- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03751306
Aerobic Exercise and Transcranial Low Laser Therapy in Patients With Central Nervous System Injury
Sensory-Motor and Cardiorespiratory Rehabilitation Associated With Transcranial Laser Therapy in Patients With Central Nervous System Injury
Study Overview
Status
Conditions
Detailed Description
Central nervous system (CNS) diseases can be acquired (such as stroke, spinal cord injury, and traumatic brain injury) or non-acquired (such as multiple sclerosis). Many diseases that affect the CNS can be fatal or cause sequelae, which affect the sensorimotor, cardiorespiratory and the quality of life of the individual. Subjects with neurological lesions present low resistance to exercise, a factor that can be attributed to decreased muscle recruitment, oxidative and metabolic capacity reduction, low aerobic resistance and increased energy expenditure. With that in mind, treatment proposals such as aerobic training and gait training with or without weight loss can maximize and restore the individual's functional abilities through active learning. Cardiorespiratory fitness in this patient profile has benefits in terms of fatigue retardation, gait improvement and regulation of the autonomic nervous system. Aerobic exercises change the heart rhythm, increase vascularity and provide oxygen. The association of these factors promote cerebral neuroprotective effect, stimulate the production of endogenous neutrotransmitters related to general well-being and favor neuroplasticity. Low-intensity laser therapy, especially transcranial photobiomodulation, has shown benefits in animals and humans such as cognitive and memory improvement, improvement in the behavioral picture, such as attenuation of depression and anxiety, and cortical oxygenation.
The study design is a randomized, double-blind, placebo-controlled trial that will compare the effect of cardiorespiratory rehabilitation, cardiorespiratory rehabilitation and low-intensity laser therapy, cardiorespiratory rehabilitation and placebo laser. It is worth mentioning that the use of a Placebo Therapy is restricted to Low Power Laser irradiation. This means that the three experimental groups will effectively be treated with cardiorespiratory rehabilitation, a therapy that improves physical fitness. The treatment with transcranial photobiomodulation irradiation aims to verify the effects and aggregates greater beneficial to the volunteers. In this case, the magnitude of the laser effect must be calculated by the difference (if any) of the group treated with "cardiorespiratory rehabilitation + laser" subtracted from the group treated with "cardiorespiratory rehabilitation + laser Placebo".
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Ana Paula Pinto
- Phone Number: 55 12 981585974
- Email: apaula@outlook.com.br
Study Contact Backup
- Name: Carolina Lobo Guimarães
- Phone Number: 55 12 981585974
- Email: caroll.guimaraes@yahoo.com.br
Study Locations
-
-
São Paulo
-
São José Dos Campos, São Paulo, Brazil, 12244-000
- Universidade do Vale do Paraíba
-
Contact:
- Ana Paula Pinto
- Phone Number: 55 12 981585974
- Email: apaula@outlook.com.br
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Persons with stroke, traumatic brain injury, spinal cord trauma, post-operative brain tumor, chronic non-progressive encephalopathy and multiple sclerosis;
- Chronic neurological diseases, from 6 months of injury;
- Caucasian individuals;
- Age between 18 and 85 years;
- Both sexes;
- Individuals with the cognitive preserved;
- Persons who are able to wander on the treadmill voluntarily or through assistance from the Rehabilitation and Physical Activity Station BrainMov®;
- Persons who make continuous and regular use of medications prescribed by the physician for the control and / or treatment of chronic diseases;
- People with the release of the cardiologist for rehabilitation.
