ExoDoF: esoscheletro robotico per la riabilitazione motoria dell'arto superiore dopo un ictus
Two decades ago, the projection of recovery of the upper extremity (UE) after a stroke had a very poor prognosis worldwide. Nowadays, thanks to medical advances and early rehabilitation, the prognosis for recovery has improved; however, there is still a limit that no therapy has been able to overcome, related to spontaneous recovery as part of the natural evolution of the pathophysiological process, rather than with the contribution of rehabilitation. Additionally, existing therapies show partial effectiveness on the recovery of UE function, but do not avoid the use of compensatory strategies or alternatives to normal movement. Given this situation, there is an active search for new therapeutic approaches. In this clinical trial the investigators propose a rehabilitation paradigm that promotes the recovery of control of specific planes of movement through the selective restriction of degrees of freedom, simplifying control demands. The investigators sought to test the hypothesis that people with stroke in the early subacute stage and who present alterations in the movement of the upper extremity, a rehabilitation protocol that reduces the degrees of freedom of the UE and trunk, enables greater recovery of the movement of the UE and less use of compensatory movements compared to a protocol without DoF control. The general objective is to demonstrate the effect of training with restriction of the degrees of freedom of UE and trunk, mediated by an exoskeleton and videogames, on the control of the UE.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Tipo di studio
Iscrizione (Stimato)
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
- Nome: Pablo Burgos, PhD
- Numero di telefono: 19713314101
- Email: pburgos@uchile.cl
Backup dei contatti dello studio
- Nome: Juan José Mariman, PhD
- Numero di telefono: +56981928168
- Email: juan.mariman@umce.cl
Luoghi di studio
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Santiago, Chile
- Reclutamento
- Hospital El Carmen
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Contatto:
- Daniel Bustos, PT
- Numero di telefono: +56 9 7754 9193
- Email: daniel.bustos.c@usach.cl
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Santiago, Chile
- Reclutamento
- Hospital Clínico Universidad de Chile
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Contatto:
- Hachi Manzur, Ph.D
- Numero di telefono: +56 9 8192 8168
- Email: hemanzur@gmail.com
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Santiago, Chile
- Reclutamento
- Hospital San José
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Contatto:
- Natalia Gonzalez, PT
- Numero di telefono: +56 9 8154 8009
- Email: nataliagonzaleznunes@gmail.com
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Temuco, Chile
- Reclutamento
- Hospital Dr. Hernán Henríquez Aravena
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Contatto:
- Pablo Hernández, PT
- Numero di telefono: +56 9 7853 9892
- Email: klgo.pablohernandez@gmail.com
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
Accetta volontari sani
Sessi ammissibili allo studio
Descrizione
Inclusion Criteria:
- Diagnosis of ischemic or hemorrhagic stroke with zero to twelve weeks of evolution.
- Subjects with alterations in active voluntary movement of ES with Fugl Meyer less than or equal to 50 points. Strength of shoulder abduction and finger extension from palpable contraction (1 in Medical Research Council (MRC) scale for muscle strength).
Exclusion Criteria:
- Cognitive impairment that prevents signing the informed consent, following the instructions and understanding the procedures. (MOCA < 18).
- Inability to perform activities sitting for more than 90 minutes or inability to perform activities without severe pain (VAS > 6) or having limited reach ranges.
- Have severe visual impairment that does not allow to carry out the activities associated with the task.
- Previous stroke with neurological sequelae in the upper extremity.
- Present bilateral sensorimotor alterations.
