- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04381546
FES-induced Muscular Control of the Knee on Balance and Gait Retraining After a Stroke or a Cerebral Injury (GONIOSEF)
Projet GonioSEF: Etude de faisabilité d'un Dispositif d'amélioration du défaut de Report d'Appui Pendant la Marche en Phase Portante Chez Des Sujets présentant Une Atteinte du système Nerveux Central
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The process of gait recovery in patients with severe post-stroke hemiplegia requires a significant investment and effort for both the patient and the therapist and is not always leading to a safe and autonomous gait. Increasing the chances for the patients of regaining a functional walking gait within limited timeframes is a challenge. Several studies have focused their attention on the neurological foot in the chronic phase because a poorly controlled foot dorsiflexion is a factor limiting gait recovery and increasing fall risk. Functional Electrical Stimulation (FES) can be used as an alternative to an orthosis to restore walking by activating paralyzed muscles. FES has been extensively studied to correct drop foot by activating foot dorsiflexors or inducing a withdrawal reflex.
Few studies have considered knee joint which has a major role, especially for the quality of the support, and this over the entire cycle of walking. In the initial phase after stroke, ensuring a safe knee control remains difficult because of the associated disorders including the lack of proprioceptive feedback. Classical observed disorders in this population are knee hyperextension during the stance phase (genu recurvatum) and flexed knees (crouch gait). Fixed orthoses are usually used to prevent this by limiting knee flexion or extension over the gait. FES is also an alternative to produce appropriately timed knee flexion or extension. Bioness L300 Plus© device proposes a thigh cuff embedding electrodes stimulating the quadriceps muscles to extend knee at the appropriate time during gait based on shank angle observation. Previous studies have investigated the contribution of quadriceps and gluteus maximus stimulation in improving standing balance and weight transfer or hamstrings stimulation associated to foot dorsiflexors stimulation in improving gait performance.
One of the main objectives of an early rehabilitation is to encourage patients with hemiplegia to rely on their paretic leg and to transfer their weight onto it while walking. Depending on the gait phase, the knee extension and flexion are restricted to a safety range by the adaptive delivery of quadriceps and hamstring electrical stimulation. A sensor network detects gait phases and knee angle evolution from which stimulation levels are modulated.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Menucourt, France, 95180
- Centre de Rééducation et de Réadaptation Fonctionnelle La Châtaigneraie
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age > or = 18 years
- Cerebral injury or stroke
- Interval time since the onset of the neurological event: min 8 weeks (in case of an acute cerebral damage) or at a any time in case of a chronic affection
- Surface electrical stimulation of quadriceps and hamstrings possible
- Free range of motion in lower limbs
- Ankle-foot orthosis, dynamic or static
- Limited perimeter distance < 50 meters with or without walking technical aids
Exclusion Criteria:
- Knee-Ankle-Foot orthosis is required
- Body mass index > or = 30
- Thrombophlebitis
- Muscular pathology
- Unstable Cardio-Vascular pathology
- Lower limb prosthesis
- Unstable seizures
- Orthostatic hypotension
- Recent fracture in lower limbs (<12 months)
- Pacemaker
- Pregnancy
- Betablockers
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: FES in patients with hemiplegia
Patients will be equipped with 5 inertial measurement units.
Two wireless bluetooth pressure insoles will be connected to the Raspberry.
Electrical stimulation will be delivered via a wireless stimulator to the quadriceps and hamstrings via surface electrodes.
Insoles will be used to online analyze Paretic Foot Support to discriminate between stance and swing phases.
Stimulation will also be delivered just before initial contact at the end of swing phase.
In stance phase, stimulation will be triggered either to quadriceps or hamstrings, depending on the paretic knee angle estimation relatively to the knee angle setpoint defined by the practitioner as the optimal flexion during stance phase (around 5°).
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Functional electrical stimulation (FES) is delivered to the quadriceps and hamstrings of the paretic limb in patients with hemiplegia.
It is based on the real-time estimation of the knee angle and support phase during gait.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Assymetry of stance phase
Time Frame: 24 hours
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symmetry ratio of stance duration between paretic and non-paretic limbs
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24 hours
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Assymetry of weight support in stance phase
Time Frame: 24 hours
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percentage of weight supported during stance phase relatively to the total weight
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24 hours
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comfortable walking speed
Time Frame: 24 hours
|
The preferred walking speed at which the participant choose to walk and speed at which there is least energy consumption per unit distance
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24 hours
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Cadence
Time Frame: 24 hours
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The total number of full cycles on a 10m walking path
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24 hours
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Physiological Cost Index (PCI)
Time Frame: 24 hours
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Energy cost in walking.
PCI is the ratio of the difference in working and resting mean heart rates (bpm) and the self-selected (comfort) walking speed (m/min).
The PCI value reflects the energy expenditure for walking and is expressed as heartbeats per meter.
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24 hours
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Borg score of the exercise intensity
Time Frame: 24 hours
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Rating of perceived exertion while walking.
Perceived effort of walking using a Borg scale from 6 (no exertion) to 20 (maximum exertion) evaluated by the participant.
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24 hours
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Collaborators and Investigators
Investigators
- Principal Investigator: Charles Fattal, MD, PhD, Centre de Rééducation et de Réadaptation Fonctionnelle La Châtaigneraie
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
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
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2017-A03611-52
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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