12 adults with spastic CP will complete 6 baseline sessions and 24 down conditioning sessions held 3 times/week. All clinical and physiological assessments collected at baseline will be reassessed after study completion, and follow ups after 2 weeks, 1 month and 3 months. The soleus H reflex (electric analogue of the stretch reflex) will be elicited in all sessions. In each session, participants will complete 20 baseline trials and 225 down conditioning trials to decrease the magnitude of the H-Reflex.
Individuals with CP face significant challenges due to spasticity that causes activity and participation restrictions with increase in secondary conditions. This is caused by injury to the upper motor neurons causing disruption to the neural circuitry responsible for maintaining motor tone. A novel intervention, OC of the H reflex has shown promising effects to reduce spasticity and improve motor function in people with stroke and spinal cord. Its many known benefits include easy administration, non-invasive technique, no side effects, and long-term retention. In the study, the investigators will attempt to decrease the increased muscle tone of individuals with CP. If successful, it will not only provide evidence for future clinical application but also broaden the scope for alternate or supplementary non-invasive treatment approaches to decrease spasticity.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
Each participant will serve as their own control. The intervention is 30 sessions. The first 6 sessions are baseline measures of reflexes. The remaining sessions will engage participants in learning how to decrease their reflex activity in their calf muscle on the more-affected leg. Each intervention visit will involve 20 trials in which participants do not get visual feedback about their performance, then 225 trials with visual feedback.
Burke Neurological Institute
White Plains, New York, United States
RECRUITINGSoleus H-Reflex size
Size of h-reflex as measured by EMG
Time frame: Within one week before first intervention session to within one week after the end of intervention
Attendance
Measure of feasibility of protocol, whether or not people can attend all sessions
Time frame: At the end of the intervention, we will count the number of sessions each participant completed
10 meter walk test
Measure of how long it takes the participant to walk 10 meters
Time frame: Within one week before the first intervention session to within one week after the end of intervention
6 minute walk test
Measure the distance a participant can walk in 6 min
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Fugl-Meyer
Standardized test of motor skill, range of motion, and spasticity
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Modified Ashworth Scale
Measure of muscle spasticity in leg muscles
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Range of motion
Measure of flexibility of leg joints
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Fatigue Severity Scale
A survey of fatigue symptoms
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Berg Balance Scale
Measure of participant's ability to balance
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Timed up and Go
Measure of how quickly a participant can stand from a chair, walk, return to chair, and sit
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Sit to Stand Test
Time it takes for a participant can stand up five times in a row
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Anxiety question bank
computer-based survey for participants to answer questions about anxiety
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Fatigue question bank
computer-based survey for participants to answer questions about fatigue
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Depression question bank
computer-based survey for participants to answer questions about depression
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) General Life Satisfaction question bank
computer-based survey for participants to answer questions about General Life Satisfaction
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) General Self Efficacy question bank
computer-based survey for participants to answer questions about General Self Efficacy
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Meaning and Purpose question bank
computer-based survey for participants to answer questions about Meaning and Purpose
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Self-Efficacy for Managing Chronic Conditions question bank
computer-based survey for participants to answer questions about Self-Efficacy for Managing Chronic Conditions
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Sleep Disturbances question bank
computer-based survey for participants to answer questions about sleep
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Pain Interference question bank
computer-based survey for participants to answer questions about pain
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Ability to Participate in Social Roles and Activities question bank
computer-based survey for participants to answer questions about Ability to Participate in Social Roles and Activities
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Physical Function
computer-based survey for participants to answer questions about physical functioning
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Satisfaction with Social Roles and Activities
computer-based survey for participants to answer questions about Satisfaction with Social Roles and Activities
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Mobility question bank
computer-based survey for participants to answer questions about mobility
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Social Isolation question bank
computer-based survey for participants to answer questions about isolation
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Patient Reported Outcome Measures (PROMIS) Upper Extremity question bank
computer-based survey for participants to answer questions about hand and arm function
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Change in size of motor evoked potential in the brain
Using single pulse transcranial magnetic stimulation, we will measure the amount of energy required to evoke a leg muscle movement from a stimulus delivered to the head
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Manual Ability Classification System
A categorical measure of how well a participant can move their hands
Time frame: Within one week before the first intervention session to within one week after the end of intervention
Jebsen-Taylor Test of Hand Function
A timed test that measures how quickly the participant can move checkers, cans, and small objects
Time frame: Within one week before the first intervention session to within one week after the end of intervention
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