Effects of Training Rhythmic and Discrete Aiming Movements on Arm Control and Functionality After Stroke
27. januar 2017 oppdatert av: Renata Morales Banjai, Universidade Cidade de Sao Paulo
Effects of Training Rhythmic and Discrete Aiming Movements on the Upper Limb Control and Functionality After Stroke: Randomized Controlled Trial
The purpose of this study is to verify the additional effects of rhythmic specific training, discrete specific training additional to conventional therapy on the upper limb after chronic stroke subjects on the outcomes: motor control and functionality.
Studieoversikt
Status
Ukjent
Forhold
Detaljert beskrivelse
Seventy-five patients will be randomized into three groups to receive conventional therapy, consisting of a combination of mobility exercises joint, muscle stretching, strength training, motor coordination exercises, unilateral and bilateral motor tasks as well as oriented tasks training upper limb with a focus on functional tasks. The other groups will receive additional intervention consisting of aiming movement practice according two different protocols: discrete movements to targets placed in different directions and distances; and rhythmic movements also to targets placed in different directions and distances. Both additional interventional interventions will be conducted for 30 minutes over a 5 week-period (total: 10 sessions).
Clinical outcomes (motor control), functional and kinematic will be collected at baseline and at five weeks. Functional results will be collected at the beginning, after 5 weeks and 3 months after randomization. Data will be collected by a blinded assessor on patients' allocation group. All statistical analyzes will be carried out following the principles of intention to treat analysis and differences between groups will be performed using linear mixed models.
Studietype
Intervensjonell
Registrering (Forventet)
75
Fase
- Ikke aktuelt
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
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Sao Paulo, Brasil, 03071-000
- Rekruttering
- Universidade Cidade de Sao Paulo
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Ta kontakt med:
- Sandra R Alouche, PhD
- Telefonnummer: +551121781565
- E-post: sandra.alouche@unicid.edu.br
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Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
18 år til 80 år (Voksen, Eldre voksen)
Tar imot friske frivillige
Nei
Kjønn som er kvalifisert for studier
Alle
Beskrivelse
Inclusion criteria:patients who participate in the survey, adult stroke survivors (>18 years), with primary diagnosis of first-ever unilateral stroke (ischaemic or haemorrhagic), stroke experienced > 6 months prior to study enrollment and score ≥ 20 on the Folstein Mini Mental Status Examination.
Exclusion criteria: patients with excessive pain in the paretic hand, arm or shoulder excessive spasticity at the paretic elbow and wrist as defined as a score of 4 on the Modified Ashworth Spasticity Scale and upper limb comorbidities that could limit their functional recovery (e.g., arthritis, pain, other neurological disorders).
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Behandling
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Enkelt
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
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Aktiv komparator: Conventional Physical Therapy
Usual therapy: joint mobility exercises, stimulating joint movement of the main active components of the upper limb; major muscle groups stretching, especially in the affected muscles by tone impairment; manual resistance training according to the degree of the patient's muscle strength, prioritizing the functional specificity of the upper limb, so the majority of the exercises will be held in open chain; motor coordination exercises, unilateral and bilateral motor tasks as well as task-oriented training of the upper limb with a focus on functional tasks.
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Combination of joint mobility exercises, specific exercises for muscle strength and motor coordination exercises, unilateral and bilateral motor tasks as well as task-oriented training of the upper limb with a focus on functional tasks.
Patients will receive 10 sessions of treatment over a period of five weeks (two sessions/week)
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Eksperimentell: discrete movement training group
Aiming movements training with the affected upper limb (unilateral training) or both limbs (bilateral training) on the surface of a table.
The starting point of the movement and its target are predetermined.
Targets will be placed in different directions and distances from the starting point and the therapist ask for variations on speed and assistance, if necessary.
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Aiming movements training with the affected upper limb (unilateral training) or both limbs (bilateral training) on the surface of a table.
The starting point of the movement and its target are predetermined.
Targets will be placed in different directions and distances from the starting point and the therapist ask for variations on speed and assistance, if necessary.
