Hemiparetic Stroke
Conditions
Keywords
Videotherapy, Lower limb rehabilitation, Hemiplegic/Hemiparetic, Single case experimental design
Brief summary
This pilot study evaluates video therapy for lower limb motor recovery after stroke, an approach remains insufficiently documented. This single-center pilot study uses a Single-Case Experimental Design (SCED) to evaluate the effects of intensive video therapy combined with conventional rehabilitation in patients with subacute or chronic post-stroke hemiparesis. Twelve participants will be included and allocated to different baseline durations according to a multiple-baseline SCED design. The primary outcome is functional mobility, assessed using the Timed Up and Go (TUG) test, measured repeatedly throughout baseline, intervention, and follow-up phases.
Detailed description
Stroke frequently results in persistent lower limb motor impairment affecting gait and functional mobility (1-2). While video-based therapies have shown proof of concept for upper limb rehabilitation after stroke, their effectiveness for lower limb motor recovery remains insufficiently documented (3-5). This study is a single-center pilot trial using a Single-Case Experimental Design (SCED) with multiple baseline durations, chosen to account for the high interindividual variability observed in subacute and chronic post-stroke patients undergoing rehabilitation (6). This design allows each participant to serve as their own control through repeated measurements over time (6). Participants are included between 1 month and 1 year post-stroke while receiving inpatient or outpatient rehabilitation in a Physical Medicine and Rehabilitation department. All participants initially undergo a control phase combining standardized rehabilitation with sham video therapy (placebo condition). The duration of this baseline phase is randomized (1, 2, or 3 weeks) across participants. The experimental phase consists of 5 weeks of intensive video therapy added to usual care, with five sessions per week. A post-intervention sham phase is followed by a follow-up period lasting up to 21 weeks post-intervention, with repeated assessments conducted at weeks 13, 17, and 21 to evaluate maintenance of treatment effects. The primary objective is to evaluate changes in functional mobility, assessed using repeated measurements of the Timed Up and Go test. Secondary objectives include evaluation of gait endurance, motor impairment, muscle tone, balance, and quality of life .
Interventions
DEVICEActive Videotherapy
During active videotherapy sessions, the image inversion program is activated, superimposing movements of the non-paretic limb onto the paretic limb, which is hidden behind the screen. Participants are instructed to imagine and attempt to reproduce the observed movements using their paretic limb. Each participant completes 25 sessions over 5 weeks (5 sessions per week).
DEVICESham videotherapy
During sham videotherapy sessions, participants are seated facing the IVS4 screen without activation of the image inversion program. Participants perform lower limb movements while directly viewing their paretic limb in real time on the screen, corresponding to an action observation condition without visual illusion.
Sponsors
Centre Hospitalier Universitaire de Saint Etienne
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
sham video therapy
Intervention model description
Model Description
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* \- First or recurrent hemispheric ischemic or hemorrhagic stroke in the subacute or chronic phase (from 1 month to 1 year post-stroke). * Currently receiving rehabilitation care in a Physical Medicine and Rehabilitation (PM\&R) department * Able to walk 3 meters back and forth, with or without an assistive device. * Provided informed consent, signed jointly with the investigator.
Exclusion criteria
* \- Severe hemispatial neglect. * Severe spasticity impairing proper positioning (Modified Ashworth Scale \> 3). * Severe general disabling medical conditions. * Associated cerebellar syndrome. * Major comprehension disorders, psychiatric illness, or cognitive impairments that could interfere with study participation. * Participants under full legal guardianship (tutorship). * Pregnant or breastfeeding women.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 1. Timed Up and Go Test (TUG) | 5-week | Time required to stand up from a chair, walk 3 meters, return, and sit down (in seconds) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 2. 2-Minute Walk Test (2MWT) | Weeks 1, 2, 3, 8, 13, 17, and 21 | Walking endurance assessed by the distance walked in 2 minutes (in meters). |
| 3. Fugl-Meyer Assessment - Lower Limb Section | Weeks 1, 2, 3, 8, 13, 17, and 21 | Motor function of the hemiplegic lower limb, assessed with the Fugl-Meyer scale (score from 0 to 34) |
| 4. Muscle Strength - Foot Dorsiflexors and extensors | Weeks 1, 2, 3, 8, 13, 17, and 21 | Muscle strength of the foot dorsiflexors and extensors, measured in Newtons using a handheld dynamometer |
| 5. Muscle Tone - Modified Ashworth Scale (MAS) | Weeks 1, 2, 3, 8, 13, 17, and 21 | Spasticity assessment of dorsiflexors and extensors of the foot using the Modified Ashworth Scale (score 0-5). |
| 6. Muscle Tone - Modified Tardieu Scale | Weeks 1, 2, 3, 8, 13, 17, and 21 | Spasticity assessment of dorsiflexors and extensors of the foot using the Modified Tardieu Scale (score 0-5). |
| 7. Postural Balance - PASS (Postural Assessment Scale for Stroke Patients) | Weeks 1, 2, 3, 8, 13, 17, and 21 | Balance ability assessed using the PASS scale (score 0-36). |
| 8. Quality of Life - Stroke Specific Quality of Life Scale (SS-QOL) | Weeks 1, 2, 3, 8, 13, 17, and 21 | Quality of life assessed with the SS-QOL scale (score range: 49-245). |
Countries
France
Contacts
CONTACTEtienne OJARDIAS, Dr
PRINCIPAL_INVESTIGATOREtienne OJARDIAS, Dr
Centre Hospitalier Universitaire de Saint Etienne
Outcome results
None listed