Prismatic Adaptation for Rehabilitation of Postural Imbalance After Stroke
- Conditions
- Chronic Right Supratensorial Stroke Patients
- Interventions
- Device: The prismatic adaptation (PA)Device: The sham prismatic adaptation (S-PA)
- Registration Number
- NCT03154138
- Lead Sponsor
- Hospices Civils de Lyon
- Brief Summary
Postural imbalance after stroke leads to limitations of activity and a worse autonomy. The postural imbalance is increased in right supratensorial stroke (RSS) compared to left supratensorial stroke. The evidences for the rehabilitation of postural imbalance are weak.
Likewise, disorders of spatial reference frames are increased in RSS. The postural imbalance is correlated with the disorders of spatial reference frames in RSS patients.
Prismatic adaptation (PA) is often used for the rehabilitation of unilateral spatial neglect after RSS. Several studies have demonstrated a peculiar expansion of sensorimotor after-effects to spatial cognition. An immediate effect of reduction in postural imbalance have been showed in acute RSS. Therefore, it is interested to investigate the immediate and delayed effects of PA on the postural balance and the spatial reference frames in chronic RSS to purpose a new therapeutic approach.
The hypothesis of the study is that PA would improve the postural balance (activity) of chronic RSS patients by a reduction in mediolateral postural asymmetry, resulting from a " bottom-up " action of PA on spatial reference frames.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 28
-
Adult, over 18 years old, and less than 80 years old
-
Stroke
- right
- supratensorial,
- unilateral,
- haemorrhagic or ischemic,
- chronic (over 12 months)
-
Ability to stay over 30 seconds in standing static position with open eyes and close eyes
-
Show a postural imbalance, determined by a body weight bearing on right lower limb ≥ 60% during at least one posturographic evaluation with open eyes and that requires an inpatient rehabilitation
-
Covered by a Health System where applicable, and/or in compliance with the recommendations of the national laws in force relating to biomedical research
-
Free, enlightened and written consent of the patient
- Cerebellar lesion
- Brainstem lesion
- Bilateral cerebral lesion
- All orthopaedic or rheumatologic diseases, retinal visual impairments or other diseases interfering with assessments in accordance with the investigator's judgment
- Pregnancy or breast feeding
- Under an administrative or legal supervision
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Prismatic adaptation (PA) group The prismatic adaptation (PA) Patients in the experimental group will benefit from 10 sessions of adaptation prismatic (PA) by means of one daily session of 20 minutes (5 times by week; 2 weeks), performed by an experienced physical therapist or occupational therapist. All patients will also benefit from conventional rehabilitation (Standard physical therapy, standard occupational therapy, standard speech therapy ...) according to the needs of the patients. Sham group The sham prismatic adaptation (S-PA) Patients in the sham group will benefit from 10 sessions of sham adaptation prismatic (S-PA) by means of one daily session of 20 minutes (5 times by week; 2 weeks), performed by an experienced physical therapist or occupational therapist. All patients will also benefit from conventional rehabilitation (Standard physical therapy, standard occupational therapy, standard speech therapy ...) according to the needs of the patients.
- Primary Outcome Measures
Name Time Method Balance: The inter-group difference of within-group changes for the Berg Balance Scale (BBS) Change from baseline (mean of the 2 pre-tests) at 7 days after the end of treatment (3 weeks about after the baseline) Balance : The inter-group difference of within-group changes for the Berg Balance Scale (BBS) Score between 0 and 56 points
- Secondary Outcome Measures
Name Time Method Balance: the inter-group difference of within-group changes for the Berg Balance Scale (BBS) Change from baseline at 1 month after the end of treatment Change from baseline (mean of the 2 pre-tests) at one month after the end of treatment (M+1) (1 month and 2 weeks about after the baseline) and at three months after the end of treatment (M+3) (3 month and 2 weeks about after the baseline) Score between 0 and 56 points.
Balance: The inter-group difference of within-group changes for standing static posturographic variables Change from baseline at +2 Hours, Day 3, Day7, Month +1 and Month +3 after the end of treatment Satnding posturographic variables include mediolateral and anteroposterior deviation of center of pression (COP), mediolateral and anteroposteriorvariability of COP, sway area of COP, body weight bearing on each lower limb.
The mediolateral and anteroposterior deviations of COP measured in millimeters, the sway area of COP calculated in square millimeters, the mediolateral and anteroposterior variability of COP calculated as the standard deviation of the mediolateral and anteroposterior deviations of COP, body weight bearing on each lower limb measured in percent of total weight bearing.Lateropulsion: The inter-group difference of within-group changes for the Scale for Contraversive Pushing (SCP) Change from baseline at +2 Hours, Day 3, Day7, Month +1 and Month +3 after the end of treatment. Score between 0 and 6 points
The inter-group difference of within-group changes for each spatial reference frame (MSSA, VSSA, OLP, LBA) Change from baseline at +2 Hours, Day 3, Day 7, Month 1 and Month 3 after the end of treatment Spatial reference frames include the measurement of the manual subjective straight aheaed (MSSA), the visual subjective straight ahead (VSSA), open-loup pointing without visual feedback (OLP), the subjective longitudinal body axis (LBA) Angular deviation measured in degrees
Autonomy : Inter-group difference of within-group changes for the Barthel index (BI) Change from baseline (pre-test) at Day7, Month +1 and Month +3 after the end of treatment. Score between 0 and 100 points
Additionnal descriptive anatomic study of cerebral lesions using diffusion tensor Magnetic Resonance Imaginig (MRI) (Tractography) Before the starting of the intervention, during the pre-tests. To determine the location of the cerebral lesion, the size of cerebral lesion and to quantify the severity of the disconnection (after tractography reconstructions of white matter pathways).
Relationship between prismatic adaptation induced changes on misperceptions of spatial reference frames and these on postural and balance disorders +2Hours, Day+3, Day+7, Month+1 and Month+3. Statistical correlations between changes (before versus after intervention) on Berg Balance Scale (BBS), postural disorders (i.e. Weight Beainf Asymetry (WBA), body sway, and lateropulsion), and spatial reference frames.
Trial Locations
- Locations (3)
CHU Grenoble
🇫🇷Grenoble, France
CHU Saint-Etienne
🇫🇷Saint-Étienne, France
Hôpital Henry Gabrielle, service de médecine physique et réadaptation
🇫🇷Saint-Genis-Laval, France