Hyperbaric Oxygen Therapy After Stroke - PILOT

Study Overview
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Brief Summary
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The goal of this pilot study is to establish more information about hyperbaric oxygen therapy for this group of patients, and give us more information of how to initiate the best possible main study. Can we find any indications that support the use of this therapy for patients suffering from chronic disability after cerebral infarction? Can we improve physical and cognitive function.

Detailed Description
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This is a pilot project including 6 patients for one session of 20 treatments of hyperbaric oxygen therapy. The objective is to establish knowledge of HBO for this group of patients in a Norwegian context, so that we can prepare for the main study afterwards, including about 60-70 patients. We need to know how to optimize the administrative and technical systems for the larger study. We want to collect feedback from the patients undergoing the pilot study. We want more information about the treatment table, if 20 treatments are enough, if 2,4 bar pressure is adequate. The treatment table is based on existing research, and is considered safe. The patients are to be treated at table 14/90, at 2,4 Absolute atmospheres, and daly 90 minutes of oxygen inhalation (medical oxygen).

Official Title
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Hyperbaric Oxygen Therapy After Cerebral Infarction - PILOT

Conditions
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Cerebral Stroke

Intervention / Treatment
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* Drug: Hyperbaric oxygen


Participation Criteria
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Eligibility Criteria
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Inlcution criteria: No age restriction Suffered from ischemic stroke (cerebral infarction) 6-12 months before inclusion. Stable phase after standard rehabilitation Measurable physical function failure and / or reduced ADL function. Sufficient physical function / mobility to be able to move into / out of the pressure chamber with the help of only one person (Tender). Patients to participate in the study must be physically, mentally and cognitively fit for pressure chamber treatment. They must be able to stand for their own help, move with support, and be able to follow instructions. This is ensured by discretionary assessment after observation and interview with the patient. Exclusion criteria: Claustrophobia Psychosis, severe anxiety Inability to equalize pressure in the middle ear Severe COPD and asthma, pathological lung sounds Hypertension (Blood pressure > 140/90 mmHg) Pregnancy Hernia Earlier fractures, or suspected fractures in the face Ongoing chemotherapy Previous treatment with Bleomycin Aphasia that prevents necessary communication Cognitive failure that prevents necessary co-operation in the pressure chamber. Previous or current pneumothorax, other lung injury Increased risk of pneumothorax Known or suspected injury to the chest Marfan syndrome Homocystinuria Family history of pneumothorax Chronic lung disease (COPD, Emphysema, Asthma eller cystic fibrosis) Tuberculosis

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 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
Interventional Model Description: Single subject SSED
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment group<br>One group of 6 patients undergoing 20 sessions of hyperbaric therapy at table 14/90. | Drug: Hyperbaric oxygen<br>* 20 sessions of hyperbaric therapy in a pressure chamber at 2,4 absolute atmospheres, 90 minutes per day of breathing 100% medical oxygen through an own mask. Table 14/90.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improved physical and cognitive function in activities of daily living. | The project's physiotherapist and ergo therapist from Western Norway University of Applied Sciences (HVL) are responsible for examining physical function and the participant's ability to acquire and use knowledge, as well as function in everyday living activities (ADL). Three measurements are made before starting treatment (establishing a baseline), where the third measurement is done on the same day as treatment starts to eliminate changes in test results as a result of learning the tests. Measurements are also made immediately after the end of treatment, as well as follow-up measurements after 6 and 12 months. Descriptions below. | 0+6+12 months after end of treatment period | 
| Short Physical Performance Battery (SPPB) | This test is very widely used to provide a quick and validated test of strength, balance and coordination. The test has a roof effect, so it is not suitable for capturing very small and subtle self-perceived disturbances in function. The test is very sensitive to change in the target group. | 0+6+12 months after end of treatment period | 
| Grip strength | There is a recognized and validated connection between general function and health and grip strength, as well as between grip strength and life span. Grip strength changes as other function changes. | 0+6+12 months after end of treatment period | 
| Fatigue Severity Scale (FSC) | A major problem after stroke and in many brain disorders is fatigue. Fatigue leads to reduced foxing and thus loss of function. The test is believed to be able to detect changes that are relevant to everyday life function and social participation. | 0+6+12 months after end of treatment period | 
| Canadian Occupational Performance Measure (COPM) | COPM is designed to help people identify and prioritize activity problems, as well as evaluate activity performance and satisfaction with activity execution. In an interview, the person is asked to describe activities they consider important but find it difficult to perform. Among the aforementioned challenges, the person is asked to prioritize a maximum of five activities he / she wants to be able to perform better after the end of treatment. Then, the person is asked to score the current performance and satisfaction with the current performance of priority activities. The score scale is from 1-10 where 10 indicates very good workmanship or high satisfaction. After the interview, partial scores for execution (COPM-U) and satisfaction (COPM-T) are calculated. A change score of 3 points is considered a clinically important change. COPM has shown good measurement properties, among other things for participants with stroke and the elderly. | 0+6+12 months after end of treatment period | 
| Action Research Arm Test (ARAT) | ARAT is a tool designed to assess motor function in the arm after stroke. The tasks in the test reflect daily activities and the patient's ability to perform them. The test contains 19 sub-tasks in which different grips (five-finger grips, cylinder grips, tweezers grips), as well as gross motor skills are specifically assessed. In each of the 19 tasks, a score is given from 0-3, where high scores indicate good arm function. The total score (0-57) is the sum of the sub-scores. The test has shown promising measurement properties. For participants in the chronic and subacute phase after stroke, a change of 5.7 points (10%) is considered clinically important. Norwegian guidelines will be used in the study. | 0+6+12 months after end of treatment period | 
| Nine Hole Peg Test (NHPT) | NHPT is a simple test of fine motor skills that is recommended, among other things, for participants with stroke. Scoring is based on the time the patient spends in placing and removing nine small pieces in nine holes. Total time (maximum 50 seconds) and total number of pins are indicated. The test has shown satisfactory reliability and validity. | 0+6+12 months after end of treatment period | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke, Hyperbaric oxygen