Muscle Coordination Feedback + Electrical Stimulation for Stroke Rehabilitation

JL
GH
Overseen ByGrace Hoo, MS
Age: 18 - 65
Sex: Any
Trial Phase: Academic
Sponsor: Shirley Ryan AbilityLab
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests new methods to improve walking and leg function in stroke survivors. Researchers compare traditional high-intensity walking exercises with treatments using electrical pulses and visual feedback to enhance muscle coordination. Participants will be divided into groups to try different therapy combinations. Ideal candidates are individuals who had a stroke over six months ago and can walk at least 10 meters independently, though they may use a cane or walker. As an unphased trial, this study provides participants the chance to explore innovative therapies that could enhance recovery and improve quality of life.

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 have had a Botox injection in the lower limbs within the last 3 months or plan to have one during the study, you may not be eligible to participate.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that functional electrical stimulation (FES) is generally well-received in stroke rehabilitation. A review of 25 studies found that FES-based treatments positively affect stroke recovery, particularly in improving movement. However, some studies noted that FES did not significantly enhance certain aspects of walking, such as the distance covered in a 6-minute walk for some patients.

For synergy-based multichannel FES, studies indicate it effectively enhances motor coordination and walking in stroke patients. This method uses multiple channels to stimulate different muscles and is considered safe and beneficial. Research supports its use in stroke rehabilitation due to positive feedback on improving motor function.

Muscle synergy visual biofeedback, which provides real-time feedback on muscle activity, has been studied for its role in rehabilitation. Evidence suggests it helps patients improve movement by aligning muscle activity with healthy patterns. Studies indicate it is a safe method with no significant adverse events reported.

Overall, current research findings suggest these treatments are well-tolerated and safe for use in stroke rehabilitation.12345

Why are researchers excited about this trial?

Researchers are excited about the trial exploring Muscle Coordination Feedback and Electrical Stimulation for stroke rehabilitation because it introduces new ways to enhance motor recovery. Unlike traditional rehabilitation methods like physical therapy, which rely on repetitive physical exercises, this approach uses advanced electrical stimulation techniques to target specific muscle groups. The synergy-based multichannel FES (MFES) and muscle synergy visual biofeedback provide real-time feedback and stimulation, helping patients retrain their muscles more effectively. This combination aims to mimic natural muscle movements more closely, potentially leading to faster and more efficient recovery for stroke survivors.

What evidence suggests that this trial's treatments could be effective for stroke rehabilitation?

Research has shown that functional electrical stimulation (FES) can help stroke patients improve their walking ability. In one study, all participants who received FES could walk after treatment, and 84.6% returned home, compared to 53.3% in a group without FES. In this trial, participants in the "Standard FES to the Tibialis Anterior (TA)" arm will receive FES applied to the TA muscle/peroneal nerve. A more advanced version, synergy-based multichannel FES (MFES), is being tested in the "Synergy-Based Multichannel FES (MFES)" arm and has shown promising results, with noticeable improvements in walking speed and distance. When combined with visual biofeedback, as in the "Synergy-Based Multichannel (MFES) + Muscle Synergy Visual Biofeedback" arm, MFES also enhances movement quality. Visual biofeedback alone, tested in the "Muscle Synergy Visual Biofeedback" arm, aids recovery by encouraging patients to adjust their muscle movements to healthier patterns. These findings suggest that these techniques could significantly aid stroke rehabilitation.13567

Who Is on the Research Team?

José L. Pons, PhD

Jose Pons, Ph.D

Principal Investigator

Shirley Ryan AbilityLab

Are You a Good Fit for This Trial?

This trial is for individuals aged 18-80 who have had a single unilateral stroke at least six months ago and can walk over 10 meters with or without an assistive device. They must be able to understand English, give consent, and have normal hearing and vision (correctable). Excluded are those with severe cognitive issues, aphasia, major medical conditions that could interfere with the study, pregnancy, prisoners, metallic/electrical implants in the body or significant spasticity in lower limbs.

Inclusion Criteria

Patients: Medical clearance from medical team (signed Medical Clearance form)
Healthy participants: Able to understand and give informed consent
I am a therapist with current CITI training or willing to complete it.
See 10 more

Exclusion Criteria

Patients: Prisoners
Healthy participants: Pregnancy
Healthy participants: Prisoners
See 22 more

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo gait training using various interventions including high-intensity gait training, standard FES, and novel muscle synergy-based interventions

6 weeks
3 sessions per week

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks
1-month follow-up assessment

What Are the Treatments Tested in This Trial?

