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出境医 / 临床实验 / Functional Outcome of Hemiplegic Upper Extremity in Patients With Subacute Stroke After Kinesiotaping and Rehabilitation

Functional Outcome of Hemiplegic Upper Extremity in Patients With Subacute Stroke After Kinesiotaping and Rehabilitation

Study Description
Brief Summary:
  1. To explore the role of sonoelastography with shear wave velocity to assess poststroke spasticity of affected arm and forearm muscles in patients with stroke.
  2. To investigate the effects of Kinesiotaping applications on motor recovery, functional performance, and spasticity of affected upper extremity in patients with subacute stroke.

Condition or disease Intervention/treatment Phase
Stroke Hemiplegia Other: Kinesiotaping Other: Hand rehabilitation program Other: Sham taping Not Applicable

Detailed Description:

Clinical characteristics of impaired motor performance on affected upper extremity in stroke patients included muscle weakness, increased muscle tone, contracture, joint instability, or impaired motor control. Poststroke spasticity (PSS) is also a common complication in stroke patients with limbs weakness and impaired coordination between agonist and antagonist contraction. Upper extremity impairments and PSS have negative effects on functional performances and quality of daily livings. In patients with subacute stroke, strengthening exercises, constraint-induce movement therapy, mirror therapy, mental practice, and neuromuscular electrical stimulation, botulinum toxin, and antidepressants are recommended. For managing PSS, several therapeutic interventions include stretching and range of motion exercises, antispasticity splint, neuromuscular electrical stimulation, oral medications, local injection with phenol or botulism, or surgery. Some investigators found that Kinesiotaping (KT) combined with other interventions may facilitate muscle function, provide joint support and proprioception feedback, and reduce pain in stroke patients with hemiplegia. The investigators will perform KT applications both on the proximal and distal parts of affected upper extremity to facilitate motor recovery and performance in subacute stroke patients with hemiplegia while receiving rehabilitation.

After reviewing literatures, sonoelastography and shear wave velocity (SWV) was applied to evaluate the muscle stiffness in stroke patients with upper limb spasticity, but mostly on biceps brachii muscle. The investigators try to use musculoskeletal sonography to explore the feasibility of sonoelastography as a quantitative tool for measuring PSS both on spastic arm and forearm muscles in patients with stroke.

In this study, sixty stroke patients with hemiplegia will be recruited for physical evaluations for PSS and functional performance of upper extremity, and sonoelastography with shear wave velocity (SWV) on biceps brachii, brachioradialis, flexor carpal radialis, and flexor carpal ulnaris muscles to explore the relationship between physical and sonographic assessements for PSS. In the next phase, 60 subacute patients with hemiplegia would be enrolled, then randomly divided into experimental or control groups. In experimental group (n=30), the patients will receive KT combined with rehabilitation once daily for five days, three weeks. In the control group (n=30), the patient will receive the same program without KT. All participants will receive following evaluations, including modified Ashworth and Tardieu scales, Fugl-Meyer Assessment for upper extremity, box and block test, the Wolf motor function test, and sonoelastography with shear wave velocity (SWV) before intervention, right after the three-week intervention, and three-week post intervention.

The aims of this study are:

  1. To explore the role of sonoelastography with shear wave velocity to assess poststroke spasticity of affected arm and forearm muscles in patients with stroke.
  2. To investigate the effects of Kinesiotaping applications on motor recovery, functional performance, and spasticity of affected upper extremity in patients with subacute stroke.
Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 62 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: The Functional Outcome of Hemiplegic Upper Extremity in Patients With Subacute Stroke After Kinesiotaping Combined With Rehabilitation
Actual Study Start Date : November 1, 2019
Estimated Primary Completion Date : March 31, 2021
Estimated Study Completion Date : March 31, 2021
Arms and Interventions
Arm Intervention/treatment
Experimental: KT group
the patients will receive KT for 5 days a week, for three weeks. And a 30-minute hand functional training would also be provided once daily every day during the intervention.
Other: Kinesiotaping
inesio tape would be applied over the extensor muscles of the affected hand for facilitating the extension of hand. We will apply the tape from the upper 1/3 length of dorsal side of the forearm and split the tape into five equal bars to the distal interphalangeal joint of each finger along the finger bones. This intervention would be executed for five days per week for three weeks.

