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StrokeNCT02565407

Robot-aided Proprioceptive Rehabilitation Training

A study testing Proprioceptive training in people with Stroke and Peripheral Sensory Neuropathy, run by University of Minnesota 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
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Trial summary

This study investigates the effect of a robot-aided 2-day proprioceptive training of the wrist on the proprioceptive and motor function of the wrist/hand complex in patients with proprioceptive impairment. Read more about this study

Who is it for?
Ages 4 to 75 yearsHealthy volunteers can take part
Conditions the study is for
Stroke, Peripheral Sensory Neuropathy
What is being tested?
Proprioceptive training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
50 participants
Where
1 siteUnited States
Study dates
Oct 2015to 24 May 2021
Phase
Interventional
Are there results?
None posted in the registry

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

Who may be able to join

  • wrist passive range of motion (ROM) more than 22.5° in flexion/extension
  • sense the vibro-tactile cues on either forearms in order to effectively receive the movement-related feedback
  • resist minimal resistance in gravity-eliminated position (score at least 2+/5 with the physical examination of manual muscle testing (Hislop, Avers, \& Brown, 2013)) ) in all wrist movement directions.
  • at least 3 months after stroke
  • whose age are between 30 to 75 years old.
  • Exclusion Criteria for Subjects undergoing the TMS procedure (Rossi, Hallett, Rossini, \& Pascual-Leone, 2009)
Show all 11Show fewer
  • Has implanted metal in the body.
  • Diagnosed with multiple sclerosis, major psychiatric conditions, epilepsy, history of seizures in the past 2 years, sleep deprivation, pregnancy, uncontrolled migraine, major traumatic head injury, severe heart disease, increased intracranial pressure, high consumption of alcohol, any conditions that predispose one to seizures
  • Is currently taking any pro-epileptic medication (e.g. epileptogenic drugs such as tricyclic antidepressants)
  • When no electromyography response can be elicited within the range of the TMS stimulator
  • Pregnant at the time of data collection .

Who cannot join

  • Regular intake of benzodiazepines.
  • Cognitive impairment: score ≥ 23 on Mini-mental state examination (Folstein, Robins \& Helzer, 1983)
  • Depressive symptoms: score ≤ 19 on Beck depression inventory (Beck, Steer, \& Carbin,1988).

Trial locations and contacts

1 site in 1 country.

United States1 site
  • University of Minnesota

    Minneapolis, Minnesota, 55455

Other trials in United States

About this study

Official title: Robot-aided Proprioceptive Rehabilitation Training With Additional Vibro-tactile Feedback

This study investigates the effect of a robot-aided 2-day proprioceptive training of the wrist on the proprioceptive and motor function of the wrist/hand complex in patients with proprioceptive impairment. The wrist proprioceptive training consists of active movement training with augmented haptic and vibro-tactile feedback provided by a patented wrist robotic system (US Serial No. 62/136,065). This study protocol can be applied to a variety of clinical and non-clinical populations. The purpose of this study is to obtain preliminary data on the effectiveness of the proprioceptive training in subjects with cortical stroke or peripheral sensory neuropathy.

Read the detailed description

This protocol seeks to improve proprioceptive-motor function. Proprioception refers to the perception of limb position or motion and the orientation of one's body in space. Numerous medical conditions with motor symptoms are also associated with proprioceptive loss, such as osteoarthritis, Parkinson's disease, peripheral sensory neuropathy, stroke, and developmental coordination disorder.

However, therapies to improve proprioceptive function in these populations are either non-existent or very limited in scope although it is established that proprioceptive impairments severely degrade motor function. The proposed protocol focuses on proprioception for fine motor function of the hand/wrist joint complex, because hand/wrist motor control is highly important for activities of daily living.

The specific aims are to determine if a 2-day wrist proprioceptive training:

  1. improves limb position sense acuity,
  2. improves the spatial precision of wrist/hand motor tasks,
  3. increases the efficiency of performing such motor tasks,
  4. is associated with neural changes in cortical processing as measured by short-latency somatosensory evoke potentials (SEP) and motor evoked potentials (MEP) using transcranial magnetic stimulation.

The study follows a crossover design with two arms and two groups. Time frame for the completion of the study is up to 7 days depending on the start day of the week (Monday through Friday). No testing will occur on the weekend.

Group 1 will have the following time frame: Day 1: pre-test (approx. 3 hrs.) and training intervention (approx. 30 min.). Day 2: training intervention (approx. 30 min.) and post-test 1 (approx. 3 hrs.). Days 3-6: Usual care (min. of 2 days required). Days 5-7: Post-test 2 (depending on the start day of the week, it is either Day 5,6, or 7).

Group 2 will have the following time frame: Day 1: pre-test 1 (approx. 3 hrs.). Days 2-4: Usual care (min. of 2 days required). Days 4-6: pre-test 2 (approx. 3 hrs.) and training intervention (approx. 30 min.). Days 5-7: Training intervention and post-test 1 (depending on the start day of the week, it is either Day 5,6, or 7).

Being tested
Proprioceptive training, Usual care
Medical subject headings
Stroke

What participants receive

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

  • Proprioceptive trainingBehavioural

    Training includes a virtual balance board and center-out task. Small vibratory motors placed on forearms provide vibro-tactile movement feedback (VTF). During familiarization participants learn to associate VTF with wrist movement and visual feedback. Vision is occluded after this phase. In the virtual balance board task participants use wrist motion to roll a ball to a target on the board. VTF indicates the desired movement direction and ball velocity. The center-out task involves wrist motion to control a cursor to reach a target. The wrist robot delivers an assistive force towards the target. VTF signals magnitude and direction of the cursor deviating away from the desired path.

  • Usual careBehavioural

    Usual care refers to care that participants receive through their healthcare providers. It may range from no treatment to various sessions of occupational and physical therapy received at in- or outpatient rehabilitation clinics or at home.

Study groups in NCT02565407
Study groupRoleWhat they receive
Proprioceptive trainingExperimentalThis arm will receive specialized robot-aided proprioceptive training of the wrist next to usual care.
Receives: Behavioral: Proprioceptive training
Usual careActive comparatorThis arm will receive what participants have been receiving from their healthcare providers. It may range from no treatment to various sessions of occupational and physical therapy at home, day rehabilitation, or outpatient visits.
Receives: Behavioral: Usual care

What is being measured

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

  1. Joint position sense acuity of the wrist (just-noticeable-difference threshold)

    Using the wrist robot, the just-noticeable-difference threshold (JND) of wrist position will measured by a 2-alternative forced choice psychophysical paradigm. Participant's wrist will be passively flexed to two positions (the standard stimulus and the comparison stimuli) in random order. The standard stimulus is always 15° wrist flexion from neutral wrist position and the comparison stimulus is always larger than the standard. Participants indicate verbally which stimulus was perceived as having a larger amplitude. Unit is degrees.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

Secondary outcomes (8)
  1. Root-mean-square tracing error as a measure of movement accuracy

    Using the wrist robot, participants perform wrist movements to move a cursor on a screen. Task is to trace various template wave forms (saw tooth, sine wave, irregular, figure-of eight) displayed on the screen. The same procedure will be performed with a pen stylus on a digital tablet. The cursor position will be recorded continuously through the tracking task. Root-mean-square tracing error is calculated based on the difference between the cursor path and the template waveform. Unit is in mm.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  2. Movement time

    Movement time is the time it takes to complete either the tracing or pointing task. Unit is in seconds.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  3. Jerk cost as a measure of movement smoothness

    The jerk cost is defined as the integral of the first derivative of acceleration.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  4. Fugl-Meyer Assessment score

    Fugl-Meyer Assessment is a clinical instrument used to evaluate and measure recovery in post-stroke patients. Only the motor section for the upper extremity of the assessment is used (Fugl-Meyer et al., 1974). Range of possible scores is 0 [no recovery] - 66 [full recovery].

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  5. Nottingham Sensory Assessment score

    Erasmus-modified Nottingham Sensory Assessment is a clinical instrument to evaluate somatosensory function. For this study only the proprioception section of upper limb is used (Stolk-Hornsveld, Crow, Hendriks, Van Der Baan, \& Harmeling-Van Der Wel, 2006). Range of possible scores is 0 [absent] - 2 [intact].

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  6. Canadian Occupational Performance Measure (COPM)

    COPM is an evidence-based outcome measure designed to capture a patient's self-perception of performance in everyday living (Law et al., 1994). One to five activities will be chosen by the participant. Range of possible scores is 1 [poor performance and low satisfaction] - 10 [very good performance and high satisfaction] per activity.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  7. Mean somatosensory-evoked potential (SEP) latencies for N20 and N30

    SEPs after median nerve stimulation are recorded. The latencies for N20 and N30 will be identified. Unit is in milliseconds.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

  8. Peak-to-peak amplitude of motor-evoked potential (MEP)

    Single-pulse transcranial magnetic stimulation (TMS) is used to assess corticospinal excitability by eliciting MEP of the wrist extensor muscles using a method described by Samargia et al. (2014). Unit is millivolts.

    Measured: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.

Timeline

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

  1. First posted1 Oct 2015 (estimated)
  2. Study startOct 2015
  3. Primary completion1 Sep 2019
  4. Study completion24 May 2021

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
Crossover
Masking
None (open label)
Enrolment
50 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02565407
Sponsor's protocol ID
1505M72302
Status last verified
Sep 2021
First submitted
27 Aug 2015
Last updated
28 Sep 2021
Results posted
No
Data monitoring committee
Yes

Publications

  • Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical psychology review, 8(1), 77-100.

  • Bell-Krotoski JA, Fess EE, Figarola JH, Hiltz D. Threshold detection and Semmes-Weinstein monofilaments. J Hand Ther. 1995 Apr-Jun;8(2):155-62. doi: 10.1016/s0894-1130(12)80314-0.

    PubMed 7550627
  • Folstein MF, Robins LN, Helzer JE. The Mini-Mental State Examination. Arch Gen Psychiatry. 1983 Jul;40(7):812. doi: 10.1001/archpsyc.1983.01790060110016. No abstract available.

    PubMed 6860082
  • Fugl-Meyer AR, Jaasko L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.

    PubMed 1135616
  • Hislop, H., Avers, D., & Brown, M. (2013). Daniels and Worthingham's muscle testing: Techniques of manual examination and performance testing: Elsevier Health Sciences.

  • Law M, Polatajko H, Pollock N, McColl MA, Carswell A, Baptiste S. Pilot testing of the Canadian Occupational Performance Measure: clinical and measurement issues. Can J Occup Ther. 1994 Oct;61(4):191-7. doi: 10.1177/000841749406100403.

    PubMed 10137673
  • Rossi S, Hallett M, Rossini PM, Pascual-Leone A; Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009 Dec;120(12):2008-2039. doi: 10.1016/j.clinph.2009.08.016. Epub 2009 Oct 14.

    PubMed 19833552
  • Samargia S, Schmidt R, Kimberley TJ. Shortened cortical silent period in adductor spasmodic dysphonia: evidence for widespread cortical excitability. Neurosci Lett. 2014 Feb 7;560:12-5. doi: 10.1016/j.neulet.2013.12.007. Epub 2013 Dec 12.

    PubMed 24333913
  • Stolk-Hornsveld F, Crow JL, Hendriks EP, van der Baan R, Harmeling-van der Wel BC. The Erasmus MC modifications to the (revised) Nottingham Sensory Assessment: a reliable somatosensory assessment measure for patients with intracranial disorders. Clin Rehabil. 2006 Feb;20(2):160-72. doi: 10.1191/0269215506cr932oa.

    PubMed 16541937
  • Turgut N, Altun BU. Cortical disinhibition in diabetic patients with neuropathic pain. Acta Neurol Scand. 2009 Dec;120(6):383-8. doi: 10.1111/j.1600-0404.2009.01235.x.

    PubMed 19922582
  • Yeh IL, Holst-Wolf J, Elangovan N, Cuppone AV, Lakshminarayan K, Cappello L, Masia L, Konczak J. Effects of a robot-aided somatosensory training on proprioception and motor function in stroke survivors. J Neuroeng Rehabil. 2021 May 10;18(1):77. doi: 10.1186/s12984-021-00871-x.

    PubMed 33971912

Questions about this trial

What is this clinical trial studying?

A study testing Proprioceptive training in people with Stroke and Peripheral Sensory Neuropathy, run by University of Minnesota 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 11 inclusion and 3 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 28 Sep 2021. 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?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

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?

Joint position sense acuity of the wrist (just-noticeable-difference threshold) (time frame: For Group1: Change from pre-test at Day 1 (prior to training) to post-test 1 at Day 2. For Group 2: Change from pre-test 2 at Days 4-6 to post-test 1 at Days 5-7.). 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 NCT02565407, which also lists 11 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 28 Sep 2021.

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