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Cerebral Palsy, SpasticCPSpastNCT04290169

Effect of Video Game-assisted and BoNT-A Injection Therapy on Spasticity, Activity and Participation in CP Patients

A study testing IncobotulinumtoxinA and Video game in people with Cerebral Palsy, Spastic, run by Sunnaas Rehabilitation Hospital.

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 The sponsor has not verified this record for over two years, so it may be out of date.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

Cerebral palsy (CP) is a non-progressive condition of the central nervous system caused by immature brain damage before, during or after birth. Persons affected by CP experience disability of various types. In individuals with CP, one of the most frequent symptoms is limited hand function. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Cerebral Palsy, Spastic
What is being tested?
IncobotulinumtoxinA and Video game
Could I receive a placebo?
No, everyone receives an active treatment
How many people
25 participants
Where
No sites listed yet
Study dates
17 Feb 2020to 1 Mar 2022
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 18 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults with CP (>= 18 years)
  • Spastic CP with one upper extremity affected
  • Grasp function and ability to open and close the hand actively
  • "Spastic hand and arm" as a prevalent finding verified by clinical examination
  • Ability to walk

Who cannot join

  • Musculoskeletal illnesses that affect limbs (e.g., arthrosis, rheumatoid arthritis and amputations).
  • BoNT-A treatment of upper limbs in the previous 6 months.
  • Orthopedic or neurosurgery procedures performed on the upper limbs in the last 12 months.
  • Wrist contracture that prevents patient to play video games
  • Severe cognitive deficits
  • Other neurological disorders and severe psychiatric illnesses
  • Active user of MCVG console at home

Trial locations and contacts

No sites are listed yet.

Jelena Simic, MD contact

0047 92839209

jelena.simic@sunnaas.no

Grethe Maanum, Phd contact

0047 91776982

grethe.manum@sunnaas.no

About this study

Official title: Utilizing Motion Controlled Video Games and Botulinum Toxin A Treatment to Improve Motor Function, Activity and Participation in Persons With Spastic Cerebral Palsy - a Single-subject Design Study

Cerebral palsy (CP) is a non-progressive condition of the central nervous system caused by immature brain damage before, during or after birth. Persons affected by CP experience disability of various types. In individuals with CP, one of the most frequent symptoms is limited hand function. Other issues that often occur are muscle weakness, spasticity and problems with balance.

Injection with Botulinum Toxin A (BoNT-A) is common treatment for spasticity in patients with injury in central nervous system, e.g. traumatic brain injury, stroke, spinal cord injuries and CP.The main goal of the project is to explore if motion controlled video game treatment alone or in combination with injection treatment with BoNT-A lead to improvement of hand function, activity and participation in adults with CP.

Read more

In the project, the investigators will evaluate if these two interventions improve balance in adults with CP.

Participants will be psychologically tested in the beginning and the end of the project to evaluate if interventions can have positive effect on psychological symptoms such as depression and anxiety, The project is multidisciplinary. It involves a doctor, a nurse, an occupational therapist, a physiotherapist and a psychologist. The team will in ordinary clinical practice examine participants. Individual goals will be set up in agreement with each participant. The goals will be measurable, achievable and time bound. By reviewing scope of agreed goals, the investigators will be able to summarize most frequent problems that CP patients experience in their daily life.

There will be 25 participants in the study and they will be followed for 9 months. During every visit the team will examine participants, perform relevant tests and obtain objective and subjective outcomes. It will be assessed to what degree the goals have been achieved.

The investigators also want to evaluate long term effects of the two intervention applied in the study. Therefore, the participants will be finally assessed 3 months after last intervention period.

Based on study results, implications for future treatment volume and organization of the rehabilitation for persons with spasticity will be discussed with the participating units, hospitals, municipalities and policy makers. Professionals included in this project are also clinicians and will have an important role in ensuring that the findings are included in clinical guidelines and educational activities.

Being tested
IncobotulinumtoxinA, Video game
Keywords
Cerebral palsy, Cognition, Spasticity, BoNT-A, Botulinum Toxin A, video game, balance, Upper extremity function
Medical subject headings
Cerebral Palsy, Muscle Spasticity

What participants receive

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

  • IncobotulinumtoxinADrug

    Also called Botulinum Toxin A, Xeomin, BoNT-A

    IncobotulinumtoxinA will be injected in upper extremities according to recommended guidelines. Two methods will be used in the study: auditive electromyography (EMG) and ultrasound guided injection technique. The decision process of which muscles to inject will be based on information obtained through examination of hand function, the presence of increased muscle tone during the clinical examination as well as a positive response from auditive EMG

  • Video gameDevice

    The study will include the Nintendo Switch or similar consoles that include games that require the players to move their bodies while holding motion controllers in order to progress. The games included in this project has been chosen by staff at our hospitals Virtual Gaming Lab. The participants are recommended to train 30 minutes each day, 4 days a week, during the training periods. It is expected that the amount of training will vary among the participants. Thus, each participant will be instructed to keep a training-diary and weekly report number of hours played/trained through an online reporting system created with "online form", an electronic data collection system available through the University of Oslo

