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Cervicogenic Concussion Rehabilitation With TopSpin360

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ClinicalTrials.gov Identifier: NCT04159298
Recruitment Status : Unknown
Verified November 2019 by Dr. Lisa Fischer, Western University, Canada.
Recruitment status was:  Not yet recruiting
First Posted : November 12, 2019
Last Update Posted : November 12, 2019
TopSpin Technologies Ltd
Information provided by (Responsible Party):
Dr. Lisa Fischer, Western University, Canada

Brief Summary:
Concussions occur most frequently in adolescents and often result in significant disruption to daily living for prolonged periods of time. Concussions are an epidemic, with the incidence rates for sports related concussions (SRC) in adolescents up to 0.47 per 1000 athlete exposures. Research would suggest that multi-planar neck strength is a protective factor of SRC risk in adolescents as greater neck strength is associated with a lower SRC risk.(Collins et al) Neck pain is a common symptom associated with SRC that is also associated with prolonged recovery from SRC. (King et al, Van der Naalt et al) Neck pain is also associated with decreased neck muscle strength (DeKoning et al). Our study will address a critical gap in concussion management - multi-planar cervical spine strengthening to specifically rehabilitate the cervicogenic component of prolonged post-concussion symptoms with a cervicogenic component and determine if this approach restores normal neck strength, decreases neck pain and headaches, improves daily global function and allow patients to return to sport and school. work more quickly than those without specific multi-planar neck strengthening.

Condition or disease Intervention/treatment Phase
Concussion, Mild Device: Top Spin 360 Not Applicable

Detailed Description:

Overall Design: This will be a randomized clinical trial using a prospective cohort model. A total of 56 adolescents/young adults with concussion symptoms that persist >4 weeks post-trauma and +ve screening for cervical involvement (rated neck pain as a symptom, TOP para cervical or suboccipital spine, +ve cervical flexion-rotation test (Hall et al)) will be assigned randomly into one of two groups: 1) Control group who undergo traditional usual clinical care comprised of bi-weekly physiotherapy sessions and home-based exercise programs (TRADITIONAL), and 2) In combination with standard clinical care as described above, 2 sessions per week training on the TopSpin360 (protocol outlined below). (INTERVENTION). The intervention will last up to 7 weeks or until medical clearance to return to normal daily activities. Balancing as much as possible the impact of age and sport is critical because mechanisms and patterns of injury differ with the patient and the sport in which the concussion occurred. The randomization process will balance the influence of one's sex on the measured outcomes.

Randomization: Patients will be randomized into one of the two groups using a 1:1 ratio to balance recruitment and covariates. A random number generator will be used to assign groups.

Test Sequence: Based on previous work, it is anticipated that 7 weeks of intervention will be required. (Versteegh et al) Following baseline measures (Week 0) upon study entry, tests will be conducted at the midway point (4 weeks) and upon completion (7 weeks) or upon medical clearance to return to sport. The test sessions ideally will occur following the clinical examination with the physician . This will increase convenience for the patient's family who, for this age group, will be with the patient. At each test session a physiotherapist will bring the participant through 1. Cervical Flexion-Rotation test, 2. Deep neck flexor endurance test, 3. a multi-planar static neck strength assessment using a handheld dynamometer (Versteegh et al), 4. Dynamic necks strength assessed via peak RPM and time to complete 20 revolutions clockwise and counterclockwise on the TopSpin360, 5. Joint position error testing (Revel et al), 6. and complete standard questionnaires: SCAT 5 symptom score, Neck Disability Index, Headache Inventory and

Intervention training protocol using TopSpin360: Participants allocated to the INTERVENTION group will participate in 2 training sessions per week using the TopSpin360 neuromuscular neck-training device. Each session will be separated by a minimum of 2 days. Given the target population for this study will include younger subjects than previous training studies using the TopSpin360 and given they will have some neck pathology, a significantly reduced training load (number of revolutions used per set) will be used. The advantage of the TopSpin360 as a training tool is its safety profile in that the device uses self-generated resistance to create the muscular load and training effect.

