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Trial record 32 of 7889 for:    "observation"

Constraint-Induced Movement Therapy and Action Observation Training in Children With Unilateral Cerebral Palsy

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ClinicalTrials.gov Identifier: NCT03256357
Recruitment Status : Recruiting
First Posted : August 22, 2017
Last Update Posted : August 22, 2017
Sponsor:
Collaborators:
ETH Zurich (Switzerland)
University of Pisa, Italy
Information provided by (Responsible Party):
Klingels Katrijn, Katholieke Universiteit Leuven

Brief Summary:
A randomized, controlled, and evaluator-blinded trail will be carried out comparing CIMT with or without AOT on sensorimotor outcome in children with unilateral CP aged 5 to 12 years. Additionally the potential role of neurological factors, including the anatomical characterization of the brain lesion, structural/functional connectivity and cortical reorganization, on treatment response will be investigated.

Condition or disease Intervention/treatment Phase
Cerebral Palsy Behavioral: Constraint-induced movement therapy Behavioral: Action observation training Behavioral: Placebo observation training Not Applicable

Detailed Description:

Background: Problems in upper limb (UL) function in children with unilateral cerebral palsy (UCP) are traditionally trained with motor execution treatment models, such as Constraint Induced Movement Therapy (CIMT). However new approaches based on a neurophysiological model such as action observation training (AOT) may provide new opportunities for enhanced motor learning.

Aim: The aim of study is to investigate the effects of an intensive treatment model consisting of CIMT and AOT compared to CIMT alone on UL function in children with UCP. Additionally the potential role of neurological factors (including the anatomical characterization of the brain lesion, structural/functional connectivity and cortical reorganization) on treatment response will be analysed.

Methods/Design: A randomized, controlled, evaluator-blinded trial (RCT) will be conducted in 40 children between 5 and 12 years of age. Before randomization, children are stratified according to their House Functional Classification Scale, age and type of cortical reorganization. The Intervention is accomplished during a 2-week day camp in which the children receive intensive therapy for six hours a day on 9 out of 11 consecutive days (54 h) including AOT or placebo observation training (POT) (15h). During the AOT the children in the experimental group watch video sequences showing goal-directed actions and subsequently execute the observed actions with the affected UL. Children in the POT group perform the same actions after watching computer games without biological movements.

Outcome assessments include qualitative and quantitative measures of UL sensorimotor function across the International Classification of Functioning, Disability and Health (ICF). The primary outcome measure is the Assisting Hand Assessment (AHA). The medical imaging protocol includes structural Magnetic Resonance Imaging (MRI), Diffusion Kurtosis Imaging (DKI), resting state functional MRI (rs-fMRI) and Transcranial magnetic stimulation (TMS). The timeline for the assessment is T0 (1-1.5 month before the camp onset), T1 (before the intervention), T2 (after the intervention) and T3 (6 months after the intervention). Linear mixed models will be used to study time effects of the interventions and the interaction with neurological variables as covariates.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Effectiveness of Intensive Upper Limb Training Combining Constraint-Induced Movement Therapy and Action Observation Training in Children With Unilateral Cerebral Palsy
Actual Study Start Date : January 1, 2014
Estimated Primary Completion Date : February 28, 2018
Estimated Study Completion Date : February 28, 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Active Comparator: CIMT + AOT

In a 2-week day camp model children receive constraint-induced movement therapy for six hours a day, for 9 out of 11 consecutive days. All children wear a tailor made hand splint on the unaffected upper limb for 6 hours per day while performing unimanual exercises individually or in a group based on shaping and repetitive practice.

Action observation training consists of 15 sessions of 1 hour. Children watch video sequences showing goal-directed actions and subsequently execute the observed actions with the affected upper limb.

Behavioral: Constraint-induced movement therapy
In a 2-week day camp model children receive constraint- induced movement therapy for six hours a day, for 9 out of 11 consecutive days. All children wear a tailor made hand splint on the unaffected upper limb for 6 hours per day while performing unimanual exercises individually or in a group based on shaping and repetitive practice.

Behavioral: Action observation training
Action observation training consists of 15 sessions of 1 hour. Children watch 3 minute video clips of unimanual goal-directed actions followed by 3 minutes of execution of the actions.

