Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design
Identifieur interne : 004B38 ( Main/Curation ); précédent : 004B37; suivant : 004B39Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design
Auteurs : Gert Kwakkel [Pays-Bas] ; Carel Gm Meskers [Pays-Bas] ; Erwin E. Van Wegen [Pays-Bas] ; Guus J. Lankhorst [Pays-Bas] ; Alexander Ch Geurts [Pays-Bas] ; Annet A. Van Kuijk [Pays-Bas] ; Eline Lindeman [Pays-Bas] ; Anne Visser-Meily [Pays-Bas] ; Erwin De Vlugt [Pays-Bas] ; J Hans Arendzen [Pays-Bas]Source :
- BMC Neurology [ 1471-2377 ] ; 2008.
English descriptors
- KwdEn :
- Adaptation, Physiological, Clinical Protocols, Electric Stimulation Therapy, Humans, Magnetic Resonance Imaging, Musculoskeletal Manipulations (methods), Nerve Regeneration, Recovery of Function, Research Design, Restraint, Physical (methods), Robotics (methods), Single-Blind Method, Stroke (rehabilitation), Time Factors, Transcranial Magnetic Stimulation, Upper Extremity.
- MESH :
- methods : Musculoskeletal Manipulations, Restraint, Physical, Robotics.
- rehabilitation : Stroke.
- Adaptation, Physiological, Clinical Protocols, Electric Stimulation Therapy, Humans, Magnetic Resonance Imaging, Nerve Regeneration, Recovery of Function, Research Design, Single-Blind Method, Time Factors, Transcranial Magnetic Stimulation, Upper Extremity.
Abstract
Main claims of the literature are that functional recovery of the paretic upper limb is mainly defined within the first month post stroke and that rehabilitation services should preferably be applied intensively and in a task-oriented way within this particular time window. EXplaining PLastICITy after stroke (acronym EXPLICIT-stroke) aims to explore the underlying mechanisms of post stroke upper limb recovery. Two randomized single blinded trials form the core of the programme, investigating the effects of early modified Constraint-Induced Movement Therapy (modified CIMT) and EMG-triggered Neuro-Muscular Stimulation (EMG-NMS) in patients with respectively a favourable or poor probability for recovery of dexterity.
180 participants suffering from an acute, first-ever ischemic stroke will be recruited. Functional prognosis at the end of the first week post stroke is used to stratify patient into a poor prognosis group for upper limb recovery (N = 120, A2 project) and a group with a favourable prognosis (N = 60, A1 project). Both groups will be randomized to an experimental arm receiving respectively modified CIMT (favourable prognosis) or EMG-NMS (poor prognosis) for 3 weeks or to a control arm receiving usual care. Primary outcome variable will be the Action Research Arm Test (ARAT), assessed at 1,2,3,4,5, 8, 12 and 26 weeks post stroke. To study the impact of modified CIMT or EMG-NMS on stroke recovery mechanisms i.e. neuroplasticity, compensatory movements and upper limb neuromechanics, 60 patients randomly selected from projects A1 and A2 will undergo TMS, kinematical and haptic robotic measurements within a repeated measurement design. Additionally, 30 patients from the A1 project will undergo fMRI at baseline, 5 and 26 weeks post stroke.
EXPLICIT stroke is a 5 year translational research programme which main aim is to investigate the effects of early applied intensive intervention for regaining dexterity and to explore the underlying mechanisms that are involved in regaining upper limb function after stroke. EXPLICIT-stroke will provide an answer to the key question whether therapy induced improvements are due to either a reduction of basic motor impairment by neural repair i.e. restitution of function and/or the use of behavioural compensation strategies i.e. substitution of function.
