Combined Cognitive and Gait Training (CogGait)
18 septembre 2018 mis à jour par: VA Office of Research and Development
Recent research in gait training for stroke survivors showed that coordinated gait components can be best restored using the following interventions together: coordination exercises, over ground gait training, and body weight supported treadmill training (BWSTT).
These results are important because, to the investigators' knowledge, there have been no other reports of the restoration of coordinated gait components for those with persistent gait deficits (> 6 months after stroke).
However, a remaining problem was that the restored coordinated gait movements measured in the laboratory did not generalize for many subjects to the everyday environment.
The confluence of several factors can cause lack of generalization.
First, dual task performance (gait and cognitive attention task) can degrade both gait and attention ability, even in healthy adults.
Second, stroke can impair attention.
Third, during walking in the everyday environment, attention is required in order to safely process normally occurring stimuli.
Therefore, given the success of the new gait training protocol in the lab setting, it is important to address the problems remaining for generalization of the recovered coordinated gait pattern to the everyday environment.
The primary hypothesis of this study is that greater gains in gait speed will be produced by combined motor and cognitive training versus motor training alone.
Aperçu de l'étude
Statut
Résilié
Les conditions
Intervention / Traitement
Description détaillée
Aim 1, Hypothesis Ia: Comparison of combined motor and cognitive training vs motor training alone. For Aim 1, Hypothesis Ia, this will be a randomized, controlled study. For the two groups, 38 subjects will be enrolled and randomized to either: A) Motor + Cognitive Training; or B) Motor Training alone. Subjects will first be stratified according to coordination and gait deficit severity, as described below. After stratification, the subject will be randomized to one of the two intervention groups for Hypothesis Ia. All the subjects will receive treatment 5 times/week, 3hrs/session, for 12 weeks or for a total of 60 treatment sessions. Group A will receive combined motor and cognitive training; Table 2 (below) shows the graduated approach to providing combined gait and cognitive training. Data collection will be at weeks 1, 6, 12, and 24 (i.e., before, mid-treatment and after treatment, and then 3 months after the end of the treatment protocol. Comparison will be made between the two groups to determine whether there was any additive effectiveness of the cognitive training.
Aim 2, Hypotheses IIa-d: Pre/post-treatment comparisons within Group A, receiving combined motor and cognitive training. For Aim 2, Hypotheses IIa-d, this will be a single cohort pre/post-treatment comparison within Group A receiving combined motor and cognitive training.
Aim 3, Hypotheses IIIa-d: Pre/post-treatment comparisons within Group B, receiving motor training alone. For Aim 3, Hypotheses IIIa-d, this will be a single cohort pre/post-treatment comparison within Group B, receiving motor training alone.
Type d'étude
Interventionnel
Inscription (Réel)
12
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
-
-
Florida
-
Gainesville, Florida, États-Unis, 32608
- North Florida/South Georgia Veterans Health System, Gainesville, FL
-
-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
21 ans et plus (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
La description
Inclusion Criteria:
Stroke Survivor inclusion/exclusion criteria Inclusion Criteria
- Cognition sufficiently intact to give valid informed consent to participate. *
- Sufficient endurance to participate in rehabilitation sessions.
- Ability to follow 2 stage commands.
- Medically Stable
- Age > 21 years.
- Impaired ambulation as follows: inability to flex the knee and ankle in the sagittal plane, in a normal manner so the foot clears the floor; inability to control normal knee angle during single limb weight bearing during stance phase.
- At least 6 months post stroke.
Able-bodied Inclusion criteria
- Criteria to be included is that they should be healthy with no history of a neurological disease or orthopedic impairment.**
- Not Pregnant.
- No Claustrophobia (only for the sub-sample asked to undergo fMRI.)
- No counterindications to MR scanning including, pregnancy, weight inappropriate for height, ferrous objects within the body (only for the sub-sample asked to undergo fMRI.)
