Stroke/Brain Attack
Conditions
Keywords
Neuromodulation, clubfoot, percutaneous, transcutaneous, tibialis anterior
Brief summary
INTRODUCTION: Clubfoot, drop foot or clubfoot, is a disorder that prevents reaching 100º of dorsiflexion actively. Its etiology is varied, and may be due to congenital problems, direct alteration of the bone structure, spasticity or shortening of the posterior musculature (triceps suralis), a neurological factor or a combination of several. Thus, we can differentiate between congenital clubfoot and acquired clubfoot. Stroke is one of the main causes of acquired clubfoot, which is due to paralysis of the dorsiflexor musculature and/or spasticity of the plantar flexor musculature. Electrical stimulation is able to increase muscle activation by depolarization of the motor plate and modulation of nerve conduction. This can be done transcutaneously, through surface electrodes or percutaneously through needles, so neuromodulation is presented as a tool applicable to the pathology of the equine foot, if we take into account the increased activation of the dorsiflexors of the foot. OBJECTIVE: The main objective is to evaluate which of the techniques, percutaneous or transcutaneous, is more effective for the approach of clubfoot in post-stroke patients. METHODOLOGY: a clinical trial with randomized probabilistic assignment in four groups is proposed: G1 (percutaneous neuromodulation): patients will receive a needle circuit approaching the deep peroneal nerve in an ultrasound-guided manner. They will receive a 20-30Hz symmetrical biphasic current; G2 (transcutaneous neuromodulation): patients will have a superficial electrode circuit placed over the belly of the tibialis anterior muscle. They will receive a symmetrical biphasic current of 20-30Hz; G3 (placebo-percutaneous group): in which the patients will receive the neuromodulation circuit with needles at 0 intensity; G2 (placebo-transcutaneous group): the patients will receive the electrodes at 0 intensity over the belly of the tibialis anterior muscle. The variables to be analyzed are: anthropometric variables (age, weight, height, BMI), muscle oxygenation (SatO2, O2Hb, HHb and THb), muscle strength of the foot dorsiflexors measured with dynamometer, muscle activation by surface electromyography, active and passive joint balance with goniometry or inclinometer, assessment of gait and balance, assessment of load distribution by static and dynamic pressure platform, spasticity and questionnaire on quality of life and functionality. The acute effects after one intervention session (pre-post intervention of one session) and the effects after a 10-session program will be analyzed.
Interventions
DEVICEPercutaneous neuromodulation
Patients will receive a needle circuit approaching the deep peroneal nerve in an echoguided manner. They will receive a symmetrical biphasic current of 20-30Hz and 250 μs at tolerable intensity.
DEVICETranscutaneous neuromodulation
Patients will have a superficial electrode circuit placed over the belly of the tibialis anterior muscle. They will receive a symmetrical biphasic current of 20-30Hz and 250 μs at tolerable intensity.
DEVICEPlacebo-percutaneous
Patients will have the neuromodulation circuit placed with needles at 0 intensity, approaching the deep peroneal nerve in an ultrasound-guided manner.
DEVICEPlacebo-transcutaneous
patients will have the electrodes placed over the tibialis anterior muscle at intensity 0.
DEVICEPercutaneous neuromodulation or Transcutaneous neuromodulation (optional)
Study participants who wish to continue may be randomized to receive a 10-session intervention program. The intervention to be received will consist of 10 sessions of percutaneous neuromodulation or 10 sessions of transcutaneous neuromodulation, two sessions per week.
Sponsors
University of Extremadura
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 65 years old. * Have had a stroke or brain damage acquired at least 1 year ago. * Have a muscle balance in the dorsiflexor musculature of the foot less than or equal to 3/5 on the Daniels scale.
Exclusion criteria
* Contraindication to electrotherapy. * Needle phobia or panic (in the case of having been assigned to the percutaneous group). * Severe cognitive impairment that prevents collaboration in the performance of the activity. * Failure to meet the inclusion criteria.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Muscle activity | 1 day | MDurance surface electromyography |
| Displacement of the center of pressures (CoP) | 1 day | Postural stability: baropodometric platform |
| Articular amplitude | 1 day | Dorsal flexion using goniometer |
| Balance | 1 day | Timed Up and Go (TUG) |
| Gait | 1 day | 10 minutes walking test |
| Tissue oxygen in muscle | 1 day | Oximeter. Moxy-3 in the thigh |
| Muscular strength | 1 day | Tibialis anterior strength by dynamometry |
| Functionality | 1 day | ECVI-38 scale (Quality of Life Scale for Stroke): 38 items hypothetically grouped into eight domains: physical state, communication, cognition, emotions, feelings, basic activities of daily living, common activities of daily living, and socio-familial functions.; plus two additional questions on sexual function and work activity. |
| quality of life index | 1 day | ECVI-38 scale (Quality of Life Scale for Stroke): 38 items hypothetically grouped into eight domains: physical state, communication, cognition, emotions, feelings, basic activities of daily living, common activities of daily living, and socio-familial functions.; plus two additional questions on sexual function and work activity. |
| Spasticity | 1 day | Ashworth scale: scale from 0 to 4. 0 means mild muscle tone and 4 means high hypertonicity. |
Countries
Spain
Outcome results
None listed