Critical Periods After Stroke Study (CPASS)
Study Details
Study Description
Brief Summary
To perform an exploratory single center randomized study that will form the basis for a larger scale, more definitive randomized clinical trial to determine the optimal time after stroke for intensive motor training. The investigators will perform a prospective exploratory study of upper extremity (UE) motor training delivered at higher than usual intensity at three different time points after stroke:
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early (initiated within 30 days)
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subacute/outpatient (initiated within 2-3 months)
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chronic (initiated within 6-9 months)
The control group will not receive the therapy intervention during the 1-year study.
Outcome measures will be assessed at baseline, pre-treatment, post-treatment, 6 months and one year after stroke onset.
Compared to individuals randomized during the outpatient (2-3 months after stroke onset) or chronic (6-9 months after stroke onset) time points, participants randomized to early intensive motor training will show greater upper extremity motor improvement measured at one year post stroke.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
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N/A |
Detailed Description
Please see the following reference:
Dromerick, A.W., Edwardson, M., Edwards, D.F., Giannetti, M.L., Barth, J., Brady, K.P., Chan, E., Tan, M.T., Tamboli, I., Chia, R., Orquiza, M., Padilla, R.M., Cheema, A.K., Mapstone, M.,
Fiandaca, M.S., Federoff, H.J., & Newport, E.L. (2015). Critical Periods after Stroke Study:
Translating animal stroke recovery experiments into a clinical trial. Frontiers in Human Neuroscience, 9, 002231. PMCID: PMC4413691.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Acute/Early Intervention: A 20-hour dose of early intensive upper extremity motor training therapy will be initiated within 30 days post-stroke. |
Behavioral: Early Intensive upper extremity motor training
Using a shaping therapy protocol, participants will receive a dose of 20 hours of intensive upper extremity therapy (in addition to their current therapy) beginning within 30 days of stroke onset.
|
Experimental: Sub-acute/Outpatient Intervention: A 20-hour dose of sub-acute intensive upper extremity motor training therapy will be initiated within 2 to 3 months post-stroke. |
Behavioral: Sub-acute intensive upper extremity motor training
Using a shaping therapy protocol, participants will receive a dose of 20 hours of intensive upper extremity therapy (in addition to their current therapy) beginning within 2 to 3 months post stroke.
|
Experimental: Chronic Intervention: A 20-hour dose of chronic intensive upper extremity motor training therapy will be initiated 6 to 9 months post-stroke |
Behavioral: Chronic intensive upper extremity motor training
Using a shaping therapy protocol, participants will receive a dose of 20 hours of intensive upper extremity therapy (in addition to their current therapy) beginning within 6 to 9 months post stroke.
|
Placebo Comparator: Control Intervention: Usual and customary care. No additional therapy will be initiated during the 1-year study. |
Behavioral: Control
Usual and Customary Care only. No additional therapy will be given during the 1-year study.
|
Outcome Measures
Primary Outcome Measures
- Action Research Arm Test (ARAT) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
The ARAT assesses functional limitations and evaluates changes in limb function for the upper extremity.
Secondary Outcome Measures
- Motor Activity Log - 28 Quality of Movement (MAL-28 QOM) [Pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
A structured interview to measure upper extremity use and function as well as assess the quality of movement of the hemiparetic arm.
- Nine Hole Peg Test (9-HPT) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
A standardized quantitative test of upper extremity function and fine manual dexterity.
- Functional Independence Measure (FIM) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
A basic indicator of severity of disability. Tracks changes in the functional ability of the patient during an episode of hospital rehabilitation care.
- Barthel Index (BI) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
Measures performance in activities of daily living and functional disability.
- Motricity Index - Arm only (MI) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
To assess motor impairment and strength in the upper extremity.
- Perception of change (POC) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended) and 1 year post stroke]
A stroke-specific self-report to assess how stroke has impacted a person's life and their overall perception of recovery.
- Stroke Impact Scale - Hand-Arm subscale (SIS) [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended) and 1 year post stroke]
A self-report health status measure to assess perceived recovery with regard to the more affected hand and arm following a stroke.
- Modified Rankin Scale (MRS) [Baseline (pre-stroke assessment), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended) and 1 year post stroke]
A measure of the degree of disability or dependence in daily activities following a stroke.
- Activity Card Sort (ACS) [Pre-treatment (ideally within 72 hours of baseline), post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
An interview-based assessment used to measure an individual's participation in instrumental, leisure and social activities.