Exclusion Criteria:
Exclusion Criteria
- Acute or progressive cardiac, vascular, renal, respiratory, neurological disorders or malignancy.
- Active psychiatric diagnosis or psychological condition, or active drug/alcohol abuse.
- Lower motor neuron damage or radiculopathy.
- Orthopedic impairment. **
- More than one stroke.
- Cerebellar dysfunction.
- Fugl-Meyer lower limb motor sub-score greater than 32.
- No simultaneous gait rehabilitation participation.
- Pregnant.
- Claustrophobia (only for the sub-sample asked to undergo fMRI.)
- Criteria specific to MR scanning, including pregnancy, weight inappropriate for height, ferrous objects within the body (only for the sub-sample asked to undergo fMRI.)
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
|
Comparateur actif: Gait plus cognitive training
Rehabilitation of walking/gait, combined with rehabilitation of cognitive function
|
Treatment will include coordination exercises and over ground gait training for impaired muscle groups and related gait deficits.
The therapy will be provided by a clinical physical therapist specializing in rehabilitation for stroke patients, according to established, conventional guidelines.
The protocol was used in the investigators' prior studies, and is designed to restore voluntary control of ankle dorsiflexion during swing phase; hip flexion during swing phase, knee flexion at toe-off, knee flexion during swing phase; knee extension before heel strike; knee control during stance phase; pelvic control during stance phase; and whole body balance control during weight shifting.
Newly-learned coordinated movements will be integrated into practice of coordinated gait components.
Cognitive rehabilitation will begin with the least difficult aspects of attention control, and progress to the more difficult.
Home practice and generalization exercises will be assigned.
Cognitive training is designed to enhance attention, intention, executive function, decision making and reaction time.
Commercially available computer software will be used, as well as custom cognitive training.
|
|
Comparateur actif: Gait plus arm training
Rehabilitation of walking/gait, combined with rehabilitation of arm function
|
Treatment will include coordination exercises and over ground gait training for impaired muscle groups and related gait deficits.
The therapy will be provided by a clinical physical therapist specializing in rehabilitation for stroke patients, according to established, conventional guidelines.
The protocol was used in the investigators' prior studies, and is designed to restore voluntary control of ankle dorsiflexion during swing phase; hip flexion during swing phase, knee flexion at toe-off, knee flexion during swing phase; knee extension before heel strike; knee control during stance phase; pelvic control during stance phase; and whole body balance control during weight shifting.
Newly-learned coordinated movements will be integrated into practice of coordinated gait components.
Cognitive rehabilitation will begin with the least difficult aspects of attention control, and progress to the more difficult.
Home practice and generalization exercises will be assigned.
Treatment will include coordination exercises for reaching and grasping.
Activities will include movement of shoulder, elbow, wrist and fingers.
|
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change in the Gait Assessment and Intervention (G.A.I.T.) Score
Délai: pre-training (0 weeks), post training (about 12 weeks)
|
Coordination of walking, scored using the investigators' novel G.A.I.T. measure.
This measure evaluated limb and joint movements while participants walk overground at preferred speed.
Range of scale: 0 (normal) to 64 (extremely discoordinated gait).
|
pre-training (0 weeks), post training (about 12 weeks)
|
Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Les enquêteurs
- Chercheur principal: Janis J. Daly, PhD MS, North Florida/South Georgia Veterans Health System, Gainesville, FL
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 décembre 2013
Achèvement primaire (Réel)
1 juin 2016
Achèvement de l'étude (Réel)
1 juin 2016
Dates d'inscription aux études
Première soumission
29 janvier 2015
Première soumission répondant aux critères de contrôle qualité
11 février 2015
Première publication (Estimation)
12 février 2015
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
11 février 2019
Dernière mise à jour soumise répondant aux critères de contrôle qualité
18 septembre 2018
Dernière vérification
1 septembre 2018
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- D7675-R
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Indécis
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .