Potential for Recovery of Voluntary Finger Extension After Stroke

NCT07592247 | Not Yet Recruiting

• 1 other identifier: 367119
• Study Type: interventional
• Target: 100
• Locations: 1 country
• Sites: 1

Brief Summary

Stroke patients with absent voluntary finger extension (VFE) 6-months after stroke are not expected to recover hand function. However, experience from the Queen Square Upper Limb neurorehabilitation service contradicts this view. In this study, we will identify the characteristics of those chronic stroke patients who regain previously absent VFE. Hundred chronic stroke patients will be recruited with absent/negligible VFE in an external pilot and feasibility study. Transcranial magnetic stimulation will be used to determine the functional integrity of descending white matter pathways. Corticospinal tract integrity to finger extensor muscles will be based on whether motor-evoked potentials are present (MEP+) or absent (MEP-). Reticulospinal tract activity will be assessed by measuring ipsilateral MEP amplitudes and the Start-React response. All patients will then receive 3-months of neuromuscular electrical stimulation plus home exercise, designed to strengthen wrist/finger extensors, reduce spasticity and increase corticospinal excitability. The primary outcome measure will be restoration of VFE. It is predicted that VFE will be restored in MEP+ but not MEP- patients. MEP- patients will have higher reticulospinal tract activity associated with spasticity. Restoration of VFE will allow patients to engage in evidence-based upper limb training to improve function e.g. constraint induced movement therapy or repetitive task training.

Conditions

Stroke

Keywords

Upper limb; Finger extension; Neurophysiological mechanisms; Neurorehabilitation; Motor recovery; functional electrical stimulation

Outcome Measures

Primary Outcomes (1)

• Voluntary Finger Extension (VFE)

  Can participants achieve at least 10° of thumb abduction/extension, and at least 10° of extension in a minimum of 2 additional digits (movements need to be repeatable 3 times in 1 minute). The extent of VFE will be measured using an electronic goniometer. Extent of finger extension is calculated for each finger as a composite of extension at metacarpophalangeal, proximal and distal interphalangeal joints.

  Day 1 and Day 90

Secondary Outcomes (10)

• Upper Extremity Fugl-Meyer Assessment

  Day 1 and Day 90

• Hand Dynamometry

  Day 1 and Day 90

• Fugl-Meyer Assessment - Sensory function

  Day 1 and Day 90

• Modified Tardieu Scale (MTS)

  Day 1 and Day 90

• KINARM- Passive Stretch Task

  Day 1 and Day 90

Study Arms (1)

Neuromuscular electrical stimulation (NMES) and home exercise programme

EXPERIMENTAL

Three month intervention programme of Neuromuscular electrical stimulation (NMES) and home exercise programme

Behavioral: Neuromuscular Electrical Stimulation and Home Exercise Programme

Interventions

Neuromuscular Electrical Stimulation and Home Exercise Programme BEHAVIORAL

-Neuromuscular and Electrical Stimulation (NMES): All participants will undergo a NMES treatment programme designed to strengthen wrist and finger extensors. Participants and their carers will receive training in NMES set up from the research physiotherapist. Surface electrodes are placed over the motor points of extensor carpi radialis and extensor digitorum communis to produce wrist and finger extension simultaneously. Home exercise: We aim for all patients to perform the Graded Repetitive Arm Supplementary Program (GRASP) level 1 (for severely affected upper limbs) for a minimum of 60 minutes/day, 5 days/week. Patients will be provided with an exercise book containing written and pictorial instructions for each exercise, and the kits contained inexpensive equipment to complete the exercises. Exercises included strengthening of the arm and hand, range of motion, and gross and fine motor skills.

Neuromuscular electrical stimulation (NMES) and home exercise programme

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed with a Stroke \>6 months previously
• Medical Research Council (MRC) grade 0 or 1 in long finger extensors.

You may not qualify if:

• Presence of spasticity in any wrist/finger flexors (including lumbricals) \>2 on Modified Ashworth Scale
• Unable to get hand flat on table top
• Botulinum toxin to long finger or wrist flexors \< 24 weeks prior to pre-treatment assessment (i.e. effects should have worn off).

Sponsors & Collaborators

• University College, London: lead
• University College London Hospitals: collaborator
• National Hospital for Neurology and Neurosurgery, London: collaborator

Study Sites (1)

University College London- Department of Clinical and Movement Neurosciences

London, WC1N 3BJ, United Kingdom

Location

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Study Officials

• Nick Ward, MD

  University College, London

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Professor Nick Ward, MD

CONTACT

+44 20 3448 3486; n.ward@ucl.ac.uk

Lisa Tedesco Triccas, PhD

CONTACT

l.triccas@ucl.ac.uk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: DIAGNOSTIC
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 24, 2026
• First Posted: May 18, 2026
• Study Start (Estimated): September 1, 2026
• Primary Completion (Estimated): June 1, 2029
• Study Completion (Estimated): September 1, 2029
• Last Updated: May 18, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)