Fall Prevention and Locomotion Recovery in Post-stroke Patients: A Multimodal Training

NCT ID: NCT02439515

Last Updated: 2017-03-07

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

72 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-12-31

Study Completion Date

2017-10-31

Brief Summary

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The study proposes a novel rehabilitative program for the recovery of locomotor abilities in post-acute stroke patients. The hypothesis is that a rehabilitative program which involves a biofeedback cycling training combining voluntary effort and Functional Electrical Stimulation (FES) of the leg muscles, and a biofeedback balance training is superior to usual care in improving walking abilities, disability, motor performance, and independence of post-acute stroke patients. The innovative approach is to investigate whether interventions which do not directly involve locomotor functions but movements similar in terms of kinematic patterns and neural commands (e.g. pedaling), or aimed at recovering an essential prerequisite for walking, such as postural control during upright stance, may improve and/or accelerate the recovery of walking abilities.

A single-blind randomized controlled study is carried out. Participants are post-acute stroke patients experiencing a first stroke less than 6 months before recruitment, with an adult age, a low level of spasticity of the leg muscles (Modified Ashworth scale \<2), no limitations at hip, knee, and ankle joints, and able to sit up to 30 minutes. Subjects are randomized to one of two groups, one performing the novel rehabilitative program in addition to usual care (experimental group), and one performing usual care alone (control group).

The experimental program consists of 15 sessions of FES-supported voluntary cycling training followed by 15 sessions of balance training. Both cycling and balance training are supported by a visual biofeedback in order to maximize patients' involvement in the exercise and are performed in addition to usual care.

The control group is involved in standard physical therapy which includes stretching, muscular conditioning, exercises for trunk control, standing, and walking training, and upper limb rehabilitation.

Both training programs last 6 weeks and patients are trained daily for about 90 minutes. Cycling and balance training last about 20 minutes; thus, patients in the experimental group perform only about 70 minutes of usual care.

Participants are evaluated at baseline (T1), after the end of the cycling training or after 3 weeks of usual care (post-treatment, T2), after the end of the whole intervention (post-treatment, T3), and about 6 months after the end of the intervention (follow-up, T4).

Detailed Description

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More details on the experimental training program are here provided.

The cycling training is performed on a motorized cycle-ergometer (MOTOmed, Reck GmbH) equipped with force sensors mounted at the base of the cranks (PowerForce system, Radlabor GmbH). The acquired force signals are displayed to the subjects who are asked to achieve a symmetrical involvement of the two legs. To deliver FES, a current-controlled 8-channel stimulator (RehaStim; Hasomed GmbH) is used and surface electrodes are applied in a bipolar configuration on the quadriceps, hamstrings, gastrocnemius lateralis, and tibialis anterior of both legs. Rectangular biphasic pulses with a pulse width of 400 μs and a stimulation frequency of 20 Hz are adopted. The stimulus intensity is set on each muscle the first day of training: for the paretic muscles values well tolerated by the subject and able to produce visibly good muscle contractions are identified, whereas for the healthy side lower values just above the sensory threshold are used. The stimulation timing is synchronized to the cycling movement according to physiological stereotyped activation patterns.

The balance training is performed during upright stance using a balance board (Balance board basic™, NeuroCom® International, Inc.). Subjects are asked to keep still or move their center of pressure following a target displayed on a screen in front of them.

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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Biofeedback training

It consists of 15 daily sessions of voluntary cycling training augmented by functional electrical stimulation (FES) followed by 15 daily sessions of balance training (multimodal biofeedback training). Both cycling and balance training are supported by a visual biofeedback and last about 20 minutes.

In addition to cycling or balance training, subjects perform standard physical therapy in order to reach 90 minutes of training per day.

Group Type EXPERIMENTAL

Cycling

Intervention Type DEVICE

Voluntary cycling augmented by electrical stimulation and biofeedback

Balance

Intervention Type DEVICE

Balance control exercises with visual biofeedback

Standard physical therapy

Intervention Type OTHER

It consists of stretching, muscular conditioning, exercises for trunk control, standing, and walking training, and upper limb rehabilitation.

Usual Care

It consists of 30 daily sessions of standard physical therapy. Each session last about 90 minutes.

