Optimizing Hand Rehabilitation Post-Stroke Using Interactive Virtual Environments

Phase 1

Completed

• Conditions: Cerebrovascular Accident; Hemiplegia; Hemiparesis
• Interventions: Behavioral: Bimanual Training; Behavioral: HAS Training; Behavioral: HAT training

• Registration Number: NCT01072461
• Lead Sponsor: New Jersey Institute of Technology

Brief Summary

The complexity of sensorimotor control required for hand function as well as the wide range of recovery of manipulative abilities makes rehabilitation of the hand most challenging. The investigators past work has shown that training in a virtual environment (VE) using repetitive, adaptive algorithms has the potential to be an effective rehabilitation medium to facilitate motor recovery of hand function. These findings are in accordance with current neuroscience literature in animals and motor control literature in humans. The investigators are now in a position to refine and optimize elements of the training paradigms to enhance neuroplasticity. The investigators first aim tests if and how competition among body parts for neural representations stifles functional gains from different types of training regimens. The second aim tests the functional benefits of unilateral versus bilateral training regimens.The third aim tests whether functional improvements gained from training in a virtual environment transfer to other (untrained) skills in the real world.

Detailed Description

The complexity of sensorimotor control required for hand function as well as the wide range of recovery of manipulative abilities makes rehabilitation of the hand most challenging. The investigators past work has shown that training in a virtual environment (VE) using repetitive, adaptive algorithms has the potential to be an effective rehabilitation medium to facilitate motor recovery of hand function. These findings are in accordance with current neuroscience literature in animals and motor control literature in humans. The investigators are now in a position to refine and optimize elements of the training paradigms to enhance neuroplasticity. The investigators first aim tests if and how competition among body parts for neural representations stifles functional gains from different types of training regimens. The second aim tests the functional benefits of unilateral versus bilateral training regimens.The third aim tests whether functional improvements gained from training in a virtual environment transfer to other (untrained) skills in the real world.

Study Timeline

• Study Start: 2009-03
• Study First Submitted: 2010-02-16
• Study First Submitted QC: 2010-02-19
• Study First Posted: 2010-02-22
• Primary Completion: 2013-03
• Study Completion: 2015-03
• Status Verified: 2015-10
• Last Update Submitted: 2015-10-06
• Last Update Posted: 2015-10-07

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 55

Inclusion Criteria

• Six months post cerebrovascular accident
• Residual upper extremity impairment that affects participation
• At least ten degrees of active finger extension
• Tolerate passive shoulder flexion to chest level

Exclusion Criteria

• Severe neglect
• Severe aphasia

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Train Both Hands Together in VE	Bimanual Training	-
Train Paretic Hand and Arm Separate	HAS Training	Eight three hour training sessions of robotically facilitated hand and arm training in complex virtual environments, using activities that train the fingers in isolation and other activities that train the arm in isolation.
Train Paretic Hand and Arm Together	HAT training	-

Primary Outcome Measures

Name	Time	Method
Change in Jebsen Test of Hand Function	Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training

Secondary Outcome Measures

Name	Time	Method
Change in Box and Blocks Test	Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training
Change in Robotically Collected Kinematics	1 day before training and 1 day after training
Change in Wolf Motor Function Test	Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training
Change in Reach to Grasp Test	1 day before training and 1 day after training
Change in 9 Hole Peg Test	Two Weeks Prior to Training, Immediately Prior to Training, Immediately After Training, 3 Months After Training

Trial Locations

Locations (1)

New Jersey Institute of Technology; 🇺🇸 Newark, New Jersey, United States