Effect of Rhythmic Upper-limb Training in Stroke Patients

Study Overview
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Brief Summary
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The purpose of this study is to determine whether rhythmic upper-limb movement training in post-stroke patients allows to improve only this particular type of movements or if it also improves some parameters of discrete movements. Based on our results we hope to be able to answer a fundamental question: are rhythmic and discrete movements two independent primitives?

Detailed Description
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Patients are assessed four times during this longitudinal study. One month separates the first two assessment, next patients are trained 12 times during one month with rhythmic movement training on an end-effector robot. After this month, patients are assessed a third time and three months later a fourth time in order to study long-time benefits of the therapy.

Conditions
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Cerebral Stroke

Intervention / Treatment
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* Procedure: Rhythmic rehabilitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: more than 6 months post-stroke patients Fugl-Meyer between 7 and 55 Maintain the same intensity of rehabilitation during the study Exclusion Criteria: cerebellar stroke severe aphasia or cognitive disorder any other neurological disorder

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Rhythmic rehabilitation<br>Patients undergo a first evaluation, and a second evaluation one month later to determine their natural evolution. The following month, patients get 12 sessions of rhythmic therapy. A third evaluation is organized straight after this month and a fourth evaluation, 3 months after to assess the after-effects of the therapy. | Procedure: Rhythmic rehabilitation<br>* Stroke patients have 12 rehabilitation sessions on a planar rehabilitation robot, Reaplan, focussed on rhythmic arm movements.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in movement smoothness in rhythmic straight movements after one month of rhythmic therapy | Patients are asked to fulfill rhythmic movements on the end-effector robot Reaplan. The smoothness is assessed with following metrics: number of peaks in velocity profile TENT value logarithmic dimensionless square jerk | 1 week to 1 day before therapy and 1 day to 1 week after therapy | 
| Change in movement smoothness in discrete straight movements after one month of rhythmic therapy | Patients are asked to fulfill discrete movements on the end-effector robot Reaplan. The smoothness is assessed with following metrics: number of peaks in velocity profile TENT value logarithmic dimensionless square jerk | 1 week to 1 day before therapy and 1 day to 1 week after therapy | 
| Change in accuracy of discrete straight movements after one month of rhythmic therapy | Patients are asked to fulfill discrete movements on the end-effector robot Reaplan. The accuracy is assessed. | 1 week to 1 day before therapy and 1 day to 1 week after therapy | 
| Change in smoothness of rhythmic circular movement after rhythmic therapy | Patients are asked to fulfill 10 circular movements on the end-effector robot Reaplan. The movement smoothness are assessed | 1 day to 1 week before therapy and 1day to 1 week after therapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of the general motricity of the patient due to one month rhythmic therapy | Upper limb Fugl-Meyer Assessment Box and block test Ashworth test | 1 week to 1 day before therapy and 1 day to 1 week after therapy | 
| Therapy after effects | Evolution of the movement smoothness in rhythmic and discrete movements, the movement accuracy in discrete movements and the general motricity | 1 day to one week after therapy and 3 months after therapy | 
| Assessment of the natural evolution of the patient | Natural evolution of the movement smoothness in rhythmic and discrete movements, of the accuracy in discrete movements and of the general motricity of the patient | 4 to 5 weeks before therapy and 1 week to 1 day before therapy | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rhythmic versus discrete movements, Rehabilitation