Motor task performance under vibratory feedback early poststroke: single center, randomized, cross-over, controlled clinical trial

Vítor Tedim Cruz, Virgílio Bento, Luís Ruano, David Dieteren Ribeiro, Luís Fontão, Cátia Mateus, Rui Barreto, Márcio Colunas, Ana Alves, Bárbara Cruz, Catarina Branco, Nelson P Rocha, Paula Coutinho, Vítor Tedim Cruz, Virgílio Bento, Luís Ruano, David Dieteren Ribeiro, Luís Fontão, Cátia Mateus, Rui Barreto, Márcio Colunas, Ana Alves, Bárbara Cruz, Catarina Branco, Nelson P Rocha, Paula Coutinho

Abstract

Stroke rehabilitation is far from meeting patient needs in terms of timing, intensity and quality. This study evaluates the efficacy and safety of an innovative technological tool, combining 3D motion analysis with targeted vibratory feedback, on upper-limb task performance early poststroke (<4 weeks). The study design was a two-sequence, two-period, randomized, crossover trial (NCT01967290) in 44 patients with upper-limb motor deficit (non-plegic) after medial cerebral artery ischemia. Participants were randomly assigned to receive either the experimental session (repetitive motor task under vibratory feedback and 3D motor characterization) or the active comparator (3D motor characterization only). The primary outcome was the number of correct movements per minute on a hand-to-mouth task measured independently. Vibratory feedback was able to modulate motor training, increasing the number of correct movements by an average of 7.2/min (95%CI [4.9;9.4]; P < 0.001) and reducing the probability of performing an error from 1:3 to 1:9. This strategy may improve the efficacy of training on motor re-learning processes after stroke, and its clinical relevance deserves further study in longer duration trials.

Conflict of interest statement

V.T.C., V.B., M.C. and D.D.R. have a shareholder position at EndeavourLab, a spin-Off company of the Aveiro University that develops and commercializes SWORD related products. L.R., L.F., C.M., R.B., A.A., B.C., C.B., N.P.R. and P.C. have no conflicts of interest to report.

Figures

Figure 1. Study flowchart and CONSORT diagram.
Figure 1. Study flowchart and CONSORT diagram.
Figure 2. Primary end point analysis in…
Figure 2. Primary end point analysis in the paretic and normal sides.
Figure 2A – Comparison of the 95% CI of the number of correct movements/min in the active comparator and vibratory feedback sessions. Figure 2B – Dot plot reporting paired data of the number of correct movements/min in the active comparator and vibratory feedback sessions. Difference between sessions is perceived by comparing the points to the diagonal “line of unity”. Figure 2C – Histogram of the absolute differences in the number of correct movements/min (Vibratory feedback – active comparator). The dashed vertical line indicates no change.
Figure 3. Representation of the task performed.
Figure 3. Representation of the task performed.
θ is the angle assessed to classify the movements as correct or incorrect. Original drawing performed by the authors V.T.C. and V.B.

