Motor Imagery for Reach-to-grasp Rehabilitation After Tetraplegia

Single center, pilot study, to evaluate the influence of Motor Imagery (MI) on functional rehabilitation and cerebral plasticity through the qualitative and quantitative mental practice approach. For this, the investigators will use magnetoencephalography (MEG) but also physiological and behavioral indicators developed by the Laboratoire de la Performance Motrice, Mentale et du Matériel (P3M) of Université Claude Bernard Lyon 1 and its partners.

Study Overview

• Status: Completed
• Conditions: Tetraplegia C5-C6; Tetraplegia C6-C7
• Intervention / Treatment: Procedure: motor imagery

• Study Type: Interventional
• Enrollment (Actual): 16
• Phase: Not Applicable

Contacts and Locations

Study Locations

• France
  • Saint-Genis-Laval, France, 69230
    • Hôpital Henry Gabrielle - Médecine physique et Réadaptation, Hospices Civils de Lyon, 20 Route de Vourles,

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 55 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 18-55 years old,
• quadriplegia elicited by spinal cord injury (SCI) at the C5, C5-C6, C6, or C6-C7 level,
• complete infra-lesional motor deficit according to the ASIA impairment scale with finger and forearm flexor muscles paralysis,
• post-traumatic period >6 months (since a motor recovery plateau is usually reached at 6-month post-SCI

Exclusion Criteria:

• non-stabilized hypertension or pathological autonomic nervous system dysfunction (e.g., orthostatic hypotension),
• cerebral damage and/or cognitive deficit,
• elbow or shoulder joint amplitude restriction, upper limb para-osteoarthropathy,
• participation to another study
• presence of metallic objects within the body incompatible with MEG or functional magnetic resonance imaging (fMRI) recordings.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: C6-C7 patients; C6-C7 patients able to recover tenodesis grasp.	Procedure: motor imagery; Intervention consisted of supervised MI during which the participants were trained to imagine performing a single-joint wrist extension movement and a multiple-joint reach-to-grasp movement using tenodesis. The two movements were practiced in separate blocks and each 45 minute MI session consisted of six to eight blocks. Within a given block patients; i) performed the movement once, ii) imagined it using visual imagery (between five and ten repetitions), iii) performed the movement again, and iv) imagined it using kinesthetic imagery (between five and ten repetitions). All movements (performed and imagined) were timed by the experimenter to ensure that the durations of both imagined and physically practiced movements were similar. Imagery vividness was controlled with self-rated assessments using a visual analogic scale (from 0, the image or feeling was absent, to 10 when it was as clear or intense as physical practice).
Experimental: C5-C6 patients; C5-C6 patients for whom surgery for rehabilitation of an upper limb is indicated with a upper limit of one year after trauma, and after complete clinical and functional evaluation	Procedure: motor imagery; Intervention consisted of supervised MI during which the participants were trained to imagine performing a single-joint wrist extension movement and a multiple-joint reach-to-grasp movement using tenodesis. The two movements were practiced in separate blocks and each 45 minute MI session consisted of six to eight blocks. Within a given block patients; i) performed the movement once, ii) imagined it using visual imagery (between five and ten repetitions), iii) performed the movement again, and iv) imagined it using kinesthetic imagery (between five and ten repetitions). All movements (performed and imagined) were timed by the experimenter to ensure that the durations of both imagined and physically practiced movements were similar. Imagery vividness was controlled with self-rated assessments using a visual analogic scale (from 0, the image or feeling was absent, to 10 when it was as clear or intense as physical practice).
No Intervention: Control group; a control group (n=6) matched on age and sex to C6-C7 without medical history or neurological disorder

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Motor imagery ability	Motor imagery ability assessed by magnetoencephalography measurements	10 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Movement time (MT)	Kinematic parameters of movement: temporal parameters: movement time (MT)	10 weeks
absolute time to peak velocity	Kinematic parameters of movement: temporal parameters: absolute time to peak velocity	10 weeks
movement amplitude at peak velocity	Kinematic parameters of movement: temporal parameters: movement amplitude at peak velocity	10 weeks
time to opening	Kinematic parameters of movement: temporal parameters: time to opening	10 weeks
time to maximal opening	Kinematic parameters of movement: temporal parameters: time to maximal opening	10 weeks
amplitude of maximal opening	Kinematic parameters of movement: temporal parameters: amplitude of maximal opening	10 weeks
Trajectory of movement measured in the XY plane	Kinematic parameters of movement: spatial parameters: Trajectory of movement measured in the XY plane	10 weeks
height of elbow and wrist at the moment of grasping an object, measured in mm in the YZ plane	Kinematic parameters of movement: spatial parameters: height of elbow and wrist at the moment of grasping an object, measured in mm in the YZ plane	10 weeks
muscular force evaluated by muscle testing performed by a physiotherapist	muscular force evaluated by muscle testing performed by a physiotherapist (score from 0 to 5)	10 weeks
joint amplitude evaluated in degrees (°) by the physiotherapist		10 weeks
Box and Block test	Box and Block test performed by an occupational therapist	10 weeks
Minnesota test.	Minnesota test performed by an occupational therapist	10 weeks
amplitude of electrodermal responses	mental chronometric assessment associated with acquisition of electrodermal responses	10 weeks
duration of electrodermal responses	mental chronometric assessment associated with acquisition of electrodermal responses	10 weeks
Kinesthetic and Visual Imagery Questionnaire	The Kinesthetic and Visual Imagery Questionnaire (KVIQ) will allow a qualitative evaluation of the mental representation capacity of patients	10 weeks

Collaborators and Investigators

• Sponsor: Hospices Civils de Lyon
• Investigators: Principal Investigator: Gilles RODE, Pr, Hospices Civils de Lyon

Publications and helpful links

General Publications

• Mateo S, Reilly KT, Collet C, Rode G. Descriptive pilot study of vividness and temporal equivalence during motor imagery training after quadriplegia. Ann Phys Rehabil Med. 2018 Sep;61(5):300-308. doi: 10.1016/j.rehab.2018.06.003. Epub 2018 Jun 23.

Study record dates

Study Major Dates

• Study Start: February 1, 2013
• Primary Completion (Actual): March 1, 2013
• Study Completion (Actual): March 1, 2013

Study Registration Dates

• First Submitted: August 4, 2016
• First Submitted That Met QC Criteria: August 8, 2016
• First Posted (Estimate): August 9, 2016

Study Record Updates

• Last Update Posted (Actual): May 28, 2019
• Last Update Submitted That Met QC Criteria: May 23, 2019
• Last Verified: August 1, 2016

More Information

Terms related to this study

• Keywords: Magnetoencephalography; Motor imagery; Cervical spinal cord injury
• Additional Relevant MeSH Terms: Nervous System Diseases; Neurologic Manifestations; Paralysis; Quadriplegia
• Other Study ID Numbers: 2008-541