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Unilateral Wrist Extension Training After Stroke

U

University of Victoria

Status

Completed

Conditions

Stroke

Treatments

Device: Unilateral wrist extension training

Study type

Interventional

Funder types

Other

Identifiers

NCT03268798
D015017-2011-2015

Details and patient eligibility

About

Following stroke, muscle weakness and impaired motor function are expressed in both the more (MA; paretic) and less affected (LA; non-paretic) sides. Although the efficacy of resistance training is well recognized, training the MA limb directly may be initially difficult due to muscular weakness. "Cross-education" is training one side of the body increases strength in the untrained and opposite side. This concept can be applied in strength training when training the more affected sides cannot be initiated. Recently, our lab found six weeks of dorsiflexion resistance training in the LA leg improved the strength of both trained and untrained legs of chronic stroke participants.

The current project explored if cross-education exists in the upper limb in chronic stroke participants and if there are related changes in cortical and spinal cord plasticity. We hypothesized that unilateral strength in the less affected arm could enhance wrist extension strength bilaterally with related neural adoption and improved clinical function.

Full description

Stroke produces muscle weakness seen on both more (paretic, MA) and less affected (non-paretic, LA) sides. "Cross-education" is training one side of the body increases strength or motor skill in the same muscles on the untrained side. This can be applied to enhance muscle strength in the MA side and we found that 6 weeks of dorsiflexion resistance training with the LA leg improved strength bilaterally in chronic stroke. To explore if cross-education occurs also in the upper limb after stroke, participants will complete a 5-week unilateral wrist extension training.

Twenty four participants will be recruited, 12 from Rehabilitation Neuroscience laboratory at University of Victoria, 12 from Brain Behaviour Laboratory at University of British Columbia. Before and after training, maximal voluntary contraction wrist extension force was measured with a 6-axis load cell using Cartesian coordinates (Fz = extension). Electromyography of extensor and flexor carpi radialis, biceps and triceps brachii were recorded. Fugl-Meyer and partial Wolf Motor Function Test were performed by the same physical therapist at each location. Reciprocal inhibition from wrist flexors to extensors, cutaneous reflexes evoked by median and superficial radial nerve stimulation were assessed in those at UVIC. Cortical silent period, short-interval intracortical inhibition, intracortical facilitation and transcallosal inhibition from transcranial magnetic stimulation were measured in participants at UBC.

Enrollment

24 patients

Sex

All

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Over 6 months post-stroke;
  • One side of arm shows muscle weakness
  • Pass the screening test of Physical Activity Readiness Questionnaire
  • Pass the screening test for dementia
  • Free from dementia (score < 24 on the Montreal Cognitive Assessment) and any other contradiction for TMS test

Exclusion criteria

  • Had medication affecting muscle tone within the past 3 months
  • Wear a pacemaker

Trial design

Primary purpose

Treatment

Allocation

N/A

Interventional model

Single Group Assignment

Masking

None (Open label)

24 participants in 1 patient group

Wrist extension training
Experimental group
Treatment:
Device: Unilateral wrist extension training

Trial contacts and locations

0

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Data sourced from clinicaltrials.gov

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