- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01963832
RCT of a Neuroplasticity Agent and CI Therapy for Severe Arm Paresis After Stroke
January 9, 2015 updated by: University of Alabama at Birmingham
Stroke patients who have little or no voluntary movement in the hand on the more affected side of their body more than one year after stroke have few treatment options.
This project proposes to test the efficacy of a form of Constraint-Induced Movement therapy designed for patients with such severe impairment in conjunction with an agent, fluoxetine, which has been shown in some studies to enhance brain neuroplasticity in response to training.
Constraint-Induced Movement therapy, which is abbreviated CIMT, is a form of physical rehabilitation based on basic research in neuroscience and behavioral science.
If the project is successful, an efficacious, evidence-based therapy will become available to stroke patients for what is now a largely untreated condition
Study Overview
Status
Withdrawn
Intervention / Treatment
Study Type
Interventional
Phase
- Phase 2
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Alabama
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Birmingham, Alabama, United States, 35233
- University of Alabama at Birmingham
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
40 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Male
Description
Inclusion Criteria:
- Motor criteria determinations will be made with the subject sitting. The more-affected forearm will be resting on a supporting surface (e.g., arm of a chair) to allow for maximum wrist flexion with gravity.
The minimum motor criterion (MMC) for inclusion in Grade 5 (severe impairment) will be ability to:
- initiate extension against gravity at the wrist or at least one digit,
- initiate extension and flexion at the elbow,
- actively move the shoulder ≥ 30° in flexion, abduction, or scaption
The MMC for inclusion in Grade 4 (moderately severe impairment) will be ability to actively:
- extend at least two fingers more than 0° but less than < 10°,
- extend or abduct thumb ≥ 10°
- extend wrist ≥ 10° from a fully flexed starting position,
- extend elbow ≥ 20° from a 90° flexed starting position,
- flex and abduct shoulder > 45°.
- Stroke patients who can extend at least two fingers ≥ 10° at the metacarpophalangeal (MCP) joint and either the proximal or distal interphalangeal (PIP or DIP) joint will be excluded.
Additional inclusion criteria are:
- must score ≤ 4 on the Modified Ashworth Scale (23)116 for all more-affected arm joints
meet the following passive range of movement criteria:
- ≥ 90° shoulder flexion,
- ≥ 90° shoulder abduction,
- ≥ 45° shoulder external rotation,
- ≤ 30° short of normal elbow extension, forearm supination to at least neutral,
- forearm pronation 45° or more from neutral,
- ≤ 35° short of normal wrist extension,
- ≤ 35° short of normal MCP extension on all the digits.
Exclusion Criteria:
- Less than 1 year post-stroke.
- Frailty or insufficient stamina to carry out the requirements of the therapy (based on clinical judgment).
- Ferrous metal in body or medical complications or psychological problems that would prohibit receiving an MRI.
- Positive pregnancy test for women of child-bearing age since 3T MRI is contraindicated for pregnant women.
- Other neurological or musculoskeletal conditions affecting UE function.
- Medication will not be exclusionary except in the following cases: a. participation in any experimental drug study, b. Botox injections to the more-affected UE < 3 months prior to enrollment, c. Baclofen or Dantrium taken orally at the time of study, d. fluoxetine or other antidepressant with SSRI-like properties taken < 3 months prior to enrollment, e. any agents that would contraindicate concurrent fluoxetine. If subjects are on other medications, the medications will be recorded and the possible effect on treatment outcome will be analyzed separately.
- Moderate or greater depressive symptoms as indicated by a score > 30/63 on the Beck Depression Inventory (24,25).117, 118
- Concurrent participation in any formal physical rehabilitation program or clinical trial.
- Excessive pain in any joint of the more-affected arm that could limit ability to cooperate with the intervention (based on clinical judgment).
- Serious cognitive deficits manifested by a Folstein Mini-Mental State Examination (MMSE) score ≤ 24 (26).119
- Inadequate ability to follow test instructions as indicated by a Token Test of the Multilingual Aphasia Examination score ≤ 36 (27).120
- Serious, uncontrolled medical problems as judged by the Medical Director (e.g., severe rheumatoid arthritis, serious joint deformity of arthritic origin, symptomatic cancer or renal disease, any end-stage pulmonary or cardiovascular disease, senility or a deteriorated condition due to age, uncontrolled epilepsy).
- Motor problems that are not primarily unilateral.
- Poor motivation to participate in the study (if a person is only marginally interested, he/she is a bad risk as a subject).
- Less than 40 years old.
- Previous CIMT.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: eCMIT and Fluoxetine
expanded form of Constraint Induced Movement Therapy (eCIMT) combined with Fluoxetine (FLX)
|
|
Experimental: eCIMT and placebo
expanded form of Constraint Induced Movement Therapy (eCIMT) combined with placebo
|
|
Experimental: Usual care and fluoxetine
Ususal physical care combined with Fluoxetine (FLX)
|
|
Experimental: Usual care and placebo
Usual physical care combined with placebo
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Grade 4/5 Motor Activity Log (MAL) Arm Use Scale
Time Frame: baseline to 90 days
|
This is a structured interview.
Patients and family caregivers, if available, are asked to rate how well and how much the stroke survivor has used his or her more-affected arm on 30 upper-extremity tasks outside of the treatment setting over a specified period.
The test score is the mean of the item scores.
The primary outcome will be change on this instrument from pre- to post-treatment.
|
baseline to 90 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Grade 4/5 MAL Arm Use scale
Time Frame: baseline to 12 months after therapy
|
See primary outcome.
|
baseline to 12 months after therapy
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Grade 4/5 Wolf Motor Function Test Performance Rate score
Time Frame: baseline to 90 days
|
This is a laboratory motor performance test.
Patients are asked to complete the items are rapidly as possible.
Performance is timed and converted to a rate (repetitions/60 s).
The test score is the mean of the item scores.
|
baseline to 90 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
November 1, 2016
Primary Completion (Anticipated)
November 1, 2020
Study Completion (Anticipated)
November 1, 2021
Study Registration Dates
First Submitted
October 11, 2013
First Submitted That Met QC Criteria
October 15, 2013
First Posted (Estimate)
October 16, 2013
Study Record Updates
Last Update Posted (Estimate)
January 12, 2015
Last Update Submitted That Met QC Criteria
January 9, 2015
Last Verified
December 1, 2014
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Cardiovascular Diseases
- Vascular Diseases
- Cerebrovascular Disorders
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Neurologic Manifestations
- Stroke
- Paresis
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Enzyme Inhibitors
- Psychotropic Drugs
- Serotonin Uptake Inhibitors
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Serotonin Agents
- Antidepressive Agents
- Cytochrome P-450 Enzyme Inhibitors
- Antidepressive Agents, Second-Generation
- Cytochrome P-450 CYP2D6 Inhibitors
- Fluoxetine
Other Study ID Numbers
- F130410007
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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