Group Type ACTIVE_COMPARATOR

Standard physical therapy

Intervention Type OTHER

It consists of stretching, muscular conditioning, exercises for trunk control, standing, and walking training, and upper limb rehabilitation.

Interventions

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Cycling

Voluntary cycling augmented by electrical stimulation and biofeedback

Intervention Type DEVICE

Balance

Balance control exercises with visual biofeedback

Intervention Type DEVICE

Standard physical therapy

It consists of stretching, muscular conditioning, exercises for trunk control, standing, and walking training, and upper limb rehabilitation.

Intervention Type OTHER

Other Intervention Names

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MOTOmed, Reck GmbH PowerForce system, Radlabor GmbH RehaStim; Hasomed GmbH Balance board basic™, NeuroCom® International, Inc.

Eligibility Criteria

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Inclusion Criteria

* post-acute stroke patients experiencing a first stroke (both ischemic or hemorrhagic) less than 6 months before recruitment
* low level of spasticity of the leg muscles (Modified Ashworth scale \<2)
* no limitations at hip, knee, and ankle joints
* able to sit up to 30 minutes

Exclusion Criteria

* neurological impairment (Mini mental scale \<24)
* presence of other neurological diseases
* spatial hemineglect
* cardiac pacemakers
* allergy to electrodes
* an inability to tolerate electrical stimulation.
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Politecnico di Milano

OTHER

Sponsor Role collaborator

Fondazione Salvatore Maugeri

OTHER

Sponsor Role lead

Responsible Party

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Simona Ferrante

PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Simona Ferrante, PhD

Role: PRINCIPAL_INVESTIGATOR

Politecnico di Milano

Locations

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Istituti Clinici e Scientifici Maugeri

Lissone, Monza Brianza, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Simona Ferrante, PhD

Role: CONTACT

+390223999004

Emilia Ambrosini, PhD

Role: CONTACT

+390223999509

Facility Contacts

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Giorgio Ferriero, PhD

Role: primary

+390394657259

Emilia Ambrosini, PhD

Role: backup

+390223999509

References

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Ambrosini E, Ferrante S, Ferrigno G, Molteni F, Pedrocchi A. Cycling induced by electrical stimulation improves muscle activation and symmetry during pedaling in hemiparetic patients. IEEE Trans Neural Syst Rehabil Eng. 2012 May;20(3):320-30. doi: 10.1109/TNSRE.2012.2191574. Epub 2012 Apr 13.

Reference Type BACKGROUND
PMID: 22514205 (View on PubMed)

Ferrante S, Ambrosini E, Ravelli P, Guanziroli E, Molteni F, Ferrigno G, Pedrocchi A. A biofeedback cycling training to improve locomotion: a case series study based on gait pattern classification of 153 chronic stroke patients. J Neuroeng Rehabil. 2011 Aug 24;8:47. doi: 10.1186/1743-0003-8-47.

Reference Type BACKGROUND
PMID: 21861930 (View on PubMed)

Ambrosini E, Ferrante S, Pedrocchi A, Ferrigno G, Molteni F. Cycling induced by electrical stimulation improves motor recovery in postacute hemiparetic patients: a randomized controlled trial. Stroke. 2011 Apr;42(4):1068-73. doi: 10.1161/STROKEAHA.110.599068. Epub 2011 Mar 3.

Reference Type BACKGROUND
PMID: 21372309 (View on PubMed)

Ambrosini E, Parati M, Peri E, De Marchis C, Nava C, Pedrocchi A, Ferriero G, Ferrante S. Changes in leg cycling muscle synergies after training augmented by functional electrical stimulation in subacute stroke survivors: a pilot study. J Neuroeng Rehabil. 2020 Feb 27;17(1):35. doi: 10.1186/s12984-020-00662-w.

Reference Type DERIVED
PMID: 32106874 (View on PubMed)

Ambrosini E, Peri E, Nava C, Longoni L, Monticone M, Pedrocchi A, Ferriero G, Ferrante S. A multimodal training with visual biofeedback in subacute stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med. 2020 Feb;56(1):24-33. doi: 10.23736/S1973-9087.19.05847-7. Epub 2019 Sep 26.

Reference Type DERIVED
PMID: 31556542 (View on PubMed)

Other Identifiers

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GR-2010-2312228-SF

Identifier Type: -

Identifier Source: org_study_id

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