AzTrials
AzTrials

StrokeNCT00891319

Electrical Stimulation for Recovery of Hand Function in Chronic Stroke Survivors

A study testing Electrical stimulator in people with Stroke and Hemiparesis, run by MetroHealth Medical Center at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

Impaired hand function is one of the most frequently persisting consequences of stroke. The purpose of this study is to compare two different treatments -- Contralataterally Controlled Functional Electrical Stimulation (CCFES) and Cyclic Neuromuscular Electrical Stimulation (cNMES) -- for improved recovery of hand… Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Stroke, Hemiparesis, Hemiplegia
What is being tested?
Electrical stimulator
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
80 participants
Where
1 siteUnited States
Study dates
Jan 2009to May 2015
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-80
  • > 6 months of first hemorrhagic or nonhemorrhagic stroke
  • Able to recall 2 of 3 items after 30 minutes
  • MRC ≤ 4 for finger extensors on paretic side
  • Able to follow 3-stage commands
  • Functional movement of shoulder and elbow (e.g., can reach ¾ hand-to- mouth movement) of paretic side
Show all 14Show fewer
  • Caregiver available to assist with device and compliance if needed
  • Skin intact on hemiparetic arm
  • Medically stable
  • Surface NMES trial opens hand without pain
  • Full volitional hand opening/closing of contralateral hand
  • Upper extremity hand section of FMA < 11/14
  • Able to hear and respond to stimulator/cue box auditory cues
  • Completed occupational therapy (no concomitant OT)

Who cannot join

  • Lack of functional PROM of the wrist or fingers of affected side
  • Severe shoulder or hand pain (unable to position hand in the workspace without pain)
  • Uncontrolled seizure disorder
  • Insensate forearm and/or hand
  • Uncompensated hemi-neglect (extinguishing to double simultaneous stimulation)
  • Edema of the affected forearm and/or hand
Show all 12Show fewer
  • History of cardiac arrhythmias with hemodynamic instability
  • Cardiac pacemaker or other implanted electronic system
  • Pregnant
  • IM Botox injections in any UE muscle in the last 3 months
  • Parkinson's disease, SCI, TBI, or MS
  • Ipsilateral motor neuron lesion

Trial locations and contacts

1 site in 1 country.

United States1 site
  • MetroHealth Medical Center

    Cleveland, Ohio, 44109

Other trials in United States

About this study

Official title: Contralaterally Controlled FES for Chronic Arm/Hand Hemiplegia: Single-Site RCT

Impaired hand function is one of the most frequently persisting consequences of stroke. The purpose of this study is to compare two different treatments -- Contralataterally Controlled Functional Electrical Stimulation (CCFES) and Cyclic Neuromuscular Electrical Stimulation (cNMES) -- for improved recovery of hand function after stroke.

Read the detailed description

Hemiparesis of the upper limb is one of the most serious and most common impairments resulting from stroke. Approximately 75% of the over 750,000 strokes that occur annually in the United States cause some degree of upper extremity paralysis. Approximately 65% of stroke survivors still cannot use their affected hand to assist with activities of daily living 6 months after their stroke. The impact of upper extremity impairments on disability and health is great, yet there are relatively few rehabilitation interventions designed to restore function to the impaired upper limb. Therefore, our long-term objective is to develop upper extremity rehabilitation therapies that are effective at restoring arm and hand function, that are applicable across a wide range of impairment severity, and that are readily implemented in the present healthcare environment.

The purpose of this study is to estimate the efficacy of Contralataterally Controlled Functional Electrical Stimulation (CCFES) in reducing upper extremity impairment and activity limitation in chronic upper extremity hemiplegia. CCFES is a rehabilitation intervention in which neuromuscular electrical stimulation (NMES) is applied to the finger and thumb extensor muscles of the paretic upper limb to open the hand. The stroke survivor controls the stimulation intensity, and consequent degree of hand opening, by modulating the degree of opening of the contralateral unimpaired hand, which is detected by an instrumented glove. Thus, volitional opening of the unaffected hand produces stimulated opening of the affected hand. The stimulation paradigm is used to assist the stroke survivor in practicing functional tasks with their affected hand. We will conduct a randomized controlled trial in which chronic stroke survivors (>6 months post-stroke) will be randomly assigned to receive 12 weeks of CCFES or cyclic NMES, an intervention that provides electrical stimulation of the hand extensors, but with preprogrammed timing and intensity. Randomization will be stratified on two levels of baseline hand impairment defined by the degree of voluntary finger extension present. Assessments of upper extremity impairment and activity limitation will be made every 3 weeks during the treatment period and every 2 months during a 6-month follow-up period.

This study is the first randomized controlled trial of CCFES in chronic upper extremity hemiplegia. Ultimately, the information learned in this study will serve to accelerate the development of treatments for reducing post-stroke disability.

Being tested
Electrical stimulator
Keywords
hand, stroke, hemiplegia, electrical stimulation, recovery
Medical subject headings
Stroke, Paresis, Hemiplegia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Electrical stimulatorDevice

    • 12-week intervention
    1. Therapist-guided task practice performed twice a week in the research laboratory. (Device used for CCFES group but not for cNMES group during these sessions.)
    2. Self-administered CCFES or cNMES-mediated hand opening exercise performed 10 sessions per week at home.
Study groups in NCT00891319
Study groupRoleWhat they receive
CCFESExperimentalCCFES - Contralaterally Controlled Functional Electrical Stimulation * Electrical stimulator * Stimulation to finger and thumb extensors only in response to, and with an intensity proportional to, opening of the contralateral unimpaired hand. * A glove instrumented with sensors and worn on the unimpaired hand detects the degree of hand opening and determines stimulation intensity. * Therapy sessions are done with the subject being assisted by the CCFES system.
Receives: Device: Electrical stimulator
cNMESActive comparatorcNMES - Cyclic NeuroMuscular Electrical Stimulation * Electrical stimulator * Preprogrammed cycles of finger and thumb extensor stimulation repeatedly and automatically open the hand. * Subject instructed to not move the contralateral arm/hand during stimulation. * Therapy sessions are done without the stimulation system.
Receives: Device: Electrical stimulator

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Box and Block Test Score at 6 Mo Post-Treatment

    The Box and Blocks test counts how many times the participant can pick up 1 block at t time, move it over a partition, and release it in a target area within 60 seconds.

