MOdularity for SEnsory Motor Control

NCT ID: NCT03530358

Last Updated: 2022-06-08

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

132 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-12-01

Study Completion Date

2022-12-01

Brief Summary

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For this project the investigators ask, how the activation and organization of muscle synergies may be disrupted by brain lesions, and whether it is possible to modify synergy activations by means of specific therapies. Will be investigated whether there is a relationship between post-stroke cortical plasticity and changes in synergy activations due to a therapy.

Detailed Description

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It has been widely recognized that neurorehabilitation can facilitate recovery of motor function after stroke. There has been increasing evidence suggesting that the execution of voluntary movement relies critically on the functional integration of the motor areas and the spinal circuitries. More precisely, it was suggested that the central nervous system may generate neural motor commands through a linear combination of spinal modules, each of which activates a group of muscles as a single unit (muscle synergy). The investigators hypothesize that descending motor cortical signals generate movements by combining and activating muscle synergies. With this background, the goal is to further improve the efficacy of rehabilitation utilizing knowledge on modular motor control. The investigators also seek to provide a better understanding of the links between brain activations and movements.

The project MO-SE has three aims, one primary and two secondary. The main primary aim is to test whether the use of virtual reality rehabilitation based therapies are superior in terms of clinical efficacy to conventional therapies (randomized clinica trial, RCT). The other two secondary aims of the project will be accomplished with further instrumental analysis in sub-samples of the group of patients enrolled for the RCT.

Conditions

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Stroke, Ischemic Upper Limb Injury Rehabilitation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Randomized Clinical Trial
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors
A simple random number sequence will be generated by a computer and the allocation concealment will be guaranteed using sequentially numbered, opaque sealed envelopes. The therapists responsible for randomization and allocation procedures will be independent of the blind therapists and medical doctors involved in patients' screening and treatment.

Study Groups

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Technology-aided rehabilitation

The technology-aided upper limb rehabilitation include reinforced feedback in virtual environment (RFVE), or robotic therapy.

Group Type EXPERIMENTAL

Technology-aided rehabilitation

Intervention Type DEVICE

VRRS involves performing different kinds of motor tasks with the patient holding a real manipulable object in their hands while interacting with a virtual scenario.

"Braccio di Ferro" task consists in center-out reaching movements and return. The subject is required to start from a central target, reach one of five peripheral targets arranged on a semi-circle with a 20 cm radius and then return to the central target.

Conventional rehabilitation

The conventional upper limb rehabilitation program will be based on traditional rehabilitation techniques aimed at restoring upper limb motor functions.

Group Type ACTIVE_COMPARATOR

Conventional rehabilitation

Intervention Type BEHAVIORAL

The patients will be asked to perform a wide range of exercises, including: shoulder flexion-extension, abduction-adduction, internal-external rotation, circumduction, elbow flexion-extension, forearm pronation-supination, hand-digit motion. Standardized instructions and modalities will be followed when providing exercises to the patients in order to control for any variability in leading the therapy session due to the therapist.

Interventions

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Technology-aided rehabilitation

VRRS involves performing different kinds of motor tasks with the patient holding a real manipulable object in their hands while interacting with a virtual scenario.

"Braccio di Ferro" task consists in center-out reaching movements and return. The subject is required to start from a central target, reach one of five peripheral targets arranged on a semi-circle with a 20 cm radius and then return to the central target.

Intervention Type DEVICE

Conventional rehabilitation

The patients will be asked to perform a wide range of exercises, including: shoulder flexion-extension, abduction-adduction, internal-external rotation, circumduction, elbow flexion-extension, forearm pronation-supination, hand-digit motion. Standardized instructions and modalities will be followed when providing exercises to the patients in order to control for any variability in leading the therapy session due to the therapist.