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Eksperimentell: rhythmic movement training group
Aiming movements training with the affected upper limb (unilateral training) or both limbs (bilateral training) on the surface of a table.
The movement begins in a predetermined starting point, directed to a target and returns to the starting point.
This activity is performed several times with rhythmic movements.
Targets will be placed in different directions and distances from the starting point and the therapist ask for variations on speed and assistance, if necessary.
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Aiming movements training with the affected upper limb (unilateral training) or both limbs (bilateral training) on the surface of a table.
The movement begins in a predetermined starting point, directed to a target and returns to the starting point.
This activity is performed several times with rhythmic movements.
Targets will be placed in different directions and distances from the starting point and the therapist ask for variations on speed and assistance, if necessary.
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Stroke Impact Scale (SIS)
Tidsramme: Five weeks after randomization and 3 months after randomization
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Functionality: questionnaire which evaluates functionality.
In this study will be evaluated four areas (arm muscle strength, hand function, activities of daily living and social participation)(Duncan et al., 1999).
Each domain is scored from 1 to 5 (1 point corresponds to the worst possible outcome and 5 points to the best result).
For the four areas the lowest possible score is 28 points and the highest is 125 points.
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Five weeks after randomization and 3 months after randomization
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Sekundære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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Motor Activity Log (MAL)
Tidsramme: Five weeks and 3 months after randomization
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Arm function: individuals are asked to rate Quality of Movement (QOM) and Amount of Movement (AOM) during 30 daily functional tasks (original MAL) (Uswatte et al., 2005). Items scored on a 6-point ordinal scale, where 0 corresponds to the weaker arm was not sued at all for that activity (never). Patients with a score 5 show the ability to use the weaker arm for that activity was as good as before the stroke (normal). |
Five weeks and 3 months after randomization
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Fugl-Meyer Assessment Scale
Tidsramme: Five weeks after randomization
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Motor control: this scale assesses sensorimotor function of upper limb, with score 0-66 points with scores 0-66 points for motor function and 0-126 points for sensory-motor function (Fugl-Meyer, 1975).
A higher score is better motor function.
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Five weeks after randomization
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Andre resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
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kinematics assessment
Tidsramme: Five weeks after randomization
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Functional capacity: It will be used an experimental apparatus that analyzes the motor behavior the aiming movement (Ribeiro et al., 2014).
They will evaluate the movement time (measured in milliseconds), reaction time (in milliseconds) and smoothness (expressed in units of motion).
The movement time is the time interval between the beginning and the end of the movement.
Reaction time is defined as the time between the start of the imperative stimulus to the beginning of the movement.
The smoothness is evaluated by computing the number of times the acceleration zero crossing (positive to negative and vice versa).
The resultant variable error (in centimeters) is a measure of variability for both the medial-lateral direction as anteroposterior, assessing the accuracy to hit the target.
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Five weeks after randomization
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Grip strength
Tidsramme: Five weeks after randomization
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Body function and structure: it will measure the strength of grip and pinch through dynamometer.
The results will be presented in kilogram-force (Kgf) (Mathiowetz et al., 1985)
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Five weeks after randomization
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Modified Ashworth Spasticity Scale
Tidsramme: Five weeks after randomization
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Body function and structure: they will be assessed flexors elbow, wrist and fingers, and forearm pronators.
A measurement scale from 0 to 4 points, with 0 representing normal muscle tone and 4 is the highest possible degree of spasticity (Bohannon and Smith, 1987)
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Five weeks after randomization
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Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Etterforskere
- Studieleder: Sandra R Alouche, PhD, Universidade Cidade São Paulo
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Generelle publikasjoner
- Fugl-Meyer AR, 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. 1975;7(1):13-31.
- Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987 Feb;67(2):206-7. doi: 10.1093/ptj/67.2.206.
- Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke. 1999 Oct;30(10):2131-40. doi: 10.1161/01.str.30.10.2131.
- Cauraugh JH, Summers JJ. Neural plasticity and bilateral movements: A rehabilitation approach for chronic stroke. Prog Neurobiol. 2005 Apr;75(5):309-20. doi: 10.1016/j.pneurobio.2005.04.001.