Exclusion Criteria:
- People who do not meet the inclusion criteria;
- Active smokers;
- Carriers of chronic respiratory diseases, such as COPD, asthma and bronchiectasis;
- Patients with decompensated heart disease;
- Obesity grade II - body mass index greater than 34.99 kg / m2;
- Patients with spinal cord injury above T6, who present autonomic dysreflexia;
- Patients with ASA A or B spinal cord injury;
- Patients with multiple sclerosis who are in an outbreak period;
- Patients taking betablockers;
- Hemorrhagic stroke.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Control-Cardiorespiratory Rehabilitation
These individuals will compose the control group for transcranial laser therapy, which will only receive cardiorespiratory rehabilitation.
|
Cardiorespiratory Rehabilitation: Aerobic training on the treadmill will be reliated for 30 minutes using the support of the Rehabilitation and Physical Activity Station BrainMov® (equipment with 4 pillars condition that favors the suspension and stabilization of people with neuromuscular dysfunctions of mild to severe impairment. For monitoring, the training heart rate equation - Karvonen equation, effort perception scale - BORG, systemic arterial pressure, peripheral oxygen saturation, and patient signs and symptoms will be used. Subsequently, respiratory exercises and muscle strengthening of lower limbs, final relaxation and general guidelines will be performed for research volunteer and his / her relatives. |
Placebo Comparator: Transcranial Photobiomodulation Placebo
In this group, the application of laser irradiation will be simulated, and the laser will be turned off.
And the simulation of irradiation, the individuals will initiate cardiorespiratory rehabilitation.
|
Cardiorespiratory Rehabilitation: Aerobic training on the treadmill will be reliated for 30 minutes using the support of the Rehabilitation and Physical Activity Station BrainMov® (equipment with 4 pillars condition that favors the suspension and stabilization of people with neuromuscular dysfunctions of mild to severe impairment. For monitoring, the training heart rate equation - Karvonen equation, effort perception scale - BORG, systemic arterial pressure, peripheral oxygen saturation, and patient signs and symptoms will be used. Subsequently, respiratory exercises and muscle strengthening of lower limbs, final relaxation and general guidelines will be performed for research volunteer and his / her relatives. Photobiomodulation Placebo Therapy: The same apparatus of the transcranial group photobiomodulation and the same irradiation points will be used. However, during the procedure, with the laser off. |
Experimental: Transcranial Photobiomodulation
In this group, low-intensity irradiation will be applied and after irradiation, the volunteers will begin cardiorespiratory rehabilitation.
|
Cardiorespiratory Rehabilitation: Aerobic training on the treadmill will be reliated for 30 minutes using the support of the Rehabilitation and Physical Activity Station BrainMov® (equipment with 4 pillars condition that favors the suspension and stabilization of people with neuromuscular dysfunctions of mild to severe impairment. For monitoring, the training heart rate equation - Karvonen equation, effort perception scale - BORG, systemic arterial pressure, peripheral oxygen saturation, and patient signs and symptoms will be used. Subsequently, respiratory exercises and muscle strengthening of lower limbs, final relaxation and general guidelines will be performed for research volunteer and his / her relatives. Photobiomodulation Rehabilitation: Diode laser, λ infrared = 810 nm, 0.028 cm2 beam area, 100 mW power, 3.5 W / cm2 power density, 3 Joules / dot and Energy Density of 107.1 J / cm2). Each point will be radiated for 30 seconds. The regions of irradiation will be in the middle cerebral arteries (points F7 and F8 will be used as reference point according to the International System 10-20 of the electroencephalogram) and anterior cerebral artery (AFz point according to the International System 10-20 of the electroencephalogram) . |
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Muscular electrical activity (Surface electromyograph).
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
The surface electrodes will be positioned in the rectus femoris and femoral biceps muscles.
The evaluation of the muscles will be realized during the squat movement.
10 seconds of signal collection (in triplicate).
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of bipodal balance during the squat movement.
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
The balance evaluation will be performed during the squat movement on the power platform (Stabilometric analysis in Kgf). 10 seconds of signal collection (in triplicate).
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of the heart rate variability to study the responses of the autonomic nervous system
Time Frame: Baseline (First day of rehabilitation) and after 9 weeks (Last day of rehabilitation).
|
Heart rate variability will be assessed during aerobic training on the treadmill for 40 minutes (5 minutes of initial rest, 30 minutes of exercise and 5 minutes of final rest).
|
Baseline (First day of rehabilitation) and after 9 weeks (Last day of rehabilitation).
|
Change in Pulmonary function analysis (spirometry): forced vital capacity
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
Using the spirometry technique, forced vital capacity (measured in liters) will be evaluated.