Study groups in NCT04290169
Study groupRoleWhat they receive
Adults with hemiplegic spastic cerebral palsyOtherAdults (> 18 years old) with hemiplegic spastic cerebral palsy, with reduced hand function and spasticity as prevalent finding under clinical examination. Also these patients can walk but have problems with balance. Participants' cognitive function does not limit them to perform video game training.
Receives: Drug: IncobotulinumtoxinA; Device: Video game

What is being measured

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

  1. Goal Attainment Scale score at baseline

    Goal Attainment Scale (GAS), where the participant defines specific problem, e.g., activity limitations and participation restrictions caused by upper limb function difficulties, and evaluates to what extent the goal is achieved after treatment and/or training. GAS have previously been utilized to quantify the treatment effects of BoNT-A. Each participant in collaboration with clinicians formulates specific short-term and long-term goals that correspond to the International Classification of Functioning, Disability and Health (ICF) Activity and Participation levels. Minimum scale value -2 (least favorable outcome), Maximum scale value +2 (most favorable outcome)

    Measured: Baseline

  2. Goal Attainment Scale score after video games therapy

    Goal Attainment Scale (GAS), where the participant defines specific problem, e.g., activity limitations and participation restrictions caused by upper limb function difficulties, and evaluates to what extent the goal is achieved after treatment and/or training. GAS have previously been utilized to quantify the treatment effects of BoNT-A. Each participant in collaboration with clinicians formulates specific short-term and long-term goals that correspond to the International Classification of Functioning, Disability and Health (ICF) Activity and Participation levels. Minimum scale value -2 (least favorable outcome), Maximum scale value +2 (most favorable outcome)

    Measured: 3 months after baseline

  3. Goal Attainment Scale score 6 weeks after injection therapy with BoNT-A

    Goal Attainment Scale (GAS), where the participant defines specific problem, e.g., activity limitations and participation restrictions caused by upper limb function difficulties, and evaluates to what extent the goal is achieved after treatment and/or training. GAS have previously been utilized to quantify the treatment effects of BoNT-A. Each participant in collaboration with clinicians formulates specific short-term and long-term goals that correspond to the International Classification of Functioning, Disability and Health (ICF) Activity and Participation levels. Minimum scale value -2 (least favorable outcome), Maximum scale value +2 (most favorable outcome)

    Measured: 4.5 months after baseline

  4. Goal Attainment Scale score 3 months after injection therapy with BoNT-A

    Goal Attainment Scale (GAS), where the participant defines specific problem, e.g., activity limitations and participation restrictions caused by upper limb function difficulties, and evaluates to what extent the goal is achieved after treatment and/or training. GAS have previously been utilized to quantify the treatment effects of BoNT-A. Each participant in collaboration with clinicians formulates specific short-term and long-term goals that correspond to the International Classification of Functioning, Disability and Health (ICF) Activity and Participation levels. Minimum scale value -2 (least favorable outcome), Maximum scale value +2 (most favorable outcome)

    Measured: 6 months after baseline

  5. Goal Attainment Scale score at the end of follow up period

    Goal Attainment Scale (GAS), where the participant defines specific problem, e.g., activity limitations and participation restrictions caused by upper limb function difficulties, and evaluates to what extent the goal is achieved after treatment and/or training. GAS have previously been utilized to quantify the treatment effects of BoNT-A. Each participant in collaboration with clinicians formulates specific short-term and long-term goals that correspond to the International Classification of Functioning, Disability and Health (ICF) Activity and Participation levels. Minimum scale value -2 (least favorable outcome), Maximum scale value +2 (most favorable outcome)

    Measured: 9 months after baseline

Secondary outcomes (15)
  1. Change from baseline Patient Specific Functional Scale score at project defined points of assesment

    Patient Specific Functional Scale helps participants to define and assess individual goals, motivation and pain related to activities. Scale range 0-10, higher score means a better outcome.

    Measured: Baseline, 3 months after baseline, 4,5 months after baseline, 6 months after baseline, 9 months after baseline

  2. Gross Motor Function Classification System

    The Gross Motor Function Classification System or GMFCS is a 5 level clinical classification system that describes the gross motor function of people with cerebral palsy on the basis of self-initiated movement abilities. Classification levels 1-5, lower score means a better outcome

    Measured: Baseline

  3. Manual Ability Classification System (MACS)

    The Manual Ability Classification System (MACS) describes how patients with cerebral palsy use their hands to handle objects in daily activities. MACS describes five levels. The levels are based on the patient's self-initiated ability to handle objects and their need for assistance or adaptation to perform manual activities in everyday life. Classification levels 1-5, lower score means a better outcome.

    Measured: Baseline

  4. Change from baseline Hand Grip Dynamometer score at project defined points of assesment

    Simultaneous bilateral dynamic grip strength testing With Hand Grip Dynamometer. Score in percentage. The higher the better.

