The purpose of this study is to evaluate the effect of the repetitive proprioceptive bilateral stimulation for the early recovery of the voluntary muscle contraction in stroke patients.
The central nervous system (CNS) has plastic properties allowing its adaptation through development. These properties are still maintained in the adult age and potentially activated in case of brain lesion. In the present study authors hypothesized that a significant recovery of voluntary muscle contraction in post stroke patients experiencing severe upper limb paresis can be obtained, when proprioceptive based stimulations are provided. The proprioceptive based training (PBT) aims to stimulate the emergence of voluntary contraction and to foster motor recovery. It is based on motor learning principles, such as the repetition of tasks with concurrent use of feedbacks. The proposed concept is based on the concurrent repetitions of movements performed with the non-affected limb and with the affected one, passively mobilized by physiotherapist in charge of guaranteeing the optimal kinematic execution.
- Proprioceptive based training (PBT) Other
Intervention Desc: During the PBT patient will stay in supine position with the upper limbs positioned in symmetric posture. He/She will be asked to move both limbs with the same frequency performing bilateral flexion-extension of one of the upper limb districts according to the available free ROM of the target joint. The movement execution of the affected arm will be supported by the physiotherapist performing passive movement at the same rhythm, as the one executed with the unaffected side. Patient will be asked to focus the attention on the movement performed against gravity, which will be reinforced by a verbal command. Afterwards, the physiotherapist will fully support movement execution coherently with the patient's movement initialization. The active movement performed voluntarily by the patient with unaffected limb will be considered as the reference movement, that the physiotherapist has to emulate passively, by synchronization of passive movement executed in phase with the affected side. ARM 1: Kind: Experimental Label: Proprioceptive based training (PBT) Description: The treatment will last one hour and will be divided as follows: 2 proprioceptive based stimulation sessions per 3 minutes for each movement, with a rest of 2 minutes between each session. Every patient will receive 15 treatments, 5 days a week, for 3 weeks.
- Conventional neuromotor treatment (CNT). Other
Intervention Desc: The patients randomized to the CNT group will be asked to perform exercises for postural control, exercises for hand pre-configuration, exercises for the stimulation of manipulation and functional skills, exercises for proximal-distal coordination. All the exercises will be performed with or without the assistance of a physiotherapist. The upper limb motricity will be trained with progressive complexity. ARM 1: Kind: Experimental Label: Conventional neuromotor treatment (CNT) Description: The CNT group will be treated for one hour daily by means of a CNT programme. The treatment will last 3 weeks.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Medical Research Council scale (MRC)||Change from baseline of the MRC scale at the end of PBT (three weeks thereafter)|
|Primary||Dynamometer||Change from baseline of dynamometer at the end of PBT (three weeks thereafter)|
|Secondary||Fugl-Meyer Upper Extremity scale (FM UE)||Change from baseline of the FM UE scale at the end of PBT (three weeks thereafter)|
|Secondary||Functional Independence Measure scale (FIM)||Change from baseline of the FIM scale at the end of PBT (three weeks thereafter)|
|Secondary||Modified Ashworth Scale||Change from baseline of the Ashworth scale at the end of PBT (three weeks thereafter)|
|Secondary||surface Electromyography (sEMG)||Change from baseline of the MVC at the end of PBT (three weeks thereafter)|