Other: Hand rehabilitation program
In the thirty-minute hand rehabilitation program, a motor-relearning theory would be implemented into the intervention by teaching the participants how to use their upper limb properly without any compensatory motions. Therefore, for establishing a correct movement pattern, an occupational therapist would provide a hand-guided activity, in which the participants could practice reaching movement as well as hand grasp and release in a more natural way. Besides, the therapist would also help the patients release their muscle tone by stretching the spastic muscles for five minutes before and after this hand rehabilitation period.

Sham Comparator: Control group
the patients will receive sham KT for 5 days a week, for three weeks. And a 30-minute hand functional training would also be provided once daily every day during the intervention.
Other: Hand rehabilitation program
In the thirty-minute hand rehabilitation program, a motor-relearning theory would be implemented into the intervention by teaching the participants how to use their upper limb properly without any compensatory motions. Therefore, for establishing a correct movement pattern, an occupational therapist would provide a hand-guided activity, in which the participants could practice reaching movement as well as hand grasp and release in a more natural way. Besides, the therapist would also help the patients release their muscle tone by stretching the spastic muscles for five minutes before and after this hand rehabilitation period.

Other: Sham taping
A short piece of kinesio tape would be cut into half and applied over the lateral side of the forearm from the lateral epicondyle till the half of the forearm. The tape would not cover the both the flexor and extensor muscle bellies.

Outcome Measures
Primary Outcome Measures :
  1. the change from baseline to time of MAS scale [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure spasticity of affected upper extremity at elbow and wrist joints (modified Ashworth scale). In this scale, muscle tone would be assessed by quick stretch of muscle belly. The scoring criteria are as follows. 0, no increase in muscle tone; 1, Slight increase in muscle tone; 2, More marked increase in muscle tone through most of the ROM; 3, considerable increase in muscle tone; 4, affected part(s) rigid in flexion or extension.

  2. the change from baseline to time of Musculoskeletal sonography [ Time Frame: 3rd week, and 6th week ]
    an experienced physiatrist will evaluate the findings on sonography, sonoelastography, and shear wave velocity (SWV). The participants will sit upright and put their upper extremities on the bed with elbow flexion in 90 degrees and the forearm full supination. The measured levels for evaluating FCR, FCU, and FDS muscles will be recorded at first time and use the same level at follow up for each patient. The SWV will be done in the longitudinal/transverse planes and be performed at the maximal cross-section area of the muscles and repeatedly measured for 7 times for each muscle. The sonoelastography will be applied in the longitudinal plane of the detected muscles at the same level of the SWV.

  3. the change from baseline to time of Fugl-Meyer assessment for upper extremity [ Time Frame: 3rd week, and 6th week ]
    a therapist will evaluate Fugl-Meyer assessment for upper extremity (FMA-UE) for each participant. In this assessment, participants would need to execute a series of movements, which involved proximal and distal part of upper limb. The higher the grade, the better the performance. The total score ranges from 0 to 66 for motor function.


Secondary Outcome Measures :
  1. the change from baseline to time of Brunnstrom stage [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure motor recovery stage (Brunnstrom stage)

  2. the change from baseline to time of modified Tardieu scale [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure spasticity of affected upper extremity at elbow and wrist joints (modified Tardieu scale).

  3. the change from baseline to time of existence of sensation [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure the sensation, including light touch, pinprick touch, proprioception.

  4. the change from baseline to time of quality of life by Stroke Impact Scale [ Time Frame: 3rd week, and 6th week ]
    Stroke Impact Scale would be used to measure the independence of daily activities. It is a self-reported questionnaire. The contents involve various aspect of life. The high the grade, the more serious the life is affected. The total score is from 0 to 100 for self-assessing the level of recovery.

  5. the change from baseline to time of quality of life by Barthel Index [ Time Frame: 3rd week, and 6th week ]
    Barthel Index would be used to measure the independence of daily activities. It is a form that contains different activities of daily living. The higher the outcome grades, the better the level of independence.

  6. the change from baseline to time of functional performance by box and block test [ Time Frame: 3rd week, and 6th week ]
    box and block test would be used to assess the grasping and release performance of the affected hand.

  7. the change from baseline to time of functional performance by STEF [ Time Frame: 3rd week, and 6th week ]
    Simple Test for Evaluating Hand Function (STEF) would be used to assess the hand function by executing various types of grasping.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • The patients have a stroke with hemiplegia (duration is 3-6 months after stroke).
  • Patients who are able to perform hand grasp.
  • Patients who could slightly do fingers extension and minimal wrist extension. (ability of extension at least 10 degrees at the metacarpophalangeal and interphalangeal joints and 20 degrees at the wrist.)

