To develop and validate a biomechanical measurement protocol that can assess wrist flexion deformity resulting from a UMN lesion.
ID
Source
Brief title
Condition
- Central nervous system vascular disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
Location of the optimal length and passive stiffness curve of the flexor
muscles and passive stiffness under high frequency perturbations; location of
the optimal length and passive stiffness curve of the extensor muscles; active
stiffness during constant activity for both muscle groups; inertia of hand,
viscosity of wrist joint under high frequency perturbations.
Secondary outcome
Passive and active range of motion of the wrist joint, neutral position of the
wrist, maximum voluntary contraction, Zancolli score, Ashworth score, Tardieu
score, selected tendon reflex tests
Background summary
Upper Motor Neuron (UMN) lesions such as stroke or Cerebral Palsy often result
in increased muscle tone, which in a number of cases leads to a flexion
deformity in mostly distal joints, such as the wrist. Causes of the deformity
may be either active/hypertonic (=hypertonic force imbalance) or
passive/structural (=contracture formation). This difference is difficult to
make clinically, but of paramount importance as the corresponding type of
treatment is fundamentally different: either muscular tone is relieved by
application of e.g. botulinum toxin, or the muscles/tendons are surgically
lengthened. To date, reliable assessment can only be made during actual
surgery. This radical, cost ineffective and time-consuming step in the process
of therapy can become unnecessary when a non-invasive biomechanical measurement
protocol is developed that can assess the affected joint. Most prone to
contracture formation are Cerebral Palsy patients, since their bodies are still
growing while motor abnormalities impair functionality.
Objective. To develop and validate a biomechanical measurement protocol that
can assess wrist flexion deformity resulting from a UMN lesion.
Study objective
To develop and validate a biomechanical measurement protocol that can assess
wrist flexion deformity resulting from a UMN lesion.
Study design
Case control; measurement of passive and active components of the force-length
relation of involved muscles by measuring torque-angle relations and isometric
force production under specified muscle activity, throughout the range of
motion (ROM) of the wrist. Measurement of wrist joint impedance by applying
perturbations and using linear system identification techniques to estimate
intrinsic parameters
Study burden and risks
Measurements will be performed only once. Measurements take in total about 1
1/2 hours including instruction, mounting and demounting etc. The actual
measuring time is small compared to the total session time. Measurements are
performed at the Laboratory of Movement Analysis of the LUMC, where there is
ample experience with the kind of measurements that comprise the present
application. During the measurements, a technician as well as a physician will
be present.
No side effects have been reported. Risks of serious side effects or
complications of the measurements are regarded to be minimal. Security measures
to prevent the wrist robot from working outside the prescribed positional
ranges include software as well as hardware (blocks) embedded limits. The
experiments can be stopped in case of emergency at any time by subject or
experimenter by the presence of emergency buttons.
Postbus 9600
2300 RC Leiden
Nederland
Postbus 9600
2300 RC Leiden
Nederland
Listed location countries
Age
Inclusion criteria
Cerebral Palsy patients
Inclusion criteria
• Young patients with motor disorders resulting from Cerebral Palsy, that have an abnormal wrist posture, i.e. showing a spontaneous flexion deformity of more than 30°
• Age between 12 and 18 years ;Stroke patients
Inclusion criteria
• Patients in the subacute to chronic stage after stroke who have developed a wrist flexion deformity, i.e. showing a wrist flexion angle of more than 30° at rest.;Control subjects
Inclusion criteria
• Age- (within one year deviation per patient), sex-matched.
• Predominantly healthy.
Exclusion criteria
Exclusion criteria CP
• A history of confounding morbidity around the wrist, e.g. fractures.
• Restricted vision (< 0.5)
• Loss of sensibility of the hand, preventing the patient from delivering the required task performance.
• Cognitive impairments preventing the patient from understanding the instructions required for the task that has to be performed.
• Other severe co- morbidity preventing patients from delivering the required task performance.
• Previous surgery on the wrist/ lower arm;Exclusion criteria stroke
• The same as for the CP patient group;Exclusion criteria control subjects
• History of previous or current neurological disorders of central origin or peripheral origin, e.g. Parkinson, Multiple Sclerosis, Stroke, nerve lesions, CRPS, plexus brachalis lesions etc.
• A history of confounding morbidity around the wrist, e.g. fractures..
• Restricted vision preventing subject from delivering the required task performance.
• Loss of sensibility of wrist, preventing from delivering the required task performance.
• Cognitive impairments preventing the subject from understanding the instructions required for the task that has to be performed.
Design
Recruitment
Followed up by the following (possibly more current) registration
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Other (possibly less up-to-date) registrations in this register
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In other registers
| Register | ID |
|---|---|
| CCMO | NL18926.058.07 |