Brachial Plexus Injury

Researchers are investigating the use of vagus nerve stimulation (VNS) combined with rehabilitation to improve arm movement after an ischemic stroke. This clinical trial compares active VNS paired with rehabilitation against a sham VNS with no electrical stimulation, also combined with rehabilitation, to assess their effects on upper extremity motor function in stroke patients. The study is conducted with a triple-blind, randomized, sham-controlled design and aims to evaluate both safety and efficacy.

Researchers are studying patients with subacute stroke to evaluate the additional effects of kinesio taping combined with conventional physical therapy on upper limb function, range of motion, and spasticity. This randomized control trial aims to determine whether adding kinesio taping provides significant improvements compared to physical therapy alone. The study is conducted in rehabilitation settings and includes adults aged 40 to 65 years with a history of diagnosed stroke and moderate spasticity. Participants are divided into two groups. The experimental group receives kinesio taping three times per week along with physical therapy exercises including passive and active range of motion (ROM), PNF stretching, D1 flexion and extension movements, and resistance training with a medium resistance band from weeks 3 to 6. The control group receives the same physical therapy regimen but without kinesio taping. Treatments last 30 minutes on alternate days over six weeks. During the study, participants' upper limb spasticity and function are assessed at baseline, week 3, and week 6 using the Modified Ashworth Scale and the Wolf Motor Function Test. Range of motion is measured with a goniometer for shoulder, elbow, and wrist joints. Data collection includes demographic information and questionnaires. The study monitors outcomes throughout the six-week treatment period to analyze differences between groups.

Researchers are comparing different nerve block techniques and patient-controlled analgesia to reduce tourniquet pain during forearm surgery. The trial focuses on the effectiveness of interscalene brachial plexus block (ISBPB), intercostobrachial nerve (ICBN) block, and supraclavicular brachial plexus block (SCBPB) combined with fentanyl for pain control. This randomized study aims to better understand which method lowers the incidence and severity of pain caused by a tourniquet used during surgery. All participants will receive a supraclavicular block as their primary anesthetic using 20 to 30 mL of 0.5% bupivacaine under ultrasound guidance. The study groups differ by additional treatments: one group receives an interscalene brachial plexus block with 10 mL of 0.125% bupivacaine around the nerve roots; another group receives an intercostobrachial nerve block with 10 mL of 0.5% bupivacaine near the second and third intercostal space; the third group uses patient-controlled analgesia with fentanyl. Midazolam may be given on request, and fentanyl is administered if pain occurs during surgery. Participants will be monitored for tourniquet pain incidence within two hours after surgery, along with hemodynamic changes, adverse reactions, and patient satisfaction up to 24 hours. Pain quality and location will be documented if pain arises during surgery. The study involves patients aged 18 to 70 undergoing forearm orthopedic or plastic surgery with specific anesthesia eligibility. Safety and effectiveness data collected during and after surgery will help determine the best pain management technique for this setting.

Researchers are investigating how individuals with limb weakness, limb paralysis, limb loss, or movement disorders move in various settings using different assistive devices and technologies. The study aims to understand how these devices impact human movement to improve technology and prepare for commercialization. Participants include both nondisabled individuals and those with disabilities who use assistive devices such as prostheses and orthoses. The study compares participants using their usual assistive devices or no device with those using investigational or commercially available devices, including prosthetic knees, ankles, feet, and ankle-foot orthoses. Activities are categorized into movement analysis in the laboratory and outside it, usability testing, and focus groups. Participants may complete different combinations of these activities, possibly more than once. During the study, participants will undergo various movement tests including walking speed, sit-to-stand timing, and the Timed Up and Go test, both with and without assistive devices. Assessments are collected at baseline and immediately after acclimating to the intervention. Participants’ perceptions are recorded, and safety during treadmill use is ensured. The study’s involvement varies per individual and includes multiple assessments to evaluate assistive technology impact on mobility.

Researchers are comparing three types of nerve blocks used for managing pain after shoulder arthroscopic surgeries. The study focuses on anterior glenoid nerve block, pericapsular nerve group (PENG) block, and interscalene brachial plexus (ISB) block. These blocks help reduce postoperative pain, improve patient comfort, speed up rehabilitation, and potentially shorten hospital stays. ISB blocks are well known as the standard method, while the PENG block is a newer technique that may provide pain relief with fewer side effects and quicker movement recovery. Participants will be randomly assigned to receive one of the three nerve blocks: the interscalene brachial plexus block, the anterior glenoid nerve block, or the pericapsular nerve group (PENG) block. All blocks are applied using ultrasound guidance during shoulder arthroscopic surgery. The study is double-blinded, meaning neither patients nor doctors know which block is given to ensure unbiased results. During the study, researchers will monitor the time until patients need their first rescue pain medication within 24 hours after surgery. They will also track total opioid use, pain levels, hospital stay duration, time to freely move the operated shoulder, and patient satisfaction. These measures help assess each block's effectiveness and safety. The entire study includes follow-up up to one week after surgery to observe recovery progress and potential complications.

