Isometric Reaching for Stroke

Overseen By Courtney Celian, OTR/L

Age: 18+

Sex: Any

Trial Phase: Phase < 1

Sponsor: Shirley Ryan AbilityLab

Must not be taking: Botox

Disqualifiers: Severe medical problems, Visual deficits, High blood pressure, Low blood oxygen, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

56 Participants Needed

Trial Summary

What is the purpose of this trial?

To determine the effects of 3D isometric movement training in healthy participants and impaired participants due to a stroke.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you are receiving Botox or other botulinum toxin injections, you must not have had them in the affected upper extremity within the previous 4 months.

What data supports the effectiveness of the treatment Isometric Reaching for stroke?

The research highlights that arm reaching is often impaired after a stroke, and direction-dependent differences in reaching performance exist, which suggests that targeted rehabilitative training, like Isometric Reaching, could be beneficial. Additionally, compensatory arm reaching strategies and the loss of independent joint control are common after a stroke, indicating that interventions focusing on improving these aspects, such as Isometric Reaching, may help in recovery. ^{1 2 3 4 5}

Is Isometric Reaching safe for humans?

The research articles provided do not contain specific safety data for Isometric Reaching or similar treatments, focusing instead on movement analysis and rehabilitation techniques for stroke survivors. ^{2 6 7 8 9}

How is the Isometric Reaching treatment for stroke different from other treatments?

Isometric Reaching is unique because it focuses on improving arm and hand movement by enhancing biomechanical changes, such as palmar arch modulation, which is not typically addressed in standard stroke rehabilitation therapies. This approach may help reduce compensatory movements and improve functional recovery of the upper extremities. ^{1 6 10 11 12}

Research Team

James L Patton, PhD

Principal Investigator

Shirley Ryan AbilityLab

Eligibility Criteria

This trial is for adults over 18 years old who are either healthy or have had a stroke. Participants must be able to understand and agree to the study's procedures by giving informed consent. People with a history of stroke can't join if they're considered neurotypical, meaning they don't currently have any impairments from a stroke.

Inclusion Criteria

Neurotypical participants must have the ability to provide informed consent

I am at least 18 years old and have had a stroke.

I have medical records and scans showing where my stroke affected my brain.

Exclusion Criteria

I can hold positions needed for tests.

Stroke participants must not be rated below 15 on the FMUE scale

Stroke participants must not be concurrently participating in upper extremity rehabilitation

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Participants practice a unilateral virtual reality targeted reaching task using a robotic arm in a 3D visual display system.

12 months

Regular sessions (frequency not specified)

Follow-up

Participants are monitored for safety and effectiveness after training

4 weeks

Treatment Details

Interventions

• Isometric Reaching

Trial Overview The IsoReach trial is testing how effective 3D isometric movement training is for people who are healthy and those impaired by a stroke. The goal is to see if this type of exercise can improve their ability to reach and move in three dimensions.

Participant Groups

Group I: Isometric Reaching condition Experimental Treatment 1 Intervention

In this arm the participant participates in "Isometric Reaching" in which they are not allowed to freely reach to the target, instead the forces they apply on the robot handle drives a reaching arm simulation

Group II: Control Reaching condition Active Control 1 Intervention

In this condition the participant moves toward target freely and the visual feedback is based on hand position and not an arm simulation.

Who Is Running the Clinical Trial?

Shirley Ryan AbilityLab

Lead Sponsor

Trials

212

Recruited

17,900+

Findings from Research

In a study involving 8 chronic stroke participants and 10 control participants, it was found that when using their more impaired upper limb, stroke patients showed decreased success and accuracy in reaching tasks, along with altered eye movement patterns, such as increased focus on the limb itself.

Providing support to the impaired upper limb improved hand-eye coordination in stroke patients, making their eye movement patterns more similar to those of control participants, suggesting that rehabilitation strategies should incorporate upper limb support to enhance motor and oculomotor performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Upper limb and eye movement coordination during reaching tasks in people with stroke. Meadmore, KL., Exell, TA., Burridge, JH., et al.[2018]

In a study of 17 stroke survivors, it was found that reaching with the stroke-affected side involved less shoulder and elbow range of motion, and more trunk flexion compared to the less-affected side, indicating altered movement patterns post-stroke.

While there were few differences in kinematics between discrete and cyclic reaching tasks on the stroke-affected side, cyclic reaching required greater trunk rotation, suggesting a unique strategy that could inform rehabilitation approaches focusing on continuous movement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Biomechanical contributions of the trunk and upper extremity in discrete versus cyclic reaching in survivors of stroke. Massie, CL., Malcolm, MP., Greene, DP., et al.[2016]

In a study involving 28 participants with post-stroke hemiparesis, it was found that reaching performance varies significantly based on the direction of the movement, with individuals showing poorer performance in the anteroposterior direction regardless of their motor recovery status.

Participants with moderate-to-severe hemiparesis initially showed less movement in the anteroposterior direction, but this bias decreased as they recovered, indicating that rehabilitation should consider direction-specific training to improve reaching abilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Direction-dependent differences in the quality and quantity of horizontal reaching in people after stroke. Uehara, S., Yuasa, A., Ushizawa, K., et al.[2023]

In a study of 12 individuals with chronic stroke, specific arm movement control strategies were identified that correlated with the level of upper limb impairment and functional improvement after bilateral arm training.