Intervention Type BEHAVIORAL

Other Intervention Names

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Virtual Reality Rehabilitation System (VRRS) Braccio di Ferro

Eligibility Criteria

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Inclusion Criteria

* diagnosis of first stroke;
* a score between 1 and 3 (included) at the upper limb sub-item on the Italian version of the National Institute of Health stroke scale (IT - NIHSS) (Pezzella et al., 2009)
* a score higher than 6 out of 66 on the Fugl - Meyer upper extremity (F-M UE) scale (Fugl-Meyer et al., 1975).

Exclusion Criteria

* the presence of a moderate cognitive decline defined as a Mini Mental State Examination (Folstein et al., 1975) score \< 20/30 points;
* the finding of severe verbal comprehension deficit defined as a number of errors \> 13 (Tau Points \< 58/78) on the Token Test (Huber et al., 1984);
* evidence of apraxia and visuospatial neglect interfering with upper arm movements and manipulation of simple objects in all the directions within the visual field, as assessed through neurological examination;
* report in the patient's clinical history or evidence from the neurological examination of behavioural disturbances (i.e. delusions, aggressiveness and severe apathy/depression) that could affect compliance with the rehabilitation programs;
* non stabilised fractures;
* diagnosis of depression/delusion;
* associated traumatic brain injury;
* drug resistant epilepsy;
* evidence of ideomotor apraxia;
* evidence of visuospatial neglect;
* severe impairment of verbal comprehension defined as a score higher than 13 errors on Token test (i.e. score\<58 out of 78 Tau points).
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fondazione Don Carlo Gnocchi Onlus

OTHER

Sponsor Role collaborator

IRCCS San Camillo, Venezia, Italy

OTHER

Sponsor Role lead

Responsible Party

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Andrea Turolla

PT, PhD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Andrea Turolla, PhD

Role: PRINCIPAL_INVESTIGATOR

IRCCS San Camillo, Venezia, Italy

Locations

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IRCCS Fondazione Don Gnocchi Onlus

Milan, , Italy

Site Status

IRCCS San Camillo, Venezia, Italy

Venice, , Italy

Site Status

Countries

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Italy

References

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Cheung VC, Piron L, Agostini M, Silvoni S, Turolla A, Bizzi E. Stability of muscle synergies for voluntary actions after cortical stroke in humans. Proc Natl Acad Sci U S A. 2009 Nov 17;106(46):19563-8. doi: 10.1073/pnas.0910114106. Epub 2009 Oct 30.

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Piron L, Turolla A, Agostini M, Zucconi C, Tonin P, Piccione F, Dam M. Assessment and treatment of the upper limb by means of virtual reality in post-stroke patients. Stud Health Technol Inform. 2009;145:55-62.

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Piron L, Turolla A, Agostini M, Zucconi CS, Ventura L, Tonin P, Dam M. Motor learning principles for rehabilitation: a pilot randomized controlled study in poststroke patients. Neurorehabil Neural Repair. 2010 Jul-Aug;24(6):501-8. doi: 10.1177/1545968310362672.

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Lencioni T, Fornia L, Bowman T, Marzegan A, Caronni A, Turolla A, Jonsdottir J, Carpinella I, Ferrarin M. A randomized controlled trial on the effects induced by robot-assisted and usual-care rehabilitation on upper limb muscle synergies in post-stroke subjects. Sci Rep. 2021 Mar 5;11(1):5323. doi: 10.1038/s41598-021-84536-8.

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Turolla A, Venneri A, Farina D, Cagnin A, Cheung VCK. Rehabilitation Induced Neural Plasticity after Acquired Brain Injury. Neural Plast. 2018 May 10;2018:6565418. doi: 10.1155/2018/6565418. eCollection 2018. No abstract available.

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Carpinella I, Lencioni T, Bowman T, Bertoni R, Turolla A, Ferrarin M, Jonsdottir J. Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial. J Neuroeng Rehabil. 2020 Jan 30;17(1):10. doi: 10.1186/s12984-020-0646-1.

Reference Type DERIVED
PMID: 32000790 (View on PubMed)

Other Identifiers

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16/GR-2011-02348942

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2015.14

Identifier Type: -

Identifier Source: org_study_id

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