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Cerebral Palsy, MixedNCT03744884

Movement Characterization in Spastic/Dystonic Cerebral Palsy Using Haptic Feedback in Virtual Reality

A study testing Force efforts with haptic feedback in virtual reality. in people with Cerebral Palsy, Mixed and Cerebral Palsy, Spastic, run by University of Illinois at Urbana-Champaign at 1 site in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This game-like intervention using virtual reality will provide an objective and quantitative characterization of dystonia and spasticity presentations in cerebral palsy, even if combined, through the process of motor learning. Read more about this study

Who is it for?
Ages 7 to 17 yearsHealthy volunteers can take part
What is being tested?
Force efforts with haptic feedback in virtual reality.
Could I receive a placebo?
No, everyone receives an active treatment
How many people
68 participants
Where
1 siteUnited States
Study dates
1 Dec 2018to 1 Jan 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 7 to 17 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Between ages 7 and 17
  • Have been diagnosed with dystonic or spastic/dystonic cerebral palsy, for the cerebral palsy groups, or have no neuromuscular conditions, for typically developing groups
  • Have mild to no difficulty understanding conversations compared to others of the same age
  • Communicates age appropriately or with some difficulty but a new listener can understand
  • Have no uncorrected vision
  • Have hearing without the need of a hearing aid
Show all 16Show fewer
  • Have no other neural, neuromuscular, or musculoskeletal conditions
  • Participation in stable school and/or private physical or occupational therapy with a frequency no greater than two sessions per week, for cerebral palsy groups
  • Have no changes in medication for the six months previous to enrollment in the study
  • Be medically stable
  • Have no other concurrent illness
  • Have not received any Botox treatment within three months previous to the initiation of the study
  • No use of cardiac pacemakers, hearing aids, or another electronic implanted device
  • Absence of allergy to silver or skin adhesives
  • Have never had seizures
  • Have Manual Ability Classification System (MACS) score I-III

Who cannot join

  • Not meeting ALL inclusion criteria

Trial locations and contacts

1 site in 1 country.

Citlali Lopez-Ortiz, PhD contact

217-300-1022

lopezort@illinois.edu

Reika McNish, BA contact

217-244-9336

rmcnish2@illinois.edu

United States1 site, 1 recruiting
  • University of Illinois at Urbana-Champaign

    Urbana, Illinois, 61801

    Citlali Lopez-Ortiz, MA. PhD, 217-300-1022, lopezort@illinois.edu

    Recruiting

Other trials in United States

About this study

Official title: Movement Impairment Characterization and Rehabilitation for Spastic/Dystonic Cerebral Palsy Using Robotic Haptic Feedback in Virtual Reality

This game-like intervention using virtual reality will provide an objective and quantitative characterization of dystonia and spasticity presentations in cerebral palsy, even if combined, through the process of motor learning. This intervention could have a therapeutic benefit in the rehabilitation of children with cerebral palsy.

Read the detailed description

Cerebral palsy is the most common developmental motor disorder in children. Individuals with cerebral palsy demonstrate abnormal muscle tone and motor control. Within the population of children with cerebral palsy, between 4% and 17% present dystonic symptoms and between 80% to 95% of cases present spasticity. In many cases spasticity and dystonia are present in the same child and accurate diagnosis may be challenging.

This study consists of a randomized controlled trial that uses a virtual reality game-based intervention incorporating fully-automated robotic haptic feedback to aid the the objective, quantitative diagnosis of spasticity and dystonia u=in CP. The study consists of face-to-face assessments of movement before, after, and one-month following the completion of the six-session game-based intervention. Children with spastic/dystonic cerebral palsy and typically developing children between the ages of 7 and 17 will be recruited for this study. The investigators anticipate to recruit a total of 68 participants, 34 with cerebral palsy and 34 typically developing. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method. Movement outcomes will be examined for changes in quantitative and clinical measures in children with spastic/dystonic cerebral palsy and typically developing children to aid on the classification of movement disorders. Pair t-tests will be conducted on movement outcomes for both groups of children independently. Positive and negative results will be reported and addressed.

