack of 3-axis misalignment capture that should be treated as a compensatory movement in the MFM scoring procedure led to a Score-D of 3 instead of 2.

DISCUSSION

This study had a medium level of agreement between scores given by the participant' s therapist in real time during the MFM completion and scores based on recorded digital data given by a therapist, assisted by an engineer for the 14 items tested. However, a higher level of agreement was found for participants with SMA type 3 than for those with SMA type 2.

The use of the Kinect was well received by therapists but some reported difficulties in obtaining the initial capture of the joints of weakest participants in their wheelchair during completion. As previously reported by Obdrzálek et al, [START_REF] Obdrzálek | Accuracy and robustness of Kinect pose estimation in the context of coaching of elderly population[END_REF] the wheelchair often interferes with the capture of the skeleton by confusing the participants' body envelope. In addition, although the Kinect has shown good performance in the capture of motor function or body joints in comparison with marker-based motion capture systems, [START_REF] Otte | Accuracy and reliability of the Kinect Version 2 for clinical measurement of motor function[END_REF][START_REF] Ma | Validation of a Kinect V2 based rehabilitation game[END_REF][START_REF] Hu | Concurrent validity of evaluating knee kinematics using Kinect system during rehabilitation exercise[END_REF] some limitations have been identified to capture lower range movements. [START_REF] Galna | Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson' s disease[END_REF][START_REF] Mortazavi | Stability of Kinect for range of motion analysis in static stretching exercises[END_REF][START_REF] Webster | Systematic review of Kinect applications in elderly care and stroke rehabilitation[END_REF] This could explain the better results achieved in participants with SMA type 3 than in those with SMA type 2 who experience more impairments and activity limitations.

The Kinect has been used mainly for rehabilitation programs, [START_REF] Clark | 3-dimensional cameras and skeleton pose tracking for physical function assessment: a review of uses, validity, current developments and Kinect alternatives[END_REF][START_REF] Webster | Systematic review of Kinect applications in elderly care and stroke rehabilitation[END_REF][START_REF] Gama | Motor rehabilitation using Kinect: a systematic review[END_REF] and it has more recently been used to assess motor function. [START_REF] Cai | Validity and reliability of upper limb functional assessment using the Microsoft Kinect V2 sensor[END_REF][START_REF] Scano | Kinect V2 implementation and testing of the reaching performance scale for motor evaluation of patients with neurological impairment[END_REF][START_REF] Lowes | Reliability and validity of activeseated: an outcome in dystrophinopathy[END_REF][START_REF] Galna | Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson' s disease[END_REF][START_REF] Blaschek | Quantitative motion measurements based on markerless 3D full-body tracking in children with SMA highly correlate with standardized motor assessments[END_REF] Based on the results here, despite some good to excellent agreement between Score-T and Score-D for some items, such as items 11, 12, 24, 26, 27, or 32, the lower agreement found for other items prevents us from considering replacing therapist scoring by a fully automatic scoring based on Kinect capture. However, the Kinect coupled to the KiMe2 software allowed for capture and display of numerous compensatory movements. These results are thus encouraging to consider using the Kinect as a scoring aid, highlighting potential compensations. With feedback of the participant' s movements recorded by the system, the therapists could check some movements and analyze them in real time.

With the recent technological advancement, a new generation of sensors has been developed that provides more accurate kinematic measurements. For example, the Azure Kinect has greater accuracy in the anterior-posterior direction than the Kinect V2 with higher resolution [START_REF] Yeung | Effects of camera viewing angles on tracking kinematic gait patterns using Azure Kinect, Kinect v2 and Orbbec Astra Pro v2[END_REF] and could give better results in the measurement of people with SMA.

Study Limitations

The small sample size is a study limitation, particularly because of the high clinical variability among people with SMA. Moreover, the participants were included from 2 different contexts; for half the MFM completion was the day of a routine clinical follow-up, while the other half were included in the SMA natural history study and for whom the MFM was completed the same day as many other tests. 20

CONCLUSION

The results of the present study prevent us from considering the use of Kinect capture to propose an automated scoring for MFM in people with SMA, particularly in the weakest participants, but may be of interest as a scoring aid, highlighting potential compensations. These preliminary results could be improved in the future with more accurate capture tools.

