Forearm Rotation Orthosis for Stroke

NCT ID: NCT01987414

Last Updated: 2019-09-06

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

18 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-08-31

Study Completion Date

2018-06-30

Brief Summary

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The purpose of this study is to examine the efficacy of a forearm rotation orthosis combined with the occupational therapy task-oriented approach on functional performance for persons with a hemiparetic arm.

Hypotheses of this study are:

1. participants who wear the forearm rotation orthosis will demonstrate significantly greater improvement in functional performance and active range of motion of forearm rotators compared to those who do not;
2. all participants who receive the occupational therapy task-oriented approach intervention will demonstrate significant improvement in functional performance; and
3. all participants who receive the occupational therapy task-oriented approach intervention will demonstrate improvement in motor function of the upper extremity.

Detailed Description

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Persons with central nervous system (CNS) dysfunction often have difficulty incorporating their affected limb effectively and efficiently into functional tasks due to muscle weakness and/or spasticity. This may further interfere with their performance of everyday activities and restrict life roles. Traditional rehabilitation interventions emphasize spasticity reduction. However, active movement and muscle strength of forearm supination are found strongly related to motor function, rather than spasticity. In contrast, task-oriented movement training trials have demonstrated promising evidence that persons with CNS dysfunction benefit from the training in improvement of motor function and increase functional use of the affected limb.

Orthotic intervention is one therapeutic option for this population. Most orthotic designs for this population are static, developed for sympton reduction or deformity prevention, and aimed at the wrist and hand. However, its effects on spasticity reduction remain controversial. Given that static orthotics may interfere with functional performance and further develop the learned nonuse of the affected limb, a dynamic or mobilization orthosis would be appropriate for enhancing functional performance. Moreover, an orthosis that assists forearm rotation is speculated to enhance functional performance. This study will examine the efficacy of a forearm rotation orthosis combined with the occupational therapy task-oriented approach on functional performance for persons with a hemiparetic arm.

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Group A

Forearm rotation orthosis (6 weeks); Forearm rotation orthosis plus occupational therapy task-oriented approach (6 weeks)

Group Type EXPERIMENTAL

occupational therapy task-oriented approach

Intervention Type BEHAVIORAL

It is a standard treatment in occupational therapy for persons post-stroke or other neurological conditions. It is an approach that emphasizes client-centered, goal-directed, and functional training for restoration of life roles.

Forearm rotation orthosis

Intervention Type DEVICE

The forearm rotation orthosis is made of Latex-free material and is a custom-molded orthosis designed to assist forearm rotation without limiting functional elbow flexion and extension.

Group B

no treatment (6 weeks); occupational therapy task-oriented approach (6 weeks)

Group Type ACTIVE_COMPARATOR

occupational therapy task-oriented approach

Intervention Type BEHAVIORAL

It is a standard treatment in occupational therapy for persons post-stroke or other neurological conditions. It is an approach that emphasizes client-centered, goal-directed, and functional training for restoration of life roles.

No treatment

Intervention Type OTHER

Participants will maintain their daily routines during the no treatment period.

Interventions

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occupational therapy task-oriented approach

It is a standard treatment in occupational therapy for persons post-stroke or other neurological conditions. It is an approach that emphasizes client-centered, goal-directed, and functional training for restoration of life roles.

Intervention Type BEHAVIORAL

Forearm rotation orthosis

The forearm rotation orthosis is made of Latex-free material and is a custom-molded orthosis designed to assist forearm rotation without limiting functional elbow flexion and extension.

Intervention Type DEVICE

No treatment

Participants will maintain their daily routines during the no treatment period.

Intervention Type OTHER

Other Intervention Names

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OT task-oriented approach control

Eligibility Criteria

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Inclusion Criteria

* Have a diagnosis of stroke for at least three months
* Be 18 years of age or older
* Have sufficient cognitive function to follow three-step verbal instruction and provide independent consent
* Have appropriate trunk and lower extremity function that does not interfere with performance of the upper extremity
* Have at least minimum voluntary movement in the upper extremity (10 degrees of shoulder flex/ abduction, 10 degrees of elbow flexion/extension)
* Not receive any rehabilitative interventions concurrent with the study

Exclusion Criteria

* Severe joint deformities or contractures of the affected upper extremity that limit range of motion required for functional tasks
* Capability of voluntarily extending the wrist and fingers through the full range
* Other rehabilitation interventions concurrent with the study
* Have serious uncontrolled medical problems, such as seizures and visual impairment
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Minnesota

