Motor Imagery for Reach-to-grasp Rehabilitation After Tetraplegia

Overview

Single center, pilot study, to evaluate the influence of Motor Imagery (MI) on functional rehabilitation and cerebral plasticity through the qualitative and quantitative mental practice approach. For this, the investigators will use magnetoencephalography (MEG) but also physiological and behavioral indicators developed by the Laboratoire de la Performance Motrice, Mentale et du Matériel (P3M) of Université Claude Bernard Lyon 1 and its partners.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: March 2013

Interventions

  • Procedure: motor imagery
    • Intervention consisted of supervised MI during which the participants were trained to imagine performing a single-joint wrist extension movement and a multiple-joint reach-to-grasp movement using tenodesis. The two movements were practiced in separate blocks and each 45 minute MI session consisted of six to eight blocks. Within a given block patients; i) performed the movement once, ii) imagined it using visual imagery (between five and ten repetitions), iii) performed the movement again, and iv) imagined it using kinesthetic imagery (between five and ten repetitions). All movements (performed and imagined) were timed by the experimenter to ensure that the durations of both imagined and physically practiced movements were similar. Imagery vividness was controlled with self-rated assessments using a visual analogic scale (from 0, the image or feeling was absent, to 10 when it was as clear or intense as physical practice).

Arms, Groups and Cohorts

  • Experimental: C6-C7 patients
    • C6-C7 patients able to recover tenodesis grasp.
  • Experimental: C5-C6 patients
    • C5-C6 patients for whom surgery for rehabilitation of an upper limb is indicated with a upper limit of one year after trauma, and after complete clinical and functional evaluation
  • No Intervention: Control group
    • a control group (n=6) matched on age and sex to C6-C7 without medical history or neurological disorder

Clinical Trial Outcome Measures

Primary Measures

  • Motor imagery ability
    • Time Frame: 10 weeks
    • Motor imagery ability assessed by magnetoencephalography measurements

Secondary Measures

  • Movement time (MT)
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: temporal parameters: movement time (MT)
  • absolute time to peak velocity
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: temporal parameters: absolute time to peak velocity
  • movement amplitude at peak velocity
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: temporal parameters: movement amplitude at peak velocity
  • time to opening
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: temporal parameters: time to opening
  • time to maximal opening
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: temporal parameters: time to maximal opening
  • amplitude of maximal opening
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: temporal parameters: amplitude of maximal opening
  • Trajectory of movement measured in the XY plane
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: spatial parameters: Trajectory of movement measured in the XY plane
  • height of elbow and wrist at the moment of grasping an object, measured in mm in the YZ plane
    • Time Frame: 10 weeks
    • Kinematic parameters of movement: spatial parameters: height of elbow and wrist at the moment of grasping an object, measured in mm in the YZ plane
  • muscular force evaluated by muscle testing performed by a physiotherapist
    • Time Frame: 10 weeks
    • muscular force evaluated by muscle testing performed by a physiotherapist (score from 0 to 5)
  • joint amplitude evaluated in degrees (°) by the physiotherapist
    • Time Frame: 10 weeks
  • Box and Block test
    • Time Frame: 10 weeks
    • Box and Block test performed by an occupational therapist
  • Minnesota test.
    • Time Frame: 10 weeks
    • Minnesota test performed by an occupational therapist
  • amplitude of electrodermal responses
    • Time Frame: 10 weeks
    • mental chronometric assessment associated with acquisition of electrodermal responses
  • duration of electrodermal responses
    • Time Frame: 10 weeks
    • mental chronometric assessment associated with acquisition of electrodermal responses
  • Kinesthetic and Visual Imagery Questionnaire
    • Time Frame: 10 weeks
    • The Kinesthetic and Visual Imagery Questionnaire (KVIQ) will allow a qualitative evaluation of the mental representation capacity of patients

Participating in This Clinical Trial

Inclusion Criteria

  • 18-55 years old, – quadriplegia elicited by spinal cord injury (SCI) at the C5, C5-C6, C6, or C6-C7 level, – complete infra-lesional motor deficit according to the ASIA impairment scale with finger and forearm flexor muscles paralysis, – post-traumatic period >6 months (since a motor recovery plateau is usually reached at 6-month post-SCI Exclusion Criteria:

  • non-stabilized hypertension or pathological autonomic nervous system dysfunction (e.g., orthostatic hypotension), – cerebral damage and/or cognitive deficit, – elbow or shoulder joint amplitude restriction, upper limb para-osteoarthropathy, – participation to another study – presence of metallic objects within the body incompatible with MEG or functional magnetic resonance imaging (fMRI) recordings.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 55 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Hospices Civils de Lyon
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Gilles RODE, Pr, Principal Investigator, Hospices Civils de Lyon

Citations Reporting on Results

Mateo S, Reilly KT, Collet C, Rode G. Descriptive pilot study of vividness and temporal equivalence during motor imagery training after quadriplegia. Ann Phys Rehabil Med. 2018 Sep;61(5):300-308. doi: 10.1016/j.rehab.2018.06.003. Epub 2018 Jun 23.

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