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Clinical Study of the L300 Versus Ankle-foot Orthosis (AFO) on Post-Stroke Subjects With Foot Drop (L300)

Primary Purpose

Sensorimotor Gait Disorder, Neurologic Ambulation Disorder, Gait, Drop Foot

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Ness L300
Ankle-foot orthosis
Sponsored by
Bioness Inc
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Sensorimotor Gait Disorder focused on measuring Poststroke/CVA hemiparesis, Drop Foot, Gait Disorders, Neurological, Gait, Drop foot

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Have ankle dorsiflexion range of motion greater than or equal to neutral when assessed concurrent with test stimulation in sitting and standing and demonstrate adequate ankle and knee stability during gait at the time of screening
  • Have had at least one stroke of any etiology (e.g., ischemic, hemorrhagic,etc.) experienced greater than or equal to 3 months prior to study enrollment, as confirmed by independent medical records, and result in drop foot sufficient to require prior or current prescription for and/or use of an AFO
  • Have adequate cognition and communication abilities for informed consent, training and instructions, use of the L300, and provide feedback, to be demonstrated by either the subjects scoring greater than or equal to 24 (out of a possible 30) on the Mini Mental State Examination, or having a competent caregiver for these purposes
  • Must be 18 years or older
  • Have the ability to safely walk at least 10-meters with a maximum of 1 person assist
  • Have a self-selected 10-meter gait speed of less than or equal to 0.8m/s at the time of assessment
  • Have inadequate dorsiflexion/limb clearance or unable to achieve normal heel strike on ambulation without AFO
  • Be medically stable

Exclusion Criteria:

  • Have fixed ankle contracture at greater than or equal to 5 degrees of plantar flexion in the hemiplegic leg with the knee extended
  • Have excessive pain in the affected leg, as measured by a score greater than or equal to 4 on a 10-point visual analog scale
  • Participation, within the past 3 months, currently, or during the course of the study in any interventional clinical studies without the Sponsor's approval
  • Have a demand-type cardiac pacemaker, defibrillator, or any electrical or metallic implant
  • Have a lower motor neuron disease or injury with inadequate response to stimulation
  • Have significant swelling/edema in the leg extending up to the knee
  • Have a history of chronic skin problems/conditions or cancerous lesion present or suspected in close proximity ot the expected site for L300 stimulation
  • Are pregnant or plan on becoming pregnant in the next 45 weeks
  • Have had botulinum toxin(type a or b) to the hemiplegic leg or arm within the past six weeks or plan to have botulinum toxin treatments during the course of the study
  • Expectation of a significant change in the subject's spasticity medications during the course of the study for the effected leg
  • Have unstable seizure disorder (average of greater or equal to 2 seizures per month)
  • Have a pre-existing significant orthopedic conditions that are, a that investigator's discretion, determined as likely to limit ambulatory progress (e.g., total hip replacement [non-metallic], total knee replacement [non-metallic], limited lower extremity (LE) range of motion (ROM), rheumatoid arthritis, osteoarthritis, or other fracture or dislocation that underlies the expected site for L300 stimulation)
  • Have a complete hemisensory loss ipsilateral to foot drop
  • Used the L300 or other FES device for foot drop (e.g., Odstock Drop Foot System (ODFS), WalkAide by Innovation Neurotronics, etc.) for greater than or equal to 3 hours within the last 6 months prior to study enrollment
  • Have major post-stroke depression (PHQ-9 greater than or equal to 10) that is not medically managed with antidepression medication and/or psychotherapy
  • Currently or planning on participating in a neuro-rehabilitation physical therapy (PT) or occupational therapy (OT) program or new independent exercise programs with enrolled in the study. However, injury or a change in condition requiring PT or OT that would not affect gait outcomes maybe assessed by an off-site study committee, on a case-by-case basis

Sites / Locations

  • Rancho Los Amigos National Rehabilitation Center
  • Long Beach Memorial Medical Center
  • Sharp Rehabilitation Center
  • National Rehabilitation Hospital
  • Brooks Center for Rehabilitation Studies
  • Kansas University Medical Center
  • Weill Cornell Medical Center
  • St.Charles Hospital & Rehabilitation
  • The Drake Center /University of Cincinnati
  • UT Southwestern
  • University of Utah, School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Ankle-foot orthosis (AFO) Control Group

Ness L300 Treatment Group

Arm Description

The Control Group will walk with the a "usual" ankle-foot orthosis (AFO) for 30 weeks.

