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| Name | Class |
|---|---|
| Istituto Italiano di Tecnologia | OTHER |
| Ospedale Policlinico San Martino | OTHER |
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Upper limb disabilities are among the most debilitating issues after a cerebral stroke. One promising approach in motor rehabilitation is the use of functional electrical stimulation (FES). This technique can be integrated into daily therapy to follow an adaptive approach, exploiting the residual capacities of patients. FES can help to stimulate the affected muscles, improve coordination and strengthen the weakened muscles, thus supporting the rehabilitation process.
FitFES is a wearable and non-invasive device that provides continuous stimulation set according to the residual myoelectric activity of hemiparetic muscles. Its bioinspired functioning has been implemented to restore the neurophysiological feedback from the muscles to the central nervous system while performing voluntary movements. This study aims to assess the effects of FitFES device on upper limb motor rehabilitation of post-stroke subjects, compared to traditional rehabilitation treatment. 50 post-stroke subjects will be recruited and randomized into an experimental group and a control group.
All participants will follow a 15-session rehabilitation program, and in each session they will execute task-oriented exercises. The experimental group will be assisted by the FitFES device, while the control group will perform the tasks without the device support.
Each subject will be assessed before and at the end of the rehabilitation protocol. Collected data from both groups will then be compared.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| FES group | Experimental | Subjects will use the device as need-based support to perform task-oriented exercises |
|
| CON group | Active Comparator | Subjects will perform task-oriented exercises without the support of the device |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| EMG-based FES rehabilitation | Device | Each subject will receive 15 individual rehabilitation sessions, each lasting 60 minutes, conducted 3 to 5 times per week over a period of 5 to 3 weeks, depending on the weekly frequency. Each participant will perform task-oriented exercises while using the FitFES device. |
| Measure | Description | Time Frame |
|---|---|---|
| Action Research Arm Test (ARAT) | The ARAT test assesses upper limb functioning through the execution of 19 tasks, divided in 4 sub-tests (grasp, grip, pinch, and gross arm movement). Each movement is scored on a 4-point ordinal scale (0=no movement, 1=movement partially performed, 2=movement completed but takes abnormally long; 3=movement performed normally). Total possible score is 57 points, with higher scores associated to best motor functioning. | Baseline (T0), after 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after T0 (T1), 1-month follow-up (T2) |
| Fugl-Meyer Upper Extremity scale (FM-UE) | The Fugl-Meyer Assessment of Motor Recovery after Stroke is one of the most widely used measures of motor impairment in post-stroke hemiplegic patients, covering 5 domains (Motor fu ENnction, sensory function, balance, joint range of motion, joint pain). The assessment of upper extremity motion is performed using the Upper Extremity assessment (FM-UE), including items scored on a 3-point ordinal scale (0: cannot perform, 1: performs partially; 2: performs fully) with a total maximum score: 66 points (higher scores, best clinical profile). | Baseline (T0), after 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after T0 (T1), 1-month follow-up (T2) |
| Box and Block test (BBT) | The Box and Block Test (BBT) measures unilateral gross manual dexterity. The BBT goal is to move, one by one, the maximum number of blocks from one compartment of a box to another of equal size, within 60 seconds. The score is determined by counting the number of blocks carried over the partition from one compartment to the other during the one-minute trial period. Higher scores on the test indicate better gross manual dexterity | Baseline (T0), after 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after T0 (T1), 1-month follow-up (T2) |
| EuroQol 5-Dimension 5-level (EQ-5D-5L) Questionnaire | EQ-5D-5L is a standardized instrument for use as a measure of health for clinical and economic appraisal. Applicable to a wide range of health conditions and treatments, the EQ-5D health questionnaire provides a simple descriptive profile and a single index value for health status. It measures the 5 dimensions of mobility, self-care, usual activities, pain/discomfort, anxiety/depression. Each dimension is scored on a Likert scale of 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. |
| Measure | Description | Time Frame |
|---|---|---|
| Surface Electromyography (EMGs) | Surface Electromyography (EMGs) is a non-invasive tool able to assess muscular electrical activity during the execution of active movements using electrodes applied on the skin surface. Muscular contraction amplitude will be recorded from 24 sensors placed on upper limbs (12 sensors/limb), during the execution of motor acts. Then, the difference between patient's and observed model's temporal dynamic of muscular contraction will be chosen as EMG outcome. |
| Measure | Description | Time Frame |
|---|---|---|
| Age data | Age of participants will be collected | Baseline (T0) |
| Gender data | Gender of participants will be collected | Baseline (T0) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Alessandro Viganò, MD, PhD | Contact | 00390240308890 | avigano@dongnocchi.it | |
| Gaia Bailo, Eng | Contact | 00390240308234 | gbailo@dongnocchi.it |
| Name | Affiliation | Role |
|---|---|---|
| Maurizio Ferrarin, PhD, Eng | IRCCS Fondazione Don Carlo Gnocchi ONLUS | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ospedale Policlinico San Martino | Recruiting | Genova | 16132 | Italy |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32156646 | Background | Villepinte C, Verma A, Dimeglio C, De Boissezon X, Gasq D. Responsiveness of kinematic and clinical measures of upper-limb motor function after stroke: A systematic review and meta-analysis. Ann Phys Rehabil Med. 2021 Mar;64(2):101366. doi: 10.1016/j.rehab.2020.02.005. Epub 2020 Mar 7. | |
| 25017296 | Background |
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Shared data will comprise only IPD used in results publication. Data will be available upon reasonable request.
Data will be available after publication with no end date
Request should be addressed to the principal investigator or the corresponding author of the publication.
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| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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|
| Traditional rehabilitation | Other | Each subject will receive 15 individual rehabilitation sessions, each lasting 60 minutes, conducted 3 to 5 times per week over a period of 5 to 3 weeks, depending on the weekly frequency. Each participant will perform task-oriented exercises. |
|
| Baseline (T0), after 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after T0 (T1), 1-month follow-up (T2) |
| Baseline (T0), after 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after T0 (T1), 1-month follow-up (T2) |
| Body Kinematics | Kinematics of the upper limb and trunk will be recorded using a 9-camera optoelectronic system during 3D motor acts. The system will measure the 3D coordinates of spherical markers attached to body landmarks to compute trunk, shoulder, elbow and wrist angles. Data processing will provide measures of deviations from physiological movement. | Baseline (T0), after 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after T0 (T1) |
| Treatment Safety | Data related to the safety of the device will be collected:
| After 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after baseline (T1) |
| Cost-effectiveness ratio | The costs of the two rehabilitation paths (with and without device), related to direct costs (maintenance device, consumables) and indirect costs will be collected (training of therapists on the device, costs related to the patient using the device). Procedures to be performed in a single treatment session will also be evaluated, in terms of time needed for preparation and dressing, and of trained personnel required during a session. An estimate of the working cycles that the device can perform in a year will also be considered. | At the end of 15 rehabilitation sessions (each session is 60 minutes) from 3 to 5 weeks after baseline (T1) |
| Scholarity data | Scholarity of participants will be collected | Baseline (T0) |
| Fondazione Don Carlo Gnocchi Onlus | Recruiting | La Spezia | 19125 | Italy |
|
| IRCCS Fondazione Don Carlo Gnocchi Onlus | Recruiting | Milan | 20148 | Italy |
|
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| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |