Personalized Upper Extremity Rehabilitation for Persons With Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Approximately 80% of individuals with chronic stroke present with long lasting upper
      extremity (UE) impairments. Advances in rehabilitation technology, such as robotics, virtual
      reality (VR) and neuromuscular electrical stimulation (NMES), have separately demonstrated
      their effectiveness in improving UE function of individuals with stroke. The potential to
      influence recovery may be further enhanced by combining these modalities in order to target
      motor deficits of the individual. Research has shown that not all persons with stroke may be
      able to recover hand function. In particular, such recovery depends on the integrity of the
      corticospinal tract (CST), which links the motor areas of the brain to the UE (and hand)
      musculature. Instead of using a 'one-size-fits-all' approach to UE rehabilitation, CST
      integrity will be assessed through transcranial magnetic stimulation (TMS), a non-invasive
      approach, and match the intervention to the individual's specific impairments. The
      perSonalized UPper Extremity Rehabilitation (SUPER) intervention is proposed, which combines
      robotics, VR activities, and NMES. The objectives of this study are to determine the
      feasibility of the SUPER intervention in individuals with moderate/severe stroke. Stroke
      participants will receive a 5-week intervention (3x per week) combining robotic therapy and
      VR activities, based on their functional level. Those with low potential for hand recovery
      will receive an intervention focussing on elbow and shoulder movements. For those with a good
      potential for hand recovery, the last 30 minutes of the robotic or VR session will be
      complemented by muscle-triggered NMES. Feasibility indicators associated with process,
      resources, management and treatment will be measured. Outcomes of UE and hand function will
      include the Fugl-Meyer upper extremity assessment, the Box and Block test and the ABILHAND.
      It is expected that feasibility criteria will be met and that the SUPER intervention will
      lead to significant improvements in UE impairment compared to a waitlist group.
    


Intervention name(s): Upper extremity rehabilitation
Intervention type(s): Device
Intervention description(s): Participants receive the SUPER intervention 3 times per week for 1 hr, during 4 weeks. For participants with a low recovery potential for hand function, the SUPER interventions consists in robot-assisted reaching movements and unilateral and bilateral VR activities. The robot-assisted activity consists of a reaching task to six targets placed at maximal reach distance. For the VR activity, we use a reach and grasp VR activity based on a shopping task. Participants with good potential for hand recovery also receive 30 min of electromyography-triggered muscle stimulation, combined with the VR activity. The muscle stimulation is triggered when the participant attempts to grasp a virtual object and helps with hand opening movements.
Intervention model: Single Group Assignment
Intervention model description: single-subject with multiple baselines (AAAB)
Masking: None (Open Label)
Primary purpose: Treatment