The Original Treatment Group will walk with the Ness L300 for 30 weeks.

Outcomes

Primary Outcome Measures

Ten Meter Walk Test (10mWT)
Determine gait velocity during a 10 meter walk test for subjects using the L300 versus subjects using a standard "usual" ankle-foot orthosis (AFO). Long term device effect at comfortable gait speed in m/s. Walk test results at 30 weeks will be compared to baseline speed. The mean difference (improvement) between baseline and week 30 will be presented by study arm.

Secondary Outcome Measures

Berg Balance Scale (BBS) Score
Clinical measurement of balance was recorded using the Berg Balance Scale which is a highly reliable and valid test used among persons with stroke. This Scale consists of 14 items/tasks of increasing difficulty graded on a five-point ordinal scale of zero to four where zero = participant is unable to perform the task and four = participant is independent in performance of task, such that overall total score may range from zero to 56 per participant. Mean Baseline and Mean Week 30 scores were calculated and used to determine change in mean score for each study group.
User Satisfaction
Total user satisfaction as measured on 12 item User Satisfaction survey with maximum score 24, minimum 0, where higher score indicated greater satisfaction with device,

Full Information

First Posted
June 4, 2010
Last Updated
March 28, 2016
Sponsor
Bioness Inc
Collaborators
Medidata Solutions, University of Cincinnati
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1. Study Identification

Unique Protocol Identification Number
NCT01138995
Brief Title
Clinical Study of the L300 Versus Ankle-foot Orthosis (AFO) on Post-Stroke Subjects With Foot Drop
Acronym
L300
Official Title
Functional Ambulation: Standard Treatment vs. Electronic Stimulation Therapy (FASTEST)Trial in Chronic Post-Stroke Subjects With Foot Drop
Study Type
Interventional

2. Study Status

Record Verification Date
March 2016
Overall Recruitment Status
Completed
Study Start Date
May 2010 (undefined)
Primary Completion Date
December 2012 (Actual)
Study Completion Date
February 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Bioness Inc
Collaborators
Medidata Solutions, University of Cincinnati

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The objective of this study is to determine the effectiveness of the NESS L300 (L300) in improving gait parameters, function, and quality of life among stroke subjects (greater than or equal to 3 months post stroke)with drop foot.
Detailed Description
Approximately 176 subjects with stroke that have drop foot will be enrolled from approximately 10 different sites in the United States depending on the rate of enrollment. This clinical study is proposed to show that the functional electrical stimulation (FES) delivered via the Ness L300 improves gait function, stroke-specific quality of life, and safety for persons with stroke.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Sensorimotor Gait Disorder, Neurologic Ambulation Disorder, Gait, Drop Foot, Poststroke Hemiparesis, Post-Cerebrovascular Accident (CVA) Hemiparesis
Keywords
Poststroke/CVA hemiparesis, Drop Foot, Gait Disorders, Neurological, Gait, Drop foot

