Intensive Upper Extremity Training Program During the Early Subacute Phase After Stroke: A Feasibility Study

Not Applicable

• Conditions: Stroke
• Interventions: Device: upper extremity training program ("Meditouch","MSQUARE")

• Registration Number: NCT04737395
• Lead Sponsor: Sheba Medical Center

Brief Summary

The study assesses the feasibility of a 4-week upper extremity training program emphasizing quality of movement practiced at high intensity and dosage applied during the early subacute phase after stroke.

Detailed Description

Participants will receive 120 minutes of upper extremity training X 5 days per week for 4 weeks in addition to their daily rehabilitative routine (total therapy time 40 hours in addition to daily routine treatments of approximately 60 hours). Each session will be staffed with a 1:1 PT/OT to patient ratio.

The aim of the program is to increase the time spent on tasks using customized game-based platforms that include highly immersive, challenging and rewarding virtual environments for upper limb training. The focus of these game-based platforms is to reduce upper extremity impairments through emphasizing the quality of movement execution.

In one platform, the participant controls virtual dolphin movements by moving his/her paretic upper limb. The game utilizes advanced artificial intelligence (AI) analysis of the video recordings in real-time. In case the participant needs arm weight support, the practice will perform the task with a mechanical wearable exoskeleton vest, EkssoUE (Ekso Bionics) that can provide support at different weight levels. Arm weight support will be titrated as the patient progresses through each session and will be reduced/removed if no significant compensatory strategies were used.

The second platform, the HandTutor system (MediTouch) consists of an ergonomic wearable glove and a dedicated software with games that allow practicing active wrist movements, grip control and finger individuation in a challenging and motivating environment. Participant progresses through simple to difficult games while adjusting the range of motion that is being practiced according to participant's abilities.

Training in both platforms will be conducted in sitting. Participant will continue with their regular rehabilitative routine that includes daily physical and occupational therapy sessions and speech therapy if needed as well as group work and gym.

To assess the feasibility of the proposed intervention the following data/measures will be documented:

Adherence rates; Time on task (in minutes); Progression in game levels and the amount of weight support; Attendance to routine rehabilitative sessions; Visual Analogue Scale will be used to monitor the levels of pain; Rating perceived exertion (RPE), the revised category-ratio scale (0 to 10 scale) will be used to monitor and guide exercise intensity; The Pittsburgh rehabilitation participation scale (PRPS); The Intrinsic Motivation Inventory (IMI) - will be assessed at the end of intervention period; Acceptability and satisfaction of the intervention to participants will be assessed at the end of training period using a self-designed questionnaire/rating scale; Adverse events; Problems/difficulties related to intervention equipment (software, hardware, vest etc.).

To evaluate the potential effectiveness of the intervention the following data/measures will be conducted at baseline (prior training), immediately post intervention and at 12 (±14) and 24 (±14) weeks post stroke:

Fugl-Meyer upper extremity assessment (FM-UE); Action research arm test (ARAT); Stroke Impact Scale (SIS) hand domain, version 2.0; Upper extremity impairment and function will be assessed using a reaching and a grasping tasks that will be recorded using multiple high resolution video-cameras and analyzed using AI algorithm (OpenPose).

Study Timeline

• Study Start: 2020-11-22
• Status Verified: 2021-01
• Study First Submitted: 2021-01-19
• Study First Submitted QC: 2021-01-31
• Last Update Submitted: 2021-01-31
• Study First Posted: 2021-02-03
• Last Update Posted: 2021-02-03
• Primary Completion: 2022-11-22
• Study Completion: 2022-11-22

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Device-assisted therapy ("Meditouch","MSQUARE")	upper extremity training program ("Meditouch","MSQUARE")	40 hours of therapy with the the Hand Tutor (MediTouch) device and a wearable vest (MSQUARE) for arm rehabilitation

Primary Outcome Measures

Name	Time	Method
Fugl-Meyer upper extremity assessment (FM-UE)	From baseline to day 3 post-training	Change in arm impairment, measured by FM-UE. Maximum score (Performs fully) =226 points Minimum score= 0 points

Secondary Outcome Measures

Name	Time	Method
Action research arm test (ARAT)	From baseline to day 3 post-training	Change in arm function, measured by. Maximum score (Performs fully) = 57 points Minimum score= 0 points
Stroke Impact Scale (SIS)	From baseline to day 3 post-training	Change in disability and health related quality of life Maximum score (Performs fully) = 25 points Minimum score= 0 points

Trial Locations

Locations (1)

Aleh Negev Nahalat Eran; 🇮🇱 Ofakim, Israel