Being tested
Force efforts with haptic feedback in virtual reality.
Keywords
Virtual reality, Haptic feedback, Robotic
Medical subject headings
Cerebral Palsy

What participants receive

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

  • Force efforts with haptic feedback in virtual reality.Behavioural

    A virtual reality game-based intervention incorporating fully-automated robotic haptic feedback. The study consists of face-to-face assessments of movement before, after, and one-month following the completion of the six-session game-based intervention. Children with spastic/dystonic cerebral palsy between the ages of 7 and 17 will be recruited for this study along with a group of typically developing children in the same age range. Both groups of children will be randomly allocated into an intervention or control group using a blocked randomization method.

Study groups in NCT03744884
Study groupRoleWhat they receive
CP intervention groupExperimentalForce efforts with haptic feedback in virtual reality for participants with CP.
Receives: Behavioral: Force efforts with haptic feedback in virtual reality.
CP control groupNo interventionRegular activity control group, for participants with CP.
TD intervention groupExperimentalForce efforts haptic feedback in virtual reality. The intervention will be the same as the CP intervention group but for typically developing participants.
Receives: Behavioral: Force efforts with haptic feedback in virtual reality.
TD control groupNo interventionRegular activity control group, same as CP no intervention group, but for typically developing participants.

What is being measured

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

  1. Smoothness Index

    The smoothness index will be measured by analyzing the the integrated accelerometry signals of sensors placed on the upper limbs. Accelerometry data will be integrated to calculate the smoothness index on the velocity profile of the trajectories.

    The maximum value is 0, being the greatest level of smoothness that can be measured, and the minimum is minus infinity. A value closer to 0 is desired.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

Secondary outcomes (9)
  1. Surface electromyography

    Surface electromyography (sEMG) data will be collected during the execution of a first port de bras. The first port de bras will follow the format from the Royal Academy of Dance as demonstrated (Figure 1). Data will be analyzed changes in muscle activity patterns as a secondary outcome measure. The sEMG data will also be acquired during maximum voluntary efforts. For calibration of game-playing.

    Measured: Tested during the assessment sessions and on the first and last day of gameplay spanning over a 6 to 7 week period.

  2. Forces and torques against force sensor during gampeplay and in robotic zero-force channel

    This involves a force/torque sensor mounted in the end effector of the robot. A pre-determined zero-force path has been programmed by the research team to allow the robot to move through straight lines connected to five points on a vertical plane. The participants will hold a gripper mounted on the force transducer and attempt to move the end effector of the robot along the zero-force path. The force transducer will measure the forces exerted by the participant as they do so. Force and torque signals will be collected during all game-playing sessions. The calibration for game playing involves a maximum voluntary effort by the participant's dominant arm against the sensor mounted on a sturdy table. Participants will also be assessed with the force sensor in fourteen different directions at 30% ± 10% of the maximal voluntary effort across all directions.

    Measured: Tested during the assessment sessions and on the first and last day of gameplay spanning over a 6 to 7 week period.

  3. Montreal Spasticity Rating Test (MSRT)

    The MSRT is a quantitative measure the onset of the stretch reflex that that correlates with clinical spasticity and shows good test re-test reliability

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

  4. Dyskinesia Impairment Scale (DIS)

    The Dyskinesia Impairment Scale (DIS) measures the severity of dystonia and choreoathetosis when an individual is at rest or moving. It was found to show good to excellent reliability and validity. Scores range from 0 to 4 for both duration and amplitude of each criterion. A score of 0 most corresponds to movement of healthy people without movement disorders. The highest score possible score is 576 indicating the most server level of impairs,ent. There are two sub scales: Dystonia and Choreoathetosis that have a range of 0-288 each. The total score is obtained by addition of the two subscores.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

  5. Selective Control of the Upper Extremity Scale (SCUES)

    The Selective Control of the Upper Extremity Scale (SCUES) is a video-based tool to measure selective control of upper limb tasks. Psychometric analysis shows "comparable validity to other accepted video-based clinical assessment tools for the upper extremity in children with CP " with content validity ratio values indicating substantial agreement for most items. Scores are assigned for each assessed joint and can be rated as M3, M2, M1, or M0 with M3 representing normal selective motor control and M0 representing no selective motor control.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

  6. Quality of Upper Extremity Skills Test (QUEST)

    The QUEST is 36 items in length and measures upper limb movement, hand function, and cooperativeness in children with CP. It has been found to be reliable to assess children with CP between 18 months and 8 years of age, with increased reliability in children up to 12 years of age [30]. It has also been found to show adequate to excellent validity.