    Measured: Baseline, 3 months after baseline, 4,5 months after baseline, 6 months after baseline, 9 months after baseline

  5. Zancolli Classification Hand Function

    This scale explains the grasping and release patterns between the wrist and fingers and hand appearance of the spastic patients. It explains the hand appearance in degrees and that, degrees of extension can be measured using goniometer. The responses of the scale is scored as 1, 1a, 2a, 2b and 3. The best score is 1

    Measured: Baseline

  6. House Functional Classification System

    Classifies thumb position from 0 to 5. The higher the better.

    Measured: Baseline

  7. Change from baseline Modified Ashworth Scales score at project defined points of assesment

    The Modified Ashworth scale (MAS) measures resistance during passive soft-tissue stretching and is used as a simple measure of spasticity. Scale range from 0 to 4, 0 is most favourable outcome.

    Measured: Baseline, 3 months after baseline, 4,5 months after baseline, 6 months after baseline, 9 months after baseline

  8. Change from baseline Range of Motion score at project defined points of assesment

    Measuring active and passive range of arm joints motion using goniometer

    Measured: Baseline, 3 months after baseline, 4,5 months after baseline, 6 months after baseline, 9 months after baseline

  9. Change from baseline Numeric rating scale (0-10) of symptoms related to pain at 9 months

    Self-perceived pain related to spasticity. Score 0 means no pain.

    Measured: Baseline, 9 months after baseline

  10. WAIS-IV Coding (Wechsler Adult Intelligence Scale )

    Coding measures visual processing speed, short-term visual memory, and the ability to shift the eyes efficiently back and forth between the "key" and the responses. This task requires fine motor skills but does not require expressive Language. The higher score is better.

    Measured: Baseline

  11. Change from baseline Hopkins Symptoms Checklist 25 score at 9 months

    The HSCL-25 is a symptom inventory which measures symptoms of anxiety and depression. It consists of 25 items: Part I of the HSCL-25 has 10 items for anxiety symptoms; Part II has 15 items for depression symptoms.

    Measured: Baseline, 9 months after baseline

  12. Change from baseline Action Research Arm Test (ARAT) score at project defined points of assesment

    Assessment for a person's ability to handle objects differing in size, weight and shape. Score range is from 0 to 3, 3 being the best score.

    Measured: Baseline, 3 months after baseline, 4.5 months after baseline, 6 months after baseline, 9 months after baseline

  13. Change from baseline Mini-Balance Evaluation Systems Test score at project defined points of assesment

    Mini-BESTest includes four subscales: transitions/anticipatory postural control, reactive postural control, sensory orientation and stability in gait. Score range 0 to 28. The higher score the better.

    Measured: Baseline, 3 months after baseline, 4.5 months after baseline, 6 months after baseline, 9 months after baseline

  14. Change from baseline Fatigue Severity Scale (FSS) at 9 months

    The Fatigue Severity Scale (FSS) is designed to differentiate fatigue from clinical depression, since both share some of the same symptoms. FSS consists of answering a short questionaire that requires the subject to rate his or her own level of fatigue.

    Measured: Baseline, 9 months after baseline

  15. Change from baseline EQ-5D-5L (EuroQol 5 Dimensions 5 Level) Health related quality of life score at 9 months

    Descriptive system of health-related quality of life states consisting of five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) each of which can take one of five responses.

    Measured: Baseline, 9 months after baseline

Timeline

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

  1. First posted28 Feb 2020
  2. Study start17 Feb 2020 (estimated)
  3. Primary completion1 Mar 2022 (estimated)
  4. Study completion1 Mar 2022 (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
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
The single subject design was chosen due to its sensitivity to individual differences which is a relevant feature when studying heterogenous population as adults with spastic CP. The study is a multiple-treatment design with two intervention phases, an ABACAA design. The study include a baseline assessment phase (A1), a three-month intervention phase with motion controlled video game training (B), post-intervention assessment (A2), a second three-month intervention phase with Motion Controlled Video Game (MCVG) treatment and BoNT-A treatment (C) including an assessment in the middle when BoNT-A usually have its peak (6 weeks after application) (A3), post-intervention assessment three months after application of BoNT-A (A4) and a follow-up assessment 9 months after beginning of first intervention (A5). All participants will be medically examined and assessed with functional measures in all assessment phases. The timeframe from baseline to follow-up is approximately 9 months.
Masking
None (open label)
Enrolment
25 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04290169
Sponsor's protocol ID
CPSpast
Acronym
CPSpast
Status last verified
Feb 2020
First submitted
17 Feb 2020
Last updated
28 Feb 2020
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: It is not yet known if there will be a plan to make IPD available.

Questions about this trial

What is this clinical trial studying?

A study testing IncobotulinumtoxinA and Video game in people with Cerebral Palsy, Spastic, run by Sunnaas Rehabilitation Hospital.

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 5 inclusion and 7 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 28 Feb 2020. Status can change between updates, so confirm with the study contact before making plans.

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 Jelena Simic, MD (0047 92839209, jelena.simic@sunnaas.no), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Goal Attainment Scale score at baseline (time frame: Baseline). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 Feb 2020.

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