Balance Rehabilitation With Sensory Recalibration After Stroke
Condition: Left-sided Hemiplegia Affecting Dominant Side as Late Effect of Cerebrovascular Accident
MeSH terms: Stroke; Hemiplegia
Study type: Interventional

Summary: 
      The main objective of this study is to test the effectiveness of a rehabilitation program
      with cervical vibration and/or prism adaptation in patients with left hemiplegia on balance.
    

Detailed description: 
      Imbalance is particularly severe after a Cerebral Vascular Accident because they not only
      limit the capacity of transfer and are a source of falls but also represent an obstacle to
      the acquisition of autonomy.

      When the brain lesion is located in the right hemisphere, the prognosis in terms of
      equilibrium is worse probably because of the presence of disorders of spatial cognition.
      These disorders of spatial cognition are manifested by a distortion of the mental
      representation of space and body in space that probably cause a deviation of the position of
      the center of pression on platform. This component of balance disorders secondary to
      disruption of spatial cognition, do not benefit at present from specific rehabilitative
      treatment despite the severity of the consequences.

      But the application of sensory manipulations has proven its effectiveness on visuospatial
      neglect that is another disorder of spatial cognition closed to the pathophysiology of
      balance disorders after right brain lesion. Sensory manipulations decrease the distortion of
      internal representations of the body in space by restoring the symmetry of sensory inputs.
      Some of these manipulations (visual manipulation by wearing prisms and proprioceptive
      manipulations) are also effective on the immediate correction of postural imbalances on force
      platform and disorders of spatial perception.

      We therefore believe that the approach by repeated sensory manipulation is a new promising
      way of research for the rehabilitative treatment of balance disorders secondary to disorders
      of spatial cognition. As the mechanisms of action and the structures involved during
      proprioceptive vibration of neck muscles and during visual prism adaptation are different, we
      believe that the combination of these two types of sensory manipulations will permit to
      obtain a greater and longer lasting effect than a lonely manipulation. The concomitant
      evaluation of the bias on postural platform and the perception of the body axis will allow us
      to assess the impact of such rehabilitation on the disorders of spatial representation and so
      better understand the mechanisms of action of sensory manipulations.

      The main objective of this study is to test the effectiveness of a rehabilitation program
      with cervical vibration (V) and / or prism adaptation (P) in patients with left hemiplegia on
      balance at the end of the intervention (day14).

      Secondary objectives are to test:

        -  The immediate effect (day 0) on force platform evaluation of balance,

        -  Maintaining the gain at 3 months and 6 months on balance,

        -  Effectiveness at day 14 on negligence

        -  Maintaining the gain at 3 months and 6 months on neglect,

        -  Effectiveness at day 14 on functional abilities,

        -  Maintaining the gain at 3 months and 6 months on functional abilities,

        -  Understanding the mechanisms of action of each of the sensory manipulations by assessing
           changes in perceptions of space, after rehabilitation programs (day 14) and at 3 months
           and 6 months.

        -  To evaluate the evolution of motility, sensitivity and spasticity in the various
           assessments.

      During the 15 days rehabilitation performed for the study, the upper and lower limbs motor
      rehabilitation will last less than one hour and a half, and will exclude instrumental
      techniques of balance rehabilitation, sensory manipulations, virtual reality, strain-induced
      therapy.

      Moreover, an ancillary study will be performed to study the immediate neurofunctional effect
      of vibratory stimulation, in right brain-damaged patients with imbalance and in healthy
      volunteers, through the assessment of cerebral activation changes in MRI. The secondary
      objectives of this ancillary study are to test the neurofunctional effect of repeated
      vibratory stimulation in right brain-damaged patients, describe the relationship between
      cerebral activation changes and evolution of balance, and describe the areas of the brain
      activated by vibratory stimulation.
    

Intervention name(s): Cervical vibration; Prism adaptation; Conventional rehabilitation
Intervention type(s): Other; Other; Other
Intervention description(s): Vibration of neck muscles during 10 minutes; Prism adaptation during 10 minutes; conventional rehabilitation
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Balance,Hemiplegia,Cervical vibration,Prism adaptation,Rehabilitation