Exclusion Criteria:

  • age is younger than 18 years old or older than 80 years old;
  • previous history of upper extremity tendon or neuromuscular injury;
  • any other systemic neuromuscular disease; cognition or language impairment leading to communication difficulty.
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Yuchi Huang, MD +866-7-7317123 ext 6286 hyuchi@gmail.com

Locations
Layout table for location information
Taiwan
Kaohsiung Chang Gung Memorial Hospital Recruiting
Kaohsiung, Taiwan, 833
Contact: Yuchi Huang, MD    +886-7-7317123      
Sponsors and Collaborators
Chang Gung Memorial Hospital
Investigators
Layout table for investigator information
Study Chair: Yuchi Huang Chang Gung Memorial Hospital
Tracking Information
First Submitted Date  ICMJE July 18, 2019
First Posted Date  ICMJE July 22, 2019
Last Update Posted Date January 27, 2021
Actual Study Start Date  ICMJE November 1, 2019
Estimated Primary Completion Date March 31, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: July 23, 2019)
  • the change from baseline to time of MAS scale [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure spasticity of affected upper extremity at elbow and wrist joints (modified Ashworth scale). In this scale, muscle tone would be assessed by quick stretch of muscle belly. The scoring criteria are as follows. 0, no increase in muscle tone; 1, Slight increase in muscle tone; 2, More marked increase in muscle tone through most of the ROM; 3, considerable increase in muscle tone; 4, affected part(s) rigid in flexion or extension.
  • the change from baseline to time of Musculoskeletal sonography [ Time Frame: 3rd week, and 6th week ]
    an experienced physiatrist will evaluate the findings on sonography, sonoelastography, and shear wave velocity (SWV). The participants will sit upright and put their upper extremities on the bed with elbow flexion in 90 degrees and the forearm full supination. The measured levels for evaluating FCR, FCU, and FDS muscles will be recorded at first time and use the same level at follow up for each patient. The SWV will be done in the longitudinal/transverse planes and be performed at the maximal cross-section area of the muscles and repeatedly measured for 7 times for each muscle. The sonoelastography will be applied in the longitudinal plane of the detected muscles at the same level of the SWV.
  • the change from baseline to time of Fugl-Meyer assessment for upper extremity [ Time Frame: 3rd week, and 6th week ]
    a therapist will evaluate Fugl-Meyer assessment for upper extremity (FMA-UE) for each participant. In this assessment, participants would need to execute a series of movements, which involved proximal and distal part of upper limb. The higher the grade, the better the performance. The total score ranges from 0 to 66 for motor function.
Original Primary Outcome Measures  ICMJE
 (submitted: July 18, 2019)
  • the change from baseline to time of MAS scale [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure spasticity of affected upper extremity at elbow and wrist joints (modified Ashworth scale). In this scale, muscle tone would be assessed by quick stretch of muscle belly. The scoring criteria are as follows. 0, no increase in muscle tone; 1, Slight increase in muscle tone; 2, More marked increase in muscle tone through most of the ROM; 3, considerable increase in muscle tone; 4, affected part(s) rigid in flexion or extension.
  • the change from baseline to time of Musculoskeletal sonography [ Time Frame: 3rd week, and 6th week ]
    an experienced physiatrist will evaluate the findings on sonography, sonoelastography, and shear wave velocity (SWV). The participants will sit upright and put their upper extremities on the bed with elbow flexion in 90 degrees and the forearm full supination. The measured levels for evaluating FCR, FCU, and FDS muscles will be recorded at first time and use the same level at follow up for each patient. The SWV will be done in the longitudinal/transverse planes and be performed at the maximal cross-section area of the muscles and repeatedly measured for 7 times for each muscle. The sonoelastography will be applied in the longitudinal plane of the detected muscles at the same level of the SWV.
  • the change from baseline to time of Fugl-Meyer assessment [ Time Frame: 3rd week, and 6th week ]