    Initial scores range from 50 to 100, which are then standardized to be between 0 and 100. The initial score is summed by scoring the ability to complete an item according to specification as 2 points, not being able to, not willing to, or not administerable as 1 point, and minus 1 point for abnormal movement in the posture section of the assessment. The standardized score is found by dividing the sum of scores for each section tested by the total number of sections tested.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

  7. Tardieu scale

    The Tardieu scale examines spasticity with quantified measures of the responses of stretch reflexes. This scale shows high test retest and poor to moderate inter-rater reliability; the Tardieu scale performs better than other similar measures, indicating it may be more reliable.

    Scores of quality of muscle reaction range from 0 to 5 with 0 being no resistance throughout passive movement and 5 being an immobile joint.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

  8. World Health Organization Disability Assessment Schedule 2 Children and Youth (WHODAS II - CY)

    The WHODAS II - CY is a self-report 36 item document that assesses daily issues surrounding health conditions such as illnesses, injuries, and problems with mental health. In a validity study, it was found to show good reliability; however, limitations regarding options for those without significant disabilities were present.

    Each item can be scored from 1 to 5, with 1 indicating none and 5 indicating extreme or cannot do. Each item is scored, summed within the domain it is in, and the average is taken for each domain. The averages are summed and converted to a metric ranging from 0 to 100 where 0 indicates no disability and 100 indicating severe disability.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

  9. Qualitative Feedback Module

    Multiple choice patient satisfaction questionnaire. Scores range from 0 to 5 for each item similar to the Wong-Baker FACES Pain Rating Scale with 0 indicating highest satisfaction and 5 indicating highest dissatisfaction.

    Measured: Tested during the assessment sessions spanning over a 6 to 7 week period.

Timeline

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

  1. First posted16 Nov 2018
  2. Study start1 Dec 2018
  3. Primary completion1 Jan 2021 (estimated)
  4. Study completion1 Jan 2021 (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
Diagnosis
Allocation
Randomised
Intervention model
Parallel groups
Model description
A group of children with dystonic or spastic/dystonic cerebral palsy and a group of typical developing children will be randomly assigned to an intervention or control group. The control group will only attend assessment sessions whereas the intervention group will attend both the assessment and intervention sessions.
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
68 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03744884
Sponsor's protocol ID
18476
Status last verified
Dec 2019
First submitted
26 Oct 2018
Last updated
3 Jan 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Christensen D, Van Naarden Braun K, Doernberg NS, Maenner MJ, Arneson CL, Durkin MS, Benedict RE, Kirby RS, Wingate MS, Fitzgerald R, Yeargin-Allsopp M. Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008. Dev Med Child Neurol. 2014 Jan;56(1):59-65. doi: 10.1111/dmcn.12268. Epub 2013 Oct 1.

    PubMed 24117446
  • Paneth N. Establishing the diagnosis of cerebral palsy. Clin Obstet Gynecol. 2008 Dec;51(4):742-8. doi: 10.1097/GRF.0b013e318187081a.

    PubMed 18981799
  • Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, Dan B, Jacobsson B. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007 Feb;109:8-14.

    PubMed 17370477
  • Liptak GS. Health and well being of adults with cerebral palsy. Curr Opin Neurol. 2008 Apr;21(2):136-42. doi: 10.1097/WCO.0b013e3282f6a499.

    PubMed 18317270
  • Rice J, Skuza P, Baker F, Russo R, Fehlings D. Identification and measurement of dystonia in cerebral palsy. Dev Med Child Neurol. 2017 Dec;59(12):1249-1255. doi: 10.1111/dmcn.13502. Epub 2017 Aug 8.

    PubMed 28786476
  • Sanger TD, Delgado MR, Gaebler-Spira D, Hallett M, Mink JW; Task Force on Childhood Motor Disorders. Classification and definition of disorders causing hypertonia in childhood. Pediatrics. 2003 Jan;111(1):e89-97. doi: 10.1542/peds.111.1.e89.

    PubMed 12509602
  • Sanger TD. Arm trajectories in dyskinetic cerebral palsy have increased random variability. J Child Neurol. 2006 Jul;21(7):551-7. doi: 10.1177/08830738060210070201.