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
Outcomes Assessor
Allocation
Randomized
Enrollment
197 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Ankle-foot orthosis (AFO) Control Group
Arm Type
Active Comparator
Arm Description
The Control Group will walk with the a "usual" ankle-foot orthosis (AFO) for 30 weeks.
Arm Title
Ness L300 Treatment Group
Arm Type
Experimental
Arm Description
The Original Treatment Group will walk with the Ness L300 for 30 weeks.
Intervention Type
Device
Intervention Name(s)
Ness L300
Other Intervention Name(s)
Leg Stimulator
Intervention Description
The Ness L300 delivers functional electrical stimulation (FES), which improves gait function, stroke-specific quality of life, functionality, and safety for persons with stroke.
Intervention Type
Device
Intervention Name(s)
Ankle-foot orthosis
Other Intervention Name(s)
drop foot orthotic
Intervention Description
The Control Group will walk with a "usual" ankle-foot orthosis (AFO).
Primary Outcome Measure Information:
Title
Ten Meter Walk Test (10mWT)
Description
Determine gait velocity during a 10 meter walk test for subjects using the L300 versus subjects using a standard "usual" ankle-foot orthosis (AFO). Long term device effect at comfortable gait speed in m/s. Walk test results at 30 weeks will be compared to baseline speed. The mean difference (improvement) between baseline and week 30 will be presented by study arm.
Time Frame
Week 30
Secondary Outcome Measure Information:
Title
Berg Balance Scale (BBS) Score
Description
Clinical measurement of balance was recorded using the Berg Balance Scale which is a highly reliable and valid test used among persons with stroke. This Scale consists of 14 items/tasks of increasing difficulty graded on a five-point ordinal scale of zero to four where zero = participant is unable to perform the task and four = participant is independent in performance of task, such that overall total score may range from zero to 56 per participant. Mean Baseline and Mean Week 30 scores were calculated and used to determine change in mean score for each study group.
Time Frame
Week 30
Title
User Satisfaction
Description
Total user satisfaction as measured on 12 item User Satisfaction survey with maximum score 24, minimum 0, where higher score indicated greater satisfaction with device,
Time Frame
Week 30

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Have ankle dorsiflexion range of motion greater than or equal to neutral when assessed concurrent with test stimulation in sitting and standing and demonstrate adequate ankle and knee stability during gait at the time of screening Have had at least one stroke of any etiology (e.g., ischemic, hemorrhagic,etc.) experienced greater than or equal to 3 months prior to study enrollment, as confirmed by independent medical records, and result in drop foot sufficient to require prior or current prescription for and/or use of an AFO Have adequate cognition and communication abilities for informed consent, training and instructions, use of the L300, and provide feedback, to be demonstrated by either the subjects scoring greater than or equal to 24 (out of a possible 30) on the Mini Mental State Examination, or having a competent caregiver for these purposes Must be 18 years or older Have the ability to safely walk at least 10-meters with a maximum of 1 person assist Have a self-selected 10-meter gait speed of less than or equal to 0.8m/s at the time of assessment Have inadequate dorsiflexion/limb clearance or unable to achieve normal heel strike on ambulation without AFO Be medically stable Exclusion Criteria: Have fixed ankle contracture at greater than or equal to 5 degrees of plantar flexion in the hemiplegic leg with the knee extended Have excessive pain in the affected leg, as measured by a score greater than or equal to 4 on a 10-point visual analog scale Participation, within the past 3 months, currently, or during the course of the study in any interventional clinical studies without the Sponsor's approval Have a demand-type cardiac pacemaker, defibrillator, or any electrical or metallic implant Have a lower motor neuron disease or injury with inadequate response to stimulation Have significant swelling/edema in the leg extending up to the knee Have a history of chronic skin problems/conditions or cancerous lesion present or suspected in close proximity ot the expected site for L300 stimulation Are pregnant or plan on becoming pregnant in the next 45 weeks Have had botulinum toxin(type a or b) to the hemiplegic leg or arm within the past six weeks or plan to have botulinum toxin treatments during the course of the study Expectation of a significant change in the subject's spasticity medications during the course of the study for the effected leg Have unstable seizure disorder (average of greater or equal to 2 seizures per month) Have a pre-existing significant orthopedic conditions that are, a that investigator's discretion, determined as likely to limit ambulatory progress (e.g., total hip replacement [non-metallic], total knee replacement [non-metallic], limited lower extremity (LE) range of motion (ROM), rheumatoid arthritis, osteoarthritis, or other fracture or dislocation that underlies the expected site for L300 stimulation) Have a complete hemisensory loss ipsilateral to foot drop Used the L300 or other FES device for foot drop (e.g., Odstock Drop Foot System (ODFS), WalkAide by Innovation Neurotronics, etc.) for greater than or equal to 3 hours within the last 6 months prior to study enrollment Have major post-stroke depression (PHQ-9 greater than or equal to 10) that is not medically managed with antidepression medication and/or psychotherapy Currently or planning on participating in a neuro-rehabilitation physical therapy (PT) or occupational therapy (OT) program or new independent exercise programs with enrolled in the study. However, injury or a change in condition requiring PT or OT that would not affect gait outcomes maybe assessed by an off-site study committee, on a case-by-case basis
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Kari Dunning, PT, Ph.D
Organizational Affiliation
The Drake Center/University of Cincinnati
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Michael O'Dell, MD
Organizational Affiliation
Weill Medical College of Cornell University
Official's Role
Study Chair
First Name & Middle Initial & Last Name & Degree
Patricia Kluding, PT, Ph.D.
Organizational Affiliation
University of Kansas
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Steven R. Edgley, MD
Organizational Affiliation
University of Utah
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Kathaleen P Brady, PT, NCS
Organizational Affiliation
MedStar National Rehabilitation Network
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Trevor Paris, MD
Organizational Affiliation
Brooks Rehabilitation
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jerome Stenehjem, MD
Organizational Affiliation
Sharp Rehabilitation Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
John Thottakara, MD
Organizational Affiliation
UT Southwestern
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Jun Zhang, MD
Organizational Affiliation
St. Charles Hospital & Rehabilitation
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ziyad Ayyoub, MD
Organizational Affiliation
Rancho Los Amigos National Rehabilitation
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Diemha Hoang, MD
Organizational Affiliation
Long Beach Memorial Medical Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rancho Los Amigos National Rehabilitation Center
City
Downey
State/Province
California
ZIP/Postal Code
90242-3496
Country
United States
Facility Name
Long Beach Memorial Medical Center
City
Long Beach
State/Province
California
ZIP/Postal Code
90806
Country
United States
Facility Name
Sharp Rehabilitation Center
City
San Diego
State/Province
California
ZIP/Postal Code
92123
Country
United States
Facility Name
National Rehabilitation Hospital
City
Washington
State/Province
District of Columbia
ZIP/Postal Code
20010
Country
United States
Facility Name
Brooks Center for Rehabilitation Studies
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32216
Country
United States
Facility Name
Kansas University Medical Center
City
Kansas City
State/Province
Kansas
ZIP/Postal Code
66160
Country
United States
Facility Name
Weill Cornell Medical Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Facility Name
St.Charles Hospital & Rehabilitation
City
Port Jefferson
State/Province
New York
ZIP/Postal Code
11777
Country
United States
Facility Name
The Drake Center /University of Cincinnati
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45216
Country
United States
Facility Name
UT Southwestern
City
Dallas
State/Province
Texas
ZIP/Postal Code
75390-9055
Country
United States
Facility Name
University of Utah, School of Medicine
City
Salt Lake City
State/Province
Utah
ZIP/Postal Code
84132
Country
United States