- Reintegration to Normal Living Index (RNLI) [Post-treatment (within 72 hours after treatment has ended), 6 months and 1 year post stroke]
To assess quantitatively the degree that individuals who have experienced a traumatic injury or illness come to manage and reintegrate normal social activities with regard to recreation, movement at home and within the community, family and relationships.
- Geriatric Depression Scale (GDS-15) [Baseline (within 30 days post stroke), pre-treatment, and 1 year post stroke]
A self-report assessment used to identify depressive symptoms in the elderly.
- NIH Stroke Scale (NIHSS) [Baseline (within 30 days post stroke), pre-treatment, 6 months and 1 year post stroke]
A systematic assessment used to evaluate and measure stroke-related. neurological impairments and stroke severity.
- Short Blessed Orientation and Memory Concentration Test (SBT) [Baseline (within 30 days post stroke)]
An assessment of cognitive ability and impairment.
- Mesulam Symbol Cancellation Test (SCT) [Baseline (within 30 days post stroke)]
An assessment used to evaluate visuospatial function and attention.
- Faces Pain Scale [Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke]
A self-report measure of pain intensity.
- Fugl Meyer Assessment (Upper Extremity) [Baseline (within 30 days post stroke) and 1 year post stroke]
A performanced-based impairment index to assess motor function, sensation and joint function.
- Manual Muscle Test (Upper Extremity) [Baseline (within 30 days post stroke)]
Muscle strength assessment
Other Outcome Measures
- Motor Assessment Scale - Upper Arm Function (MAS) [Baseline (within 30 days of stroke onset)]
Performance-based scale to assess everyday motor function.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Ischemic or hemorrhagic stroke (with confirmatory neuroimaging) within 28 days of admission to inpatient rehabilitation (allows those randomized to the early arm to begin study-related treatment within 30 days)
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Age >21 years
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Able to participate in first study-related treatment session within 30 days of stroke onset
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Able to participate in all study-related activities, including one year follow up and blood draws
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Persistent hemiparesis leading to impaired upper extremity function. Hemiparesis as indicated by NIHSS Motor Arm score ≥ 1
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Recovering moderate motor impairment at the shoulder and elbow or hand such as:
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Proximal UE voluntary activity indicated by a score of ≥ 3 on the upper arm item of the Motor Assessment Scale - wrist and finger movement is not required
or
- Manual Muscle Test (MMT) score of ≥ 2 on shoulder flexion or abduction and MMT score of ≥ 2 for any of the following: elbow flexion, elbow extension, wrist flexion, wrist extension, finger flexion or finger extension.
or
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Active range of motion (AROM) to at least 50% of range in gravity eliminated position for shoulder flexion or abduction, and for any of the following motions: elbow flexion, elbow extension, wrist flexion, wrist extension, finger flexion or finger extension.
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Score of ≤ 8 on the Short Blessed Memory Orientation and Concentration Scale
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Follows 2 step commands
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No upper extremity injury or conditions that limited use prior to the stroke
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Pre-stroke independence: Modified Rankin Score 0 or 1
Exclusion Criteria:
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Inability to give informed consent
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Prior stroke with persistent motor impairment or other disabling neurologic condition such as multiple sclerosis, parkinsonism, amyotrophic lateral sclerosis (ALS), dementia requiring medication
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Rapidly improving motor function
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Clinically significant fluctuations in mental status in the 72 hours prior to randomization
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Hemispatial neglect as determined by >3 errors on the Mesulam Symbol Cancellation Test
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Not independent prior to stroke (determined by scores of <95 on Barthel Index or >1 on Modified Rankin Scale
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Dense sensory loss indicated by a score of 2 on NIHSS sensory item
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Ataxia out of proportion to weakness in the affected arm as described by a score of ≥ 1 on the NIHSS limb ataxia item
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Active or prior psychosis within 2 years
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Active or prior (within 2 years) substance abuse
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Not expected to survive 1 year due to other illnesses (cardiac disease, malignancy, etc)
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Received upper extremity botulinum toxin within 6 months (other medications do not exclude)
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | MedStar National Rehabilitation Hospital | Washington | District of Columbia | United States | 20010 |
Sponsors and Collaborators
- MedStar National Rehabilitation Network
- Georgetown University
- University of Wisconsin, Madison
- The Catholic University of America
- Medstar Health Research Institute
Investigators
- Principal Investigator: Alexander W Dromerick, MD, MedStar National Rehabilitation Network
Study Documents (Full-Text)
None provided.More Information
Publications
- MNRH-2014-065