Stroke
Conditions
Keywords
Functional Electrical Stimulation
Brief summary
The purpose of the study is to investigate new Technology for recovery of ankle walking function after stroke.
Detailed description
Background and Purpose: Conventional rehabilitation does not restore normal, upper limb function or normal gait to many stroke survivors. Functional neuromuscular stimulation (FNS) has shown promise for functional enhancement of both upper and lower limb motor control following stroke. Gains included muscle activation latencies, strength, coordination, upper limb functional tasks, gait kinematics, walking endurance, and quality of life. The purpose of the proposed work is to test the radio frequency-controlled (RF) Microstimulator (RFM) Gait System regarding system performance and subject response to treatment. Methods: This is a feasibility study in which up to four subjects will receive the (RFM) Gait System. Up to ten RFMs will be placed for a given subject. An RFM ankle muscle system will be used to train ankle gait components. A separate RFM system will be used to train knee gait components. Subjects will be treated for 6 months, four sessions/wk. Primary outcome measures for the RFM Gait System will be: kinematic swing phase gait components and walking endurance. Secondary outcome measures will include: strength, coordination, spasticity, function, and quality of life. Data collections will occur at months 1, 3 and 6, and for follow-up times up to a year after the end of treatment. The results of the RFM ankle system have the potential to provide a new technology for ankle muscle gait components.
Interventions
Fully Implanted FES system to assist patient with gait component practice
Sponsors
Study design
Eligibility
Inclusion criteria
* Sufficient endurance to participate in rehabilitation sessions. * Medically Stable * Age \>21 years. * Inability to perform normal ankle coordinated gait components. * Participants should be able to walk and keep balance without physical assistance from another person
Exclusion criteria
* Acute or progressive cardiac, renal, respiratory, neurological disorders or malignancy. * Lower motor neuron damage or radiculopathy * Allergy or contraindication to anesthesia, Versed, (or comparable substitute. * Active implantable device (e.g. pacemaker, implantable cardiac defibrillator, neurostimulator, or drug infusion device. * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Kinematic Gait Measures | Day 1 and at 3 months, following treatment | assessment of the lower limb kinematics during ambulation at chosen speed. |
| Walking Endurance (6MWT) | Day 1 and at 3 months, following treatment | The Six Minute Walk Test (6MWT) is a measure of the distance measured in feet ambulated by the participant during six minutes. A further distance walked in 6 minutes indicates improvement on the measure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fugl-Meyer Lower Extremity Score | Day 1 and at 3 months, following treatment | Fugl-Meyer Lower Extremity Score (FMLE) is an itemized measure of lower extremity coordination following stroke. Scores for the FMLE range from 0 (most impaired) to 34 (normal). |
| Ashworth Scale | Day 1 and at 3 months, following treatment | The Ashworth Scale is a measure of muscle spasticity; muscle groups are graded from 0 (no spasticity) to 4 (greatest spasticity/contracture). The lower limb muscle groups are summed for a total lower limb Ashworth score. A lower score indicates better performance. (range is 0-40) |
| Stroke Impact Scale (SIS) | Day 1 and at 3 months, following treatment | The SIS is a measure of Quality of Life/Life Role Participation following stroke. Each item in a domain is scored between 0 and 5. A higher score indicates better performance (range 0-295). |
| Manual Muscle Testing (MMT) | Day 1 and at 3 months, following treatment | This is a measure of strength of the various muscle groups of the lower limb. Each is graded on a 0 to 5 scale; the final score is the summed total of the lower limb muscle groups tested. (score range of summed muscles is 0-50, with 50 being the maximum highest score) |
Countries
United States
Participant flow
Recruitment details
Dec 2008 - October 2009, recruitment by flier and by word of mouth
Participants by arm
| Arm | Count |
|---|---|
| Arm 1 Gait training using radio frequency-controlled (RF) Microstimulator (RFM) Gait System ) | 1 |
| Total | 1 |
Baseline characteristics
| Characteristic | Arm 1 |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 1 Participants |
| Age, Continuous | 37 years STANDARD_DEVIATION 0 |
| Region of Enrollment United States | 1 participants |
| Sex: Female, Male Female | 1 Participants |
| Sex: Female, Male Male | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 1 / 1 |
| serious Total, serious adverse events | 0 / 1 |
Outcome results
Kinematic Gait Measures
assessment of the lower limb kinematics during ambulation at chosen speed.
Time frame: Day 1 and at 3 months, following treatment
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Arm 1 | Kinematic Gait Measures | 0 percentage of change Day 1 to 3 months |
Walking Endurance (6MWT)
The Six Minute Walk Test (6MWT) is a measure of the distance measured in feet ambulated by the participant during six minutes. A further distance walked in 6 minutes indicates improvement on the measure.
Time frame: Day 1 and at 3 months, following treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Walking Endurance (6MWT) | Day 1-6MWT | 843 feet |
| Arm 1 | Walking Endurance (6MWT) | After 3 months of treatment- 6MWT | 771 feet |
Ashworth Scale
The Ashworth Scale is a measure of muscle spasticity; muscle groups are graded from 0 (no spasticity) to 4 (greatest spasticity/contracture). The lower limb muscle groups are summed for a total lower limb Ashworth score. A lower score indicates better performance. (range is 0-40)
Time frame: Day 1 and at 3 months, following treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Ashworth Scale | Day 1-Ashworth Score | 1.5 units on a scale |
| Arm 1 | Ashworth Scale | After 3 months of treatment- Ashworth Score | 1.0 units on a scale |
Fugl-Meyer Lower Extremity Score
Fugl-Meyer Lower Extremity Score (FMLE) is an itemized measure of lower extremity coordination following stroke. Scores for the FMLE range from 0 (most impaired) to 34 (normal).
Time frame: Day 1 and at 3 months, following treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Fugl-Meyer Lower Extremity Score | Day 1- Fugl Meyer Score | 22 units on a scale |
| Arm 1 | Fugl-Meyer Lower Extremity Score | After 3 months of treatment- Fugl Meyer Score | 26 units on a scale |
Manual Muscle Testing (MMT)
This is a measure of strength of the various muscle groups of the lower limb. Each is graded on a 0 to 5 scale; the final score is the summed total of the lower limb muscle groups tested. (score range of summed muscles is 0-50, with 50 being the maximum highest score)
Time frame: Day 1 and at 3 months, following treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Manual Muscle Testing (MMT) | Day 1-MMT | 21.35 units on a scale |
| Arm 1 | Manual Muscle Testing (MMT) | After 3 months of treatment- MMT | 23.33 units on a scale |
Stroke Impact Scale (SIS)
The SIS is a measure of Quality of Life/Life Role Participation following stroke. Each item in a domain is scored between 0 and 5. A higher score indicates better performance (range 0-295).
Time frame: Day 1 and at 3 months, following treatment
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Arm 1 | Stroke Impact Scale (SIS) | Day 1-SIS | 261 units on a scale |
| Arm 1 | Stroke Impact Scale (SIS) | After 3 months of treatment- SIS | 264 units on a scale |