Combining Physical Therapy With Vestibular Stimulation to Improve Postural Stability in Pusher's Syndrome

Imperial College London

Status: Withdrawn

Conditions: Pusher Syndrome

Treatments: Device: Galvanic Vestibular Stimulation; Other: Standard Physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT03831594

222784

Details and patient eligibility

About

The study is evaluating the effect of combining Galvanic Vestibular Stimulation (GVS) with standard Physiotherapy treatment in patients admitted to a neurological rehabilitation unit with Pusher syndrome (PS). Patients will be randomised to receive standard Physiotherapy treatment or standard treatment with GVS.

Perceived verticality data will also be collected and analysed on age-matched controls. This data will be used to compare these results with the patients with PS.

The investigators hypothesis that GVS and standard Physiotherapy treatment will lead to a greater improvement in functional ability and awareness of perceived verticality compared to standard Physiotherapy alone.

Full description

Pusher syndrome (PS) can be described as disordered balance and orientation which causes patients to perceive they are in an upright position when in fact they are positioned towards their affected side. These patients use their unaffected limbs to 'push' themselves away from their unaffected side in an attempt to correct their perceived postural alignment. PS is a common disorder and can affect 16% of stroke patients.

Patients with PS have shown to take longer to improve in rehabilitation than non-PS patients and tend to stay in hospital for longer.

Galvanic Vestibular Stimulation (GVS) involves passing a small electrical current behind the ear to stimulate the vestibular system to in-turn cause the head and body to move.

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Pusher Inclusion Criteria:

• Identified hemiparetic neglect - identified PS from a stroke or acquired brain injury (using the Scale of Contraversive Pushing and The Burke Lateropulsion Scale)
• Consenting to participate in the trial

Pusher Exclusion Criteria:

• Severe cognitive impairment

• Receptive aphasia

• Medical co-morbidities

• Opthalamic impairment

• Vestibular impairment

• Peripheral neuropathy

• Also any contraindications to GVS including:

  • Brain metallic implants
  • Pacemakers
  • Recent brain surgery
  • Skull defect
  • Preceding epileptic seizures
  • Sensitive skin behind the ears.

Healthy volunteers inclusion criteria:

• 40 years old minimum age
• Consent to taking part in the trial

Healthy volunteers exclusion criteria:

• Vestibular impairment
• History of medical/psychiatric/neurological disorders
• Currently taking any psychoactive medication
• Drunk more than 3 units of alcohol in the past 24 hours

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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0 participants in 2 patient groups

Standard Physiotherapy and Galvanic Vestibular Stimulation

Experimental group

Description:

Standard physiotherapy concurrently with Galvanic Vestibular Stimulation for 45 minutes a day for two weeks (five days per week)

Treatment:

Other: Standard Physiotherapy

Device: Galvanic Vestibular Stimulation

Standard Physiotherapy

Active Comparator group

Description:

Standard Physiotherapy for 45 minutes a day for two weeks (five days per week)

Treatment:

Other: Standard Physiotherapy