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Contralaterally Controlled FES for Hand Opening in Hemiplegic Cerebral Palsy

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02925455
Recruitment Status : Completed
First Posted : October 5, 2016
Last Update Posted : May 28, 2020
The Cleveland Clinic
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Information provided by (Responsible Party):
Michael Fu, MetroHealth Medical Center

Brief Summary:
This is a pilot randomized controlled trial of an intervention to improve arm function in children ages 6 to 17 with cerebral palsy and upper limb hemiparesis. Twenty participants will be randomized to either a group treated with neuromuscular electrical stimulation and video games or video games alone. Both groups will receive 6 wks of treatment consisting of home and lab sessions. Both the experiment group and control group interventions consist of therapist-guided sessions in the rehabilitation clinic and self-administered or caregiver-assisted sessions at home. While both groups will receive the same task practice and video game training, only the experiment group will receive an electrical stimulation device to assist with hand opening during practice. Changes in upper extremity motor impairment and function will be assessed for each participant at baseline, mid treatment, end of treatment and at 3 mo follow-up.

Condition or disease Intervention/treatment Phase
Cerebral Palsy Device: Contralaterally-controlled functional electrical stimulation Device: Hand therapy video games Not Applicable

Detailed Description:

Rehabilitation clinic sessions - These will occur up to twice per week for the first 3 weeks and once per week for the second 3 weeks of the 6 week treatment. They are therapist-guided and last up to 90 min consisting of 45 minutes of contralaterally-controlled functional electrical stimulation (CCFES)-mediated video games and up to 45 minutes of CCFES-mediated functional task practice. Early sessions will focus on training the patient and caregiver to self-administer play of a CCFES-mediated video game at home. As proficiency with one game develops, more games will be introduced. The functional task practice part of the session will engage the participant in using the CCFES system to assist them in practicing using their hand in activities such as lacing beads, throwing balls, eating finger foods, and other play and activities of daily living. Prior to the start of lab treatment, the investigators will assess hand extensor and flexor muscle co-activation (see below).

Home sessions - These consist of CCFES-mediated hand opening and video game exercises with caregiver assistance and supervision as needed. As proficiency develops and more games are added, each home session will increase in duration up to 90 minutes per day, as determined by the treating therapist based on the adherence of each participant. Self report of game difficulty and engagement will be made at the completion of each game (see below)

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 18 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Contralaterally Controlled Functional Electrical Stimulation for Hand Opening in Hemiplegic Cerebral Palsy: Pilot Randomized Controlled Trial
Actual Study Start Date : October 16, 2016
Actual Primary Completion Date : December 31, 2019
Actual Study Completion Date : April 30, 2020

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Stimulation + Video Games
Contralaterally-controlled functional electrical stimulation (CCFES) enables patients with upper extremity hemiplegia to open their paretic hand by stimulating finger and thumb extensors with surface electrodes. CCFES is used during functional task practice and hand therapy video games to link motor intent with execution. Four intuitive and engaging games were developed to provide goal-oriented motor skill training, impairment-appropriate difficulty, and performance feedback that motivates iterative play and skill improvement.
Device: Contralaterally-controlled functional electrical stimulation
Contralaterally-controlled functional electrical stimulation (CCFES) is electrical stimulation of weak muscles of an impaired limb controlled via movement of the unimpaired contralateral limb.

Device: Hand therapy video games
Hand therapy video games are designed to provide therapy to weak muscles of an impaired limb via goal-directed movements.

Active Comparator: Video Games (no stimulation)
Participants receive duration-matched, identical hand therapy video games and task practice therapy as the experiment arm, but do not receive CCFES to assist hand opening.
Device: Hand therapy video games
Hand therapy video games are designed to provide therapy to weak muscles of an impaired limb via goal-directed movements.

Primary Outcome Measures :
  1. Change in Assisting Hands Assessment at 6 weeks [ Time Frame: 6 weeks ]

Secondary Outcome Measures :
  1. Change in Melbourne 2 Motor Assessment at 6 weeks [ Time Frame: 6 weeks ]

Information from the National Library of Medicine

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Ages Eligible for Study:   6 Years to 17 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Upper Extremity hemiparesis from Cerebral Palsy
  • Age 6-17
  • Caregiver can transport participant to weekly sessions and assist with home treatment
  • Medically stable; stable medications
  • Recall 2 of 3 items after 30 min
  • Finger extension strength ≤ 4/5 on paretic side
  • Able to follow 3-stage commands
  • Adequate active movement of paretic arm to position the hand for table-top task practice
  • Skin intact on hemiparetic arm
  • Surface neuromuscular electrical stimulation trial opens hand without pain
  • Full volitional hand opening and closing of contralateral hand
  • Box & Blocks Score of weaker side < 90% of stronger side score
  • Able to hear and respond to auditory cues
  • English proficiency of both caregiver and child

Exclusion Criteria:

  • Uncontrolled seizure disorder
  • Co-existing neurological conditions other than cerebral palsy affecting the hemiparetic upper limb (e.g., peripheral nerve injury, Parkinson's disease, spinal cord injury, traumatic brain injury, multiple sclerosis, stroke, hemispherectomy)
  • Severely impaired cognition and communication
  • History of cardiac arrhythmias with hemodynamic instability
  • Insensate arm, forearm, or hand
  • Uncompensated hemi-neglect
  • Cardiac pacemaker or any other implanted electronic systems
  • Pregnant
  • Intramuscular Botox injections in any upper extremity muscle in the last 3 months
  • Severe visual impairment

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02925455

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United States, Ohio
Cleveland Clinic Foundation
Cleveland, Ohio, United States, 44104
MetroHealth Medical Center
Cleveland, Ohio, United States, 44109
Sponsors and Collaborators
MetroHealth Medical Center
The Cleveland Clinic
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Principal Investigator: Michael J Fu, PhD MetroHealth Medical Center
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Responsible Party: Michael Fu, Assistant Professor, Physical Medicine and Rehabilitation, MetroHealth Medical Center Identifier: NCT02925455    
Other Study ID Numbers: 16-400
1R21HD088987-01 ( U.S. NIH Grant/Contract )
First Posted: October 5, 2016    Key Record Dates
Last Update Posted: May 28, 2020
Last Verified: May 2020
Keywords provided by Michael Fu, MetroHealth Medical Center:
Functional Electrical Stimulation
Video Games
Occupational Therapy
Additional relevant MeSH terms:
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Cerebral Palsy
Nervous System Diseases
Brain Damage, Chronic
Brain Diseases
Central Nervous System Diseases