    a therapist will evaluate Fugl-Meyer assessment for upper extremity (FMA-UE) for each participant. In this assessment, participants would need to execute a series of movements, which involved proximal and distal part of upper limb. The higher the grade, the better the performance.
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: July 23, 2019)
  • the change from baseline to time of Brunnstrom stage [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure motor recovery stage (Brunnstrom stage)
  • the change from baseline to time of modified Tardieu scale [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure spasticity of affected upper extremity at elbow and wrist joints (modified Tardieu scale).
  • the change from baseline to time of existence of sensation [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure the sensation, including light touch, pinprick touch, proprioception.
  • the change from baseline to time of quality of life by Stroke Impact Scale [ Time Frame: 3rd week, and 6th week ]
    Stroke Impact Scale would be used to measure the independence of daily activities. It is a self-reported questionnaire. The contents involve various aspect of life. The high the grade, the more serious the life is affected. The total score is from 0 to 100 for self-assessing the level of recovery.
  • the change from baseline to time of quality of life by Barthel Index [ Time Frame: 3rd week, and 6th week ]
    Barthel Index would be used to measure the independence of daily activities. It is a form that contains different activities of daily living. The higher the outcome grades, the better the level of independence.
  • the change from baseline to time of functional performance by box and block test [ Time Frame: 3rd week, and 6th week ]
    box and block test would be used to assess the grasping and release performance of the affected hand.
  • the change from baseline to time of functional performance by STEF [ Time Frame: 3rd week, and 6th week ]
    Simple Test for Evaluating Hand Function (STEF) would be used to assess the hand function by executing various types of grasping.
Original Secondary Outcome Measures  ICMJE
 (submitted: July 18, 2019)
  • the change from baseline to time of Brunnstrom stage [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure motor recovery stage (Brunnstrom stage)
  • the change from baseline to time of modified Tardieu scale [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure spasticity of affected upper extremity at elbow and wrist joints (modified Tardieu scale).
  • the change from baseline to time of existence of sensation [ Time Frame: 3rd week, and 6th week ]
    a therapist will measure the sensation, including light touch, pinprick touch, proprioception.
  • the change from baseline to time of quality of life by Stroke Impact Scale [ Time Frame: 3rd week, and 6th week ]
    Stroke Impact Scale would be used to measure the independence of daily activities. It is a self-reported questionnaire. The contents involve various aspect of life. The high the grade, the more serious the life is affected.
  • the change from baseline to time of quality of life by Barthel Index [ Time Frame: 3rd week, and 6th week ]
    Barthel Index would be used to measure the independence of daily activities. It is a form that contains different activities of daily living. The higher the outcome grades, the better the level of independence.
  • the change from baseline to time of functional performance by box and block test [ Time Frame: 3rd week, and 6th week ]
    box and block test would be used to assess the grasping and release performance of the affected hand.
  • the change from baseline to time of functional performance by STEF [ Time Frame: 3rd week, and 6th week ]
    Simple Test for Evaluating Hand Function (STEF) would be used to assess the hand function by executing various types of grasping.
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Functional Outcome of Hemiplegic Upper Extremity in Patients With Subacute Stroke After Kinesiotaping and Rehabilitation
Official Title  ICMJE The Functional Outcome of Hemiplegic Upper Extremity in Patients With Subacute Stroke After Kinesiotaping Combined With Rehabilitation
Brief Summary
  1. To explore the role of sonoelastography with shear wave velocity to assess poststroke spasticity of affected arm and forearm muscles in patients with stroke.
  2. To investigate the effects of Kinesiotaping applications on motor recovery, functional performance, and spasticity of affected upper extremity in patients with subacute stroke.
Detailed Description