The attached weight is only 125gm, and the resistance is generated through the centripetal force created as the participant swings the weight about the centrally mounted axis. Much like a hula-hoop, the participant is only capable of spinning the weight as quickly as his or her neck muscles and coordination are capable of getting it spinning, if they fatigue or lose coordination, the weight stops spinning and the resistance is removed. The first 2 weeks will involve 3 sets of 20 revolutions in each direction of clockwise and counterclockwise. Weeks 3 and 4 will involve 3 sets of 30 revolutions in each direction and weeks 4-7 will involve 3 sets of 40 revolutions in each direction.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 56 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Novel Multi-planar Neuromuscular Neck Strengthening for the Treatment of Delayed Recovery of Concussion in Adolescence and Young Adults With Cervicogenic Symptoms
Estimated Study Start Date : April 1, 2020
Estimated Primary Completion Date : October 1, 2021
Estimated Study Completion Date : October 1, 2021

Arm Intervention/treatment
Experimental: Intervention
Intervention group who will undergo the Top Spin 360 study protocol.
Device: Top Spin 360
The TopSpin360 is a dynamic multi-planar neuromuscular training device that has been shown to improve static and dynamic multi-planar neck strength in a healthy athletic population

No Intervention: Traditional
Control group who undergo traditional usual clinical care comprised of bi-weekly physiotherapy sessions and home-based exercise programs.

Primary Outcome Measures :
  1. Cervical Flexion-Rotation Test (CFRT) [ Time Frame: 8 weeks ]
    Static neck strength measurement tool

  2. Multi-planar static neck strength (MicroFET2) [ Time Frame: 8 weeks ]
    Dynamic neck strength assessment tool

  3. Deep neck flexor endurance test [ Time Frame: 8 weeks ]
    Timed test to determine how long a participant can hold an isometric contraction of the deep neck flexor

Secondary Outcome Measures :
  1. SCAT 5 Symptom Score [ Time Frame: 8 weeks ]
    22 item symptom checklist using a 7 point likert scale from 0 to 6 (0 absence of symptom, 1-2 mild severity, 3-4 moderate severity, 5-6 severe)

  2. Neck Disability Index (NDI) [ Time Frame: 8 weeks ]
    Functional status questionnaire with 10 items including pain, personal care, lifting, reading, headaches, concentration, work, driving, sleeping and recreation.

  3. Headache Disability Inventory (HDI) [ Time Frame: 8 weeks ]
    Consists of 40 items, each requiring a "yes" (four points), "sometimes" (two points), or "no" (zero points) response based on items derived empirically from case history responses of subjects with headache.

  4. Global Disability Index [ Time Frame: 8 weeks ]
    25 item self reported instrument assessing different aspects of disability

  5. SF-36 [ Time Frame: 8 weeks ]
    36-item self-report measure of health-related quality of life

Information from the National Library of Medicine

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Ages Eligible for Study:   13 Years to 21 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • > 28 symptoms cervicogenic symptoms

Exclusion Criteria:

  • < 28 symptoms
  • no cervicogenic symptoms

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): NCT04159298

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Canada, Ontario
Fowler Kennedy Sports Medicine Clinic
London, Ontario, Canada, N6A 3K7
Contact: Lisa Fischer, MD    519 661 3011      
Contact: Stacey Wanlin    519 661 3011      
Sub-Investigator: Doug Fraser, MD         
Sub-Investigator: Laura Graham, PT, PhD         
Sub-Investigator: Michael Robinson, PhD         
Principal Investigator: Lisa Fishcer, MD         
Sponsors and Collaborators
Western University, Canada
TopSpin Technologies Ltd
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Responsible Party: Dr. Lisa Fischer, Director, Sport and Exercise Medicine, Western University, Canada
ClinicalTrials.gov Identifier: NCT04159298    
Other Study ID Numbers: CCRT360
First Posted: November 12, 2019    Key Record Dates
Last Update Posted: November 12, 2019
Last Verified: November 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Dr. Lisa Fischer, Western University, Canada:
sports medicine
Test a New Treatment
randomized control trial
Additional relevant MeSH terms:
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Brain Concussion
Brain Injuries, Traumatic
Brain Injuries
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Craniocerebral Trauma
Trauma, Nervous System
Head Injuries, Closed
Wounds and Injuries
Wounds, Nonpenetrating