12. IPD Sharing Statement

Citations:
PubMed Identifier
29288141
Citation
Alenazi AM, Alshehri MM, Alothman S, Rucker J, Dunning K, D'Silva LJ, Kluding PM. Functional Reach, Depression Scores, and Number of Medications Are Associated With Number of Falls in People With Chronic Stroke. PM R. 2018 Aug;10(8):806-816. doi: 10.1016/j.pmrj.2017.12.005. Epub 2017 Dec 26.
Results Reference
derived
PubMed Identifier
24412265
Citation
O'Dell MW, Dunning K, Kluding P, Wu SS, Feld J, Ginosian J, McBride K. Response and prediction of improvement in gait speed from functional electrical stimulation in persons with poststroke drop foot. PM R. 2014 Jul;6(7):587-601; quiz 601. doi: 10.1016/j.pmrj.2014.01.001. Epub 2014 Jan 9. Erratum In: PM R. 2014 Oct;6(10):967.
Results Reference
derived
PubMed Identifier
23640829
Citation
Kluding PM, Dunning K, O'Dell MW, Wu SS, Ginosian J, Feld J, McBride K. Foot drop stimulation versus ankle foot orthosis after stroke: 30-week outcomes. Stroke. 2013 Jun;44(6):1660-9. doi: 10.1161/STROKEAHA.111.000334. Epub 2013 May 2.
Results Reference
derived

Learn more about this trial

Clinical Study of the L300 Versus Ankle-foot Orthosis (AFO) on Post-Stroke Subjects With Foot Drop

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