Fig. 1 .

 1 Fig. 1. Kinematic curve (left) and digital skeleton 3D reconstruction (right) display by KiMe2, example of item 15. Seated on a chair or a wheelchair, forearms on a table, the participant should place both hands on top of his or her head at the same time while the head and the trunk remain in the midline position. Kinematic curves shown represent the following movements of interest joints for item 15 according to time in seconds: head (in red), left hand (blue), right hand (green), left elbow (brown), and right elbow (yellow).

Fig. 2 .

 2 Fig. 2. Flowchart of the recorded items in the study. MFM indicates Motor Function Measure.

TABLE 1

 1

	Participant Characteristics at Baseline
	Age, y: median (IQR), y	10.7 (9-16.3)
	Gender: Male/female, n	9/11
	SMA type: 2/3, n	10/10
	Walking status: walking/not walking, n	7/13
	MFM scores: median (IQR), %
	MFM D1	5.9 (2.6-40.4)
	MFM D2	91.7 (55.6-94.4)
	MFM D3	93.4 (72.6-100)
	MFM total score	58.3 (40.6-74.5)
	Abbreviations: IQR, interquartile range; MFM, Motor Function Measure;
	SMA, Spinal muscular atrophy.

TABLE 2

 2 Percentages of Agreement and Disagreement Between Scores From Therapists (Score-T) and Scores Based on Digital Data Analysis (Score-D)

		Agreements		Disagreements
		Score-T/			Score-T/
		Score-D a	n	%	Score-D a	n	%
	n = 142	0/0	2	1.4	. . .	. . .	. . .
		1/1	17	12.0	. . .	. . .	. . .
		2/2	18	12.7	. . .	. . .	. . .
		3/3	53	37.3	. . .	. . .	. . .
		. . .	. . .	. . .	1/0	3	2.1
		. . .	. . .	. . .	2/1	2	1.4
		. . .	. . .	. . .	2/3	9	6.3
		. . .	. . .	. . .	3/2	15	10.6
		. . .	. . .	. . .	0/NK b	1	0 . 7
		. . .	. . .	. . .	1/NK b	4	2 . 8
		. . .	. . .	. . .	2/NK b	8	5 . 6
		. . .	. . .	. . .	3/NK b	10	7.0

TABLE 3

 3 Agreement Between Score-T and Score-D Abbreviations: MFM, Motor Function Measure; NA, not applicable; SMA, Spinal muscular atrophy. a Item for which the starting position could not be achieved by the participants.

				SMA 2			SMA 3
				Number of			Number of
	MFM	MFM	Number of	Identical	Percentage of	Number of	Identical	Percentage of
	Domain	Item	Recordings	Scoring	Agreement	Recordings	Scoring	Agreement
	D2	9	7	2	28.6	10	9	90.0
	D2	10	7	2	28.6	12	9	75.0
	D1	11	NA a	. . .	. . .	5	5	100
	D1	12	NA a	. . .	. . .	5	5	100
	D2	13	5	3	60.0	10	5	50.0
	D2	14	10	2	20.0	9	3	33.3
	D2	15	6	2	33.3	8	8	100
	D2	16	6	2	33.3	11	10	90.9
	D1	24	NA a	. . .	. . .	7	6	8 5 . 7
	D1	25	NA a	. . .	. . .	7	2	2 8 . 5
	D1	26	NA a	. . .	. . .	6	6	100
	D1	27	NA a	. . .	. . .	5	4	8 0 . 0
	D1	31	NA a	. . .	. . .	3	2	6 6 . 7
	D1	32	NA a	. . .	-	3	3	100
	Total		41	13	31.7	101	77	76.2

Pediatric Physical TherapyScoring People With Spinal Muscular Atrophy on the Motor Function Measure 5

ACKNOWLEDGMENTS

The authors acknowledge Philip Robinson from DRS (Direction de la Recherche en Santé) of Hospices Civils de Lyon for his critical and English review.

This study was supported by a grant from FONDATION EOVI MCD, Paris, France (grant number: EO5-001). Coton and Adriana Gomes-Lisboade-Souza were students at Grenoble Alpes University,