- Damage to the cerebellum/peduncles described in the radiological report or classic signs of cerebellar damage (Upper extremity SARA items of 2 or more)
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Trattamento
- Assegnazione: Randomizzato
- Modello interventistico: Assegnazione parallela
- Mascheramento: Doppio
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
|---|---|
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Sperimentale: DoF Group
The experimental group with control of the degrees of freedom will receive treatment for 4 weeks using an exoskeleton and also it will be supervised by a physiotherapist.The exoskeleton will restrict the movement of the trunk and upper extremity to leave only the joint free to work in the plane of interest. The training will be selective in an articular plane with biofeedback of movement through videogames and external movement sensors installed in the upper extremity. This movement sensor will allow to interact with the videogames through the movement of the trained movement. |
Training of specific uniarticular and single plane movement of the upper limb through an exoskeleton and videogames that will be supervised by a physiotherapist. |
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Comparatore attivo: Task Group
The group without control of the degrees of freedom (Task Group) will receive a therapeutic intervention equivalent in dose, but without any restriction of joint movement (without the exoskeleton). Each session will be divided into two parts. In the first part, participants will train with combined planes and in a multi-joint manner with the same video games as DoF Group but with the movement sensor in your hand performing 4 direction movements with the upper limb (horizontal, vertical and diagonals). In the second training part, patients will perform functional tasks: raise and lower your hand on the table, cleaning a table, put cream on the non-paretic arm, hold a bottle, put a piece of bread or something similar in your mouth, wash your face, brush your hair, store items in a basket, brush teeth, wrote and serve water in glass. |
Training of multiarticular upper limb movements (vertical, horizontal and diagonal) through videogames and also training of functional task (raise and lower your hand on the table, cleaning a table, put cream on the non-paretic arm, hold a bottle, put a piece of bread or something similar in your mouth, wash your face, brush your hair, store items in a basket, brush teeth, wrote and serve water in glass). This activities will be supervised by a physiotherapist. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Change in UE-FMA at the end of the training
Lasso di tempo: 3 days post training
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Differences between the Upper Extremity Fugl-Meyer Assessment (UE-FMA) at the beginning of the recruitment and at the end of the training |
3 days post training
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Change in UE-FMA at 6 months post stroke
Lasso di tempo: 180 days post stroke
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Differences between the Upper Extremity Fugl-Meyer Assessment (UE-FMA) at the beginning of the recruitment and at 6 months post stroke |
180 days post stroke
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Change in ARAT at the end of the training
Lasso di tempo: 3 days post training
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Differences between the Action Research Arm Test (ARAT) at the beginning of the recruitment and at the end of the training |
3 days post training
|
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Change in ARAT at 6 months post stroke
Lasso di tempo: 180 days post stroke
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Differences between the Action Research Arm Test (ARAT) at the beginning of the recruitment and at 6 months post stroke |
180 days post stroke
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Change in iCoh at the end of the training
Lasso di tempo: 3 days post training
|
Differences between EEG Ipsi-Contralateral Motor Cortex connectivity (iCoh) at the beginning of the training and at the end of the training |
3 days post training
|
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Change in iCoh connectivity at 6 months post stroke
Lasso di tempo: 180 days post stroke
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Differences between EEG Ipsi-Contralateral Motor Cortex connectivity (iCoh) at the beginning of the training and at 6 months post stroke |
180 days post stroke
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Change in arm kinematics at the end of the training
Lasso di tempo: 3 days post training
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Differences between arm kinematics (shoulder, elbow, wrist and finger angles during reaching and grasping a glass) at the beginning of the training and at the end of the training |
3 days post training
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Change in arm kinematics at 6 months post stroke
Lasso di tempo: 180 days post stroke
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Differences between arm kinematics (shoulder, elbow, wrist and finger angles during reaching and grasping a glass) at the beginning of the training and at 6 months post stroke |
180 days post stroke
|
Collaboratori e investigatori
Sponsor
Collaboratori
Investigatori
- Direttore dello studio: Pablo Burgos, PhD, University of Chile
Studiare le date dei record
Studia le date principali
Inizio studio (Effettivo)
Completamento primario (Stimato)
Completamento dello studio (Stimato)
Date di iscrizione allo studio
Primo inviato
Primo inviato che soddisfa i criteri di controllo qualità
Primo Inserito (Effettivo)
Aggiornamenti dei record di studio
Ultimo aggiornamento pubblicato (Effettivo)
Ultimo aggiornamento inviato che soddisfa i criteri QC
Ultimo verificato
Maggiori informazioni
Termini relativi a questo studio
Parole chiave
Termini MeSH pertinenti aggiuntivi
Altri numeri di identificazione dello studio
- FONDEF IDeA 2023 ID23I104
Piano per i dati dei singoli partecipanti (IPD)
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Descrizione del piano IPD
all collected IPD
Periodo di condivisione IPD
After the publication of the clinical trial, for 5 years.
Criteri di accesso alla condivisione IPD
Based on reasonable request to the project director (Pablo Burgos, pburgos@uchile.cl), the data will be shared.
Tipo di informazioni di supporto alla condivisione IPD
- STUDIO_PROTOCOLLO
- LINFA
- CODICE_ANALITICO
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