Clinical characteristics of impaired motor performance on affected upper extremity in stroke patients included muscle weakness, increased muscle tone, contracture, joint instability, or impaired motor control. Poststroke spasticity (PSS) is also a common complication in stroke patients with limbs weakness and impaired coordination between agonist and antagonist contraction. Upper extremity impairments and PSS have negative effects on functional performances and quality of daily livings. In patients with subacute stroke, strengthening exercises, constraint-induce movement therapy, mirror therapy, mental practice, and neuromuscular electrical stimulation, botulinum toxin, and antidepressants are recommended. For managing PSS, several therapeutic interventions include stretching and range of motion exercises, antispasticity splint, neuromuscular electrical stimulation, oral medications, local injection with phenol or botulism, or surgery. Some investigators found that Kinesiotaping (KT) combined with other interventions may facilitate muscle function, provide joint support and proprioception feedback, and reduce pain in stroke patients with hemiplegia. The investigators will perform KT applications both on the proximal and distal parts of affected upper extremity to facilitate motor recovery and performance in subacute stroke patients with hemiplegia while receiving rehabilitation.

After reviewing literatures, sonoelastography and shear wave velocity (SWV) was applied to evaluate the muscle stiffness in stroke patients with upper limb spasticity, but mostly on biceps brachii muscle. The investigators try to use musculoskeletal sonography to explore the feasibility of sonoelastography as a quantitative tool for measuring PSS both on spastic arm and forearm muscles in patients with stroke.

In this study, sixty stroke patients with hemiplegia will be recruited for physical evaluations for PSS and functional performance of upper extremity, and sonoelastography with shear wave velocity (SWV) on biceps brachii, brachioradialis, flexor carpal radialis, and flexor carpal ulnaris muscles to explore the relationship between physical and sonographic assessements for PSS. In the next phase, 60 subacute patients with hemiplegia would be enrolled, then randomly divided into experimental or control groups. In experimental group (n=30), the patients will receive KT combined with rehabilitation once daily for five days, three weeks. In the control group (n=30), the patient will receive the same program without KT. All participants will receive following evaluations, including modified Ashworth and Tardieu scales, Fugl-Meyer Assessment for upper extremity, box and block test, the Wolf motor function test, and sonoelastography with shear wave velocity (SWV) before intervention, right after the three-week intervention, and three-week post intervention.

The aims of this study are:

  1. To explore the role of sonoelastography with shear wave velocity to assess poststroke spasticity of affected arm and forearm muscles in patients with stroke.
  2. To investigate the effects of Kinesiotaping applications on motor recovery, functional performance, and spasticity of affected upper extremity in patients with subacute stroke.
Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Condition  ICMJE
  • Stroke
  • Hemiplegia
Intervention  ICMJE
  • Other: Kinesiotaping
    inesio tape would be applied over the extensor muscles of the affected hand for facilitating the extension of hand. We will apply the tape from the upper 1/3 length of dorsal side of the forearm and split the tape into five equal bars to the distal interphalangeal joint of each finger along the finger bones. This intervention would be executed for five days per week for three weeks.
  • Other: Hand rehabilitation program
    In the thirty-minute hand rehabilitation program, a motor-relearning theory would be implemented into the intervention by teaching the participants how to use their upper limb properly without any compensatory motions. Therefore, for establishing a correct movement pattern, an occupational therapist would provide a hand-guided activity, in which the participants could practice reaching movement as well as hand grasp and release in a more natural way. Besides, the therapist would also help the patients release their muscle tone by stretching the spastic muscles for five minutes before and after this hand rehabilitation period.
  • Other: Sham taping
    A short piece of kinesio tape would be cut into half and applied over the lateral side of the forearm from the lateral epicondyle till the half of the forearm. The tape would not cover the both the flexor and extensor muscle bellies.
Study Arms  ICMJE
  • Experimental: KT group
    the patients will receive KT for 5 days a week, for three weeks. And a 30-minute hand functional training would also be provided once daily every day during the intervention.
    Interventions:
    • Other: Kinesiotaping
    • Other: Hand rehabilitation program
  • Sham Comparator: Control group
    the patients will receive sham KT for 5 days a week, for three weeks. And a 30-minute hand functional training would also be provided once daily every day during the intervention.
    Interventions:
    • Other: Hand rehabilitation program
    • Other: Sham taping
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Recruiting
Estimated Enrollment  ICMJE
 (submitted: July 18, 2019)
62
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE March 31, 2021
Estimated Primary Completion Date March 31, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • The patients have a stroke with hemiplegia (duration is 3-6 months after stroke).
  • Patients who are able to perform hand grasp.
  • Patients who could slightly do fingers extension and minimal wrist extension. (ability of extension at least 10 degrees at the metacarpophalangeal and interphalangeal joints and 20 degrees at the wrist.)

Exclusion Criteria:

  • age is younger than 18 years old or older than 80 years old;
  • previous history of upper extremity tendon or neuromuscular injury;
  • any other systemic neuromuscular disease; cognition or language impairment leading to communication difficulty.
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 80 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE
Contact: Yuchi Huang, MD +866-7-7317123 ext 6286 hyuchi@gmail.com
Listed Location Countries  ICMJE Taiwan
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04027985
Other Study ID Numbers  ICMJE NMRPG8J0221
Has Data Monitoring Committee No
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: No
Responsible Party Chang Gung Memorial Hospital
Study Sponsor  ICMJE Chang Gung Memorial Hospital
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Study Chair: Yuchi Huang Chang Gung Memorial Hospital
PRS Account Chang Gung Memorial Hospital
Verification Date January 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP

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