Non-use After Stroke: Influence of Applied Force and Precision When Reaching With the Paretic Upper Limb

Completed

• Conditions: Stroke
• Interventions: Other: Reaching Session

• Registration Number: NCT04747587
• Lead Sponsor: Centre Hospitalier Universitaire de Nīmes

Brief Summary

After a stroke, 80% of patients have an upper limb deficit, limiting activity. Some develop a non-use: they can, but do not, use their paretic limb. Non-use is a general phenomenon applied to all situations where the patient applies unnecessary compensation. Several rehabilitation techniques are effective to counter non-use, but there is insufficient knowledge to choose the most suitable technique. Optimal control theory could help guide these choices. It assumes that the chosen coordination satisfies the constraints of the task (force, amplitude, tolerance) while reducing the cost of the movement. This study will assess non-use by anticipating the sensitivity to the constraints of force and precision deduced from the logic of optimal control. The study authors expect to observe a weakness effect: in a reaching task (i.e. when the person has to touch an object placed in front of them), lightening the paretic arm makes it possible to reduce non-use, and a precision effect: in a reaching task, non-use increases with the required spatial precision.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2021-02-05
• Study First Submitted QC: 2021-02-05
• Study First Posted: 2021-02-10
• Study Start: 2021-05-11
• Primary Completion: 2023-04-25
• Study Completion: 2023-04-25
• Status Verified: 2023-05
• Last Update Submitted: 2023-05-03
• Last Update Posted: 2023-05-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 53

Inclusion Criteria

Inclusion criteria specific to the stroke group:

• Patient having had a 1st stroke
• Patient whose stroke occurred more than a month ago.
• Patient having had a supratentorial stroke
• Patient able to touch the opposite knee with the paretic arm

Inclusion criteria specific to the control group:

• Subject who has never had a stroke
• Subject without motor or orthopedic impairment of the upper limbs and in particular of the shoulder

General inclusion criteria:

• Subject who has given free and informed consent.
• Subject who signed the consent form.
• Subject affiliated or beneficiary of a health insurance plan.

Exclusion criteria:

• Pregnant, parturient or breastfeeding subject.
• The subject is participating in a category 1 interventional study, or is in a period of exclusion determined by a previous study
• The subject refuses to sign the consent
• It is impossible to give the subject informed information
• The patient is under safeguard of justice or state guardianship
• Patient with cognitive disorders incompatible with a good understanding of the use of the device
• Patient with other neurological or osteoarticular history that may limit the performance of the task - criterion left to the deiscretion of the investigator

Exclusion Criteria

Not provided

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Controls	Reaching Session	-
Patients with stroke	Reaching Session	-

Primary Outcome Measures

Name	Time	Method
Evaluate the modifications of the proximal non-use after stroke on the paretic side according to the extent of force constraint	Inclusion	Proximal Arm Non Use (PANU) score (%): A significant PANU (\> 7.5%) indicates non-use

Secondary Outcome Measures

Name	Time	Method
Evaluate the modifications of the proximal non-use in the control subjects according to the constraints of force or precision	Inclusion	PANU score (%) of force and precision
Intensity of arm deficit	Inclusion	Fugl-Meyer Upper Extremity score ) (score between 0 and 66)
height of the target	Inclusion	Evaluate changes in the proximal non-use after stroke on the paretic side according to the height of the target to be reached with PANU score (%) : A significant PANU (\> 7.5%) indicates non-use
Model the constraints and costs explaining non-use patient by patient, to distinguish between physiological and psycho-behavioral non-use	Inclusion	Weight-over-force ratio of the arm (Ratio between 0 \& + ∞)
Evaluate the level of neuromuscular activation during reaching	Inclusion	% Voluntary Maximum Contraction (VMC) of anterior and intermediate part of the deltoid, biceps brachii and pectoralis major
Time since stroke (acute, subacute or chronic phase)	Inclusion	months
Evaluate the modifications of the proximal non-use after stroke on the paretic side according to the precision required	Inclusion	PANU score (%): Physiological non-use considered as a decrease in PANU due to to the increase in the size of the target; A psychological non-use considered as absence of decrease in PANU, regardless of the condition

Trial Locations

Locations (2)

CHU de Nîmes; 🇫🇷 Nîmes, France

CHU de Montpellier; 🇫🇷 Montpellier, France