Functional Electrical Stimulation Mediated Neuroplasticity: Lower Extremity CCNMES in Stroke

NCT ID: NCT02199795

Last Updated: 2017-11-08

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

7 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-05-31

Study Completion Date

2015-02-28

Brief Summary

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This is a small pilot randomized controlled trial which will enroll both subacute (\<6 mos) and chronic (\>6 mos) stroke survivors with ankle dorsiflexion weakness. The subjects will be randomized to Contralaterally Controlled Neuromuscular Electrical Stimulation (CCNMES) versus control. The primary objective of this study is to compare the effect of 6-weeks of lower extremity CCNMES, applied in an anti-phase application, on motor impairment and functional mobility to a control group.

Detailed Description

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Conditions

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Stroke Hemiparesis Footdrop

Keywords

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stroke hemiplegia footdrop electrical stimulation

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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CCNMES

Contralaterally Controlled Neuromuscular Electrical Stimulation (CCNMES): CCNMES uses electrical stimulation to move the weaker ankle up and down. The user will control the stimulation using the other (stronger) ankle. A special sock is worn on the stronger ankle. When the stronger ankle is moved, a signal is sent from a sensor on the sock to the electrical stimulator. The stimulator then sends stimulation to the weaker ankle which causes it to move. Sound and light cues coming from the stimulator will tell the user when to move the stronger ankle and when to relax.

Group Type EXPERIMENTAL

Contralaterally Controlled Neuromuscular Electrical Stimulation

Intervention Type DEVICE

Cyclic NMES

Cyclic Neuromuscular Electrical Stimulation (NMES) uses automatic, repetitive electrical stimulation to stimulate the muscles in order to move the weaker ankle up and down.

Group Type ACTIVE_COMPARATOR

Cyclic Neuromuscular Electrical Stimulation

Intervention Type DEVICE

Interventions

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Contralaterally Controlled Neuromuscular Electrical Stimulation

Intervention Type DEVICE

Cyclic Neuromuscular Electrical Stimulation

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 21 to 75 years
* Minimum of 2 wks from a first clinical non-hemorrhagic or hemorrhagic stroke
* Medically stable
* Unilateral lower extremity hemiparesis
* Ankle dorsiflexor strength of ≤4/5 on the Medical Research Council scale, while seated
* NMES of the paretic ankle dorsiflexors produces ankle dorsiflexion to neutral without pain.
* Full voluntary ROM of the contralateral ankle
* Skin intact on bilateral lower extremities
* Able to don the NMES system or caregiver available to assist with device if needed.
* Able to hear and respond to stimulator auditory cues
* Able to follow 3-stage commands
* Able to recall 2 of 3 items after 30 minutes
* Cognition and communication adequate for safe use of the device based on neurological assessment by physician principal investigator

Exclusion Criteria

* Severely impaired cognition and communication
* History of peroneal nerve injury
* History of Parkinson's, spinal cord injury, traumatic brain injury, or multiple sclerosis
* Uncontrolled seizure disorder
* Uncompensated hemi-neglect (extinguishing to double simultaneous stimulation)
* Edema of the paretic lower extremity
* Absent sensation of paretic lower extremity
* Evidence of deep venous thrombosis or thromboembolism
* History of cardiac arrhythmias with hemodynamic instability
* Cardiac pacemaker or other implanted electronic system
* Botulinum toxin injections to any lower extremity muscle in the last 3 months
* Pregnancy
* Symptomatic peripheral neuropathy
* Current use of psychoactive medications (except selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor antidepressants)
* Acetylcholinesterase inhibitor usage
* Unstable asthmatic condition
* Metallic implants (including clips and/or wires)
* Prosthetic heart valves
* Cardiac, renal or other stent
* History of claustrophobia
* Low visual acuity
* Body weight or body habitus not compatible to MRI machine
* Medical, psychological, or social concern identified by the principal investigator or co-investigator which suggests inappropriateness of subject participation
Minimum Eligible Age

21 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Case Western Reserve University

OTHER

Sponsor Role collaborator

MetroHealth Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Jayme Knutson

Assistant Professor, Physical Medicine and Rehabilitation

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Lynne R. Sheffler, MD

Role: PRINCIPAL_INVESTIGATOR

MetroHealth Medical Center

Locations

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MetroHealth Medical Center

Cleveland, Ohio, United States

Site Status

Countries

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United States

References

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Knutson JS, Hansen K, Nagy J, Bailey SN, Gunzler DD, Sheffler LR, Chae J. Contralaterally controlled neuromuscular electrical stimulation for recovery of ankle dorsiflexion: a pilot randomized controlled trial in patients with chronic post-stroke hemiplegia. Am J Phys Med Rehabil. 2013 Aug;92(8):656-65. doi: 10.1097/PHM.0b013e31829b4c16.

Reference Type BACKGROUND
PMID: 23867888 (View on PubMed)

Knutson JS, Chae J. A novel neuromuscular electrical stimulation treatment for recovery of ankle dorsiflexion in chronic hemiplegia: a case series pilot study. Am J Phys Med Rehabil. 2010 Aug;89(8):672-82. doi: 10.1097/PHM.0b013e3181e29bd7.

Reference Type BACKGROUND
PMID: 20531158 (View on PubMed)

Swinnen SP. Intermanual coordination: from behavioural principles to neural-network interactions. Nat Rev Neurosci. 2002 May;3(5):348-59. doi: 10.1038/nrn807.

Reference Type BACKGROUND
PMID: 11988774 (View on PubMed)

Kawashima N, Nozaki D, Abe MO, Akai M, Nakazawa K. Alternate leg movement amplifies locomotor-like muscle activity in spinal cord injured persons. J Neurophysiol. 2005 Feb;93(2):777-85. doi: 10.1152/jn.00817.2004. Epub 2004 Sep 22.

Reference Type BACKGROUND
PMID: 15385590 (View on PubMed)

Vasudevan EV, Zehr EP. Multi-frequency arm cycling reveals bilateral locomotor coupling to increase movement symmetry. Exp Brain Res. 2011 Jun;211(2):299-312. doi: 10.1007/s00221-011-2687-y. Epub 2011 Apr 23.

Reference Type BACKGROUND
PMID: 21516330 (View on PubMed)

Related Links

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http://fescenter.org/index.php

Cleveland Functional Electrical Stimulation Center

Other Identifiers

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K23HD060689

Identifier Type: NIH

Identifier Source: secondary_id

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K23HD060689

Identifier Type: NIH

Identifier Source: org_study_id

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