None listed
Conditions
Brief summary
Arm/hand dysfunction after stroke is a common (85% of stroke survivors), disabling and persistent problem which contributes to poor well-being and quality of life and is rated as a top ten research priority in stroke by both survivors and their carers. Neuroplasticity is the term used to describe the ability of our brain to change, make new connections and re-wire itself in response to internal and external demands and stimuli. Evidence suggests that aerobic exercise can facilitate neuroplasticity by increasing the number of and connections between brain cells, increasing the release of various neurotransmitters (chemical messengers in the brain) and nerve growth factors, and stimulating the formation of new blood vessels necessary for neuronal growth. Due to the positive effects of aerobic exercise on neuroplasticity, it has been suggested that it could be utilised to improve the efficacy of rehabilitation programs by ‘priming’ the brain prior to the delivery of therapy. Our study explores the feasibility of using Aerobic Exercise and Consecutive Task-specific Training (AExaCTT) to investigate whether the addition of aerobic exercise enhances the efficacy of task-specific training to improve arm/hand motor function after stroke.
Interventions
Aerobic Exercise and Consecutive Task-specific Training
The intervention will be delivered 3 days per week for 10 weeks.
Aerobic Exercise (30 minutes)
The aerobic exercise is performed on an upright or semi-recumbent cycle ergometer (depending on individual ability and impairment). Participants will perform 4×4-minute intervals of high-intensity exercise (85% of HRpeak) with a 3-minute active recovery (70% of HRpeak) period between each interval per 30 minute session. In the last 15 seconds
Aerobic Exercise and Consecutive Task-specific Training The intervention will be delivered 3 days per week for 10 weeks. Aerobic Exercise (30 minutes) The aerobic exercise is performed on an upright or semi-recumbent cycle ergometer (depending on individual ability and impairment). Participants will perform 4×4-minute intervals of high-intensity exercise (85% of HRpeak) with a 3-minute active recovery (70% of HRpeak) period between each interval per 30 minute session. In the last 15 seconds of each interval heart rate (via a polar heart rate monitor) and rating of perceived exertion (RPE) will be recorded in the exercise logs by research assistants, along with watts, cadence and actual duration of exercise achieved. The aerobic exercise will be supervised by a physiotherapist. Task-specific Training (60 minutes, performed immediately after aerobic exercise) The task-specific training comprises of breaking down everyday skills into functional components that maintain a strong resemblance to the original skill itself. Task prescription will consider individual goals and appropriate exercises are then selected from an upper limb rehabilitation manual containing 142 predefined activities and movements (Cunningham et al. 2015). The difficulty of each component exercise is graded, reviewed and progressed according to the individual ability of the participant, with the aim of completing between 100-300 repetitions per session. If necessary, participants initially train on component movements of a skill until each component is mastered, and then combined into their original sequence to perform the whole skill, or as much of the whole skill as possible. Participants are encouraged to use different objects that vary in terms of shape, size and texture to ensure variability of training. Task-specific training will be supervised by a physiotherapist or occupational therapist. Participants will also be provided with an individually-prescribed task-specific training programme to practice at home for 60 minutes, 3 times per week. Any variations to intervention protocol will be recorded in the participant training diaries by the researcher supervising the session and adherence to the home-based practice will be self-reported once a week. Compliance will be determined as the number of training sessions attended and time spent actively training relative to the total prescribed. Rate of retention will be measured as the per cent of participants who complete the intervention relative to the number randomised. Cunningham, P., Turton, A., Van Wijck, F. and Van Vliet, P., 2015. Task-specific reach-to-grasp training after stroke: Development and description of a home-based intervention. Clinical rehabilitation, p.0269215515603438.
Sponsors
University of Newcastle
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Clinical diagnosis of ischaemic or haemorrhagic stroke Remaining upper limb movement deficit (i.e., score <63 on WMFT) Able to partake in the aerobic exercise training GP medical clearance Willing to participate in the project Have the capacity to provide informed written consent.
Exclusion criteria
Upper limb movement deficits attributable to non-stroke pathology Cannot lift their hand off their lap when asked to place their hand behind their head (gross motor task from the ARAT) Have severe fixed contractures of elbow or wrist (i.e. grade 4 on the modified Ashworth scale) Have moderate to severe receptive aphasia (<10 on ‘receptive skills’ of Sheffield Screening Test for Acquired Language Disorders)
Outcome results
None listed