    PubMed 16970842
  • Sellier E, Platt MJ, Andersen GL, Krageloh-Mann I, De La Cruz J, Cans C; Surveillance of Cerebral Palsy Network. Decreasing prevalence in cerebral palsy: a multi-site European population-based study, 1980 to 2003. Dev Med Child Neurol. 2016 Jan;58(1):85-92. doi: 10.1111/dmcn.12865. Epub 2015 Aug 28.

    PubMed 26330098
  • Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DL, Becher JG, Gaebler-Spira D, Colver A, Reddihough DS, Crompton KE, Lieber RL. Cerebral palsy. Nat Rev Dis Primers. 2016 Jan 7;2:15082. doi: 10.1038/nrdp.2015.82.

    PubMed 27188686
  • Cramer SC, Sur M, Dobkin BH, O'Brien C, Sanger TD, Trojanowski JQ, Rumsey JM, Hicks R, Cameron J, Chen D, Chen WG, Cohen LG, deCharms C, Duffy CJ, Eden GF, Fetz EE, Filart R, Freund M, Grant SJ, Haber S, Kalivas PW, Kolb B, Kramer AF, Lynch M, Mayberg HS, McQuillen PS, Nitkin R, Pascual-Leone A, Reuter-Lorenz P, Schiff N, Sharma A, Shekim L, Stryker M, Sullivan EV, Vinogradov S. Harnessing neuroplasticity for clinical applications. Brain. 2011 Jun;134(Pt 6):1591-609. doi: 10.1093/brain/awr039. Epub 2011 Apr 10.

    PubMed 21482550
  • Sukal-Moulton T, Clancy T, Zhang LQ, Gaebler-Spira D. Clinical application of a robotic ankle training program for cerebral palsy compared to the research laboratory application: does it translate to practice? Arch Phys Med Rehabil. 2014 Aug;95(8):1433-40. doi: 10.1016/j.apmr.2014.04.010. Epub 2014 May 2.

    PubMed 24792141
  • Beveridge B, Feltracco D, Struyf J, Strauss E, Dang S, Phelan S, Wright FV, Gibson BE. "You gotta try it all": Parents' Experiences with Robotic Gait Training for their Children with Cerebral Palsy. Phys Occup Ther Pediatr. 2015;35(4):327-41. doi: 10.3109/01942638.2014.990547. Epub 2014 Dec 20.

    PubMed 25529412
  • Chen K, Ren Y, Gaebler-Spira D, Zhang LQ. Home-based tele-assisted robotic rehabilitation of joint impairments in children with cerebral palsy. Annu Int Conf IEEE Eng Med Biol Soc. 2014;2014:5288-91. doi: 10.1109/EMBC.2014.6944819.

    PubMed 25571187
  • Krebs HI, Fasoli SE, Dipietro L, Fragala-Pinkham M, Hughes R, Stein J, Hogan N. Motor learning characterizes habilitation of children with hemiplegic cerebral palsy. Neurorehabil Neural Repair. 2012 Sep;26(7):855-60. doi: 10.1177/1545968311433427. Epub 2012 Feb 13.

    PubMed 22331211
  • Fasoli SE, Fragala-Pinkham M, Hughes R, Krebs HI, Hogan N, Stein J. Robotic therapy and botulinum toxin type A: a novel intervention approach for cerebral palsy. Am J Phys Med Rehabil. 2008 Dec;87(12):1022-5. doi: 10.1097/PHM.0b013e31817fb346.

    PubMed 18617860

Questions about this trial

What is this clinical trial studying?

A study testing Force efforts with haptic feedback in virtual reality. in people with Cerebral Palsy, Mixed and Cerebral Palsy, Spastic, run by University of Illinois at Urbana-Champaign 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 16 inclusion and 1 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: status not confirmed, as of the sponsor's last update on 3 Jan 2020. 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?

Results are not available in the source record.

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

Contact Citlali Lopez-Ortiz, PhD (217-300-1022, lopezort@illinois.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Smoothness Index (time frame: Tested during the assessment sessions spanning over a 6 to 7 week period.). 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 NCT03744884, which also lists 54 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 3 Jan 2020.

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