The volunteer will be asked to perform the maximum inspiration and exhale with maximum effort.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in Pulmonary function analysis (spirometry): forced expiratory volume in the first second
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
Using the spirometry technique, forced expiratory volume in the first second (measured in liters) will be evaluated.
The volume of exhaled air in the first second in the forced vital capacity maneuver will be evaluated.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in Pulmonary function analysis (spirometry): Tiffeneau Index
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
Using the spirometry technique, Tiffeneau Index will be evaluated.
The Tiffeneau index is the result of the division of forced expiratory volume in the first second in relation to forced vital capacity.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in Pulmonary function analysis (spirometry): maximum voluntary ventilation
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
Using the spirometry technique, maximum voluntary ventilation will be evaluated.
Maximum voluntary ventilation is the largest volume of air that the individual can mobilize in one minute with maximum voluntary effort.
The test gives an overview of the ventilatory function (measured in L / min).
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of inspiratory muscle strength
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
The inspiratory muscle strength will be evaluated by means of the manovacuometer.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Analysis of expiratory muscle strength
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
The expiratory muscle strength will be evaluated by means of the manovacuometer
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of Peak expiratory flow.
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
To analyze the velocity of the air out of the lungs.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of the thoracic expandability (axillary level).
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
In order to analyze the chest expansion at the axillary level, a metric tape placed at the torarico-axillary level will be used, which will measure the inspiratory and expiration mobility values, and will be subtracted (Insp-Exp).
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of the thoracic expandability (xiphoid level).
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
In order to analyze the chest expansion at the xiphoid level, a metric tape will be used, placed at the thoracic-xiphoid level, which will measure the inspiratory and expiration mobility values and then be subtracted (Insp-Exp).
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of abdominal level expandability.
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
In order to analyze abdominal expansibility, a tape measure will be used, placed at the level of the umbilical scar, which will measure the inspiratory and expiration mobility values and will be subtracted (Insp-Exp).
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in analysis of change in Infrared Thermography.
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
By means of an infrared thermographic camera, the blood circulation of the lower limbs will be evaluated by the temperature difference.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in aariation of blood lactate level.
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
The blood lactate level will be measured by a lactometer, which will be collected from the volunteer's blood sample before starting the aerobic training on the treadmill and after training.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in 6-Minute Walk Test (Adapted)
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
The 6-minute-walk test will be adapted for neurological patients, which will be evaluated for exercise tolerance using a treadmill (Moviment RT200®).
Volunteers will be assisted by the BrainMov® Rehabilitation and Physical Activity Station to stabilize the trunk and thus remain upright to wander on the treadmill
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in Mini-Mental State Examination (MINI MENTAL).
Time Frame: Baseline (before starting rehabilitation) and after 9 weeks.
|
To evaluate the cognitive functions, the MINI MENTAL test will be applied.
|
Baseline (before starting rehabilitation) and after 9 weeks.
|
Change in Short Form 36 questionnaire (SF-36)
Time Frame: Baseline (before starting rehabilitation) and after 9 week.
|
To evaluate the domains of quality of life: Functional Capacity, physical aspect, pain, general health, vitality, social aspect, emotional spectrum and mental health
|
Baseline (before starting rehabilitation) and after 9 week.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Follow-up: Evaluation Muscular electrical activity (Surface electromyograph)
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Evaluation of muscular electrical activity after 9 weeks of the end of rehabilitation.
The surface electrodes will be positioned in the rectus femoris and femoral biceps muscles.
The evaluation of the muscles will be realized during the squat movement.
10 seconds of signal collection (in triplicate).
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of bipodal balance during the squat movement
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
The balance evaluation will be performed during the squat movement on the power platform.
10 seconds of signal collection (in triplicate).
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of the heart rate variability to study the responses of the autonomic nervous system
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
The heart rate variability will be evaluated during aerobic training on the treadmill using a frequency for 5 minutes of initial rest, 30 minutes of exercise and 5 minutes of final rest.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Pulmonary function analysis (spirometry): forced vital capacity
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Using the spirometry technique, forced vital capacity (measured in liters) will be evaluated.
