Stroke
Conditions
Keywords
upper limb, somatosensory impairments, motor impairments, brain imaging
Brief summary
Stroke survivors often encounter impairments in the upper limb after stroke. Sensorimotor impairments are present in 67% of the stroke patients, resulting in problems with independency and performance of activities of daily life. In addition, the pattern of recovery in the brain is still a matter of ongoing debate. Although the importance of somatosensory function on motor performance is well described, evidence for somatosensory or sensorimotor therapy and brain-related changes is scares. Therefore, we aim to explore the effect of a sensorimotor therapy compared to pure motor therapy on motor function of the upper limb. A second objective is to investigate therapy-induced brain-behavior associations using resting state functional Magnetic Resonance Imaging of the brain.
Detailed description
Stroke survivors often encounter impairments in the upper limb after stroke. Sensorimotor impairments are present in 67% of the stroke patients, resulting in problems with independency and performance of activities of daily life. In addition, the pattern of recovery in the brain is still a matter of ongoing debate. Although the importance of somatosensory function on motor performance is well described, evidence for somatosensory or sensorimotor therapy and brain-related changes is scares. Therefore, will conduct a Randomized Controlled Trial with three main objectives. The first objective of this project is to investigate the effect of sensorimotor therapy on motor function of the upper limb. To achieve this objective, a sensorimotor program will be developed based on the SENSE therapy. Patients will be randomly allocated to either the sensorimotor therapy group or the pure motor therapy group; and will receive 16 hours of therapy. Motor and Somatosensory assessments will be performed at three time points: baseline(admission to rehabilitation center), immediately after the 16 hours of therapy and after 4 weeks of follow-up. The second objective is to investigate therapy-induced brain-behavior associations with resting state functional connectivity. In order to achieve insights in brain-behavior associations, we will perform resting-state functional Magnetic Resonance Imaging (fMRI) scans at the same time points as the clinical assessments: baseline, immediately after the 16 hours of therapy, and four weeks after the end of the therapy. Both measurements, brain-imaging and clinical measurements will be combined to investigate the associations. This project will lead to new insights in brain-behavior associations of sensorimotor function of the upper limb after stroke and will provide evidence for a new therapy in upper limb stroke rehabilitation.
Interventions
OTHERadditional sensorimotor therapy for the upper limb
The intervention will consist of additional physiotherapy for the upper limb after stroke consisting of sensory discrimination training and sensorimotor training.
OTHERadditional motor therapy for the upper limb after stroke
The intervention will consist of additional physiotherapy for the upper limb after stroke consisting of cognitive-attention based training and motor training
Sponsors
Research Foundation Flanders
KU Leuven
Universitaire Ziekenhuizen KU Leuven
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The assessor will be masked for treatment group
Intervention model description
Randomized controlled Trial with two therapy groups ( experimental and control therapy) and one healthy control group
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* first ever stroke as defined by the WHO (world health organisation) criteria * assessed and included within 8 weeks after stroke onset * unilateral motor impairment in the upper limb (ARAT \<52/56) * unilateral somatosensory impairment in the upper limb (SSD \<0.00) * minimally 18 years old * substantially cooperation to perform the assessments and therapy * written informed consent
Exclusion criteria
* musculoskeletal and/or other neurological disorders such as previous stroke, head injuries, multiple sclerosis of Parkinson's disease * a subdural hematoma, tumor, encephalitis or trauma that lead to similar symptoms as a stroke * severe communication deficits * severe cognitive deficits * the presence of contra-indications for proceeding an MRI scan such as defibrillator, pacemaker or metal prosthesis ( as defined in the MRI checklist of Radiology UZ Leuven)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Action Research Arm Test | within 4 months post stroke | grasp, grip, pinch and gross movement of the affected arm and hand |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| composite standardized somatosensory deficit index | within 4 months post stroke | composite standardized score consisting of fabric matching test, wrist position sense test and functional tactile object recognition test |
| Erasmus modified Nottingham Sensory Assessment | within 4 months post stroke | light touch, pressure, sharp, sharp-dull discrimination, position sense of the arm and hand |
| Perceptual Threshold of Touch | within 4 months post stroke | threshold of light touch determined with Transcutaneous Electric Nerve Stimulation at the index finger. |
| Fugl-Meyer motor Assessment-upper Extremity | within 4 months post stroke | overall motor impairment of the affected upper limb: shoulder, arm, wrist , hand and fingers |
| Stroke Upper Limb Capacity Scale | within 4 months post stroke | upper limb capacity by the means of ten functional and meaningful tasks related to daily live activities |
| functional connectivity | within 4 months post stroke | resting-state fMRI functional connectivity between Regions of Interest of the sensorimotor network |
| Nine Hole Peg test | within 4 months post stroke | manual dexterity |
Countries
Belgium
Outcome results
None listed