This study evaluates the effect of a specific, multidisciplinary and personalized rehabilitation program compared to usual care, on motor control and functional disability in patients with neuralgic amyotrophy. Half of the participants will start with the 17-week specific rehabilitation program while the other half will first continue their usual care for 17 weeks, after which they will also receive the 17-week specific rehabilitation program.
Neuralgic amyotrophy (NA) is a common (incidence 1:1000) peripheral nervous system disorder caused by acute autoimmune inflammation of the brachial plexus, the nerve bundle going to the shoulder and arm. Many NA patients develop abnormal motor control of the shoulder region (i.e. scapular dyskinesia), which persists even after the peripheral nerve damage has recovered. This suggests that persistent scapular dyskinesia in NA may result from (mal)adaptive changes in the central motor system. Clinical experience shows that the specific, multidisciplinary and personalized rehabilitation program, focused on cognitive motor control can restore scapular dyskinesia in NA patients. This indicates that impairments in the central motor system likely play a role in persistent scapular dyskinesia and that specific rehabilitation may restore any alterations in central motor control. We hypothesize that the specific rehabilitation program, focused on cognitive motor control is more effective in improving functional disability than usual care and that it can reverse maladaptive changes in central motor control.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
47
17-week specific and personalised rehabilitation program. The program starts with a visit to the Plexus out patient clinic in week 1. During this visit, the patient will be examined by a multidisciplinary team, consisting of a rehabilitation physician, neurologist, physical therapist and occupational therapist, which will form a rehabilitation treatment plan. This treatment plan is implemented through 4 weekly sessions in week 2-5, 2 biweekly sessions in week 6-9 and 2 monthly sessions in week 10-17 . Each treatment session involves one hour of physical- and one hour of occupational therapy.
Participants will receive their usual care for 17 weeks, which may vary for each individual
Radboud university medical center
Nijmegen, Netherlands
Change in Shoulder Rating Questionnaire (SRQ) score from baseline
Change in functional (dis)ability of the shoulder, arm and hand measured with the SRQ
Time frame: Baseline (0 weeks) and post-intervention (17 weeks)
Change in brain activity related to central motor control from baseline
Change in the magnitudes of mean functional Magnetic Resonance Imaging signal (Blood-oxygen-level dependent (BOLD) activity) related to motor imagery of the affected arm, quantifying changes in central motor control
Time frame: Baseline (0 weeks) and post-intervention (17 weeks)
Change in performance on motor imagery tasks assessing motor control
Change in performance on motor imagery tasks. Performance is evaluated by means of reaction times and error rates.
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in Disability of Shoulder, Arm and Hand (DASH) score from baseline
Change in functional (dis)ability of the shoulder, arm and hand measured with the DASH
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in Checklist individual strength - subscale fatigue (CIS-fatigue) score from baseline
Change in experienced fatigue
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in McGill Pain Questionnaire (MPQ) score from baseline
Change in nature, intensity, location, course, and effect on daily life of experienced pain
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in self-efficacy for performing energy conservation strategies assessment (SEPECSA) score from baseline
Change in patient's perceived ability to apply energy conservation strategies to their daily life
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in Utrecht scale for evaluation of rehabilitation-participation (USER-P) score from baseline
Change in patient's participation
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in Pain self efficacy questionnaire (PSEQ) score from baseline
Change in confidence people with ongoing pain have in performing activities while in pain.
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in Patient activation measure (PAM) score from baseline
Change in knowledge, skills and confidence in managing one's own health and/or disease
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in Short-form 36 (SF-36) score from baseline
Change in experienced health and health related quality of life
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in serratus anterior muscle strength from baseline
Change in maximal force exerted with the serratus anterior muscle from baseline, measured when reaching with extended arm and flexed arm
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in shoulder endorotation strength from baseline
Change in maximal force exerted while endorotating the shoulder
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in shoulder exorotation strength from baseline
Change in maximal force exerted while exorotating the shoulder
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in key grip strength from baseline
Change in maximal force exerted while performing a key grip
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in pinch grip strength from baseline
Change in maximal force exerted while performing a pinch grip
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in hand grip strength from baseline
Change in maximal force exerted while performing a hand grip
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
Change in reachable workspace from baseline
Reachable workspace is an objective measure of upper extremity impairment. Reachable workspace is quantified by the relative surface area representing the portion of the unit hemisphere that is covered by the hand movements made during a standardized movement protocol which covers cardinal movements of the shoulder
Time frame: Baseline (0 weeks), post-intervention (17 weeks)
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