Unilateral Wrist Extension Training After Stroke

NCT ID: NCT03268798

Last Updated: 2017-08-31

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 24 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-03-31
• Study Completion Date: 2017-07-01

Brief Summary

Following stroke, muscle weakness and impaired motor function are expressed in both the more (MA; paretic) and less affected (LA; non-paretic) sides. Although the efficacy of resistance training is well recognized, training the MA limb directly may be initially difficult due to muscular weakness. "Cross-education" is training one side of the body increases strength in the untrained and opposite side. This concept can be applied in strength training when training the more affected sides cannot be initiated. Recently, our lab found six weeks of dorsiflexion resistance training in the LA leg improved the strength of both trained and untrained legs of chronic stroke participants.

The current project explored if cross-education exists in the upper limb in chronic stroke participants and if there are related changes in cortical and spinal cord plasticity. We hypothesized that unilateral strength in the less affected arm could enhance wrist extension strength bilaterally with related neural adoption and improved clinical function.

Detailed Description

Stroke produces muscle weakness seen on both more (paretic, MA) and less affected (non-paretic, LA) sides. "Cross-education" is training one side of the body increases strength or motor skill in the same muscles on the untrained side. This can be applied to enhance muscle strength in the MA side and we found that 6 weeks of dorsiflexion resistance training with the LA leg improved strength bilaterally in chronic stroke. To explore if cross-education occurs also in the upper limb after stroke, participants will complete a 5-week unilateral wrist extension training.

Twenty four participants will be recruited, 12 from Rehabilitation Neuroscience laboratory at University of Victoria, 12 from Brain Behaviour Laboratory at University of British Columbia. Before and after training, maximal voluntary contraction wrist extension force was measured with a 6-axis load cell using Cartesian coordinates (Fz = extension). Electromyography of extensor and flexor carpi radialis, biceps and triceps brachii were recorded. Fugl-Meyer and partial Wolf Motor Function Test were performed by the same physical therapist at each location. Reciprocal inhibition from wrist flexors to extensors, cutaneous reflexes evoked by median and superficial radial nerve stimulation were assessed in those at UVIC. Cortical silent period, short-interval intracortical inhibition, intracortical facilitation and transcallosal inhibition from transcranial magnetic stimulation were measured in participants at UBC.

Conditions

Stroke

Keywords

stroke; strength training; rehabilitation

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Wrist extension training

Group Type: EXPERIMENTAL

Unilateral wrist extension training

Intervention Type: DEVICE

Participants will join a five-week training protocol with 3 sessions per week. During each session, 5 sets 5 maximal wrist extension training will be performed on participants less affected side.

Interventions

Unilateral wrist extension training

Participants will join a five-week training protocol with 3 sessions per week. During each session, 5 sets 5 maximal wrist extension training will be performed on participants less affected side.

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Over 6 months post-stroke;
• One side of arm shows muscle weakness
• Pass the screening test of Physical Activity Readiness Questionnaire
• Pass the screening test for dementia
• Free from dementia (score < 24 on the Montreal Cognitive Assessment) and any other contradiction for TMS test

Exclusion Criteria

• Had medication affecting muscle tone within the past 3 months
• Wear a pacemaker

• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of British Columbia

OTHER

Sponsor Role: collaborator

University of Victoria

OTHER

Sponsor Role: lead

Responsible Party

Dr. E. Paul Zehr

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

E.Paul Zehr

Role: PRINCIPAL_INVESTIGATOR

Rehabilitation Neuroscience Laboratory, University of Victoria

Other Identifiers

D015017-2011-2015

Identifier Type: -

Identifier Source: org_study_id