References

    1. Rathore S. S., Hinn A. R., Cooper L. S., Tyroler H. A. & Rosamond W. D. Characterization of incident stroke signs and symptoms: findings from the atherosclerosis risk in communities study. Stroke 33, 2718–2721 (2002).
    1. Stinear C. Prediction of recovery of motor function after stroke. Lancet Neurol 9, 1228–1232 (2010).
    1. Langhorne P., Bernhardt J. & Kwakkel G. Stroke rehabilitation. Lancet 377, 1693–1702 (2011).
    1. Hankey G. J., Jamrozik K., Broadhurst R. J., Forbes S. & Anderson C. S. Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990. Stroke 33, 1034–1040 (2002).
    1. Douiri A., Rudd A. G. & Wolfe C. D. Prevalence of poststroke cognitive impairment: South London Stroke Register 1995–2010. Stroke 44, 138–145 (2013).
    1. Pinter M. M. & Brainin M. Rehabilitation after stroke in older people. Maturitas 71, 104–108 (2012).
    1. Cramer S. C. Repairing the human brain after stroke. II. Restorative therapies. Ann Neurol 63, 549–560 (2008).
    1. Cramer S. C. et al. Harnessing neuroplasticity for clinical applications. Brain 134, 1591–1609 (2011).
    1. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25, 457–507 (2008).
    1. Warlow C. P. et al. Stroke: Practical Management (Wiley, London, 2011).
    1. Bernhardt J., Indredavik B. & Langhorne P. When should rehabilitation begin after stroke? Int J Stroke 8, 5–7 (2013).
    1. Cramer S. C. Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Ann Neurol 63, 272–287 (2008).
    1. Walker M. F., Sunnerhagen K. S. & Fisher R. J. Evidence-based community stroke rehabilitation. Stroke 44, 293–297 (2013).
    1. World Health Organization. Neurological disorders: public health challenges, (World Health Organization, Geneva, 2006).
    1. Norrving B. & Kissela B. The global burden of stroke and need for a continuum of care. Neurology 80, S5–12 (2013).
    1. Dhamoon M. S. et al. Long-term functional recovery after first ischemic stroke: the Northern Manhattan Study. Stroke 40, 2805–2811 (2009).
    1. Wolfe C. D. et al. Estimates of outcomes up to ten years after stroke: analysis from the prospective South London Stroke Register. PLoS Med 8, e1001033 (2011).
    1. Chollet F. & Albucher J. F. Strategies to augment recovery after stroke. Curr Treat Options Neurol 14, 531–540 (2012).
    1. Abo M. et al. Randomized, multicenter, comparative study of NEURO versus CIMT in poststroke patients with upper limb hemiparesis: the NEURO-VERIFY Study. Int J Stroke Sep 9, 10.1111/ijs.12100 (2013).
    1. Saposnik G. et al. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke 41, 1477–1484 (2010).
    1. Subramanian S. K., Lourenco C. B., Chilingaryan G., Sveistrup H. & Levin M. F. Arm motor recovery using a virtual reality intervention in chronic stroke: randomized control trial. Neurorehab Neural Re 27, 13–23 (2013).
    1. Wolf S. L. et al. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA 296, 2095–2104 (2006).
    1. Dromerick A. W. et al. Very Early Constraint-Induced Movement during Stroke Rehabilitation (VECTORS): A single-center RCT. Neurology 73, 195–201 (2009).
    1. Bento V. F., Cruz V. T., Ribeiro D. D., Colunas M. M. & Cunha J. P. The SWORD tele-rehabilitation system. Stud Health Technol Inform 177, 76–81 (2012).
    1. Bento V. F., Cruz V. T., Ribeiro D. D. & Cunha J. P. The vibratory stimulus as a neurorehabilitation tool for stroke patients: proof of concept and tolerability test. NeuroRehabilitation 30, 287–293 (2012).
    1. Bento V. F., Cruz V. T., Ribeiro D. D., Branco C. & Coutinho P. The potential of motion quantification systems in the automatic evaluation of motor function after stroke. Int J Stroke 8, E37 (2013).
    1. Dobkin B. H. & Dorsch A. New evidence for therapies in stroke rehabilitation. Curr Atheroscler Rep 15, 331 (2013).
    1. Wolf S. L., Lecraw D. E., Barton L. A. & Jann B. B. Forced use of hemiplegic upper extremities to reverse the effect of learned nonuse among chronic stroke and head-injured patients. Exp Neurol 104, 125–132 (1989).
    1. Fugl-Meyer A. R., Jaasko L., Leyman I., Olsson S. & Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 7, 13–31 (1975).
    1. Krakauer J. W., Carmichael S. T., Corbett D. & Wittenberg G. F. Getting neurorehabilitation right: what can be learned from animal models? Neurorehab Neural Re 26, 923–931 (2012).
    1. Kitago T. & Krakauer J. W. Motor learning principles for neurorehabilitation. Handb Clin Neurol 110, 93–103 (2013).
    1. Buxbaum L. J., Shapiro A. D. & Coslett H. B. Critical brain regions for tool-related and imitative actions: a componential analysis. Brain Apr 27, 10.1093/brain/awu111 (2014).
    1. Billinger S. A., Coughenour E., Mackay-Lyons M. J. & Ivey F. M. Reduced cardiorespiratory fitness after stroke: biological consequences and exercise-induced adaptations. Stroke Res Treat 2012, 959120 (2012).
    1. Baert I. et al. Evolution of cardiorespiratory fitness after stroke: a 1-year follow-up study. Influence of prestroke patients' characteristics and stroke-related factors. Arch Phys Med Rehab 93, 669–676 (2012).
    1. Zeiler S. R. & Krakauer J. W. The interaction between training and plasticity in the poststroke brain. Curr Opin Neurol 26, 609–616 (2013).
    1. Shmuelof L. et al. Overcoming motor “forgetting” through reinforcement of learned actions. J Neurosci 32, 14617–14621 (2012).
    1. Kitago T. et al. Unlearning versus savings in visuomotor adaptation: comparing effects of washout, passage of time, and removal of errors on motor memory. Front Hum Neurosci 7, 307 (2013).
    1. Carmichael S. T. & Krakauer J. W. The promise of neuro-recovery after stroke: introduction. Stroke 44, S103 (2013).
    1. Hillier S. & Inglis-Jassiem G. Rehabilitation for community-dwelling people with stroke: home or centre based? A systematic review. Int J Stroke 5, 178–186 (2010).
    1. United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: interim results. UK-TIA Study Group. Br Med J (Clin Res Ed) 296, 316–320 (1988).
    1. Brott T. et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20, 864–870 (1989).
    1. Folstein M. F., Robins L. N. & Helzer J. E. The Mini-Mental State Examination. Arch Gen Psychiatry 40, 812 (1983).
    1. Adams H. P. Jr et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24, 35–41 (1993).
    1. Bamford J., Sandercock P., Dennis M., Burn J. & Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 337, 1521–1526 (1991).
    1. Bohannon R. W. & Smith M. B. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 67, 206–207 (1987).
    1. Mahoney F. I. & Barthel D. W. Functional Evaluation: The Barthel Index. Md State Med J 14, 61–65 (1965).
    1. Precision Microdrives Limited. “Product Data Sheet - Pico Vibe 9 mm Vibration Motor”, (ed. Canterbury Court, 1-3 Brixton Road, London, UK, 2011).
    1. Bento V. F., Cruz V. T., Ribeiro D. D. & Cunha J. P. Towards a movement quantification system capable of automatic evaluation of upper limb motor function after neurological injury. Conf Proc IEEE Eng Med Biol Soc 2011, 5456–5460 (2011).
    1. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2, 92–98 (1970).

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