Multimodal Platform Combining VR and TENS for Stroke Rehabilitation

NCT ID: NCT06400823

Last Updated: 2024-12-09

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

40 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-04-22

Study Completion Date

2026-06-01

Brief Summary

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Stroke is a disabling medical condition annually affecting up to 15 million people worldwide. It leads to upper-limb impairments encompassing motor and sensory deficits together with cognitive self-body and space misrepresentation, overall limiting the functional independence of 70% of stroke survivors. On the motor side, stroke could account for hemiparesis (weakness or paralysis affecting the side contralateral to the brain lesion), muscle weakness, spasticity, loss of coordination, and others. On the sensory side, especially in the first stages after the stroke occurs, stroke could account for sensory loss, with the patient not being able to perceive what he's touching with the impaired arm.On a cognitive level, it has been shown that chronic stroke patients have distorted body representation and space representation. They perceive their impaired arm as shorter and the impaired hand as larger.

Despite initial evidence of the crucial role of sensory-motor integration toward a restored body representation to promote effective rehabilitation, conventional approaches suffer from the bias of prioritizing motor recovery, while disregarding stroke-induced sensory and body representation deficits.

In this view, the creation of a virtual reality (VR) scenario in which the person is fully immersed, could potentially play a significant role in improving stroke patients' rehabilitation.

Taking this into consideration, this project aims to assess whether a multimodal platform combining VR with TENS inducing full-body illusion toward a virtual avatar could positively impact motor performances, sensory assessments, and self-body and space representation of stroke patients.

More into detail, the intervention will consist of the patient performing some task-oriented movement within the virtual reality and congruently tactile receiving feedback through transcutaneous electrical nerve stimulation. The subject will receive clear instruction within the virtual reality scenario to perform specific actions toward a final goal. These actions will be designed to make the subject repeat some crucial movements in their rehabilitation process. Depending on the motor impairment of the patient, the investigators will adapt the characteristics and the difficulty of the task accordingly.

Detailed Description

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Conditions

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Stroke

Keywords

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Virtual Reality TENS Stoke Task-oriented rehabilitation Multimodal intervention

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The study has a parallel design, with two different groups.

1. TENS+VR group
2. Conventional therapy group
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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VR+TENS

Patients will undergo goal-oriented movements for upper-limb rehabilitation in a VR scenario. While performing the movement, patients will receive synchronous electrical stimulation targeting the medial nerve. The provided sensation will stimulate the interaction with elements in the virtual world.

The intervention phase will last 3 weeks. Patients will undergo a minimum of three sessions per week (of around 60'). During each of these sessions, the first 10' will be employed for the calibration of the Transcutaneous Electrical Nerve Stimulation (TENS). In the remaining part of the session, subjects will perform some of the VR-based task-oriented games targeting different components.

Group Type EXPERIMENTAL

VR+TENS

Intervention Type OTHER

During the invention, patients will be in VR scenarios and play task-oriented games, interacting with elements that appear in the virtual world, to improve mobility and functional independence of the upper limbs.

The task-oriented games will target different components depending on the disability of the patient.

Conventional rehabilitation

Patients in the control group will perform physical conventional rehabilitation provided by the rehabilitation clinic.

The total amount of therapy will be the same as that of the VR+TENS group. The exercises will target the same components of the VR+TENS arm.

Group Type ACTIVE_COMPARATOR

Conventional rehabilitation

Intervention Type OTHER

Patients will perform conventional upper-limb stroke rehabilitation. The movement performed will be comparable with the movement performed in the VR+TENS group

Interventions

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VR+TENS

During the invention, patients will be in VR scenarios and play task-oriented games, interacting with elements that appear in the virtual world, to improve mobility and functional independence of the upper limbs.

The task-oriented games will target different components depending on the disability of the patient.

