Non-use After Stroke: Influence of Applied Force and Precision When Reaching With the Paretic Upper Limb

NCT04747587 | Completed

• 2 other identifiers: NIMAO/2020-1/JF-01NCT04747587
• Study Type: interventional
• Target: 53
• Locations: 1 country
• Sites: 2

Brief Summary

After a stroke, 80% of patients have an upper limb deficit, limiting activity. Some develop a non-use: they can, but do not, use their paretic limb. Non-use is a general phenomenon applied to all situations where the patient applies unnecessary compensation. Several rehabilitation techniques are effective to counter non-use, but there is insufficient knowledge to choose the most suitable technique. Optimal control theory could help guide these choices. It assumes that the chosen coordination satisfies the constraints of the task (force, amplitude, tolerance) while reducing the cost of the movement. This study will assess non-use by anticipating the sensitivity to the constraints of force and precision deduced from the logic of optimal control. The study authors expect to observe a weakness effect: in a reaching task (i.e. when the person has to touch an object placed in front of them), lightening the paretic arm makes it possible to reduce non-use, and a precision effect: in a reaching task, non-use increases with the required spatial precision.

Conditions

Stroke

Keywords

Non-use; Compensation; Weakness; Optimal control

Outcome Measures

Primary Outcomes (1)

• Evaluate the modifications of the proximal non-use after stroke on the paretic side according to the extent of force constraint

  Proximal Arm Non Use (PANU) score (%): A significant PANU (\> 7.5%) indicates non-use

  Inclusion

Secondary Outcomes (7)

• Evaluate the modifications of the proximal non-use after stroke on the paretic side according to the precision required

  Inclusion

• Evaluate the modifications of the proximal non-use in the control subjects according to the constraints of force or precision

  Inclusion

• Evaluate the level of neuromuscular activation during reaching

  Inclusion

• Model the constraints and costs explaining non-use patient by patient, to distinguish between physiological and psycho-behavioral non-use

  Inclusion

• Time since stroke (acute, subacute or chronic phase)

  Inclusion

Study Arms (2)

Patients with stroke

EXPERIMENTAL

Other: Reaching Session

Controls

EXPERIMENTAL

Other: Reaching Session

Interventions

Reaching Session OTHER

Two x 45 minutes sessions of reaching tasks. Patients in the stroke group will perform the task with the paretic arm using a weight reduction system, allowing movement in the horizontal plane. Subjects in the control group will perform the task with the randomly selected arm weighted at 80% of their maximum voluntary shoulder torque

Controls; Patients with stroke

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patient having had a 1st stroke
• Patient whose stroke occurred more than a month ago.
• Patient having had a supratentorial stroke
• Patient able to touch the opposite knee with the paretic arm
• Subject who has never had a stroke
• Subject without motor or orthopedic impairment of the upper limbs and in particular of the shoulder
• Subject who has given free and informed consent.
• Subject who signed the consent form.
• Subject affiliated or beneficiary of a health insurance plan.

You may not qualify if:

• Pregnant, parturient or breastfeeding subject.
• The subject refuses to sign the consent
• It is impossible to give the subject informed information
• The patient is under safeguard of justice or state guardianship
• Patient with cognitive disorders incompatible with a good understanding of the use of the device
• Patient with other neurological or osteoarticular history that may limit the performance of the task - criterion left to the deiscretion of the investigator

Sponsors & Collaborators

• Centre Hospitalier Universitaire de Nīmes: lead

Study Sites (2)

CHU de Montpellier

Montpellier, France

Location

CHU de Nîmes

Nîmes, France

Location

MeSH Terms

Conditions

Stroke; Asthenia

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Jérôme Froger

  Centre Hospitalier Universitaire de Nīmes

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 5, 2021
• First Posted: February 10, 2021
• Study Start: May 11, 2021
• Primary Completion: April 25, 2023
• Study Completion: April 25, 2023
• Last Updated: December 18, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will share
• Shared Documents: ANALYTIC CODE

Locations

FR (2)