The findings suggest that improving the coordination between shoulder and elbow movements could enhance recovery outcomes, as better shoulder control was linked to less impairment and faster functional task performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Compensatory arm reaching strategies after stroke: induced position analysis. Liu, W., McCombe Waller, S., Kepple, TM., et al.[2021]

The study followed 15 stroke patients for up to 32 weeks and found that loss of independent joint control can be detected as early as 2 weeks post-stroke, highlighting the importance of early assessment in recovery.

Patients with mild strokes showed a rapid recovery, while those with severe strokes experienced persistent impairments, suggesting that targeted interventions, especially robotic rehabilitation, could be beneficial for those with significant joint control loss.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quantifying loss of independent joint control in acute stroke with a robotic evaluation of reaching workspace. Ellis, MD., Kottink, AI., Prange, GB., et al.[2022]

In a study involving 18 stroke patients and 18 control participants, reaching for targets beyond arm's length significantly altered arm and trunk movements, indicating that distance affects motor control in stroke patients.

The results suggest that therapists should consider restraining trunk movements during reaching exercises to prevent asymmetrical movements and improve rehabilitation outcomes for stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke: Within vs. Beyond Arm's Length. Ma, HI., Lin, KC., Hsieh, FH., et al.[2017]

Stroke survivors exhibit significant kinematic differences compared to healthy adults during reach-to-target tasks, including longer movement times, lower peak velocities, and greater trunk displacement, indicating specific areas where rehabilitation can be focused.

The meta-analysis of 32 studies involving 618 stroke patients and 429 healthy adults revealed that stroke survivors also show delayed muscle activation and reduced coordination, suggesting that tailored interventions could enhance upper limb recovery by addressing these deficits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis. Collins, KC., Kennedy, NC., Clark, A., et al.[2020]

The Oblique Direction Reach Test (ODRT) is a highly valid and reliable method for assessing balance in stroke patients, showing strong correlations with established balance measures like the Berg Balance Scale (r = 0.905).

In a study involving 96 first-time stroke patients, it was found that these individuals reached significantly shorter distances in the ODRT compared to healthy controls, indicating impaired stability and balance post-stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Oblique direction reach test: evaluating psychometric properties in stroke population. Mascarenhas, R., Nayak, A., Joshua, AM., et al.[2023]

The study found that intrinsic factors, such as the participant's reach distance and the weight of the power drill, were better predictors of how they transitioned between using just their arms or involving their torso during a seated reach task.

Discomfort levels and muscle activation, particularly in the upper trapezius, also played significant roles in determining how participants adjusted their movements to effectively use the power drill.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of object weight, reach distance, discomfort and muscle activation on the location of preferred critical boundary during a seated reaching task. Petrovic, M., Berg, WP., Mark, LS., et al.[2018]

In a study of 10 stroke survivors with mild hand paresis, significant differences in hand shape modulation were observed during grasping tasks compared to healthy controls, particularly in the final phase of grasping where fine adjustments are made.

The analysis of palmar arch modulation revealed that stroke survivors required more time and effort to adjust their hand shape during grasping, indicating the need for targeted rehabilitation strategies to improve their motor recovery and reduce compensatory movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Palmar arch modulation in patients with hemiparesis after a stroke. Sangole, AP., Levin, MF.[2021]

A meta-analysis of 29 studies involving 460 individuals with stroke and 324 control participants revealed significant kinematic differences in reach-to-grasp movements, with stroke survivors showing lower peak velocity and greater trunk displacement compared to controls.

The study suggests that the location of objects affects kinematic characteristics during reach-to-grasp tasks, indicating that rehabilitation strategies should consider object placement to improve motor function in stroke patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Getting a kinematic handle on reach-to-grasp: a meta-analysis. Collins, KC., Kennedy, NC., Clark, A., et al.[2018]

A machine learning system successfully detected compensatory movements in stroke patients with high accuracy (average F1-score over 0.95), demonstrating the feasibility of using pressure distribution data for real-time monitoring.

Real-time feedback significantly reduced compensatory behaviors in stroke patients, with force feedback proving to be more effective than audiovisual feedback in promoting proper movement patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online compensation detecting for real-time reduction of compensatory motions during reaching: a pilot study with stroke survivors. Cai, S., Wei, X., Su, E., et al.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

Upper limb and eye movement coordination during reaching tasks in people with stroke. [2018]

2. England pubmed.ncbi.nlm.nih.gov

Biomechanical contributions of the trunk and upper extremity in discrete versus cyclic reaching in survivors of stroke. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

Direction-dependent differences in the quality and quantity of horizontal reaching in people after stroke. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Compensatory arm reaching strategies after stroke: induced position analysis. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Quantifying loss of independent joint control in acute stroke with a robotic evaluation of reaching workspace. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke: Within vs. Beyond Arm's Length. [2017]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis. [2020]

8. United States pubmed.ncbi.nlm.nih.gov

Oblique direction reach test: evaluating psychometric properties in stroke population. [2023]

9. Netherlands pubmed.ncbi.nlm.nih.gov

The impact of object weight, reach distance, discomfort and muscle activation on the location of preferred critical boundary during a seated reaching task. [2018]

10. Germany pubmed.ncbi.nlm.nih.gov

Palmar arch modulation in patients with hemiparesis after a stroke. [2021]

11. England pubmed.ncbi.nlm.nih.gov

Getting a kinematic handle on reach-to-grasp: a meta-analysis. [2018]

12. England pubmed.ncbi.nlm.nih.gov

Online compensation detecting for real-time reduction of compensatory motions during reaching: a pilot study with stroke survivors. [2020]