Placebo Comparator: CIMT + POT

In a 2-week day camp model children receive constraint- induced movement therapy for six hours a day, for 9 out of 11 consecutive days. All children wear a tailor made hand splint on the unaffected upper limb for 6 hours per day while performing unimanual exercises individually or in a group based on shaping and repetitive practice.

Placebo observation training consists of 15 sessions of 1 hour.This group performs the same actions after watching computer games without biological movements.

Behavioral: Constraint-induced movement therapy
In a 2-week day camp model children receive constraint- induced movement therapy for six hours a day, for 9 out of 11 consecutive days. All children wear a tailor made hand splint on the unaffected upper limb for 6 hours per day while performing unimanual exercises individually or in a group based on shaping and repetitive practice.

Behavioral: Placebo observation training
Placebo observation training consists of 15 sessions of 1 hour. Children perform the same actions as the AOT training after watching computer games without biological movements.




Primary Outcome Measures :
  1. Change in Assisting Hand Assessment (AHA) [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    The AHA, a Rasch-based performance scale, measures how effectively the affected hand is spontaneously used during performance of bimanual tasks.


Secondary Outcome Measures :
  1. Change in Melbourne Assessment of Unilateral Upper Limb Function [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    The Melbourne Assessment evaluates quality of movement in 16 functional unimanual tasks.

  2. Change in Jebsen-Taylor Hand Function Test [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    The Jebsen-Taylor hand function test measures manual dexterity in six unimanual tasks, by means of movement time expressed in seconds for both hands.

  3. Change in Tyneside Pegboard test [ Time Frame: pre and post intervention (within one week), 6 months follow-up ]
    The Tyneside pegboard test is an adapted 9-hole pegboard test and assesses unimanual and bimanual dexterity.

  4. Change in passive range of motion (PROM) [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    PROM of shoulder flexion, abduction, external and internal rotation, elbow extension, forearm supination and wrist extension is measured using a universal goniometer.

  5. Change in muscle tone [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    Muscle tone is evaluated in 11 muscle groups using the Modified Ashworth Scale (MAS), ranging from 0 to 4.

  6. Change in muscle strength [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    Muscle strength is evaluated in nine muscle groups using manual muscle testing (MMT), ranging from 0 to 5.

  7. Change in grip strength [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    Grip strength is assessed with a Jamar dynamometer®. The average of three consecutive maximum contractions is recorded for both hands.

  8. Change in muscle fatigability [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    Muscle fatigability during an isometric grip strength task is assessed based on a 30 second sustained contraction with E-link software.

  9. Change in Abilhand-Kids questionnaire [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    The Abilhand- Kids questionnaire is a Rasch-based inventory of 21 mostly bimanual activities that the parents are asked to judge as: 0 (impossible), 1 (difficult), and 2 (easy), irrespective of the limb(s) actually used to do the activity.

  10. Change in Children's Hand-use Experience Questionnaire (CHEQ) [ Time Frame: baseline, pre and post intervention (within one week), 6 months follow-up ]
    CHEQ is a questionnaire to evaluate the experience of children and adolescents in using the affected hand in activities where usually two hands are needed.

  11. Change in Upper limb Three-dimensional movement analysis (3DMA) [ Time Frame: pre and post intervention (within one week), 6 months follow-up ]
    This quantitative assessment comprises upper limb kinematics during functionally relevant aiming and grasping tasks.

  12. Change in Assessment of Life Habits for children (LIFE-H Kids) [ Time Frame: pre intervention (within one week), 6 months follow-up ]
    LIFE-H Kids assesses the quality of social participation of children with disabilities by estimating how a client accomplishes activities of daily living and social roles

  13. Change in Cerebral Palsy Quality of Life Questionnaire (CP-QOL) [ Time Frame: pre intervention (within one week), 6 months follow-up ]
    CP-QOL is a parent report that assesses the wellbeing across various domains of life in children with cerebral palsy.


Other Outcome Measures:
  1. Structural Magnetic Resonance Imaging (MRI) [ Time Frame: baseline ]
    Structural images are acquired using three-dimensional fluid-attenuated inversion recovery (3D FLAIR) with following parameters: 321 sagittal slices, slice thickness 1.2, slice gap 0.6, repetition time=4800 ms, echo time=353 ms, field of view=250 x 250 mm², 1.1 x 1.1 x 0.56 mm³ voxel size, acq time = 5'02". Brain lesions will be first classified according to the timing of the lesion and the predominant pattern of damage as described by Kragelöh-mann (2007): cortical malformations (first and second trimester of pregnancy), periventricular white matter (PWM) lesions (from late second till early third trimester) and cortical and deep greymatter (CDGM) lesions (around term age) and acquired brain lesions (between 28 days 3 years postnatally). Second, a more detailed evaluation of the brain lesion (i.e. location and extent) will be performed using the semi-quantitative MRI (sqMRI) scale developed by Fiori et al. (2014).

  2. Resting state functional Magnetic Resonance Imaging (rsfMRI) [ Time Frame: baseline ]
    rsfMRI images are acquired using a T2*-weighted gradient-echo planar imaging (GE-EPI) sequence with the following parameters: TR = 1700 ms; TE = 30 ms; matrix size = 64x64; FOV = 230 mm; flip angle = 90º; slice thickness = 4 mm; no gap; axial slices = 30; number of functional volumes = 250; acquisition time = 7 min. rsfMRI will be pre-processed with Statistical Parametric Mapping version 12 (SPM12) software. Functional connectivity analysis will be computed with the CONN toolbox v17b.

  3. Diffusion weighted imaging [ Time Frame: baseline ]
    Diffusion weighted images will be acquired using a single shot spin echo sequence with the following parameters: slice thickness = 2.5 mm, TR = 8700 ms, TE = 116 ms, number of diffusion directions = 150, number of sagittal slices = 58, voxel size = 2.5 x 2.5 x 2.5 mm³, acq time = 18'. Implemented b values are 700, 1000, and 2800 s/mm², applied in 25, 40, and 75 uniformly distributed directions, respectively. In addition, 11 non-diffusion weighted images are obtained. Diffusion data will be pre-processed and analyzed in ExploreDTI toolbox, version 4.8.6. Diffusion metrics, such as fractional anisotropy and mean diffusivity of white matter tracts of interest (i.e. corpus callosum, corticospinal tract, superior thalamic radiations, medial lemniscus) will be calculated for both hemispheres.

  4. Transcranial Magnetic Stimulation (TMS) [ Time Frame: baseline ]
    TMS was performed using a MagStim 200 Stimulator (Magstim Ltd, Whitland, Wales, UK) equipped with a focal 70mm figure-eight coil and a Bagnoli electromyography (EMG) system with two single differential surface electrodes (Delsys Inc, Natick, MA, USA). A Micro1401-3 acquisition unit and Spike software version 4.11 (Cambridge Electronic Design Limited, Cambridge, UK) were used to synchronize the TMS stimuli and the EMG data acquisition. Motor Evoked Potentials (MEPs) were bilaterally recorded, using single differential surface EMG electrodes attached on the muscles adductor pollicis brevis of both hands.



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Ages Eligible for Study:   5 Years to 12 Years   (Child)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • confirmed diagnosis of unilateral CP
  • aged 5-12 years
  • sufficient cooperation to comprehend and complete the test procedure
  • minimal ability to actively grasp and stabilize an object

Exclusion Criteria:

  • upper limb surgery two years prior to enrollment
  • botulinum toxin A injections six months prior to enrollment

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 ClinicalTrials.gov identifier (NCT number): NCT03256357


Contacts
Contact: Katrijn Klingels, Dr katrijn.klingels@kuleuven.be

Locations
Belgium
KU Leuven Recruiting
Leuven, Belgium, 3000
Contact: Katrijn Klingels         
Sponsors and Collaborators
Katholieke Universiteit Leuven
ETH Zurich (Switzerland)
University of Pisa, Italy
Investigators
Principal Investigator: Cristina Simon-Martinez KU Leuven
Study Director: Hilde Feys, Prof KU Leuven

Responsible Party: Klingels Katrijn, Principal Investigator, Katholieke Universiteit Leuven
ClinicalTrials.gov Identifier: NCT03256357     History of Changes
Other Study ID Numbers: CIMT and AOT in unilateral CP
First Posted: August 22, 2017    Key Record Dates
Last Update Posted: August 22, 2017
Last Verified: August 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Keywords provided by Klingels Katrijn, Katholieke Universiteit Leuven:
unilateral cerebral palsy
upper limb rehabilitation

Additional relevant MeSH terms:
Paralysis
Cerebral Palsy
Neurologic Manifestations
Nervous System Diseases
Signs and Symptoms
Brain Damage, Chronic
Brain Diseases
Central Nervous System Diseases