Control of Degrees of Freedom Post-stroke for the Recovery of the Upper Limb (DoF_UL_S)

Effects of Control of Joint Degrees of Freedom in the Early Rehabilitation Post-stroke for the Recovery of Normal Movement (Non-compensatory) of the Upper Limb

The study's methodology will be a single-blind, multicenter, parallel-group randomized controlled trial (RCT). The sample consists of stroke patients (supratentorial ischemic and hemorrhagic stroke of anterior territory) between 18 and 80 years of age, separated into 3 groups of 20 participants. The experimental group called "controlled DoF", the control group 1 called "non controlled DoF" and the control group 2 called "Conventional". The "controlled DoF" group will use an exoskeleton that will restrict the movement of the trunk and upper limb to release only the joint to work in the plane of interest. The "non-controlled DoF" group will receive the same therapy time as the previous group but without any restriction of joint movements. The training will be functional with multiarticular and combined planes tasks. All groups receive the conventional rehabilitation of the health center (ideally 45 minutes 1 per day) and the "Conventional" group receives only this intervention. Using motion sensors, clinical scales, and electroencephalography (EEG), the data will be obtained pre-intervention, post-intervention, and in a follow-up at 3 and 6 months.

This proposal seeks to demonstrate if the control of joint degrees of freedom (DoF) of the trunk and upper limb is determinant during the early rehabilitation phase post-stroke (here from day 1 to day 28 or first month) for the recovery of upper limb movements without compensations and the normal brain control (true recovery). The study's methodology will be a single-blind, multicenter, parallel-group randomized controlled trial (RCT). The sample consists of stroke patients (supratentorial ischemic and hemorrhagic stroke of anterior territory) between 18 and 80 years of age, separated into 3 groups of 20 participants. The experimental group called "controlled DoF", the control group 1 called "non controlled DoF" and the control group 2 called "Conventional". The "controlled DoF" group will receive for the initial 2 weeks, 2 hours of therapy, 5 times a week (2 sessions of 1 hour per day, 5 days) and the next 2 weeks, 2 hours of therapy, 3 times a week(2 sessions of 1 hour of therapy, 3 days), using an exoskeleton that will restrict the movement of the trunk and upper limb to release only the joint to work in the plane of interest. The training will be selective in an articulation plane with the biofeedback of active movements (or active-assisted) employing a video game controlled by an external movement sensor installed in the segment of interest. The "non-controlled DoF" group will receive the same therapy time as the previous group but without any restriction of joint movements. The training will be functional with multiarticular and combined planes tasks. All groups receive the conventional rehabilitation of the health center (ideally 45 minutes 1 per day) and the "Conventional" group only receives this intervention. Using motion sensors, clinical scales, and electroencephalography (EEG), the data will be obtained pre-intervention, post-intervention, and in a follow-up at 3 and 6 months. The expected results would show more functional improvements with less compensatory kinematics for therapy that control DoF than for the therapy without control of the DoF or for conventional therapy in acute post-stroke patients. About this result, the EEG connectivity analysis would show a lower interhemispheric inhibition of the motor areas and a greater frontal-parietal flow during reaching and manipulation tasks in the group with DoF control.

The treatment that this gruop will receive consist in a training with the exoskeleton that will restrict the DoF of the arm and trunk

The treatment that this gruop will receive consist in a training with out the exoskeleton and without restriction of the DoF

The intervention is based in the training of a single DoF of the upper extremity with restriction of the rest DoF of the arm and trunk that aren't being trained being restrained by an exoskeleton

The intrevention is based in the training of the upper extremity movements without the restriction of DoF

Inclusion Criteria: (1) Clinical diagnosis of supratentorial ischemic stroke. (2) Time of onset <72 hours. (3) With alterations of the active voluntary movement of UL. (4) At least 3/8 DoF of the UE with MRC force scale of 3 or less. Exclusion Criteria: (1) Cognitive impairment that prevents signing informed consent, following instructions and understanding procedures. (MoCA ≥ 18). (2) Musculoskeletal pathologies that prevent activities without pain or with limited ranges for the scope. (3) Severe visual impairment that does not allow the activities associated with the task. (4) Cerebellar o brainstem stroke. (5) Previous stroke leaving upper limb impairment. (6) Bilateral sensorimotor alterations. (7) Do not present alterations in functional clinical tests.