- Naghdi S, Ansari NN, Mansouri K, Hasson S. A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke. Brain Inj. 2010;24(11):1372-8. doi: 10.3109/02699052.2010.506860.
- Harris JE, Eng JJ. Paretic upper-limb strength best explains arm activity in people with stroke. Phys Ther. 2007 Jan;87(1):88-97. doi: 10.2522/ptj.20060065. Epub 2006 Dec 19.
- Faria-Fortini I, Michaelsen SM, Cassiano JG, Teixeira-Salmela LF. Upper extremity function in stroke subjects: relationships between the international classification of functioning, disability, and health domains. J Hand Ther. 2011 Jul-Sep;24(3):257-64; quiz 265. doi: 10.1016/j.jht.2011.01.002. Epub 2011 Mar 21.
- Sirtori V, Corbetta D, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in stroke patients. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004433. doi: 10.1002/14651858.CD004433.pub2.
- Liepert J. Evidence-based therapies for upper extremity dysfunction. Curr Opin Neurol. 2010 Dec;23(6):678-82. doi: 10.1097/WCO.0b013e32833ff4c4.
- Ada L, O'Dwyer N, O'Neill E. Relation between spasticity, weakness and contracture of the elbow flexors and upper limb activity after stroke: an observational study. Disabil Rehabil. 2006 Jul 15-30;28(13-14):891-7. doi: 10.1080/09638280500535165.
- Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009 Apr;52(3):269-93. doi: 10.1016/j.rehab.2008.10.003. Epub 2009 Apr 9. English, French.
- Cauraugh JH, Lodha N, Naik SK, Summers JJ. Bilateral movement training and stroke motor recovery progress: a structured review and meta-analysis. Hum Mov Sci. 2010 Oct;29(5):853-70. doi: 10.1016/j.humov.2009.09.004. Epub 2009 Nov 18.
- van Delden AE, Peper CE, Beek PJ, Kwakkel G. Unilateral versus bilateral upper limb exercise therapy after stroke: a systematic review. J Rehabil Med. 2012 Feb;44(2):106-17. doi: 10.2340/16501977-0928.
- Chang JJ, Tung WL, Wu WL, Huang MH, Su FC. Effects of robot-aided bilateral force-induced isokinetic arm training combined with conventional rehabilitation on arm motor function in patients with chronic stroke. Arch Phys Med Rehabil. 2007 Oct;88(10):1332-8. doi: 10.1016/j.apmr.2007.07.016.
- Smits-Engelsman BC, Swinnen SP, Duysens J. The advantage of cyclic over discrete movements remains evident following changes in load and amplitude. Neurosci Lett. 2006 Mar 20;396(1):28-32. doi: 10.1016/j.neulet.2005.11.001. Epub 2005 Dec 2.
- Uswatte G, Taub E, Morris D, Vignolo M, McCulloch K. Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke. 2005 Nov;36(11):2493-6. doi: 10.1161/01.STR.0000185928.90848.2e. Epub 2005 Oct 13.
- Ribeiro Coqueiro P, de Freitas SM, Assuncao e Silva CM, Alouche SR. Effects of direction and index of difficulty on aiming movements after stroke. Behav Neurol. 2014;2014:909182. doi: 10.1155/2014/909182. Epub 2014 Jan 28.
- Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985 Feb;66(2):69-74.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart
1. juni 2016
Primær fullføring (Forventet)
1. juni 2018
Studiet fullført (Forventet)
1. september 2018
Datoer for studieregistrering
Først innsendt
19. april 2016
Først innsendt som oppfylte QC-kriteriene
3. mai 2016
Først lagt ut (Anslag)
6. mai 2016
Oppdateringer av studieposter
Sist oppdatering lagt ut (Anslag)
30. januar 2017
Siste oppdatering sendt inn som oppfylte QC-kriteriene
27. januar 2017
Sist bekreftet
1. januar 2017
Mer informasjon
Begreper knyttet til denne studien
Nøkkelord
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- Universidade Cidade Sao Paulo
Plan for individuelle deltakerdata (IPD)
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Nei
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