Within the first year after stroke, approximately 38% of stroke survivors experience an increased resistance to movement, also called spasticity. One type of treatment that is approved for stroke survivors in Canada that could reduce spasticity is the injection of Botulinum toxin (BTX) into the affected muscle. While BTX reduces spasticity, there is limited evidence to show that BTX administration leads to functional improvements. This may occur because the outcomes aren't sensitive enough to detect change, some people may have better responses to BTX, or because BTX hasn't been paired with the right exercises to improve function. The aims of this research are: i) to determine if there is a way of improving the markers that measure change in response to treatment; and ii) to identify the ideal type of exercise that should be paired with BTX to allow the drug to have it greatest effect.
There are two primary research questions: a) What are the measures that will indicate whether a person with post-stroke spasticity will benefit from BTX therapy? It is hypothesized that EMG latency and amplitude, for those who best respond to BTX, will differ from those who demonstrate a weaker response to BTX; b)What is the ideal training approach for improving muscle function in stroke survivors receiving BTX injections? It is hypothesized that a training protocol that focuses on optimizing specific muscle activation patterns will demonstrate better outcomes than a training program designed to improve function.
- Optimal muscle activation therapy Behavioral
Other Names: Botulinum Toxin-A; Therapy Intervention Desc: The proposed study uses a longitudinal, within-subject, pre/post intervention, cross-over design. All participants will complete each of 4 study phases (each 12 weeks long). These include: a) focal BTX injections in combination with either Standard Therapy or Optimal Muscle Activity Therapy; b) a three-month period where no treatment is given; c) focal BTX injections in combination either Standard Therapy or Optimal Muscle Activation Therapy; d) another three-month period where no treatment is given. The order of treatment phases will be counter-balanced across participants. ARM 1: Kind: Experimental Label: Optimal Muscle Activation Therapy Description: Coupling focal BoNT-A injections with a motor training program that focuses on developing and maintaining activation patterns in the muscle treated with BoNT-A.
- Standard Therapy Other
ARM 1: Kind: Experimental Label: Standard Therapy Description: Coupling focal BoNT-A injections with a therapy program comprising of functional tasks.
- Allocation: Randomized
- Masking: Single Blind (Investigator)
- Purpose: Treatment
- Endpoint: Efficacy Study
- Intervention: Crossover Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||Amplitude and timing of electromyographic signals (EMG)||Baseline, Month 1, Month 2, Month 3, Month 6, Month 7, Month 8, Month 9, Month 12||No|
|Secondary||Motor Evoked Potential amplitude||Baseline, Month 1, Month 2, Month 3, Month 6, Month 7, Month 8, Month 9, Month 12||No|
|Secondary||Goal Attainment Scale||Baseline, 6 Months||No|
|Secondary||Modified Ashworth Scale||Baseline, Month 1, Month 2, Month 3, Month 6, Month 7, Month 8, Month 9, Month 12||No|
|Secondary||Modified Tardieu Scale||Baseline, Month 1, Month 2, Month 3, Month 6, Month 7, Month 8, Month 9, Month 12||No|
|Secondary||Frequency and amplitude of electroencephalographic (EEG) activity||Baseline, Month 1, Month 2, Month 3, Month 6, Month 7, Month 8, Month 9, Month 12||No|