Stroke
Conditions
Keywords
Stroke, Upper limb, Somatosensation, Sensory processing, Proprioception, Robot-based therapy, Robot-based assessment
Brief summary
After a stroke, more than two out of three patients experience problems with upper limb movement and sensation. Current evidence on treatment of upper limb sensory impairments is scarce and shows unclear results. Robot-based therapy has been increasingly used to treat upper limb motor impairments, with similar positive results as compared to conventional therapy. This study aims to investigate a novel robot-based therapy program for treatment of upper limb sensory impairments. The therapy program consists of 10 one-hour session spread over 4 weeks and will be evaluated for its effect in 20 chronic stroke patients. The investigators hypothesize that a 4-week robot-based therapy program can improve upper limb sensation and movement.
Detailed description
Up to 70% of stroke survivors show upper limb impairments consisting of motor and/or somatosensory impairments. These impairments often persist well into the chronic stage, and may lead to significant limitations in activities of daily living and may negatively affect quality of life. Different interventions have been investigated to treat upper limb motor impairments, including robot-based therapy, which shows similar positive results as compared to conventional therapy. Evidence on interventions for somatosensory impairments is scarce and often of low quality. This study therefore aims to evaluate the effect of a robot-based therapy program on sensorimotor function of the upper limb in a group of 20 chronic stroke patients. The robot-based therapy will be provided using the Kinarm End-Point Lab (BKIN Technologies Ltd., Canada) and consists of passive and active therapy tasks for proprioception and sensory processing. The therapy consists of 10 one-hour sessions spread over 4 weeks. Clinical and robot-based motor and somatosensory assessments will be performed at 4 time points: twice at baseline, once at mid intervention, and once after 10 hours of therapy. The investigators hypothesize to find improvement in both upper limb motor and somatosensory function after the therapy program. The results from this pilot study will provide a basis for further research.
Interventions
DEVICERobot-based therapy
Active and passive therapy tasks for proprioception and sensory processing, with use of the Kinarm End-Point Lab (BKIN Technologies Ltd., Canada)
Sponsors
Universitaire Ziekenhuizen KU Leuven
KU Leuven
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* At least 18 years old * A first-ever unilateral, supratentorial stroke (as defined by WHO) * In the chronic phase after stroke (i.e. being at least 6 months after stroke) * Motor deficits of the upper limb (Fugl-Meyer Motor Assessment - Upper Extremity \< 60/66) * Somatosensory deficits of the upper limb (Erasmus modified Nottingham Sensory Assessment \< 36/40) * Ability to perform, at least to some extent, active shoulder abduction and wrist extension against gravity * Ability to perform passive and active sensory processing assessment task (primary outcome measure)
Exclusion criteria
* History of previous stroke or TIA * Any serious musculoskeletal and/or other neurological conditions * Serious communication or cognitive deficits * No written informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Kinarm: sensory processing task | Change during 4 weeks of therapy provided at least 6 months after stroke | Newly-developed task on the Kinarm End-Point Lab used to assess passive and active sensory processing |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Kinarm: arm movement matching task | Change during 4 weeks of therapy provided at least 6 months after stroke | Assessment of limb movement sense using a mirror-matching task on the Kinarm Exoskeleton Lab |
| Kinarm: visually guided reaching task | Change during 4 weeks of therapy provided at least 6 months after stroke | Assessment of motor function using a 4-target centre-out reaching task on the Kinarm End-Point Lab |
| Kinarm: working memory task | Change during 4 weeks of therapy provided at least 6 months after stroke | Assessment of working memory on the Kinarm End-Point Lab, by asking the participant to remember the position of 3, 4, 5 or 6 targets simultaneously. |
| Erasmus modified Nottingham sensory assessment | Change during 4 weeks of therapy provided at least 6 months after stroke | Clinical assessment of somatosensory function (including exteroception, proprioception and sensory processing) on an ordinal scale ranging from 0 to 40, with higher scores meaning better performance |
| Tactile discrimination test | Change during 4 weeks of therapy provided at least 6 months after stroke | Clinical assessment of sensory processing with an area under the curve based scoring system, with higher scores meaning better performance |
| Functional tactile object recognition test | Change during 4 weeks of therapy provided at least 6 months after stroke | Clinical assessment of sensory processing on an ordinal scale ranging from 0 to 42, with higher scores meaning better performance |
| Kinarm: arm position matching task | Change during 4 weeks of therapy provided at least 6 months after stroke | Assessment of limb position sense using a 9-target mirror-matching task on the Kinarm Exoskeleton Lab |
| Action research arm test | Change during 4 weeks of therapy provided at least 6 months after stroke | Timed clinical assessment of motor activity performance on an ordinal scale ranging from 0 to 57, with higher scores meaning better performance |
| Sensorimotor action research arm test | Change during 4 weeks of therapy provided at least 6 months after stroke | Timed clinical assessment of sensorimotor performance on an ordinal scale ranging from 0 to 57, with higher scores meaning better performance |
| Montreal cognitive assessment | Change during 4 weeks of therapy provided at least 6 months after stroke | Clinical assessment of cognitive function on an ordinal scale ranging from 0 to 30, with higher scores meaning better performance |
| Star cancellation test | Change during 4 weeks of therapy provided at least 6 months after stroke | Clinical assessment of visuospatial neglect on an ordinal scale ranging from 0 to 54, with higher scores meaning better performance, and a score below 44 indicating the presence of visuospatial neglect |
| Kinarm: sensory processing task | Change in 2 baseline measures taken 2 days apart, at least 6 months after stroke | Newly-developed task on the Kinarm End-Point Lab used to assess passive and active sensory processing |
| Fugl-Meyer upper extremity assessment | Change during 4 weeks of therapy provided at least 6 months after stroke | Clinical assessment of motor function on an ordinal scale ranging from 0 to 66, with higher scores meaning better performance |
Countries
Belgium
Outcome results
None listed