    The minimum score is 0. There is no maximum score. The average score of healthy individuals within the age range of this study ranges from 70 to 79.

    Higher scores are considered to be a better outcome. For each individual, the score prior to treatment was subtracted from the score at 6 months after completion of treatment. Then for each treatment group, these change scores were averaged.

    Measured: 2 timepoints: Prior to treatment, and 6 months after completion of treatment.

Secondary outcomes (2)
  1. Change in Arm Motor Abilities Test Score at 6-Month Post-Treatment

    The Arm Motor Abilities Test assesses the participant's ability to execute specific upper limb tasks and does not allow for compensation with the unimpaired side. The test consists of 9 compound tasks composed of 1 to 3 component tasks, each of which is rated on a 0 - 5 ordinal scale: 0, no attempt to use affected limb; 1, attempt to use affected limb but it does not participate functionally; 2, affected limb is used only as a helper or stabilizer; 3, affected limb is used slowly or within synergy patterns; 4, almost normal use of affected limb; 5, normal use. The final score is the average of all component task scores across all 9 compound tasks.

    The minimum score is 0; maximum score is 5. Higher scores are considered to be a better outcome. For each individual, the score prior to treatment was subtracted from the score at 6 months after completion of treatment. Then for each treatment group, these change scores were averaged.

    Measured: 2 timepoints: Prior to treatment, and 6 months after completion of treatment.

  2. Change in Upper Extremity Fugl-Meyer Score at 6-Months Post-Treatment

    The Upper Extremity Fugl-Meyer (UEFM) Assessment is a measure of upper limb motor impairment. Participants are asked to attempt to perform a list of very specific movements of the arm, elbow, forearm, wrist, and hand that take into account synergy patterns, isolated strength, coordination, and hypertonia. Each movement attempt is graded on a 3-point ordinal scale (0, cannot perform; 1, perform partially; and 2, perform fully) and these subscores are summed to provide a maximum score of 66, minimum score of 0.

    Higher scores are considered to be a better outcome. For each individual, the score prior to treatment was subtracted from the score at 6 months after completion of treatment. Then for each treatment group, these change scores were averaged.

    Measured: 2 timepoints: Prior to treatment, and 6 months after completion of treatment.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 May 2009 (estimated)
  2. Study startJan 2009
  3. Primary completionMay 2015
  4. Study completionMay 2015

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
80 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00891319
Sponsor's protocol ID
R01HD059814
Other IDs
R01HD059814
Status last verified
Oct 2017
First submitted
25 Sep 2008
Last updated
6 Nov 2017
Data monitoring committee
No
FDA-regulated drug
No
Individual data sharing
No

Publications

  • Knutson JS, Harley MY, Hisel TZ, Chae J. Improving hand function in stroke survivors: a pilot study of contralaterally controlled functional electric stimulation in chronic hemiplegia. Arch Phys Med Rehabil. 2007 Apr;88(4):513-20. doi: 10.1016/j.apmr.2007.01.003.

    PubMed 17398254
  • Glanz M, Klawansky S, Stason W, Berkey C, Chalmers TC. Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials. Arch Phys Med Rehabil. 1996 Jun;77(6):549-53. doi: 10.1016/s0003-9993(96)90293-2.

    PubMed 8831470
  • Chae J, Bethoux F, Bohine T, Dobos L, Davis T, Friedl A. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke. 1998 May;29(5):975-9. doi: 10.1161/01.str.29.5.975.

    PubMed 9596245
  • Luft AR, McCombe-Waller S, Whitall J, Forrester LW, Macko R, Sorkin JD, Schulz JB, Goldberg AP, Hanley DF. Repetitive bilateral arm training and motor cortex activation in chronic stroke: a randomized controlled trial. JAMA. 2004 Oct 20;292(15):1853-61. doi: 10.1001/jama.292.15.1853.

    PubMed 15494583
  • Whitall J, McCombe Waller S, Silver KH, Macko RF. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000 Oct;31(10):2390-5. doi: 10.1161/01.str.31.10.2390.

    PubMed 11022069
  • Mudie MH, Matyas TA. Can simultaneous bilateral movement involve the undamaged hemisphere in reconstruction of neural networks damaged by stroke? Disabil Rehabil. 2000 Jan 10-20;22(1-2):23-37. doi: 10.1080/096382800297097.

    PubMed 10661755
  • Knutson JS, Gunzler DD, Wilson RD, Chae J. Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis: A Randomized Trial. Stroke. 2016 Oct;47(10):2596-602. doi: 10.1161/STROKEAHA.116.013791. Epub 2016 Sep 8.

    PubMed 27608819

Questions about this trial

What is this clinical trial studying?

A study testing Electrical stimulator in people with Stroke and Hemiparesis, run by MetroHealth Medical Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 14 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Nov 2017. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 6 Nov 2017). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Box and Block Test Score at 6 Mo Post-Treatment (time frame: 2 timepoints: Prior to treatment, and 6 months after completion of treatment.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00891319, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Nov 2017.

Free account

Log in to keep searching

You’ve used your 3 free searches. AzTrials is free: log in or create a free account to keep searching clinical trials and save the ones you want to follow.

Create a free accountLog in