Abstract
BackgroundRecovery of upper limb function in individuals after a stroke remains challenging. Modified constraint-induced movement therapy (m-CIMT) has strong evidence for increasing the use and recovery of sensorimotor function of the paretic upper limb. Recent studies have shown that priming with aerobic exercise prior to task-specific training potentiates upper limb recovery in individuals with stroke. This protocol describes a randomized clinical trial designed to determine whether priming with moderate-high intensity aerobic exercise prior to m-CIMT will improve the manual dexterity of the paretic upper limb in individuals with chronic hemiparesis.MethodsSixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + m-CIMT or Stretching + m-CIMT. m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence. Aerobic exercise will be conducted on a stationary bicycle at intervals of moderate to high intensity. Participants will be evaluated at baseline, 3, 30, and 90 days postintervention by the following instruments: Motor Activity Log, Nottingham Sensory Assessment, Wolf Motor Function Test, Box and Block Test, Nine-Hole Peg Test, Stroke Specific Quality of Life Scale and three-dimensional kinematics. The data will be tested for normality and homogeneity. Parametric data will be analyzed by two-way ANOVA with repeated measures and Bonferroni’s adjustment. For nonparametric data, the Friedman test followed by the Wilcoxon test with Bonferroni’s adjustment will be used to compare the ratings for each group. To compare the groups in each assessment, the Mann-Whitney test will be used.DiscussionThis study will provide valuable information about the effect of motor priming for fine upper limb skill improvement in people with chronic poststroke hemiparesis, bringing new evidence about the association of two therapies commonly used in clinical practice.Trial registrationThis trial was retrospectively registered (registration number RBR-83pwm3) on 07 May 2018.
Highlights
MethodsSixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + Modified Constraint-Induced Movement Therapy (mCIMT) or Stretching + Modified constraintinduced movement therapy (m-CIMT). m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence
Recovery of upper limb function in individuals after a stroke remains challenging
Based on neural plasticity mechanisms [7], Modified Constraint-Induced Movement Therapy (m-CIMT) [8, 9] emerged to provide poststroke individuals with greater functional use of the paretic upper limb [10], reverse learned nonuse [11], and improve motor function and manual dexterity [12]. Modified constraintinduced movement therapy (m-CIMT) has high levels of evidence for the recovery of upper-limb poststroke according to recent guidelines [13, 14]
Summary
This study is a randomized, single-blinded, intention-totreat controlled clinical trial in which 78 participants of both genders in a chronic stage poststroke will be randomized into two groups of 39 participants. Upper limb performance in 3D kinematics Three-dimensional Motion Analysis (3DMA) of three functional activities will be quantified using the optoelectronic ProReflex Motion Capture System (Qualisys Medical AB, Gothenburg, Sweden) with eight high-speed cameras at a sampling frequency of 120 Hz. One trained physiotherapist will perform this analysis following the standard protocol of the International Society of Biomechanics (ISB) [52]; (1) placement of clusters on trunk, hemiparetic scapula, arm, forearm, and hand [52,53,54,55], (Fig. 2); (2) collection of seated static posture for five seconds; (3) ten passive circumduction movements of the shoulder (right and left sides) to calculate the glenohumeral joint center [56]; (4) removal of anatomical markers; and (5) collection of 3D kinematics during the functional tasks. The mean difference from pre- and post-interventions and the corresponding 95% confidence interval (95% CI) will be calculated for each group (EA + m-CIMT and Stretching + m-CIMT) in order to estimate the effect of the intervention
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