Motor imagery has shown promising results to optimize tenodesis grasp in individuals with C6-C7 tetraplegia. However, efficacy of using motor imagery to improve grasping after tetraplegia requires further study with higher level of evidence. In addition, controlling covert practice remains difficult due to the absence of overt movements. However, similar brain activity measured during both over and cover movements makes possible to provide visual information about the covert practice performance using neurofeedback. The Investigators thus designed this multicentric randomized controlled trial to investigate the effect of motor imagery with or with no visual neurofeedback on grasping capabilities after C6-C7 tetraplegia. They hypothesized that providing neurofeedback based on brain activity measured by electroencephalography namely knowing the covert practice performance would results in greater grasping improvement in response to practice as compared to motor imagery practice alone.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
21
7 individuals with C6-C7 tetraplegia randomize in the experimental group consisting in motor imagery practice combined with visual neurofeedback (NF - i.e. performance of the imagined movement). Intervention consists in a total of 15 sessions repeated 3 times a week and lasting 5 weeks. Each session will last 45 minutes. An experienced physical therapist supervised all sessions. After each imagined movement, the NF based on brain activity measured by electroencephalography is display on a screen.
7 individuals with C6-C7 tetraplegia randomized in the active comparator group consisting in motor imagery practice alone without visual NF. This means that the performance of the imagined movement is not displayed to the participants. Intervention consists in a total of 15 sessions repeated 3 times a week and lasting 5 weeks. Each session will last 45 minutes. An experienced physical therapist supervised all sessions.
7 individuals with C6-C7 tetraplegia randomized in the sham comparator group consisting in imagining geometric shapes by visualization. Shapes are successively displayed on a screen. Intervention consists in a total of 15 sessions repeated 3 times a week and lasting 5 weeks. Each session will last 45 minutes. An experienced physical therapist supervised all sessions.
Le Centre Mutualiste Neurologique PROPARA, Parc Euromédecine
Montpellier, France
RECRUITINGService de médecine physique et de réadaptation, Hôpital Henry Gabrielle
Saint-Genis-Laval, France
RECRUITINGWrist extension angle in degree during grasping with 3D motion analysis system
Individuals with C6-C7 tetraplegia extend their wrist to grasp using tenodesis. Specifically, the wrist extension shortens the tendons of fingers and thumbs flexors that elicit either a palmar or a lateral grip. A complete reach-to-grasp movement will be recorded using a 3D motion analysis system (Vicon Motion Systems Ltd. UK). Wrist extension angle in degree will be measure during grasping when the object is grasped.
Time frame: Up to 19 weeks
Temporal kinematic parameters of reach-to-grasp movements with 3D motion analysis system (Vicon Motion Systems Ltd. UK).
Computation of temporal kinematic parameters (e.g. movement duration) measured during a complete reach-to-grasp movement using a 3D motion analysis system (Vicon Motion Systems Ltd. UK). Temporal parameters are also aggregated with spatial parameters.
Time frame: Up to 19 weeks
Spatial kinematic parameters of reach-to-grasp movements with 3D motion analysis system (Vicon Motion Systems Ltd. UK).
Computation of spatial kinematic parameters (e.g. movement trajectory) measured during a complete reach-to-grasp movement using a 3D motion analysis system (Vicon Motion Systems Ltd. UK).Spatial parameters are also aggregated with temporal parameters.
Time frame: Up to 19 weeks
Brain activity change in response to intervention using magnetoencephalography
Brain activity will be measured during upper limb movement (e.g. a complete reach-to-grasp movement) using magnetoencephalography. The device is only available in Lyon Hospital. Correspondingly, fifteen participants included in Lyon Hospital will achieve this measure.
Time frame: Up to 19 weeks
passive upper limb range of motion (ROM) measured using goniometer and/or inclinometer
This outcome will be measured using goniometer and/or inclinometer by the same blind and experienced physical therapist
Time frame: Up to 19 weeks
Upper limb strength measured using the hand held dynamometer
This outcome will be measured using the manual muscle test and the hand held dynamometer by the same blind and experienced physical therapist.
Time frame: Up to 19 weeks
Upper limb strength measured using the manual muscle test
This outcome will be measured using the manual muscle test and the hand held dynamometer by the same blind and experienced physical therapist.
Time frame: Up to 19 weeks
Hand dexterity measured using the Box and Block test
This outcome will be measured using i) the Box and Block Test, ii) the Nine Hole Peg Test, iii) the Jebsen Test and iv) the Capability of Upper Limb Test supervised by the same blind and experienced occupational therapist
Time frame: Up to 19 weeks
Hand dexterity measured using the Nine Hole Peg test
This outcome will be measured using i) the Box and Block Test, ii) the Nine Hole Peg Test, iii) the Jebsen Test and iv) the Capability of Upper Limb Test supervised by the same blind and experienced occupational therapist
Time frame: Up to 19 weeks
Hand dexterity measured using the Jebsen test
This outcome will be measured using i) the Box and Block Test, ii) the Nine Hole Peg Test, iii) the Jebsen Test and iv) the Capability of Upper Limb Test supervised by the same blind and experienced occupational therapist
Time frame: Up to 19 weeks
Hand dexterity measured using the Capability of Upper Limb test
This outcome will be measured using i) the Box and Block Test, ii) the Nine Hole Peg Test, iii) the Jebsen Test and iv) the Capability of Upper Limb Test supervised by the same blind and experienced occupational therapist
Time frame: Up to 19 weeks
Quality of Life measured using the WHOQOL-Bref
This outcome will be measured using the WHOQOL-Bref by the same blind and experienced physical therapist.
Time frame: Up to 19 weeks
Daily life autonomy measured using the Quadriplegic Index of Function
This outcome will be measured using the Quadriplegic Index of Function by the same blind and experienced physical therapist.
Time frame: Up to 19 weeks
Motor imagery capability measured by the Kinesthetic Visual Imagery Questionnaire
Motor imagery capability will be measured by the Kinesthetic Visual Imagery Questionnaire by the same blind and experienced physical therapist along with comparing overt and covert movement duration, galvanic skin response, electroencephalography activity.
Time frame: Up to 19 weeks
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