Anti-Spastic Splint With Focal Muscle Vibration for Stroke Hand Spasticity

April 11, 2024 updated by: Amer Jaroshy, Arab American University (Palestine)

The Effectiveness of Anti-spastic Splint With Added Focal Muscle Vibration (FMV) in Decreasing Hand Spasticity and Improving Hand Functionality Among Individuals With Chronic Stroke: a Pilot Randomized Control Trial

Title: The Effect of Vibrating Splint on Hand Function After Stroke

Summary:

This study aims to investigate the effectiveness of a vibrating splint in improving hand function and reducing spasticity among individuals who have experienced a stroke. Stroke is a major global health issue, often resulting in long-term disability and impairments in the upper limbs. Spasticity, a common complication of stroke, causes stiffness and involuntary muscle contractions, leading to difficulties in performing daily activities.

Current treatment options for spasticity include medications and physical therapy techniques. However, these approaches may have limitations in terms of effectiveness and duration of benefits. Therefore, non-pharmacological interventions are being explored to enhance rehabilitation outcomes.

The hypothesis of this study is that the use of a vibrating splint, which applies mechanical vibrations to the hand muscles, will decrease spasticity and improve hand functionality in individuals with chronic stroke. The vibrations from the splint stimulate the sensory receptors in the skin and muscles, leading to muscle relaxation and improved motor control.

The study will be conducted as a pilot randomized controlled trial, involving participants who meet specific eligibility criteria. The participants will be divided into three arms, with each arm receiving a different intervention. Outcome measures, including assessments of spasticity, range of motion, pain levels, and functional abilities, will be collected before and after the intervention period.

The findings from this study will contribute to the understanding of non-pharmacological approaches in managing spasticity and improving hand function after stroke. If the vibrating splint proves to be effective, it could offer a safe and accessible option for stroke survivors to enhance their recovery and regain independence in daily activities.

This research is essential as it addresses the need for more effective interventions for spasticity management and hand rehabilitation after stroke. By providing valuable insights into the potential benefits of the vibrating splint, this study has the potential to improve the quality of life for individuals who have experienced a stroke and empower them to regain control over their hand movements.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

This pilot randomized controlled trial (RCT) aims to assess the clinical effectiveness and efficacy of adding focal muscle vibration (FMV) to anti-spastic splint therapy for individuals with spasticity following a stroke. The study involves multiple centers in the Jenin area of Palestine, utilizing outpatient rehabilitation centers to recruit participants who have chronic spasticity post-stroke.

Study Objectives and Questions:

Determine whether adding FMV to anti-spastic splint therapy provides additional benefit for individuals with spasticity after a stroke.

Compare the outcomes of anti-spastic splint therapy, FMV therapy, and a combination of both interventions in individuals with post-stroke spasticity.

Explore participant perceptions regarding the effectiveness, acceptability, and adherence to the interventions.

Study Design and Procedures:

The study is a pilot, multi-center RCT with a single evaluator (evaluator-blind) approach to avoid bias.

Forty-eight participants will be randomly assigned to one of three groups: Arm 1 (anti-spastic splint and FMV), Arm 2 (FMV only), or Arm 3 (anti-spastic splint only).

Interventions will be delivered by trained rehabilitation specialists, including occupational and physical therapists.

Standardized intervention protocols will guide the delivery of FMV and anti-spastic splint therapy for a period of four weeks.

Participant Recruitment:

Participants with chronic post-stroke spasticity are recruited from multiple rehabilitation centers and screened based on specific inclusion and exclusion criteria.

Convenience sampling is used to enroll participants from available populations in the participating centers.

Data Collection and Management:

Baseline and post-treatment evaluations include measurements of spasticity, hand functionality, range of motion, and pain level.

Qualitative interviews will explore participants' experiences with the interventions and their perceptions of the treatments' effectiveness.

Data will be securely stored and anonymized to protect participants' privacy.

Statistical Analysis Plan:

Linear Mixed-Effects Models (LMEM) will be used to assess treatment effects, adjusting for correlation over time within participants.

The safety analysis will involve documenting and summarizing adverse events (AEs) across treatment groups.

The study aims to provide preliminary data on treatment effects and inform the design of future larger RCTs.

Study Type

Interventional

Enrollment (Estimated)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Individuals affected by chronic (more than one year) spastic ischemic or hemorrhagic stroke
  • Aged above 18 years old
  • Medically stable (has no cardiovascular event in the last 12 months)
  • A score of 1-4 on modified Ashworth scale.

Exclusion Criteria:

  • Cardiovascular event in the past 12 months
  • Received anti-spastic injections drugs into the affected hand in the last 6 months
  • A score of less than 21 on Rowland Universal Dementia Assessment Scale (RUDAS)
  • Upper limb and trunk musculoskeletal injuries
  • A score of 0 on modified Ashworth scale.

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: Other
  • Allocation: Randomized
  • Interventional Model: Factorial Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Vibration plus anti-spastic hand splint Arm
In this clinical trial, vibration stimulation will be applied to the spastic hand antagonistic muscles using a specific device consisting of a volar anti-spastic hand splint and the arm vibrator. The volar anti-spastic hand splint will be custom-made for each participant at the prosthetic and orthotic clinic, following a standardized protocol. The arm vibrator, designed to fit the arm, will deliver the required vibration parameters. The intervention protocol involves a 30-minute vibration session administered three times weekly for four weeks, accompanied by daily utilization of the custom-made splint for 30 minutes each day.
Other: Vibration plus anti-spastic hand splint
vibration stimulation will be applied to the spastic hand antagonistic muscles using a volar anti-spastic hand splint and the Myovolt Arm vibrator.
Active Comparator: Anti-spastic hand splint Arm
In the anti-spastic hand splint arm , participants will be provided with an anti-spastic splint without vibration. Both vibration plus anti-spastic hand splint arm and anti-spastic hand splint arm will adhere to the same splint standard regime and recommendations, which outlines the specific positioning for the splint.
Other: Anti-spastic hand splint
the use of anti-spastic hand splint alone.
Active Comparator: Vibration Arm
In vibration arm , participants will be provided with arm vibrator held in place by appropriate padded harness. A Standardized study protocol will be used each time with no splint.
Other: Vibration
The use of hand vibrator alone

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fugl-Meyer Assessment of Upper Extremity (FMA-UE)
Time Frame: At day one, and the end of the intervention (after 4 weeks).
The FMA-UE looks at reflex activity, volitional movement within synergies, volitional movement mixing synergies, and volitional movement with little or no synergy. The outcome scale's 33 items are divided into four subscales: shoulder and elbow, wrist, hand, and coordination. On a three-point ordinal scale, each of these items is assessed. 2 points are granted if a movement is completely completed, 1 point is awarded if the movement is half completed, and 0 points are awarded if the movement cannot be completed.
At day one, and the end of the intervention (after 4 weeks).
Modified Ashworth Scale (MAS)
Time Frame: At day one, and the end of the intervention (after 4 weeks).

Spasticity level will be evaluated using the MAS scale. The MAS measures muscle resistance during passive stretching. The test will be applied for spastic joints of affected upper extremities. The score will be recorded as (0, 1, +1, 2, 3, 4), (0= normal tone, 4 = affected part rigid in flexion or extension). The reliability of the modified Ashworth scale is very good (kappa = .84 for interrater and .83 for intra-rater comparisons). Measurement repetition will be performed by the same assessor to avoid affecting reliability.

The test will be conducted in the assessment quiet room, with no distractions. The participants will be supine in a treatment bed, and therapist will assess the affected upper limb spasticity once and record the result in the assessment form. The assessor will be a qualified trained occupational therapist who has worked in a clinical role treating stroke patients with hand spasticity and familiar with MAS.
At day one, and the end of the intervention (after 4 weeks).
Range of Motion Assessment
Time Frame: At day one, and the end of the intervention (after 4 weeks).
The assessment of Range of Motion (ROM) for the affected upper limb in stroke patients will employ the use of a goniometer to precisely measure joint mobility across multiple planes of movement. This comprehensive evaluation entails examining the patient's ability to actively or passively articulate their affected elbow, wrist, and hand joints. The measurement of each movement will be made through the goniometer-based approach.
At day one, and the end of the intervention (after 4 weeks).
Numeric pain rating scale (NRS)
Time Frame: At day one, and the end of the intervention (after 4 weeks).
Numeric pain scale (NRS) is an essential tool for the assessment of pain intensity. It is widely used by healthcare providers. It consists of a horizontal line where the left end is labeled "no pain" or "0," indicating the absence of pain, while the right end is labeled as "worst pain imaginable" or "10". The participants are required to mark on the line the point that shows the pain level they are experiencing. The distance from the origin of the line, which is the left end, to the participant's symbol mark is the one that is used to present a numerical value. a representation which shows pain intensity, where the higher the value the more pain there is. The NRS is taken into account as a valid and reliable scale and is usually employed in to analyze pain intensity in clinical practice and to conduct research.
At day one, and the end of the intervention (after 4 weeks).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Arab American University (Palestine)

Investigators

  • Study Chair: Hisham Arab Alkabeya, PhD, Assistant Professor

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Estimated)

August 1, 2024

Primary Completion (Estimated)

November 30, 2024

Study Completion (Estimated)

December 30, 2024

Study Registration Dates

First Submitted

April 6, 2024

First Submitted That Met QC Criteria

April 6, 2024

First Posted (Actual)

April 11, 2024

Study Record Updates

Last Update Posted (Actual)

April 15, 2024

Last Update Submitted That Met QC Criteria

April 11, 2024

Last Verified

April 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Spasticity splint and FMV

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

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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