EXPLICIT is registered at the Netherlands Trial Register (NTR,
Url:
DOI: 10.1186/1471-2377-8-49
PubMed: 19091088
PubMed Central: 2630975
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Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Van Kuijk, Annet A" sort="Van Kuijk, Annet A" uniqKey="Van Kuijk A" first="Annet A" last="Van Kuijk">Annet A. Van Kuijk</name><affiliation wicri:level="3"><nlm:aff id="I3">Dept. Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Lindeman, Eline" sort="Lindeman, Eline" uniqKey="Lindeman E" first="Eline" last="Lindeman">Eline Lindeman</name><affiliation wicri:level="3"><nlm:aff id="I4">Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Visser Meily, Anne" sort="Visser Meily, Anne" uniqKey="Visser Meily A" first="Anne" last="Visser-Meily">Anne Visser-Meily</name><affiliation wicri:level="3"><nlm:aff id="I4">Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="I5">Rehabilitation Centre "De Hoogstraat", PO Box 85238, 3508 AE, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Rehabilitation Centre "De Hoogstraat", PO Box 85238, 3508 AE, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="De Vlugt, Erwin" sort="De Vlugt, Erwin" uniqKey="De Vlugt E" first="Erwin" last="De Vlugt">Erwin De Vlugt</name><affiliation wicri:level="1"><nlm:aff id="I6">Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft</wicri:regionArea><wicri:noRegion>Delft</wicri:noRegion></affiliation></author><author><name sortKey="Arendzen, J Hans" sort="Arendzen, J Hans" uniqKey="Arendzen J" first="J Hans" last="Arendzen">J Hans Arendzen</name><affiliation wicri:level="3"><nlm:aff id="I2">Dept. Rehabilitation Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. 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Rehabilitation Medicine, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="I4">Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Meskers, Carel Gm" sort="Meskers, Carel Gm" uniqKey="Meskers C" first="Carel Gm" last="Meskers">Carel Gm Meskers</name><affiliation wicri:level="3"><nlm:aff id="I2">Dept. Rehabilitation Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author><author><name sortKey="Van Wegen, Erwin E" sort="Van Wegen, Erwin E" uniqKey="Van Wegen E" first="Erwin E" last="Van Wegen">Erwin E. Van Wegen</name><affiliation wicri:level="3"><nlm:aff id="I1">Dept. Rehabilitation Medicine, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Lankhorst, Guus J" sort="Lankhorst, Guus J" uniqKey="Lankhorst G" first="Guus J" last="Lankhorst">Guus J. Lankhorst</name><affiliation wicri:level="3"><nlm:aff id="I1">Dept. Rehabilitation Medicine, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Geurts, Alexander Ch" sort="Geurts, Alexander Ch" uniqKey="Geurts A" first="Alexander Ch" last="Geurts">Alexander Ch Geurts</name><affiliation wicri:level="3"><nlm:aff id="I3">Dept. Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Van Kuijk, Annet A" sort="Van Kuijk, Annet A" uniqKey="Van Kuijk A" first="Annet A" last="Van Kuijk">Annet A. Van Kuijk</name><affiliation wicri:level="3"><nlm:aff id="I3">Dept. Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen</wicri:regionArea><placeName><settlement type="city">Nimègue</settlement><region type="province" nuts="2">Gueldre</region></placeName></affiliation></author><author><name sortKey="Lindeman, Eline" sort="Lindeman, Eline" uniqKey="Lindeman E" first="Eline" last="Lindeman">Eline Lindeman</name><affiliation wicri:level="3"><nlm:aff id="I4">Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="Visser Meily, Anne" sort="Visser Meily, Anne" uniqKey="Visser Meily A" first="Anne" last="Visser-Meily">Anne Visser-Meily</name><affiliation wicri:level="3"><nlm:aff id="I4">Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, University Medical Centre and Rudolf Magnus Institute of Neuroscience, Heidelberglaan 100, 3584 CX, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="I5">Rehabilitation Centre "De Hoogstraat", PO Box 85238, 3508 AE, Utrecht, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Rehabilitation Centre "De Hoogstraat", PO Box 85238, 3508 AE, Utrecht</wicri:regionArea><placeName><settlement type="city">Utrecht</settlement><region nuts="2" type="province">Utrecht (province)</region></placeName></affiliation></author><author><name sortKey="De Vlugt, Erwin" sort="De Vlugt, Erwin" uniqKey="De Vlugt E" first="Erwin" last="De Vlugt">Erwin De Vlugt</name><affiliation wicri:level="1"><nlm:aff id="I6">Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft</wicri:regionArea><wicri:noRegion>Delft</wicri:noRegion></affiliation></author><author><name sortKey="Arendzen, J