H-reflex Measurement in Hemiplegic Stroke Patients

NCT ID: NCT04977531

Last Updated: 2021-07-27

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

Total Enrollment

60 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-08-01

Study Completion Date

2022-12-31

Brief Summary

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As human beings live longer, geriatric disease develop, one of which was stroke whose prevalence elevated by aging. Increased spasticity is a common symptom after stroke and may hinder patient from rehabilitation. The spasticity was evaluated by subjective judgement before. However, in the recent studies, the electrophysiological test, an objective evaluation, showed possibly positive correlation with the spasticity. They compared stroke patients' hemiplegic side with non-hemiplegic side by H/M ratio which showed significant difference. The stroke patients included in studies had stroke onset over 2 years. Therefore, investigators wonder if H/M ratio can evaluate spasticity in stroke patients onset within 2 years and if H/M ratio is correlated to spasticity.

Detailed Description

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Stroke is a condition that insufficient brain blood supply due to ischemia or hemorrhage causes brain cell death, which impacts normal function of motor, sensory, and speech, depending on the damaged location. Over the world wide, the incidence of stroke is 119 per 100,000 population per year with death rate up to 10-42% in one month after stroke. The survivor developed varying degrees of spasticity up to 42.6%.

In the conventional physical examination, modified Ashworth scale is used to evaluate spasticity, but its results may be influenced by temperature, joints range of motion, subjective judgement by tester or patient's nervousness. In the previous studies, spasticity between hemiplegic side and sound side showed significant difference in ratio of H/M amplitude, H/M threshold and H/M slope. Among them, H/M slope is the most sensitive tool and may be correlated to increased spasticity because H/M slope showed higher value in people with Brunnstrom stage III.

However, patients included in previous studies had disease onset over 2 years. The gold recovery stage after stroke is within 6 months. During this time, many methods can be used to reduce spasticity, such as medicine, stretching exercise, and injection. Therefore, it is very important whether H/M ratio for spasticity evaluation can be performed in patients with disease onset less than 2 years.

In our study, according to onset time, participants will be assigned to three groups: less than 6 months, 6 months to 2 years, and over 2 years. All the participants will accept electrophysiological test over four limbs to collect data of H/M ratio of slope, maximal amplitude and threshold. Hemiplegic side will be compared with sound side for significant difference. The relation between H/M ratio and modified Ashworth Scale will also be identified.

Conditions

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Stroke Hemiplegia Spasticity as Sequela of Stroke

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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6 months less

Stroke onset less than 6 months

No interventions assigned to this group

6 months to 2 years

Stroke onset between 6 months and 2 years

No interventions assigned to this group

over 2 years

Stroke onset over 2 years

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Single episode of stroke
* Single side hemiplegia after stroke

Exclusion Criteria

* Other diagnosis of neurovascular disease or major cardiovascular disease
* Poor cognition
* Poor cooperation
* Aphasia
* People who can not tolerate the exam
Minimum Eligible Age

20 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Heng-Yi, Shen

OTHER

Sponsor Role lead

Responsible Party

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Heng-Yi, Shen

Resident of Physical Medicine and Rehabilitation

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Szu-fu Chen, MD, PHD

Role: STUDY_DIRECTOR

Cheng-Hsin General Hospital

Central Contacts

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Heng-Yi Shen, MD

Role: CONTACT

+886911733228

Szu-fu Chen, MD, PHD

Role: CONTACT

+886-2-28264400

References

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Thrift AG, Thayabaranathan T, Howard G, Howard VJ, Rothwell PM, Feigin VL, Norrving B, Donnan GA, Cadilhac DA. Global stroke statistics. Int J Stroke. 2017 Jan;12(1):13-32. doi: 10.1177/1747493016676285. Epub 2016 Oct 28.

Reference Type BACKGROUND
PMID: 27794138 (View on PubMed)

Koton S, Schneider AL, Rosamond WD, Shahar E, Sang Y, Gottesman RF, Coresh J. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014 Jul 16;312(3):259-68. doi: 10.1001/jama.2014.7692.

Reference Type BACKGROUND
PMID: 25027141 (View on PubMed)

Bejot Y, Bailly H, Durier J, Giroud M. Epidemiology of stroke in Europe and trends for the 21st century. Presse Med. 2016 Dec;45(12 Pt 2):e391-e398. doi: 10.1016/j.lpm.2016.10.003. Epub 2016 Nov 2.

Reference Type BACKGROUND
PMID: 27816343 (View on PubMed)

Hendricks HT, van Limbeek J, Geurts AC, Zwarts MJ. Motor recovery after stroke: a systematic review of the literature. Arch Phys Med Rehabil. 2002 Nov;83(11):1629-37. doi: 10.1053/apmr.2002.35473.

Reference Type BACKGROUND
PMID: 12422337 (View on PubMed)

Wissel J, Verrier M, Simpson DM, Charles D, Guinto P, Papapetropoulos S, Sunnerhagen KS. Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention. PM R. 2015 Jan;7(1):60-7. doi: 10.1016/j.pmrj.2014.08.946. Epub 2014 Aug 27.

Reference Type BACKGROUND
PMID: 25171879 (View on PubMed)

Stowe AM, Hughes-Zahner L, Stylianou AP, Schindler-Ivens S, Quaney BM. Between-day reliability of upper extremity H-reflexes. J Neurosci Methods. 2008 May 30;170(2):317-23. doi: 10.1016/j.jneumeth.2008.01.031. Epub 2008 Mar 10.

Reference Type BACKGROUND
PMID: 18377996 (View on PubMed)

Aloraini SM, Gaverth J, Yeung E, MacKay-Lyons M. Assessment of spasticity after stroke using clinical measures: a systematic review. Disabil Rehabil. 2015;37(25):2313-23. doi: 10.3109/09638288.2015.1014933. Epub 2015 Feb 18.

Reference Type BACKGROUND
PMID: 25690684 (View on PubMed)

Funase K, Higashi T, Yoshimura T, Imanaka K, Nishihira Y. Evident difference in the excitability of the motoneuron pool between normal subjects and patients with spasticity assessed by a new method using H-reflex and M-response. Neurosci Lett. 1996 Jan 19;203(2):127-30. doi: 10.1016/0304-3940(95)12284-2.

Reference Type RESULT
PMID: 8834110 (View on PubMed)

Walton C, Kalmar J, Cafarelli E. Caffeine increases spinal excitability in humans. Muscle Nerve. 2003 Sep;28(3):359-64. doi: 10.1002/mus.10457.

Reference Type RESULT
PMID: 12929197 (View on PubMed)

Phadke CP, Robertson CT, Condliffe EG, Patten C. Upper-extremity H-reflex measurement post-stroke: reliability and inter-limb differences. Clin Neurophysiol. 2012 Aug;123(8):1606-15. doi: 10.1016/j.clinph.2011.12.012. Epub 2012 Jan 23.

Reference Type RESULT
PMID: 22277759 (View on PubMed)

Higashi T, Funase K, Kusano K, Tabira T, Harada N, Sakakibara A, Yoshimura T. Motoneuron pool excitability of hemiplegic patients: assessing recovery stages by using H-reflex and M response. Arch Phys Med Rehabil. 2001 Nov;82(11):1604-10. doi: 10.1053/apmr.2001.25081.

Reference Type RESULT
PMID: 11689982 (View on PubMed)

Other Identifiers

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(868)110-14

Identifier Type: -

Identifier Source: org_study_id

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