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| ID | Type | Description | Link |
|---|---|---|---|
| NCT04747587 | Other Identifier | ANSM |
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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients with stroke | Experimental |
| |
| Controls | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Reaching Session | Other | Two x 45 minutes sessions of reaching tasks. Patients in the stroke group will perform the task with the paretic arm using a weight reduction system, allowing movement in the horizontal plane. Subjects in the control group will perform the task with the randomly selected arm weighted at 80% of their maximum voluntary shoulder torque |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate the modifications of the proximal non-use after stroke on the paretic side according to the extent of force constraint | Proximal Arm Non Use (PANU) score (%): A significant PANU (> 7.5%) indicates non-use | Inclusion |
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate the modifications of the proximal non-use after stroke on the paretic side according to the precision required | 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 | Inclusion |
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Inclusion Criteria:
Inclusion criteria specific to the stroke group:
Inclusion criteria specific to the control group:
General inclusion criteria:
Exclusion criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jérôme Froger | Centre Hospitalier Universitaire de Nīmes | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| CHU de Montpellier | Montpellier | France | ||||
| CHU de Nîmes |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 42080459 | Derived | Faity G, Mottet D, Froger J, Delorme M. Neuromechanics of Nonuse and Compensation: Implications for Rehabilitation After Stroke. Neurorehabil Neural Repair. 2026 May 4:15459683261445442. doi: 10.1177/15459683261445442. Online ahead of print. |
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Anonymised raw datasets and code used for the analysis will be available on reasonable request.
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D001247 | Asthenia |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Evaluate the modifications of the proximal non-use in the control subjects according to the constraints of force or precision | PANU score (%) of force and precision | Inclusion |
| Evaluate the level of neuromuscular activation during reaching | % Voluntary Maximum Contraction (VMC) of anterior and intermediate part of the deltoid, biceps brachii and pectoralis major | Inclusion |
| Model the constraints and costs explaining non-use patient by patient, to distinguish between physiological and psycho-behavioral non-use | Weight-over-force ratio of the arm (Ratio between 0 & + ∞) | Inclusion |
| Time since stroke (acute, subacute or chronic phase) | months | Inclusion |
| Intensity of arm deficit | Fugl-Meyer Upper Extremity score ) (score between 0 and 66) | Inclusion |
| height of the target | 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 | Inclusion |
| Nîmes |
| France |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |