Exercise Primed Stroke Rehabilitation
Priming the Rehabilitation Engine: Aerobic Exercise as the Fuel to Spark Behavioral Improvements in Stroke
VA Office of Research and Development
40 participants
Jul 1, 2021
INTERVENTIONAL
Conditions
Summary
Stroke is a leading cause of disability in the U.S. and many Veteran stroke survivors live with severe disability. Despite recent advances in rehabilitation treatments many stroke survivors have persistent physical and mental difficulties such as reduced physical and cognitive function and depression. Developing innovative treatments that address these problems is necessary to improve long-term outcomes for stroke survivors. Aerobic exercise (AEx) can improve physical and cognitive function, and reduce depression. Additionally, AEx may enhance physical rehabilitation by making the brain more receptive to, and consequently improving the response to an intervention. Therefore, combining AEx with physical rehabilitation has the potential to improve multiple aspects of stroke recovery. This study will examine the effect of combining AEx with physical rehabilitation on physical and mental function in stroke survivors. By gaining a better understanding of the effects of this combined intervention the investigators aim to advance the rehabilitative care of Veteran stroke survivors.
Eligibility
Inclusion Criteria7
- experienced unilateral stroke at least 6 months prior;
- voluntarily shoulder flexion of the affected arm 20 degrees with simultaneous elbow extension 10 degrees;
- moderate arm movement impairment (UE Fugl-Meyer Assessment \> 21 but \< 52 points;
- passive range of motion in paretic shoulder, elbow, wrist, thumb and fingers within 20 degrees of normal;
- years of age;
- ability to communicate as per the therapists' judgement at baseline testing;
- ability to complete and pass an exercise tolerance test; 8) Box \& Block test score of at least 3 blocks in 60 seconds with the affected arm.
Exclusion Criteria17
- lesion in brainstem/cerebellum as these may interfere with visual-perceptual/cognitive skills needed for motor re-learning;
- presence of other neurological disease that may impair motor learning skills;
- orthopedic condition or impaired corrected vision that alters reaching ability (e.g., prior rotator cuff tear without full recovery);
- paretic arm pain that interferes with reaching;
- unable to understand or follow 3-step directions;
- severe cognitive impairment (MoCA score 17);
- severe aphasia;
- inability to read English,
- history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during ADL's;
- Severe hypertension with systolic \>200 mmHg and diastolic \>110 mmHg at rest;
- History of COPD or oxygen dependence;
- History of DVT or pulmonary embolism within 6 months;
- Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin reactions;
- UBACC score \< 15; and for brain stimulation procedures only:
- electronic or metallic implants;
- history of seizures;
- women of child bearing potential.
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Interventions
Duck Duck Punch (DDP) is an interactive computer game deliberately designed to enhance UE movement quality via individualized progressive movement practice. DDP is unique as it uses Microsoft Kinect skeletal tracking technology to assess movement performance. The participant sits in front of the Microsoft Kinect and controls a virtual arm with his/her physical arm; reaching forward to "punch" virtual ducks. The goal 'dose' of DDP will be 200 repetitions.
Subjects will perform 15 minutes of aerobic exercise on a recumbent stationary cycle. The target intensity of aerobic exercise is 70% heart rate reserve. Following aerobic exercise subject will play an upper extremity rehabilitation game called Duck Duck Punch.
Subjects will perform 15 minutes of lower extremity stretching. Following aerobic exercise subject will play an upper extremity rehabilitation game called Duck Duck Punch.
Locations(1)
View Full Details on ClinicalTrials.gov
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NCT04877444