Intervention Type OTHER

Conventional rehabilitation

Patients will perform conventional upper-limb stroke rehabilitation. The movement performed will be comparable with the movement performed in the VR+TENS group

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Ischemic or haemorrhagic stroke patient
* At least 3 months after the stroke incident
* 10 \<= FMUE \<= 60 (motor function)

Exclusion Criteria

* Prior neurological or psychiatric disorders
* Severe cognitive impairment (MoCA score \<10)
* Epilepsy
* Pacemakers or other electronic implants
* Unable to give an informed consent form
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ETH Zurich (Switzerland)

OTHER

Sponsor Role collaborator

Institute Mihajlo Pupin

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Stanisa Raspopovic, PhD

Role: PRINCIPAL_INVESTIGATOR

Mihajlo Pupin Institute

Locations

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Clinic for rehabilitation dr Miroslav Zotovic

Belgrade, , Serbia

Site Status RECRUITING

Countries

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Serbia

Central Contacts

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Natalija Secerovic, PhD

Role: CONTACT

Phone: +381631268862

Email: [email protected]

Giuseppe Valerio Aurucci

Role: CONTACT

Phone: +393931595791

Email: [email protected]

Facility Contacts

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Olivera Djordjevic

Role: primary

References

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Edwards LL, King EM, Buetefisch CM, Borich MR. Putting the "Sensory" Into Sensorimotor Control: The Role of Sensorimotor Integration in Goal-Directed Hand Movements After Stroke. Front Integr Neurosci. 2019 May 22;13:16. doi: 10.3389/fnint.2019.00016. eCollection 2019.

Reference Type BACKGROUND
PMID: 31191265 (View on PubMed)

Bassolino M, Franza M, Guanziroli E, Sorrentino G, Canzoneri E, Colombo M, Crema A, Bertoni T, Mastria G, Vissani M, Sokolov AA, Micera S, Molteni F, Blanke O, Serino A. Body and peripersonal space representations in chronic stroke patients with upper limb motor deficits. Brain Commun. 2022 Aug 5;4(4):fcac179. doi: 10.1093/braincomms/fcac179. eCollection 2022.

Reference Type BACKGROUND
PMID: 35950092 (View on PubMed)

Doyle S, Bennett S, Fasoli SE, McKenna KT. Interventions for sensory impairment in the upper limb after stroke. Cochrane Database Syst Rev. 2010 Jun 16;2010(6):CD006331. doi: 10.1002/14651858.CD006331.pub2.

Reference Type BACKGROUND
PMID: 20556766 (View on PubMed)

Ingram LA, Butler AA, Brodie MA, Lord SR, Gandevia SC. Quantifying upper limb motor impairment in chronic stroke: a physiological profiling approach. J Appl Physiol (1985). 2021 Sep 1;131(3):949-965. doi: 10.1152/japplphysiol.00078.2021. Epub 2021 Jul 15.

Reference Type BACKGROUND
PMID: 34264125 (View on PubMed)

Odermatt IA, Buetler KA, Wenk N, Ozen O, Penalver-Andres J, Nef T, Mast FW, Marchal-Crespo L. Congruency of Information Rather Than Body Ownership Enhances Motor Performance in Highly Embodied Virtual Reality. Front Neurosci. 2021 Jul 2;15:678909. doi: 10.3389/fnins.2021.678909. eCollection 2021.

Reference Type BACKGROUND
PMID: 34295219 (View on PubMed)

Gladstone DJ, Danells CJ, Black SE. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002 Sep;16(3):232-40. doi: 10.1177/154596802401105171.

Reference Type BACKGROUND
PMID: 12234086 (View on PubMed)

Hsieh CL, Hsueh IP, Chiang FM, Lin PH. Inter-rater reliability and validity of the action research arm test in stroke patients. Age Ageing. 1998 Mar;27(2):107-13. doi: 10.1093/ageing/27.2.107.

Reference Type BACKGROUND
PMID: 16296669 (View on PubMed)

Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Haythornthwaite JA, Jensen MP, Kerns RD, Ader DN, Brandenburg N, Burke LB, Cella D, Chandler J, Cowan P, Dimitrova R, Dionne R, Hertz S, Jadad AR, Katz NP, Kehlet H, Kramer LD, Manning DC, McCormick C, McDermott MP, McQuay HJ, Patel S, Porter L, Quessy S, Rappaport BA, Rauschkolb C, Revicki DA, Rothman M, Schmader KE, Stacey BR, Stauffer JW, von Stein T, White RE, Witter J, Zavisic S. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008 Feb;9(2):105-21. doi: 10.1016/j.jpain.2007.09.005. Epub 2007 Dec 11.

Reference Type BACKGROUND
PMID: 18055266 (View on PubMed)

Other Identifiers

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VRTENSSTROKE

Identifier Type: -

Identifier Source: org_study_id