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StrokeH2-NeuroExoNCT02114450

Human-Machine System for the H2 Lower Limb Exoskeleton

A study testing Robot-assisted training with the H2 lower limb powered exoskeleton and Supervised motor practice in people with Stroke and Hemiparesis, run by University of Houston at 2 sites in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This research study will investigate the use of smart lower limb robotic exoskeleton (developed by the CSIC, Spain) in rehabilitation after stroke. It will compare robotic-assisted rehabilitation with supervised motor practice. Read more about this study

Who is it for?
Ages 18 to 75 yearsHealthy volunteers can take part
Conditions the study is for
Stroke, Hemiparesis
What is being tested?
Robot-assisted training with the H2 lower limb powered exoskeleton and Supervised motor practice
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
2 sitesUnited States
Study dates
20 Nov 2015to Dec 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

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 75 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Sub-acute or chronic stroke i.e., interval of at least 3 months or interval of at least 6 months from stroke to time of enrollment, respectively;
  • Cognitive ability to assimilate and participate actively in the treatment protocol (Mini Mental State Examination score > 24 points, out of a total 30 indicating normal cognitive ability);
  • Modified Rankin scale scores 2-4 (Mild-Moderate functional disability post-stroke);
  • Modified Ashworth Scale of Spasticity score <= 2 (ranges from 0-4 with 4 reflecting maximum spasticity);
  • Have no skin integrity issues;
  • Sufficient passive range of motion at the hip (at least 90 deg flexion, 15-20 deg extension), knee (90 deg flexion, complete extension) and ankle (15 deg dorsiflexion, 15 deg plantarflexion);
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  • Have no contraindications to standing or walking; able to stand with assistive device for at least 5 minutes, and able to walk with assistive device for 10 m.
  • Able to understand and sign the consent form
  • Age 18-75 years

Who cannot join

  • Severe cognitive and/or visual deficit;
  • Hemineglect (determined based on medical record or initial clinical assessment);
  • Severe sensory deficit;
  • Joint contractures of any extremity that limits normal range of motion during ambulation with assistive devices;
  • Skin lesions that may hinder or prevent the application of exoskeleton;
  • Uncontrolled angina;
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  • Severe chronic obstructive pulmonary disease;
  • Other medical contraindications; any medical co-morbidities that would prevent standard rehabilitation.
  • History of neurological, neuromuscular or physical disability.

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Jose L Contreras-Vidal, PhD contact

713-743-4429

jlcontreras-vidal@UH.EDU

United States2 sites, 2 recruiting
  • TIRR Memorial Hermann Hospital

    Houston, Texas, 77056

    Gerard E Francisco, MD, 713-797-5244, gerard.e.francisco@uth.tmc.edu

    Shuo-Hsiu Chang, PT, PhD, 713-799-7016, Shuo-Hsiu.Chang@uth.tmc.edu

    Not yet recruiting
  • University of Houston

    Houston, Texas, 77204

    Jose L Contreras-Vidal, PhD, 713-743-4429, jlcontreras-vidal@uh.edu

    Jose L Contreras-Vidal, PhD

    Recruiting

Other trials in United States

About this study

Official title: Human Machine Interface System With the H2 Lower Limb Exoskeleton for Rehabilitation

This research study will investigate the use of smart lower limb robotic exoskeleton (developed by the CSIC, Spain) in rehabilitation after stroke. It will compare robotic-assisted rehabilitation with supervised motor practice. Additionally, it will also examine the use of noninvasive scalp electroencephalography (EEG) to learn specific brain wave patterns associated with learning to walk on the powered lower limb exoskeleton. The findings will be used to understand human-robot interaction and to design smart orthotic devices that can be controlled by thought activity and assist those that have lost all or part of their walking abilities.

Read the detailed description

Stroke is the leading cause of neurological disability in the United States and accounts for the poor physical health and the social dysfunction evident in survivors. Gait impairment is a large contributor to long-term disability and ambulatory function in daily living. Many patients, however, lose the ability to walk independently, and furthermore, a large proportion does not regain their normal walking speeds following a stroke. In this context, newer robotic-aided therapeutic tools such as "wearable" lower-limb robotic exoskeletons have been developed, which allow for the user to be augmented by mechanically actuated lower limb joints that can either completely or partially assist movements of the lower limb segments depending on the patient needs.

