Potential for Recovery of Voluntary Finger Extension After Stroke (PROVES)
Stroke patients with absent voluntary finger extension (VFE) 6-months after stroke are not expected to recover hand function. However, experience from the Queen Square Upper Limb neurorehabilitation service contradicts this view. In this study, we will identify the characteristics of those chronic stroke patients who regain previously absent VFE.
Hundred chronic stroke patients will be recruited with absent/negligible VFE in an external pilot and feasibility study. Transcranial magnetic stimulation will be used to determine the functional integrity of descending white matter pathways. Corticospinal tract integrity to finger extensor muscles will be based on whether motor-evoked potentials are present (MEP+) or absent (MEP-). Reticulospinal tract activity will be assessed by measuring ipsilateral MEP amplitudes and the Start-React response.
All patients will then receive 3-months of neuromuscular electrical stimulation plus home exercise, designed to strengthen wrist/finger extensors, reduce spasticity and increase corticospinal excitability. The primary outcome measure will be restoration of VFE.
It is predicted that VFE will be restored in MEP+ but not MEP- patients. MEP- patients will have higher reticulospinal tract activity associated with spasticity. Restoration of VFE will allow patients to engage in evidence-based upper limb training to improve function e.g. constraint induced movement therapy or repetitive task training.
Panoramica dello studio
Stato
Condizioni
Intervento / Trattamento
Tipo di studio
Iscrizione (Stimato)
Fase
- Non applicabile
Contatti e Sedi
Contatto studio
- Nome: Professor Nick Ward, MD
- Numero di telefono: +44 20 3448 3486
- Email: n.ward@ucl.ac.uk
Backup dei contatti dello studio
- Nome: Lisa Tedesco Triccas, PhD
- Email: l.triccas@ucl.ac.uk
Luoghi di studio
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London, Regno Unito, WC1N 3BJ
- University College London- Department of Clinical and Movement Neurosciences
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Descrizione
Inclusion Criteria
- Diagnosed with a Stroke >6 months previously
- Medical Research Council (MRC) grade 0 or 1 in long finger extensors.
Exclusion Criteria
- Presence of spasticity in any wrist/finger flexors (including lumbricals) >2 on Modified Ashworth Scale
- Unable to get hand flat on table top
- Botulinum toxin to long finger or wrist flexors < 24 weeks prior to pre-treatment assessment (i.e. effects should have worn off).
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
- Scopo principale: Diagnostico
- Assegnazione: N / A
- Modello interventistico: Assegnazione di gruppo singolo
- Mascheramento: Nessuno (etichetta aperta)
Armi e interventi
Gruppo di partecipanti / Arm |
Intervento / Trattamento |
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Sperimentale: Neuromuscular electrical stimulation (NMES) and home exercise programme
Three month intervention programme of Neuromuscular electrical stimulation (NMES) and home exercise programme
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-Neuromuscular and Electrical Stimulation (NMES): All participants will undergo a NMES treatment programme designed to strengthen wrist and finger extensors. Participants and their carers will receive training in NMES set up from the research physiotherapist. Surface electrodes are placed over the motor points of extensor carpi radialis and extensor digitorum communis to produce wrist and finger extension simultaneously. Home exercise: We aim for all patients to perform the Graded Repetitive Arm Supplementary Program (GRASP) level 1 (for severely affected upper limbs) for a minimum of 60 minutes/day, 5 days/week. Patients will be provided with an exercise book containing written and pictorial instructions for each exercise, and the kits contained inexpensive equipment to complete the exercises. Exercises included strengthening of the arm and hand, range of motion, and gross and fine motor skills. |
Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Voluntary Finger Extension (VFE)
Lasso di tempo: Day 1 and Day 90
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Can participants achieve at least 10° of thumb abduction/extension, and at least 10° of extension in a minimum of 2 additional digits (movements need to be repeatable 3 times in 1 minute).
The extent of VFE will be measured using an electronic goniometer.
Extent of finger extension is calculated for each finger as a composite of extension at metacarpophalangeal, proximal and distal interphalangeal joints.
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Day 1 and Day 90
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
|---|---|---|
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Upper Extremity Fugl-Meyer Assessment
Lasso di tempo: Day 1 and Day 90
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Measurement of upper limb motor recovery after stroke
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Day 1 and Day 90
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Hand Dynamometry
Lasso di tempo: Day 1 and Day 90
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Measurement of grip strength
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Day 1 and Day 90
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Fugl-Meyer Assessment - Sensory function
Lasso di tempo: Day 1 and Day 90
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As of part of the Fugl-Meyer Assessment, this measure is used to evaluate somatosensory function of the upper limbs.
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Day 1 and Day 90
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Modified Tardieu Scale (MTS)
Lasso di tempo: Day 1 and Day 90
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MTS is a clinical tool used to assess spasticity.
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Day 1 and Day 90
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KINARM- Passive Stretch Task
Lasso di tempo: Day 1 and Day 90
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The KINARM Passive Stretch Task is a quantitative assessment performed with the KINARM robotic assessment system in which the participant's limb is passively displaced by the robot while they are instructed to remain relaxed.
The device applies controlled position- or torque-driven perturbations to one or more joints (typically elbow and/or shoulder) across predefined velocities and ranges of motion.
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Day 1 and Day 90
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Box and Block Test (BBT)
Lasso di tempo: Day 1 and Day 90
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BBT is a standard assessment to measure manual dexterity and gross motor coordination of the hands.
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Day 1 and Day 90
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Stroke Impact Scale (SIS)
Lasso di tempo: Day 1 and Day 90
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SIS is a self-reported questionnaire designed to measure the multidimensional impact of stroke on a person's life.
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Day 1 and Day 90
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Neurophysiological- Corticospinal Tract Integrity
Lasso di tempo: Day 1 and Day 90
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Corticospinal tract integrity is measured using Transcranial Magnetic Stimulation (TMS) to evaluate the functional status of motor pathways in the brain and spinal cord - identified as Motor Evoked Potential Positive (MEP+) or Negative (MEP-).
Resting and Active Motor Threshold will also be measured in addition with the Compound Muscle Action Potential.
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Day 1 and Day 90
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Neurophysiological- Reticulospinal Tract Integrity
Lasso di tempo: Day 1 and Day 90
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This will be assessed using the Start React Protocol and measurement of ipsilateral Motor Evoked Potentials (iMEPs).
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Day 1 and Day 90
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Neurophysiological- Somatosensory Evoked Potentials
Lasso di tempo: Day 1 and Day 90
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Median nerve somatosensory evoked potentials will be measured using Electroencephalography (EEG).
The measures will mainly involve recording cortical responses to peripheral nerve stimulation.
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Day 1 and Day 90
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Collaboratori e investigatori
Sponsor
Collaboratori
Investigatori
- Investigatore principale: Nick Ward, MD, University College, London
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Altri numeri di identificazione dello studio
- 367119
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