Upper Limb Mirror Therapy with Bilateral Transcutaneous Electrical Nerve Stimulation to Improve Upper Limb Functions in Patients with Stroke

NCT ID: NCT03631628

Last Updated: 2024-10-03

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

RECRUITING

Clinical Phase

NA

Total Enrollment

90 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-01

Study Completion Date

2024-12-31

Brief Summary

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This study compare the effectiveness of 2 rehabilitation programmes that use (1) MT with Bilateral TENS (Bi-TENS), (2) sham-MT with Bi-TENS (Bi-TENS), respectively, in addition to conventional rehabilitation of standardized upper limb training, in improving upper limb motor functions, activities of daily living, community integration, and quality of life in patients with stroke.

Detailed Description

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The principal aim of the proposed study will be to demonstrate whether MT with Bi-TENS is more effective than sham-MT with Bi-TENS in improving upper limb motor functions, activities of daily living, community integration and quality of life in patients with stroke.

The null hypothesis will be that MT with Bi-TENS is not significantly different from sham-MT with Bi-TENS in improving upper limb motor functions, activities of daily living, community integration, and quality of life in patients with stroke.

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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MT+ Bilateral TENS

All subjects will undergo 16 sessions of treatment (2 times per week, for 8 weeks). Subjects will receive 1.5 hours rehabilitation program: 30 minutes of MT+bilateral TENS and 1 hour conventional training of standardized upper limb training.

Group Type EXPERIMENTAL

Bilateral Transcutaneous electrical nerve stimulation (Bi-TENS)

Intervention Type DEVICE

The stimulator is a 120z Dual-Channel TENS Unit (ITO Physiotherapy \& Rehabilittaion, Co, Ltd, Tokyo, Japan). The TENS stimulation will be at 100 Hz, with 0.2 ms square pulses at an intensity of twice the sensory threshold (defined as the minimum intensity at which subject reported feeling a tingling sensation and below the motor threshold as indicated by the absence of muscle twitching, to provide sensory stimulation to both paretic and intact arms. Two pairs of disposable surface electrodes will be applied over the median nerve from the carpal tunnel to the flexor digitorum superficialis and the superficial radial nerve from the extensor pollicis longus to the extensor digitorum communis, with the cathode on the proximal site, and the anode on the distal site.

Mirror Therapy (MT)

Intervention Type BEHAVIORAL

A customised angle-adjustable frame with a mirror board will be used. All subjects are instructed to perform

1. Elbow flexion and extension exercise
2. Forearm pronation and supination exercise
3. Wrist flexion and extension exercise
4. Wrist radial and ulnar deviation exercise
5. Fingers opposition exercise
6. Gripping exercise

The subject will complete bilaterally upper limb exercises during the 30 minutes period.

Intact arm will be placed in front of mirror, and paretic arm will be placed behind the mirror.

Joints involved will be flexed and extended in full available range in sitting positon, in order to improve the active control of elbow joint, wrist joint and all fingers joint respectively.

Participants will be encouraged to focus on the image of intact arm when performing upper limb exercises bilaterally.

Conventional Rehabilitation Program

Intervention Type BEHAVIORAL

Standardized upper limb training

sham-MT+ Bilateral TENS

All subjects will undergo 16 sessions of treatment (2 times per week, for 8 weeks). Subjects will receive 1.5 hours rehabilitation program: 30 minutes of sham-MT+bilateral TENS and 1 hour conventional training of standardized upper limb training.

Group Type PLACEBO_COMPARATOR

Bilateral Transcutaneous electrical nerve stimulation (Bi-TENS)

Intervention Type DEVICE

The stimulator is a 120z Dual-Channel TENS Unit (ITO Physiotherapy \& Rehabilittaion, Co, Ltd, Tokyo, Japan). The TENS stimulation will be at 100 Hz, with 0.2 ms square pulses at an intensity of twice the sensory threshold (defined as the minimum intensity at which subject reported feeling a tingling sensation and below the motor threshold as indicated by the absence of muscle twitching, to provide sensory stimulation to both paretic and intact arms. Two pairs of disposable surface electrodes will be applied over the median nerve from the carpal tunnel to the flexor digitorum superficialis and the superficial radial nerve from the extensor pollicis longus to the extensor digitorum communis, with the cathode on the proximal site, and the anode on the distal site.

sham-Mirror Therapy (sham-MT)

Intervention Type BEHAVIORAL

A customised angle-adjustable frame with a mirror board will be used while the reflecting surface of the mirror was covered with paper. All subjects are instructed to perform

1. Elbow flexion and extension exercise
2. Forearm pronation and supination exercise
3. Wrist flexion and extension exercise
4. Wrist radial and ulnar deviation exercise
5. Fingers opposition exercise
6. Gripping exercise

The subject will complete bilaterally upper limb exercises during the 30 minutes period.

