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出境医 / 临床实验 / Optimal Interstimulus Interval For Consecutive H-Reflex Responses In Patients With Spasticity

Optimal Interstimulus Interval For Consecutive H-Reflex Responses In Patients With Spasticity

Study Description
Brief Summary:
This study evaluates the optimal interstimulus interval for consecutive H-reflex responses in patients with spasticity.

Condition or disease Intervention/treatment Phase
Muscle Hypertonia Reflex, Abnormal Diagnostic Test: H-reflex Not Applicable

Detailed Description:

This study will include 15 patients with spastic stroke patients H-reflex with different interstimulus interval of the plegic side soleus muscle will be tested.

Subjects lay comfortably in the supine position on an examination bed. The subject will be asked not to contract the lower extremity muscles during the experiment. Surface EMG (SEMG) will be recorded from the plegic side soleus muscle using bipolar electrodes. These electrodes will be placed on the soleus muscle according to the SENIAM guideline.The reference electrode will be placed on medial malleolus. Prior to electrode placement, the skin will be shaved, lightly abraded, and cleaned with alcohol wipes. Self-adhesive, disposable, Ag-AgCl disc electrodes with a disc radius of 10 mm (KENDALL® Arbo; Coviden; Massachusetts, USA) will be used. To prevent the sway of electrode cables, it will be fixed to the body. SEMG and stimulator data will be obtained by using a data acquisition system (POWERLAB® ADInstruments Co, Oxford, United Kingdom). Sampling rate will be 10 kHz.

The recorded data will be processed and analyzed offline using LabChart7® Software Version V7.3.3 (PowerLab® system ADInstruments, Oxford, United Kingdom).

A cathode (5×5 mm) will be placed at the midpoint of popliteal fossa and an anode (10×10 cm) will be placed immediately proximal to the patella to evoke the H-reflex for monopolar stimulation of the posterior tibial nerve. A monophasic electrical current will be delivered as square pulses with a width of 1 ms by using a stimulator (FE155 Stimulator HC ADInstrument, Oxford UK). Taking into consideration study of Ozyurt et al, interstimulus interval will be selected as 10 seconds for determining the maximum H-reflex (Hmax). Then, Hmax and M-response (Mmax) will be determined.

We will be tested four different ISI (10s, 5s, 3s and 1s) for stroke patients in this study. The stimulus intensity for tested H-reflex will be selected as a constant stimulus strength that will be 50 percent of the Hmax.

Thirty consecutive stimuli will be delivered in separate sets for each tested ISI of 10, 5, 3 and 1s. The ISI sets will be tested in random order to negate any order effect. There will be a 15s of interval between sets.

SEMG recordings will be filtered using a bandpass filter from 5 to 500 Hz. Then the peak-to-peak (P-P) amplitudes of H-reflex will be measured then normalized using by two different methods to estimate H-reflex suppression due to consecutive stimuli. In the first method, P-P amplitude of the first H-reflex response will be used as a control, and P-P amplitude of the second H-reflex response will be normalized by using the control for each ISI set. Thus, HPP2 / HPP1 ratio will be calculated. Similar to the previous method, the first H-reflex response will be used as the control in the second method. Unlike the first method, not only the second H-reflex response, but the remaining 29 H-responses will be normalized to the first H-response. P-P amplitude of the 29 normalized H-reflex responses will be averaged and HPP29/HPP1 ratio will be calculated.

The peak-to-peak amplitude of the first H-reflex response will be measured then normalized to the Mmax (HPP1/Mmax) to compare H-reflexes between subjects and conditions.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 16 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: Effects of spasticity on consecutive H-reflex response in patients with hemiplegia
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Optimal Interstimulus Interval For Consecutive H-Reflex Responses In Patients With Spasticity
Actual Study Start Date : June 30, 2019
Actual Primary Completion Date : July 17, 2019
Actual Study Completion Date : July 17, 2019
Arms and Interventions
Arm Intervention/treatment
Experimental: H-reflex
H-reflex with different interstimulus interval of the plegic side soleus muscle were tested
Diagnostic Test: H-reflex
Electrical stimulation of Group Ia afferent of muscle spindle

Outcome Measures
Primary Outcome Measures :
  1. H-reflex suppression [ Time Frame: 1 day ]
    Change in H-reflex amplitude throughout consecutive stimuli


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   20 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Cerebrovascular stroke
  • Both sex

Exclusion Criteria:

  • Duration after stroke is less than 20 days
  • Lesions in calf skin
  • Excessive spasticity (Ashworth 4) / Contracture (foot joint)
  • Absent of soleus spasticity
  • Peripheral nerve diseases / muscle diseases
  • Absent of H-reflex
  • Botulinum toxin injection within last 12 weeks
  • Anxiety
  • Patients with pain on test day
Contacts and Locations

