Mental Practice in Post-stroke Subjects

Influence of Mental Practice on Manual Dexterity Associated Before and After Physical Practice in Patients With Stroke Sequelae

Among the limitations caused by cerebrovascular accident (CVA), the upper limb (MS) undergoes changes that limit the individual in his ability to maintain an active social life. Mental Practice (MP) consists of the internal reproduction of an event, which is repeated extensively in order to learn or improve an already known skill. The objective of the study is evaluate the effects of the physical practice associated with PM, on paretic MS. Subjects with unilateral stroke over 6 months, age> 18 years and who were able to hold objects will be selected. Subjects with painful conditions that affected exercise performance,> 3 spasticity by Ashworth, and cognitive deficit suggested by the Mini Mental State Examination will be excluded.

Study Overview

• Status: Unknown
• Conditions: Stroke; Stroke Sequelae
• Intervention / Treatment: Other: Physical practice; Other: Mental practice; Other: Videotherapy

Detailed Description

There are 3 study protocols. The MP protocol 1 comprise 4 steps: 1) 5 minutes of global relaxation; 2) Video therapy, being 2 minutes / task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles); 3) MP: think about the tasks assisted in the video for 5 minutes / task. 4) Physical Practice: reproduce through the motor execution, the activities assisted in the video (5 minutes / task). The MP protocol 2 was the same, changing the order: first physical practice and after MP. For the protocol 3 without PM, step 3 was suppressed, remaining the remaining steps. There were 15 sessions, 2x / week, for 1 hour. The Fugl-Meyer (FM) Scales, Ashworth Modified Scale (EMA), Functional Independence Measurement (MIF), Action Research Arm Test (ARAt), Box and block task (BBT) and Theory of mind battery (ToM) will be applied before and after the sessions, and in 3 months follow-up.

• Study Type: Interventional
• Enrollment (Anticipated): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • Rio Grande do Norte
    • Santa Cruz, Rio Grande do Norte, Brazil, 59200000
      • Faculty of Health Science - Facisa/UFRN

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Clinical diagnosis of stroke, ischemic or hemorrhagic, for more than 6 months, age above 18 years, unilateral involvement and are able to hold objects

Exclusion Criteria:

• Painful conditions that affect the ability to perform the proposed exercises, spasticity greater than 3 by the Ashworth Scale and cognitive deficits that will be evaluated by the Mini Mental State Examination (MMSE)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group 1; Post-stroke participants receive the mental practice before the physical practice. The activities will be presented in a videotherapy way.	Other: Physical practice; Physical Practice: reproduce through the motor execution (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles), the activities assisted in the video (5 minutes / task).; Other: Mental practice; Mental practice: think about the tasks watched in the videotherapy (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles) for 5 minutes / task.; Other: Videotherapy; Videotherapy, being 2 minutes per task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles)
Experimental: Group 2; Post-stroke participants receive the mental practice after the physical practice. The activities will be presented in a videotherapy way.	Other: Physical practice; Physical Practice: reproduce through the motor execution (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles), the activities assisted in the video (5 minutes / task).; Other: Mental practice; Mental practice: think about the tasks watched in the videotherapy (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles) for 5 minutes / task.; Other: Videotherapy; Videotherapy, being 2 minutes per task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles)
Active Comparator: Group 3; Post-stroke participants receive only physical practice. The activities will be presented in a videotherapy way.	Other: Physical practice; Physical Practice: reproduce through the motor execution (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles), the activities assisted in the video (5 minutes / task).; Other: Videotherapy; Videotherapy, being 2 minutes per task (4 distinct tasks: stacking cubes, opposition of fingers with precision gripping, passing water from one glass to another, sequencing of bottles)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fugl-Meyer Scale	Sensory-motor impairment of upper limb	Change from baseline sensory-motor impairmente at 8 weeks and 3 months (follow-up).
surface electromyography	Short radial extensor of the carpus and superficial flexor of the fingers	change from baseline muscle activity at 8 weeks and 3 months (follow-up)
Functional independence measure (FIM)	assess the dependence of others for activities of daily living	change from baseline functional independence at 8 weeks and 3 months (follow-up)
Action Research Arm Test (ARAT)	functional test of upper limb	change from baseline dexterity at 8 weeks and 3 months (follow-up)
Box and Block test (BBT)	manual dexterity	change from baseline dexterity at 8 weeks and 3 months (follow-up)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Movement Imagery Questionnaire-Revised second version (MIQ-RS)	evaluate the ability to imagine thick movements related to the upper and include movements referring to the ADLs.	change from baseline ability to imagine at 8 weeks
Kinesthetic and Visual Imagery Questionnaire (KVIQ - 10)	assessing visual and kinesthetic motor imagery	change from baseline capacity of imagination at 8 weeks
Mini-mental State Examination	evaluation of cognition	baseline
Theory of Mind Task Battery (ToM)	evaluation of mental function	change from mental function baseline at 8 weeks
Modified ashworth scale (MAS)	evaluation of muscle tone of upper limb	change fom baseline muscle tone at 8 weeks and 3 months (follow-up)

Collaborators and Investigators

• Sponsor: Universidade Federal do Rio Grande do Norte

Study record dates

Study Major Dates

• Study Start (Actual): April 20, 2017
• Primary Completion (Actual): June 10, 2017
• Study Completion (Anticipated): December 1, 2017

Study Registration Dates

• First Submitted: August 7, 2017
• First Submitted That Met QC Criteria: August 15, 2017
• First Posted (Actual): August 16, 2017

Study Record Updates

• Last Update Posted (Actual): August 16, 2017
• Last Update Submitted That Met QC Criteria: August 15, 2017
• Last Verified: August 1, 2017

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; Stroke
• Other Study ID Numbers: 1.978.586/2017

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No