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Chih-Huang Yu, MS

Role: PRINCIPAL_INVESTIGATOR

Rehabilitation Science Program at the University of Minnesota

Virgil Mathiowetz, PhD

Role: STUDY_DIRECTOR

Program in Occupational Therapy, University of Minnesota

Locations

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Children's Rehabilitation Building, University of Minnesota

Minneapolis, Minnesota, United States

Site Status

Countries

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United States

References

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Braendvik SM, Elvrum AK, Vereijken B, Roeleveld K. Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy. Dev Med Child Neurol. 2010 Feb;52(2):e29-34. doi: 10.1111/j.1469-8749.2009.03490.x. Epub 2009 Oct 7.

Reference Type BACKGROUND
PMID: 19811515 (View on PubMed)

O'Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain. 1996 Oct;119 ( Pt 5):1737-49. doi: 10.1093/brain/119.5.1737.

Reference Type BACKGROUND
PMID: 8931594 (View on PubMed)

Dunning K, Berberich A, Albers B, Mortellite K, Levine PG, Hill Hermann VA, Page SJ. A four-week, task-specific neuroprosthesis program for a person with no active wrist or finger movement because of chronic stroke. Phys Ther. 2008 Mar;88(3):397-405. doi: 10.2522/ptj.20070087. Epub 2008 Jan 10.

Reference Type BACKGROUND
PMID: 18187493 (View on PubMed)

Page SJ, Levine P, Leonard AC. Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study. Neurorehabil Neural Repair. 2005 Mar;19(1):27-32. doi: 10.1177/1545968304272701.

Reference Type BACKGROUND
PMID: 15673841 (View on PubMed)

Page SJ, Levine P, Leonard A, Szaflarski JP, Kissela BM. Modified constraint-induced therapy in chronic stroke: results of a single-blinded randomized controlled trial. Phys Ther. 2008 Mar;88(3):333-40. doi: 10.2522/ptj.20060029. Epub 2008 Jan 3.

Reference Type BACKGROUND
PMID: 18174447 (View on PubMed)

Taub E, Uswatte G, King DK, Morris D, Crago JE, Chatterjee A. A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke. 2006 Apr;37(4):1045-9. doi: 10.1161/01.STR.0000206463.66461.97. Epub 2006 Mar 2.

Reference Type BACKGROUND
PMID: 16514097 (View on PubMed)

Watanabe T. The role of therapy in spasticity management. Am J Phys Med Rehabil. 2004 Oct;83(10 Suppl):S45-9. doi: 10.1097/01.phm.0000141130.58285.da.

Reference Type BACKGROUND
PMID: 15448577 (View on PubMed)

Lannin NA, Horsley SA, Herbert R, McCluskey A, Cusick A. Splinting the hand in the functional position after brain impairment: a randomized, controlled trial. Arch Phys Med Rehabil. 2003 Feb;84(2):297-302. doi: 10.1053/apmr.2003.50031.

Reference Type BACKGROUND
PMID: 12601664 (View on PubMed)

Taub E, Uswatte G, Elbert T. New treatments in neurorehabilitation founded on basic research. Nat Rev Neurosci. 2002 Mar;3(3):228-36. doi: 10.1038/nrn754.

Reference Type BACKGROUND
PMID: 11994754 (View on PubMed)

Gillen G. Upper extremity function and management. In G. Gillen (Ed.), Stroke rehabilitation: A function-based approach (3rd ed., pp. 218-279). St. Louis: Mosby, 2011.

Reference Type BACKGROUND

Milazzo S, Gillen G. Splinting applications. In G Gillen (Ed.), Stroke rehabilitation: A function-based approach (3rd ed., pp. 326-349). St. Louis: Mosby, 2011

Reference Type BACKGROUND

Wolf SL, Winstein CJ, Miller JP, Thompson PA, Taub E, Uswatte G, Morris D, Blanton S, Nichols-Larsen D, Clark PC. Retention of upper limb function in stroke survivors who have received constraint-induced movement therapy: the EXCITE randomised trial. Lancet Neurol. 2008 Jan;7(1):33-40. doi: 10.1016/S1474-4422(07)70294-6.

Reference Type BACKGROUND
PMID: 18077218 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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1309M42881

Identifier Type: -

Identifier Source: org_study_id

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