Clinical Application of Cross-education During Stroke Rehabilitation (X-Ed-Stroke01)
Stroke
About this trial
This is an interventional other trial for Stroke
Eligibility Criteria
Inclusion Criteria:
- 18 years or older
- within 18 months of stroke recovery
- medically stable
- ambulatory
- have moderate to severe upper limb hemiparesis as diagnosed by clinicians
- Consent
Exclusion Criteria:
- significant cognitive impairment or aphasia affecting understanding, as assessed by clinician
- severe upper limb spasticity preventing any movement of the proximal arm and shoulder
- diagnosis of hemorrhagic or bilateral stroke
- history of other severe upper limb musculoskeletal injury
- other neurological diseases
- intracranial metal clips or cardiac pacemaker, or anything that would preclude an MRI
- Any condition that would preclude the participant's ability to attend follow-up visits in the opinion of the Investigator
Sites / Locations
- Royal University Hospital
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
cross-education + standard rehabilitation
standard rehabilitation
The cross-education group will engage in strength training of the non-paretic hand in addition to standard rehabilitation. Cross-education will be progressive in nature, beginning with 2 sets of 8 repetitions and increasing up to a maximum of 6 sets of 8 repetitions of maximal voluntary effort isometric handgrip contractions as tolerated. Grip training will be performed using standard grip trainers (Digi-Flex Grip trainers) to train both finger flexors and full hand and wrist isometric contractions. In addition, patients will perform controlled dynamic wrist flexion and extension training of the non-paretic hand using exercise tubing with the same prescription. Patients will be asked to complete exercises 3 times per week for 26 weeks, and to record adherence in a training log. An average of one session per week will be considered 'trained'.
Standardized rehabilitation involves several strategies tailored to the patient and remains somewhat based on clinician preference. These therapies may involve functional electrical stimulation, neuro-facilitation, strengthening, range of motion (ROM), mirror therapy, and force-use therapy (e.g., CIMT). Patients engage in therapy 5 days per week as inpatients, and 2 days per week as outpatients with additional home exercises. Specific therapies for each patient will be tracked using a therapy log.