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StrokeCPASSNCT02235974

Critical Periods After Stroke Study (CPASS)

A study testing Early Intensive upper extremity motor training, Sub-acute intensive upper extremity motor training and Chronic intensive upper extremity motor training in people with Stroke and Brain Infarction, run by MedStar National Rehabilitation Network at 1 site in United States.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

To perform an exploratory single center randomized study that will form the basis for a larger scale, more definitive randomized clinical trial to determine the optimal time after stroke for intensive motor training. Read more about this study

Who is it for?
Ages 21 years and olderHealthy volunteers can take part
Conditions the study is for
Stroke, Brain Infarction, Brain Ischemia
What is being tested?
Early Intensive upper extremity motor training, Sub-acute intensive upper extremity motor training and Chronic intensive upper extremity motor training
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
150 participants
Where
1 siteUnited States
Study dates
26 Aug 2014to 31 Jan 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Ischemic or hemorrhagic stroke (with confirmatory neuroimaging) within 28 days of admission to inpatient rehabilitation (allows those randomized to the early arm to begin study-related treatment within 30 days)
  • Age >21 years
  • Able to participate in first study-related treatment session within 30 days of stroke onset
  • Able to participate in all study-related activities, including one year follow up and blood draws
  • Persistent hemiparesis leading to impaired upper extremity function. Hemiparesis as indicated by NIHSS Motor Arm score ≥ 1
  • Recovering moderate motor impairment at the shoulder and elbow or hand such as:
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  • Proximal UE voluntary activity indicated by a score of ≥ 3 on the upper arm item of the Motor Assessment Scale - wrist and finger movement is not required
  • or
  • Manual Muscle Test (MMT) score of ≥ 2 on shoulder flexion or abduction and MMT score of ≥ 2 for any of the following: elbow flexion, elbow extension, wrist flexion, wrist extension, finger flexion or finger extension.
  • or
  • Active range of motion (AROM) to at least 50% of range in gravity eliminated position for shoulder flexion or abduction, and for any of the following motions: elbow flexion, elbow extension, wrist flexion, wrist extension, finger flexion or finger extension.
  • Score of ≤ 8 on the Short Blessed Memory Orientation and Concentration Scale
  • Follows 2 step commands
  • No upper extremity injury or conditions that limited use prior to the stroke
  • Pre-stroke independence: Modified Rankin Score 0 or 1

Who cannot join

  • Inability to give informed consent
  • Prior stroke with persistent motor impairment or other disabling neurologic condition such as multiple sclerosis, parkinsonism, amyotrophic lateral sclerosis (ALS), dementia requiring medication
  • Rapidly improving motor function
  • Clinically significant fluctuations in mental status in the 72 hours prior to randomization
  • Hemispatial neglect as determined by >3 errors on the Mesulam Symbol Cancellation Test
  • Not independent prior to stroke (determined by scores of <95 on Barthel Index or >1 on Modified Rankin Scale
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  • Dense sensory loss indicated by a score of 2 on NIHSS sensory item
  • Ataxia out of proportion to weakness in the affected arm as described by a score of ≥ 1 on the NIHSS limb ataxia item
  • Active or prior psychosis within 2 years
  • Active or prior (within 2 years) substance abuse
  • Not expected to survive 1 year due to other illnesses (cardiac disease, malignancy, etc)
  • Received upper extremity botulinum toxin within 6 months (other medications do not exclude)

Trial locations and contacts

1 site in 1 country.

United States1 site
  • MedStar National Rehabilitation Hospital

    Washington D.C., District of Columbia, 20010

Other trials in United States

About this study

Official title: Critical Periods After Stroke Study (CPASS); Sensitive Periods and Consumer Preferences: Optimizing Upper Extremity Stroke Rehabilitation

To perform an exploratory single center randomized study that will form the basis for a larger scale, more definitive randomized clinical trial to determine the optimal time after stroke for intensive motor training. The investigators will perform a prospective exploratory study of upper extremity (UE) motor training delivered at higher than usual intensity at three different time points after stroke:

  • early (initiated within 30 days)
  • subacute/outpatient (initiated within 2-3 months)
  • chronic (initiated within 6-9 months)
Read more

The control group will not receive the therapy intervention during the 1-year study.

Outcome measures will be assessed at baseline, pre-treatment, post-treatment, 6 months and one year after stroke onset.

Compared to individuals randomized during the outpatient (2-3 months after stroke onset) or chronic (6-9 months after stroke onset) time points, participants randomized to early intensive motor training will show greater upper extremity motor improvement measured at one year post stroke.

Read the detailed description

Please see the following reference:

Dromerick, A.W., Edwardson, M., Edwards, D.F., Giannetti, M.L., Barth, J., Brady, K.P., Chan, E., Tan, M.T., Tamboli, I., Chia, R., Orquiza, M., Padilla, R.M., Cheema, A.K., Mapstone, M., Fiandaca, M.S., Federoff, H.J., \& Newport, E.L. (2015). Critical Periods after Stroke Study: Translating animal stroke recovery experiments into a clinical trial. Frontiers in Human Neuroscience, 9, 002231. PMCID: PMC4413691.

Being tested
Early Intensive upper extremity motor training, Sub-acute intensive upper extremity motor training, Chronic intensive upper extremity motor training, Control
Keywords
stroke, critical periods, sensitive periods, hemiparesis, upper extremity, physical rehabilitation, arm therapy, occupational therapy, physical therapy, task oriented training, patient focused, arm function, hand function, neurorehabilitation, motor learning, motor control, motor function, motor recovery, skill acquisition, skill training
Medical subject headings
Stroke, Brain Infarction, Brain Ischemia, Cerebral Infarction, Cerebrovascular Disorders, Paresis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Early Intensive upper extremity motor trainingBehavioural

    Using a shaping therapy protocol, participants will receive a dose of 20 hours of intensive upper extremity therapy (in addition to their current therapy) beginning within 30 days of stroke onset.

  • Sub-acute intensive upper extremity motor trainingBehavioural

    Using a shaping therapy protocol, participants will receive a dose of 20 hours of intensive upper extremity therapy (in addition to their current therapy) beginning within 2 to 3 months post stroke.

  • Chronic intensive upper extremity motor trainingBehavioural

    Using a shaping therapy protocol, participants will receive a dose of 20 hours of intensive upper extremity therapy (in addition to their current therapy) beginning within 6 to 9 months post stroke.

  • ControlBehavioural

    Usual and Customary Care only. No additional therapy will be given during the 1-year study.

Study groups in NCT02235974
Study groupRoleWhat they receive
Acute/EarlyExperimentalIntervention: A 20-hour dose of early intensive upper extremity motor training therapy will be initiated within 30 days post-stroke.
Receives: Behavioral: Early Intensive upper extremity motor training
Sub-acute/OutpatientExperimentalIntervention: A 20-hour dose of sub-acute intensive upper extremity motor training therapy will be initiated within 2 to 3 months post-stroke.
Receives: Behavioral: Sub-acute intensive upper extremity motor training
ChronicExperimentalIntervention: A 20-hour dose of chronic intensive upper extremity motor training therapy will be initiated 6 to 9 months post-stroke
Receives: Behavioral: Chronic intensive upper extremity motor training
ControlPlacebo comparatorIntervention: Usual and customary care. No additional therapy will be initiated during the 1-year study.
Receives: Behavioral: Control

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Action Research Arm Test (ARAT)

    The ARAT assesses functional limitations and evaluates changes in limb function for the upper extremity.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

Secondary outcomes (17)
  1. Motor Activity Log - 28 Quality of Movement (MAL-28 QOM)

    A structured interview to measure upper extremity use and function as well as assess the quality of movement of the hemiparetic arm.

    Measured: Pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  2. Nine Hole Peg Test (9-HPT)

    A standardized quantitative test of upper extremity function and fine manual dexterity.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  3. Functional Independence Measure (FIM)

    A basic indicator of severity of disability. Tracks changes in the functional ability of the patient during an episode of hospital rehabilitation care.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  4. Barthel Index (BI)

    Measures performance in activities of daily living and functional disability.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  5. Motricity Index - Arm only (MI)

    To assess motor impairment and strength in the upper extremity.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  6. Perception of change (POC)

    A stroke-specific self-report to assess how stroke has impacted a person's life and their overall perception of recovery.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended) and 1 year post stroke

  7. Stroke Impact Scale - Hand-Arm subscale (SIS)

    A self-report health status measure to assess perceived recovery with regard to the more affected hand and arm following a stroke.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended) and 1 year post stroke

  8. Modified Rankin Scale (MRS)

    A measure of the degree of disability or dependence in daily activities following a stroke.