The patient will be asked to perform the maximum inspiration and exhale with maximum effort.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Pulmonary function analysis (spirometry): forced expiratory volume in the first second
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Using the spirometry technique, forced expiratory volume in the first second (measured in liters) will be evaluated.
The volume of exhaled air in the first second in the forced vital capacity maneuver will be evaluated.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Pulmonary function analysis (spirometry):Tiffeneau Index
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Using the spirometry technique, Tiffeneau Index will be evaluated.
The Tiffeneau index is the result of the division of forced expiratory volume in the first second in relation to forced vital capacity.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Pulmonary function analysis (spirometry): maximum voluntary ventilation
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Using the spirometry technique, maximum voluntary ventilation will be evaluated.
Maximum voluntary ventilation is the largest volume of air that the individual can mobilize in one minute with maximum voluntary effort.
The test gives an overview of the ventilatory function (measured in L / min).
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of inspiratory muscle strength
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
The inspiratory muscle strength will be evaluated by means of the manovacuometer.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of expiratory muscle strength
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
The expiratory muscle strength will be evaluated by means of the manovacuometer.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of Peak expiratory flow.
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
To analyze the velocity of the air out of the lungs.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of the thoracic expandability (axillary level).
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
In order to analyze the chest expansion at the axillary level, a metric tape placed at the torarico-axillary level will be used, which will measure the inspiratory and expiration mobility values, and will be subtracted (Insp-Exp).
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of the thoracic expandability (xiphoid level).
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
In order to analyze the chest expansion at the xiphoid level, a metric tape will be used, placed at the thoracic-xiphoid level, which will measure the inspiratory and expiration mobility values and then be subtracted (Insp-Exp).
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of abdominal level expandability.
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
In order to analyze abdominal expansibility, a tape measure will be used, placed at the level of the umbilical scar, which will measure the inspiratory and expiration mobility values and will be subtracted (Insp-Exp).
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis of change in Infrared Thermography.
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
By means of an infrared thermographic camera, the blood circulation of the lower limbs will be evaluated by the temperature difference.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Variation of blood lactate level.
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
The blood lactate level will be measured by a lactometer, which will be collected from the volunteer's blood sample before starting the aerobic training on the treadmill and after training.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Analysis 6-Minute Walk Test (Adapted)
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
The 6-minute-walk test will be adapted for neurological patients, which will be evaluated for exercise tolerance using a treadmill (Moviment RT200®).
Volunteers will be assisted by the BrainMov® Rehabilitation and Physical Activity Station to stabilize the trunk and thus remain upright to wander on the treadmill.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Evaluation Mini-Mental State Examination (MINI MENTAL).
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
To evaluate the cognitive functions, the MINI MENTAL test will be applied.
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Follow-up: Evaluation Short Form 36 questionnaire (SF-36)
Time Frame: The follow-up revaluation will be 2 months after the end of rehabilitation.
|
To evaluate the domains of quality of life: Functional Capacity, physical aspect, pain, general health, vitality, social aspect, emotional spectrum and mental health
|
The follow-up revaluation will be 2 months after the end of rehabilitation.
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Mário Oliveira Lima, Doctor, Universidade do Vale do Paraíba - Univap
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Anticipated)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Immune System Diseases
- Demyelinating Autoimmune Diseases, CNS
- Autoimmune Diseases of the Nervous System
- Demyelinating Diseases
- Autoimmune Diseases
- Pain
- Neurologic Manifestations
- Brain Damage, Chronic
- Musculoskeletal Diseases
- Muscular Diseases
- Neuromuscular Manifestations
- Headache Disorders
- Muscle Hypertonia
- Back Injuries
- Headache Disorders, Secondary
- Multiple Sclerosis
- Cerebral Palsy
- Wounds and Injuries
- Headache
- Muscle Spasticity
- Trauma, Nervous System
- Spinal Injuries
- Post-Traumatic Headache
Other Study ID Numbers
- 94858718.3.0000.5503
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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