Hans" sort="Arendzen, J Hans" uniqKey="Arendzen J" first="J Hans" last="Arendzen">J Hans Arendzen</name><affiliation wicri:level="3"><nlm:aff id="I2">Dept. Rehabilitation Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands</nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Dept. Rehabilitation Medicine, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden</wicri:regionArea><placeName><settlement type="city">Leyde</settlement><region nuts="2" type="province">Hollande-Méridionale</region></placeName></affiliation></author></analytic><series><title level="j">BMC Neurology</title><idno type="eISSN">1471-2377</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adaptation, Physiological</term><term>Clinical Protocols</term><term>Electric Stimulation Therapy</term><term>Humans</term><term>Magnetic Resonance Imaging</term><term>Musculoskeletal Manipulations (methods)</term><term>Nerve Regeneration</term><term>Recovery of Function</term><term>Research Design</term><term>Restraint, Physical (methods)</term><term>Robotics (methods)</term><term>Single-Blind Method</term><term>Stroke (rehabilitation)</term><term>Time Factors</term><term>Transcranial Magnetic Stimulation</term><term>Upper Extremity</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Musculoskeletal Manipulations</term><term>Restraint, Physical</term><term>Robotics</term></keywords><keywords scheme="MESH" qualifier="rehabilitation" xml:lang="en"><term>Stroke</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adaptation, Physiological</term><term>Clinical Protocols</term><term>Electric Stimulation Therapy</term><term>Humans</term><term>Magnetic Resonance Imaging</term><term>Nerve Regeneration</term><term>Recovery of Function</term><term>Research Design</term><term>Single-Blind Method</term><term>Time Factors</term><term>Transcranial Magnetic Stimulation</term><term>Upper Extremity</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Main claims of the literature are that functional recovery of the paretic upper limb is mainly defined within the first month post stroke and that rehabilitation services should preferably be applied intensively and in a task-oriented way within this particular time window. EXplaining PLastICITy after stroke (acronym EXPLICIT-stroke) aims to explore the underlying mechanisms of post stroke upper limb recovery. Two randomized single blinded trials form the core of the programme, investigating the effects of early modified Constraint-Induced Movement Therapy (modified CIMT) and EMG-triggered Neuro-Muscular Stimulation (EMG-NMS) in patients with respectively a favourable or poor probability for recovery of dexterity.</p></sec><sec><title>Methods/design</title><p>180 participants suffering from an acute, first-ever ischemic stroke will be recruited. Functional prognosis at the end of the first week post stroke is used to stratify patient into a poor prognosis group for upper limb recovery (N = 120, A2 project) and a group with a favourable prognosis (N = 60, A1 project). Both groups will be randomized to an experimental arm receiving respectively modified CIMT (favourable prognosis) or EMG-NMS (poor prognosis) for 3 weeks or to a control arm receiving usual care. Primary outcome variable will be the Action Research Arm Test (ARAT), assessed at 1,2,3,4,5, 8, 12 and 26 weeks post stroke. To study the impact of modified CIMT or EMG-NMS on stroke recovery mechanisms i.e. neuroplasticity, compensatory movements and upper limb neuromechanics, 60 patients randomly selected from projects A1 and A2 will undergo TMS, kinematical and haptic robotic measurements within a repeated measurement design. Additionally, 30 patients from the A1 project will undergo fMRI at baseline, 5 and 26 weeks post stroke.</p></sec><sec><title>Conclusion</title><p>EXPLICIT stroke is a 5 year translational research programme which main aim is to investigate the effects of early applied intensive intervention for regaining dexterity and to explore the underlying mechanisms that are involved in regaining upper limb function after stroke. EXPLICIT-stroke will provide an answer to the key question whether therapy induced improvements are due to either a reduction of basic motor impairment by neural repair i.e. restitution of function and/or the use of behavioural compensation strategies i.e. substitution of function.</p><p>EXPLICIT is registered at the Netherlands Trial Register (NTR, <ext-link ext-link-type="uri" xlink:href="http://www.trialregister.nl"></ext-link>., TC 1424)</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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