The H2 exoskeleton (developed by Technaid S.L., Spain) is an example of one such system that has hip, knee and ankle joints actuated for both lower limbs. These devices are very new, and therefore, systematic investigations of therapeutic benefits of these devices are lacking in the field. Further, the nature of plasticity in the brain triggered by wearing and training such exoskeletons is unknown. In this exploratory research study, the investigators aim to compare robotic-assisted rehabilitation using the H2 exoskeleton with supervised motor practice particularly in terms of functional recovery. Additionally, this study will also examine brain plasticity associated with robotic-assisted training using non-invasive scalp electroencephalography (EEG) and changes in lower limb joint kinematics during robotic-assisted training. Taken together, the findings from this research will be used to understand human-robot interaction and to design smart powered orthotic devices that can be controlled directly by brain activity and assist those that have lost all or part of their walking abilities due to neurological disease or injury. Moreover, this study will systematically track neuroplasticity associated with functional recovery after stroke, which will help determine optimal windows for treatment that would maximize therapeutic benefit. Lastly, it will also help characterize markers of learning to use these new devices, which will be important in the clinical setting for modifying and adapting rehabilitation protocols to suit changing needs of the patient (user).

Conditions
Stroke, Hemiparesis
Being tested
Robot-assisted training with the H2 lower limb powered exoskeleton, Supervised motor practice
Keywords
Stroke, Paresis, Gait rehabilitation, Human-Machine Interaction, Wearable Robotic Devices
Medical subject headings
Stroke, Paresis

What participants receive

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

  • Robot-assisted training with the H2 lower limb powered exoskeletonBehavioural

    The H2 is a powered, robotic lower limb exoskeleton with actuated hips, knees and ankles. A custom control algorithm has been implemented in this device, which allows for provision of assistance to lower limb segments during movement, dependent on user needs.

  • Supervised motor practiceBehavioural

    Supervised motor practice involves lower limb rehabilitation, primarily walking and other applicable lower limb exercises performed by participants under the guidance and supervision of a research physical therapist.

Study groups in NCT02114450
Study groupRoleWhat they receive
Robot-assisted RehabilitationExperimentalParticipants will receive Robot-assisted training with the H2 lower limb powered exoskeleton. They will perform walking and other lower limb exercises (as applicable) while wearing the H2 lower limb powered exoskeleton. Training will involve 3 sessions per week for 4 weeks, each lasting about 1.5 hours.
Receives: Behavioral: Robot-assisted training with the H2 lower limb powered exoskeleton
Supervised motor practiceActive comparatorParticipants in this group will perform walking and other lower limb exercises (as applicable) under the supervision of a research physical therapist. Training will be for 3 sessions per week for 4 weeks, each session lasting about 1.5 hours.
Receives: Behavioral: Supervised motor practice

What is being measured

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

  1. Change from baseline in Fugl-Meyer Assessment - Lower Extremity Motor Function

    This test evaluates and measures recovery in post-stroke hemiplegic patients, used in both clinical and research settings and is one of the most widely used quantitative measures of motor impairment. It uses an ordinal scale for scoring of 17 items for the lower limb component and 7 items on the Balance component of the F-M scale (0;con not perform; 1:can perform partially; 2:can perform fully). The total score ranges from 0 to 34, with higher scores representing better function.

    Measured: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months

  2. Change from baseline in Functional Gait Assessment

    This scale assesses postural stability during various walking tasks using a 10-item test with each item scored from 0 to 3 (0 = severe impairment and 3 = normal ambulation). This test has high criterion validity to assess functional status in stroke patients, and has been shown to be responsive to measure change.

    Measured: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months

  3. Change from baseline in Lower limb joint kinematics during walking

    Lower limb joint kinematics (bilateral hip, knee and ankle joints) will be assessed through surface motion sensors placed on the skin during walking. This assessment will help study and characterize subtle changes in lower limb kinematics pre- and post-intervention.

