Combining Physical Therapy With Vestibular Stimulation to Improve Postural Stability in Pusher's Syndrome

NCT ID: NCT03831594

Last Updated: 2023-11-08

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

WITHDRAWN

Clinical Phase

NA

Study Classification

INTERVENTIONAL

Study Start Date

2018-11-01

Study Completion Date

2021-01-20

Brief Summary

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The study is evaluating the effect of combining Galvanic Vestibular Stimulation (GVS) with standard Physiotherapy treatment in patients admitted to a neurological rehabilitation unit with Pusher syndrome (PS). Patients will be randomised to receive standard Physiotherapy treatment or standard treatment with GVS.

Perceived verticality data will also be collected and analysed on age-matched controls. This data will be used to compare these results with the patients with PS.

The investigators hypothesis that GVS and standard Physiotherapy treatment will lead to a greater improvement in functional ability and awareness of perceived verticality compared to standard Physiotherapy alone.

Detailed Description

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Pusher syndrome (PS) can be described as disordered balance and orientation which causes patients to perceive they are in an upright position when in fact they are positioned towards their affected side. These patients use their unaffected limbs to 'push' themselves away from their unaffected side in an attempt to correct their perceived postural alignment. PS is a common disorder and can affect 16% of stroke patients.

Patients with PS have shown to take longer to improve in rehabilitation than non-PS patients and tend to stay in hospital for longer.

Galvanic Vestibular Stimulation (GVS) involves passing a small electrical current behind the ear to stimulate the vestibular system to in-turn cause the head and body to move.

Conditions

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Pusher Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Standard Physiotherapy and Galvanic Vestibular Stimulation

Standard physiotherapy concurrently with Galvanic Vestibular Stimulation for 45 minutes a day for two weeks (five days per week)

Group Type EXPERIMENTAL

Galvanic Vestibular Stimulation

Intervention Type DEVICE

Electrical current (under 1.5mA) applied to the mastoid processes to stimulate the balance organs in the inner ear

Standard Physiotherapy

Intervention Type OTHER

45 minutes of standard physiotherapy treating impairments and functional problems

Standard Physiotherapy

Standard Physiotherapy for 45 minutes a day for two weeks (five days per week)

Group Type ACTIVE_COMPARATOR

Standard Physiotherapy

Intervention Type OTHER

45 minutes of standard physiotherapy treating impairments and functional problems

Interventions

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Galvanic Vestibular Stimulation

Electrical current (under 1.5mA) applied to the mastoid processes to stimulate the balance organs in the inner ear

Intervention Type DEVICE

Standard Physiotherapy

45 minutes of standard physiotherapy treating impairments and functional problems

Intervention Type OTHER

Other Intervention Names

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Standard Physical Therapy

Eligibility Criteria

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Inclusion Criteria

* Identified hemiparetic neglect - identified PS from a stroke or acquired brain injury (using the Scale of Contraversive Pushing and The Burke Lateropulsion Scale)
* Consenting to participate in the trial


* 40 years old minimum age
* Consent to taking part in the trial

Exclusion Criteria

* Severe cognitive impairment
* Receptive aphasia
* Medical co-morbidities
* Opthalamic impairment
* Vestibular impairment
* Peripheral neuropathy
* Also any contraindications to GVS including:

* Brain metallic implants
* Pacemakers
* Recent brain surgery
* Skull defect
* Preceding epileptic seizures
* Sensitive skin behind the ears.


* Vestibular impairment
* History of medical/psychiatric/neurological disorders
* Currently taking any psychoactive medication
* Drunk more than 3 units of alcohol in the past 24 hours
Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Homerton University Hospital NHS Foundation Trust

OTHER

Sponsor Role collaborator

Imperial College London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Diego Kaski, PhD

Role: PRINCIPAL_INVESTIGATOR

Imperial College London

Locations

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Imperial College London

London, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Baccini M, Paci M, Nannetti L, Biricolti C, Rinaldi LA. Scale for contraversive pushing: cutoff scores for diagnosing "pusher behavior" and construct validity. Phys Ther. 2008 Aug;88(8):947-55. doi: 10.2522/ptj.20070179. Epub 2008 Jul 10.