Intact arm will be placed in front of covered mirror, and paretic arm will be placed behind the covered mirror.

Joints involved will be flexed and extended in full available range in sitting positon, in order to improve the active control of elbow joint, wrist joint and all fingers joint respectively.

Conventional Rehabilitation Program

Intervention Type BEHAVIORAL

Standardized upper limb training

Interventions

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Bilateral Transcutaneous electrical nerve stimulation (Bi-TENS)

The stimulator is a 120z Dual-Channel TENS Unit (ITO Physiotherapy \& Rehabilittaion, Co, Ltd, Tokyo, Japan). The TENS stimulation will be at 100 Hz, with 0.2 ms square pulses at an intensity of twice the sensory threshold (defined as the minimum intensity at which subject reported feeling a tingling sensation and below the motor threshold as indicated by the absence of muscle twitching, to provide sensory stimulation to both paretic and intact arms. Two pairs of disposable surface electrodes will be applied over the median nerve from the carpal tunnel to the flexor digitorum superficialis and the superficial radial nerve from the extensor pollicis longus to the extensor digitorum communis, with the cathode on the proximal site, and the anode on the distal site.

Intervention Type DEVICE

Mirror Therapy (MT)

A customised angle-adjustable frame with a mirror board will be used. All subjects are instructed to perform

1. Elbow flexion and extension exercise
2. Forearm pronation and supination exercise
3. Wrist flexion and extension exercise
4. Wrist radial and ulnar deviation exercise
5. Fingers opposition exercise
6. Gripping exercise

The subject will complete bilaterally upper limb exercises during the 30 minutes period.

Intact arm will be placed in front of mirror, and paretic arm will be placed behind the mirror.

Joints involved will be flexed and extended in full available range in sitting positon, in order to improve the active control of elbow joint, wrist joint and all fingers joint respectively.

Participants will be encouraged to focus on the image of intact arm when performing upper limb exercises bilaterally.

Intervention Type BEHAVIORAL

sham-Mirror Therapy (sham-MT)

A customised angle-adjustable frame with a mirror board will be used while the reflecting surface of the mirror was covered with paper. All subjects are instructed to perform

1. Elbow flexion and extension exercise
2. Forearm pronation and supination exercise
3. Wrist flexion and extension exercise
4. Wrist radial and ulnar deviation exercise
5. Fingers opposition exercise
6. Gripping exercise

The subject will complete bilaterally upper limb exercises during the 30 minutes period.

Intact arm will be placed in front of covered mirror, and paretic arm will be placed behind the covered mirror.

Joints involved will be flexed and extended in full available range in sitting positon, in order to improve the active control of elbow joint, wrist joint and all fingers joint respectively.

Intervention Type BEHAVIORAL

Conventional Rehabilitation Program

Standardized upper limb training

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. have been diagnosed with ischemic brain injury or intracerebral hemorrhage by MRI or computed tomography within three weeks to 10 years after the first onset of stroke;
2. have volitional control of the non-paretic arm, and at least minimal antigravity movement in the shoulder of the paretic arm;
3. have at least 5 degrees in wrist extension of the paretic arm in the antigravity position
4. are able to score \> 6 of 10 of abbreviated Mental Test;
5. are able to follow instruction and give informed consent of the study.

Exclusion Criteria

1. Have any additional medical, cardiovascular and orthopedic condition that would hinder the proper assessment and treatment;
2. Use cardiac pacemakers;
3. Have receptive dysphasia;
4. Have a significant upper limb peripheral neuropathy (e.g., diabetic polyneuropathy);
5. Have severe shoulder, elbow, wrist or finger contractures that would preclude a passive range of motions of the arm;
6. Have skin allergy that would prevent electrical stimulation;
7. Are involved in drug studies or other clinical trials.
Minimum Eligible Age

50 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Hong Kong Polytechnic University

OTHER

Sponsor Role lead

Responsible Party

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Shamay Ng

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Shamay Ng, PhD

Role: PRINCIPAL_INVESTIGATOR

The Hong Kong Polytechnic University

Locations

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The Hong Kong Polytechnic University

Hong Kong, Hong Kong, Hong Kong

Site Status RECRUITING

Shatin Hospital

Hong Kong, Hong Kong, Hong Kong

Site Status RECRUITING

Countries

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Hong Kong

Central Contacts

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Shamay NG, PhD

Role: CONTACT

+852 2766-4889

Facility Contacts

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Shamay SM Ng, PhD

Role: primary

Shamay SM Ng, PhD

Role: backup

Shamay S M Ng, PhD

Role: primary

Other Identifiers

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2019_MT_TENS_UL

Identifier Type: -

Identifier Source: org_study_id

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