    Measured: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months

  4. Change in cortical dynamics measured by Electroencephalography (EEG)

    Time and frequency domain analysis will be performed on scalp EEG signals to characterize changes in cortical dynamics, specifically in gait initiation and sensory-motor cortical networks. Additionally, we will also evaluate the extent to which lower limb kinematics during gait can be reconstructed from scalp EEG of the user. This will be used to evaluate the neural basis of changes in lower limb joint motion as well as develop EEG-based brain-machine interfaces to robotic exoskeletons.

    Measured: Each Experimental/Training Session (12 visits) over the 4 week training period

Secondary outcomes (4)
  1. Change in robotic measure of performance measured by the H2

    The amount of assistance provided by robotic joint motors will be monitored across treatment sessions. This will help better understand human-robotic interaction while walking with the H2, and also help characterize changes in human adaptation while using the device.

    Measured: Each Experimental/Training Session (12 visits) over the 4 week training period

  2. Change from baseline in Berg Balance Scale score

    A 14-item objective measure designed to assess static balance and fall risk in adult populations, with maximum summed score of 56 (higher scores represent better functional outcome). This test has been widely used to measure functional recovery in stroke patients with high reliability.

    Measured: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months

  3. Change from baseline in distance walked during the 6-minute walk test

    This test assesses distance walked over 6 minutes as a sub-maximal test of aerobic capacity/endurance. It has good responsiveness to detect improvements in capacity to walk in stroke patients.

    Measured: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months

  4. Change from baseline in Timed Up and Go Test score

    This test assesses mobility, balance, walking ability, and fall risk in older adults. Scores range from 1 to 5 based on the observer's perception of the patient's risk of falling. This test has been used in assessing stroke recovery with high reliability and validity.

    Measured: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months

Timeline

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

  1. First posted15 Apr 2014 (estimated)
  2. Study start20 Nov 2015
  3. Primary completionDec 2027 (estimated)
  4. Study completionDec 2029 (estimated)

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
Basic science
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02114450
Sponsor's protocol ID
14107
Other IDs
HSC-MS-14-0129
Acronym
H2-NeuroExo
Status last verified
Oct 2024
First submitted
8 Apr 2014
Last updated
30 Oct 2024
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

  • M. Bortole and J.L. Pons, "Development of a Exoskeleton for Lower Limb Rehabilitation," in Converging Clinical and Engineering Research on Neurorehabilitation Biosystems & Biorobotics vol. 1, no. 14, Berlin, Heidelberg: Springer Berlin Heidelberg, 2013, pp. 85-90

  • Bortole M, Venkatakrishnan A, Zhu F, Moreno JC, Francisco GE, Pons JL, Contreras-Vidal JL. The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study. J Neuroeng Rehabil. 2015 Jun 17;12:54. doi: 10.1186/s12984-015-0048-y.

    PubMed 26076696
  • Contreras-Vidal JL, Bortole M, Zhu F, Nathan K, Venkatakrishnan A, Francisco GE, Soto R, Pons JL. Neural Decoding of Robot-Assisted Gait During Rehabilitation After Stroke. Am J Phys Med Rehabil. 2018 Aug;97(8):541-550. doi: 10.1097/PHM.0000000000000914.

    PubMed 29481376

Questions about this trial

What is this clinical trial studying?

A study testing Robot-assisted training with the H2 lower limb powered exoskeleton and Supervised motor practice in people with Stroke and Hemiparesis, run by University of Houston at 2 sites 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 9 inclusion and 9 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: looking for participants now, as of the sponsor's last update on 30 Oct 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Jose L Contreras-Vidal, PhD (713-743-4429, jlcontreras-vidal@UH.EDU), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change from baseline in Fugl-Meyer Assessment - Lower Extremity Motor Function (time frame: Baseline, Post-Intervention (within a week of completion), Follow-up at 2 weeks, Follow-up at 2 months). The study lists 4 primary outcomes in all. 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 NCT02114450, which also lists 3 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 30 Oct 2024.

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Human-Machine System for the H2 Lower Limb Exoskeleton | AzTrials