Interventions

  • Muscle Coordination-Based Feedback
Trial Overview The study compares traditional high-intensity gait training and gait training using functional electrical stimulation (FES) against new methods providing real-time feedback on muscle coordination. Participants will receive either standard FES to the Tibialis Anterior muscle or Synergy-Based Multichannel FES combined with visual biofeedback based on muscle synergies.
How Is the Trial Designed?
5Treatment groups
Experimental Treatment
Active Control
Group I: Synergy-Based Multichannel FES (MFES)Experimental Treatment1 Intervention
Group II: Synergy-Based Multichannel (MFES) + Muscle Synergy Visual BiofeedbackExperimental Treatment2 Interventions
Group III: Standard FES to the Tibialis Anterior (TA)Experimental Treatment1 Intervention
Group IV: Muscle Synergy Visual BiofeedbackExperimental Treatment1 Intervention
Group V: Conventional High Intensity Gait TrainingActive Control1 Intervention

Find a Clinic Near You

Who Is Running the Clinical Trial?

Shirley Ryan AbilityLab

Lead Sponsor

Trials
212
Recruited
17,900+

Published Research Related to This Trial

The study involving 9 chronic stroke survivors showed that using a surface electromyography (sEMG) biofeedback system through a video game significantly improved muscle activation during wrist movements, indicating potential for enhancing motor control.
However, while there were positive changes in muscle activation, the intervention did not lead to significant improvements in overall movement quality or functional abilities, suggesting that adding more functional activities could enhance the effectiveness of the treatment.
Preliminary investigation of an electromyography-controlled video game as a home program for persons in the chronic phase of stroke recovery.Donoso Brown, EV., McCoy, SW., Fechko, AS., et al.[2022]
The study demonstrated that using real-time feedback surface electromyography (sEMG) to control muscle activation is a reliable method for measuring motor evoked potentials (MEPs) in stroke patients, with high test-retest reliability for motor threshold and moderate reliability for MEP latency and amplitude.
Patients with detectable MEPs showed significantly better muscle power and functional scores compared to those without MEPs, indicating that sEMG-guided muscle activation can effectively assess recovery and may be useful for long-term monitoring in stroke rehabilitation.
Using surface electromyography to guide the activation during motor-evoked potential measurement: An activation control method for follow-up studies.Lin, LF., Huang, YZ., Hu, CJ., et al.[2016]
Functional electrical stimulation (FES) combined with voluntary movement (FESVOL) enhances cerebellar activity and may improve rehabilitation outcomes for post-stroke hemiplegia, suggesting a synergistic effect between electrical stimulation and voluntary effort.
The study indicates that FESVOL leads to reduced activity in secondary somatosensory areas, which may reflect a more accurate internal model of movement, potentially improving the effectiveness of rehabilitation strategies.
Interaction of electrical stimulation and voluntary hand movement in SII and the cerebellum during simulated therapeutic functional electrical stimulation in healthy adults.Iftime-Nielsen, SD., Christensen, MS., Vingborg, RJ., et al.[2021]

Citations

Muscle synergies in upper limb stroke rehabilitation: a scoping ...A review by Hong et al. suggests that models combined with robotic exoskeletons may enhance rehabilitation outcomes through synergy-based training, with only ...
Applicable to Arm Movement Recovery After Ischemic StrokeThis study aimed to evaluate the effect of a novel underlining mechanism of visual biofeedback based on muscle synergy pattern on upper extremity motor ...
Applicable to Arm Movement Recovery After Ischemic StrokePDF | This study aimed to evaluate the effect of a novel underlining mechanism of visual biofeedback based on muscle synergy pattern on upper extremity.
A Pilot Study - The Neuroscience Journal of Shefaye KhatamA New Visual Biofeedback Protocol Based on Analyzing the Muscle Synergy Patterns to Recover the Upper Limbs Movement in Ischemic Stroke Patients: A Pilot Study.
Application of Muscle Synergies for Gait Rehabilitation After ...This review seeks to integrate the results of existing studies on the features of muscle synergies in stroke-related gait abnormalities
Evidence for shared neural information between muscle ...Muscle Synergy Analysis (MSA), derived from electromyography (EMG), has been argued as a method to quantify the complexity of descending motor commands.
Presenting a New Muscle Synergy Analysis Based ...Therefore, in this study, we present a fun- damental method for designing visual biofeedback based on muscle synergy pattern analysis for the ...
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