Reference Type BACKGROUND
PMID: 18617579 (View on PubMed)

P. Azouvi (1996) Functional Consequences and Awareness of Unilateral Neglect: Study of an Evaluation Scale, Neuropsychological Rehabilitation, 6:2, 133-150, DOI: 10.1080/713755501

Reference Type BACKGROUND

Maggie J. Bailey, M. Jane Riddoch & Peter Crome (2004) Test-retest stability of three tests for unilateral visual neglect in patients with stroke: Star Cancellation, Line Bisection, and the Baking Tray Task, Neuropsychological Rehabilitation, 14:4, 403-419, DOI: 10.1080/09602010343000282

Reference Type BACKGROUND

Barra J, Marquer A, Joassin R, Reymond C, Metge L, Chauvineau V, Perennou D. Humans use internal models to construct and update a sense of verticality. Brain. 2010 Dec;133(Pt 12):3552-63. doi: 10.1093/brain/awq311. Epub 2010 Nov 19.

Reference Type BACKGROUND
PMID: 21097492 (View on PubMed)

Day BL, Severac Cauquil A, Bartolomei L, Pastor MA, Lyon IN. Human body-segment tilts induced by galvanic stimulation: a vestibularly driven balance protection mechanism. J Physiol. 1997 May 1;500 ( Pt 3)(Pt 3):661-72. doi: 10.1113/jphysiol.1997.sp022051.

Reference Type BACKGROUND
PMID: 9161984 (View on PubMed)

Fitzpatrick RC, Wardman DL, Taylor JL. Effects of galvanic vestibular stimulation during human walking. J Physiol. 1999 Jun 15;517 ( Pt 3)(Pt 3):931-9. doi: 10.1111/j.1469-7793.1999.0931s.x.

Reference Type BACKGROUND
PMID: 10358131 (View on PubMed)

Karnath HO, Johannsen L, Broetz D, Ferber S, Dichgans J. Prognosis of contraversive pushing. J Neurol. 2002 Sep;249(9):1250-3. doi: 10.1007/s00415-002-0824-z.

Reference Type BACKGROUND
PMID: 12242549 (View on PubMed)

Karnath HO, Broetz D. Understanding and treating "pusher syndrome". Phys Ther. 2003 Dec;83(12):1119-25.

Reference Type BACKGROUND
PMID: 14640870 (View on PubMed)

Karnath HO. Pusher syndrome--a frequent but little-known disturbance of body orientation perception. J Neurol. 2007 Apr;254(4):415-24. doi: 10.1007/s00415-006-0341-6. Epub 2007 Mar 25.

Reference Type BACKGROUND
PMID: 17385082 (View on PubMed)

Nakamura J, Kita Y, Yuda T, Ikuno K, Okada Y, Shomoto K. Effects of galvanic vestibular stimulation combined with physical therapy on pusher behavior in stroke patients: a case series. NeuroRehabilitation. 2014;35(1):31-7. doi: 10.3233/NRE-141094.

Reference Type BACKGROUND
PMID: 24990006 (View on PubMed)

Parton A, Malhotra P, Husain M. Hemispatial neglect. J Neurol Neurosurg Psychiatry. 2004 Jan;75(1):13-21.

Reference Type BACKGROUND
PMID: 14707298 (View on PubMed)

Perennou DA, Mazibrada G, Chauvineau V, Greenwood R, Rothwell J, Gresty MA, Bronstein AM. Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain. 2008 Sep;131(Pt 9):2401-13. doi: 10.1093/brain/awn170. Epub 2008 Aug 4.

Reference Type BACKGROUND
PMID: 18678565 (View on PubMed)

Utz KS, Korluss K, Schmidt L, Rosenthal A, Oppenlander K, Keller I, Kerkhoff G. Minor adverse effects of galvanic vestibular stimulation in persons with stroke and healthy individuals. Brain Inj. 2011;25(11):1058-69. doi: 10.3109/02699052.2011.607789. Epub 2011 Aug 31.

Reference Type BACKGROUND
PMID: 21879800 (View on PubMed)

Other Identifiers

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222784

Identifier Type: -

Identifier Source: org_study_id

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