    Measured: Baseline (pre-stroke assessment), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended) and 1 year post stroke

  9. Activity Card Sort (ACS)

    An interview-based assessment used to measure an individual's participation in instrumental, leisure and social activities.

    Measured: Pre-treatment (ideally within 72 hours of baseline), post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  10. Reintegration to Normal Living Index (RNLI)

    To assess quantitatively the degree that individuals who have experienced a traumatic injury or illness come to manage and reintegrate normal social activities with regard to recreation, movement at home and within the community, family and relationships.

    Measured: Post-treatment (within 72 hours after treatment has ended), 6 months and 1 year post stroke

  11. Geriatric Depression Scale (GDS-15)

    A self-report assessment used to identify depressive symptoms in the elderly.

    Measured: Baseline (within 30 days post stroke), pre-treatment, and 1 year post stroke

  12. NIH Stroke Scale (NIHSS)

    A systematic assessment used to evaluate and measure stroke-related. neurological impairments and stroke severity.

    Measured: Baseline (within 30 days post stroke), pre-treatment, 6 months and 1 year post stroke

  13. Short Blessed Orientation and Memory Concentration Test (SBT)

    An assessment of cognitive ability and impairment.

    Measured: Baseline (within 30 days post stroke)

  14. Mesulam Symbol Cancellation Test (SCT)

    An assessment used to evaluate visuospatial function and attention.

    Measured: Baseline (within 30 days post stroke)

  15. Faces Pain Scale

    A self-report measure of pain intensity.

    Measured: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke

  16. Fugl Meyer Assessment (Upper Extremity)

    A performanced-based impairment index to assess motor function, sensation and joint function.

    Measured: Baseline (within 30 days post stroke) and 1 year post stroke

  17. Manual Muscle Test (Upper Extremity)

    Muscle strength assessment

    Measured: Baseline (within 30 days post stroke)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Sep 2014 (estimated)
  2. Study start26 Aug 2014
  3. Primary completion31 Dec 2020 (estimated)
  4. Study completion31 Jan 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
150 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02235974
Sponsor's protocol ID
MNRH-2014-065
Acronym
CPASS
Status last verified
Apr 2020
First submitted
14 Jul 2014
Last updated
7 Apr 2020
Results posted
No
Data monitoring committee
No
Individual data sharing
No: There is no plan at this time to make individual participant data available.

Publications

  • Dromerick AW, Edwardson MA, Edwards DF, Giannetti ML, Barth J, Brady KP, Chan E, Tan MT, Tamboli I, Chia R, Orquiza M, Padilla RM, Cheema AK, Mapstone ME, Fiandaca MS, Federoff HJ, Newport EL. Critical periods after stroke study: translating animal stroke recovery experiments into a clinical trial. Front Hum Neurosci. 2015 Apr 29;9:231. doi: 10.3389/fnhum.2015.00231. eCollection 2015.

    PubMed 25972803
  • Geed S, Feit P, Edwards DF, Dromerick AW. Why Are Stroke Rehabilitation Trial Recruitment Rates in Single Digits? Front Neurol. 2021 Jun 8;12:674237. doi: 10.3389/fneur.2021.674237. eCollection 2021.

    PubMed 34168611

Questions about this trial

What is this clinical trial studying?

A study testing Early Intensive upper extremity motor training, Sub-acute intensive upper extremity motor training and Chronic intensive upper extremity motor training in people with Stroke and Brain Infarction, run by MedStar National Rehabilitation Network at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 15 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 7 Apr 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Action Research Arm Test (ARAT) (time frame: Baseline (within 30 days post stroke), pre-treatment, post-treatment (ideally within 72 hours after treatment has ended), 6 months and 1 year post stroke). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02235974, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Apr 2020.

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Critical Periods After Stroke Study (CPASS) | AzTrials