Locations
Layout table for location information
Turkey
stanbul Physical Medicine Rehabilitation Training and Research Hospital
Istanbul, Bahçelievler, Turkey, 34186
Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Istanbul, Turkey
Sponsors and Collaborators
Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Investigators
Layout table for investigator information
Principal Investigator: Dilara Ekici, MD stanbul Physical Medicine Rehabilitation Training and Research Hospital Istanbul
Tracking Information
First Submitted Date  ICMJE June 30, 2019
First Posted Date  ICMJE July 2, 2019
Last Update Posted Date July 23, 2019
Actual Study Start Date  ICMJE June 30, 2019
Actual Primary Completion Date July 17, 2019   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 30, 2019)
H-reflex suppression [ Time Frame: 1 day ]
Change in H-reflex amplitude throughout consecutive stimuli
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE Not Provided
Original Secondary Outcome Measures  ICMJE Not Provided
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Optimal Interstimulus Interval For Consecutive H-Reflex Responses In Patients With Spasticity
Official Title  ICMJE Optimal Interstimulus Interval For Consecutive H-Reflex Responses In Patients With Spasticity
Brief Summary This study evaluates the optimal interstimulus interval for consecutive H-reflex responses in patients with spasticity.
Detailed Description

This study will include 15 patients with spastic stroke patients H-reflex with different interstimulus interval of the plegic side soleus muscle will be tested.

Subjects lay comfortably in the supine position on an examination bed. The subject will be asked not to contract the lower extremity muscles during the experiment. Surface EMG (SEMG) will be recorded from the plegic side soleus muscle using bipolar electrodes. These electrodes will be placed on the soleus muscle according to the SENIAM guideline.The reference electrode will be placed on medial malleolus. Prior to electrode placement, the skin will be shaved, lightly abraded, and cleaned with alcohol wipes. Self-adhesive, disposable, Ag-AgCl disc electrodes with a disc radius of 10 mm (KENDALL® Arbo; Coviden; Massachusetts, USA) will be used. To prevent the sway of electrode cables, it will be fixed to the body. SEMG and stimulator data will be obtained by using a data acquisition system (POWERLAB® ADInstruments Co, Oxford, United Kingdom). Sampling rate will be 10 kHz.

The recorded data will be processed and analyzed offline using LabChart7® Software Version V7.3.3 (PowerLab® system ADInstruments, Oxford, United Kingdom).

A cathode (5×5 mm) will be placed at the midpoint of popliteal fossa and an anode (10×10 cm) will be placed immediately proximal to the patella to evoke the H-reflex for monopolar stimulation of the posterior tibial nerve. A monophasic electrical current will be delivered as square pulses with a width of 1 ms by using a stimulator (FE155 Stimulator HC ADInstrument, Oxford UK). Taking into consideration study of Ozyurt et al, interstimulus interval will be selected as 10 seconds for determining the maximum H-reflex (Hmax). Then, Hmax and M-response (Mmax) will be determined.

We will be tested four different ISI (10s, 5s, 3s and 1s) for stroke patients in this study. The stimulus intensity for tested H-reflex will be selected as a constant stimulus strength that will be 50 percent of the Hmax.

Thirty consecutive stimuli will be delivered in separate sets for each tested ISI of 10, 5, 3 and 1s. The ISI sets will be tested in random order to negate any order effect. There will be a 15s of interval between sets.

SEMG recordings will be filtered using a bandpass filter from 5 to 500 Hz. Then the peak-to-peak (P-P) amplitudes of H-reflex will be measured then normalized using by two different methods to estimate H-reflex suppression due to consecutive stimuli. In the first method, P-P amplitude of the first H-reflex response will be used as a control, and P-P amplitude of the second H-reflex response will be normalized by using the control for each ISI set. Thus, HPP2 / HPP1 ratio will be calculated. Similar to the previous method, the first H-reflex response will be used as the control in the second method. Unlike the first method, not only the second H-reflex response, but the remaining 29 H-responses will be normalized to the first H-response. P-P amplitude of the 29 normalized H-reflex responses will be averaged and HPP29/HPP1 ratio will be calculated.

The peak-to-peak amplitude of the first H-reflex response will be measured then normalized to the Mmax (HPP1/Mmax) to compare H-reflexes between subjects and conditions.

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description:
Effects of spasticity on consecutive H-reflex response in patients with hemiplegia
Masking: None (Open Label)
Primary Purpose: Basic Science
Condition  ICMJE
  • Muscle Hypertonia
  • Reflex, Abnormal
Intervention  ICMJE Diagnostic Test: H-reflex
Electrical stimulation of Group Ia afferent of muscle spindle
Study Arms  ICMJE Experimental: H-reflex
H-reflex with different interstimulus interval of the plegic side soleus muscle were tested
Intervention: Diagnostic Test: H-reflex
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 Completed
Actual Enrollment  ICMJE
 (submitted: July 21, 2019)
16
Original Estimated Enrollment  ICMJE
 (submitted: June 30, 2019)
15
Actual Study Completion Date  ICMJE July 17, 2019
Actual Primary Completion Date July 17, 2019   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • Cerebrovascular stroke
  • Both sex

Exclusion Criteria:

  • Duration after stroke is less than 20 days
  • Lesions in calf skin
  • Excessive spasticity (Ashworth 4) / Contracture (foot joint)
  • Absent of soleus spasticity
  • Peripheral nerve diseases / muscle diseases
  • Absent of H-reflex
  • Botulinum toxin injection within last 12 weeks
  • Anxiety
  • Patients with pain on test day
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 20 Years to 80 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE Yes
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Turkey
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT04005937
Other Study ID Numbers  ICMJE IstPMRTRH
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 Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Study Sponsor  ICMJE Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Dilara Ekici, MD stanbul Physical Medicine Rehabilitation Training and Research Hospital Istanbul
PRS Account Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Verification Date July 2019

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

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