Researchers are investigating upper-extremity proprioception impairment in patients experiencing radicular neuropathic symptoms caused by cervical disc herniation. This study focuses on the specific subgroup of cervical radiculopathy, which has not been systematically examined before, aiming to better understand the relationship between proprioceptive deficits and clinical outcomes such as pain and functional status. The study compares patients aged 18 to 65 years with cervical radiculopathy to a healthy control group matched by age, sex, and body mass index. Proprioception is assessed using the PRO-Reach method, which measures multisensory spatial representation of the entire upper limb through multiplanar and multi-joint evaluations without the need for computerized or robotic devices. Participants undergo baseline assessments including the Upper Limb Proprioception Reaching Test (PRO-Reach), pain rating scales (Numeric Rating Scale and DN-4 Questionnaire), quality of life evaluation (SHORT FORM-12), handgrip strength testing, and disability questionnaires (Quick Disabilities of the Arm, Shoulder and Hand Questionnaire). These measures help researchers evaluate sensory-motor function and its impact. The study involves healthy volunteers and patients, with data collection focused on initial measurements before any treatments, and participation is expected to last during the baseline assessment period.

This research aims to assess Associative Peripheral Stimulation (APS), a non-invasive therapy combining electrical muscle stimulation with voluntary movement, for helping people recover upper limb function during the acute phase after a stroke. The focus is on reducing motor impairment in patients who have recently experienced ischemic or hemorrhagic stroke and are showing weakness or paralysis in their upper extremity. Participants are randomly assigned to one of two groups: one receiving APS paired with rehabilitative exercises, and a control group receiving random peripheral stimulation paired with similar exercises. The study is conducted under triple masking to ensure unbiased results and compares outcomes over a 5-week and 3-month period. Throughout the study, participants undergo assessments including measurements of upper limb range of motion and the Fugl-Meyer Assessment for upper extremity function. Additional evaluations such as the Action Research Arm Test are also used. The study tracks progress at 5 weeks and 3 months to monitor motor recovery and function improvement, aiming to provide insight into APS's potential role in stroke rehabilitation.

Researchers are studying an experimental therapy to help people recover arm movement after a stroke. This therapy combines functional electrical stimulation with a P-300 based Brain-Computer Interface system (BCI-FES) to assist arm rehabilitation. The study compares two groups: one receives only conventional physical therapy, and the other receives both conventional therapy and BCI-FES. The goal is to improve motor recovery and independence in patients with moderate to severe upper limb weakness due to stroke. Both groups will undergo 20 sessions of conventional physical therapy over 4 weeks, with five sessions each week. The experimental group will also receive 20 sessions of BCI-FES therapy during the same period. The BCI system detects the patient's intended hand movements and assists with movements such as hand opening, grasping, pinching, pronation, and supination. These movements are practiced alongside daily tasks using objects like bottles and spoons. The therapy aims to stimulate brain pathways involved in movement to support recovery. Participants will be evaluated before and after the 4-week treatment using tests that measure arm motor function, spasticity, independence, and depression. Brain imaging with MRI and EEG will assess changes in brain structure and activity. Safety and comfort during sessions will be monitored, including fatigue and skin irritation. The total involvement lasts about one month, with close follow-up during therapy and assessments of progress and brain changes.

Researchers are evaluating a new deep brain stimulation (DBS) therapy for adults with treatment-resistant chronic pain. Chronic pain affects many adults and is often difficult to treat with existing methods. This study focuses on improving DBS by targeting multiple brain regions involved in different pain aspects and using adaptive stimulation to potentially provide longer-lasting relief. The study uses advanced devices (Medtronic Summit RC+S or Percept RC) to deliver personalized, closed-loop DBS that responds to real-time brain signals. Participants undergo an inpatient trial with temporary electrode implants in several brain areas related to pain. Those who respond positively may receive permanent implants targeting up to three optimal regions. The study compares closed-loop DBS to traditional continuous stimulation and sham treatment in a randomized, single-blind crossover design. Participants will be closely monitored with brain recordings, pain and mood assessments, and sensory testing over two years. Researchers will measure pain intensity using a visual analog scale and assess quality of life, pain thresholds, and neuropathic pain symptoms. The study aims to develop personalized stimulation algorithms and evaluate their safety and effectiveness in reducing chronic pain.

This research focuses on individuals with tetraplegia caused by cervical spinal cord injury, which severely limits their ability to use their hands and perform daily activities. It aims to compare two surgical approaches to restore hand function: a combined nerve and tendon transfer procedure (CNaTT) and the traditional tendon transfer surgery alone. The study addresses a significant gap by evaluating whether the combined approach, which may improve hand opening and grip function, offers better clinical outcomes than the traditional method. The combined procedure involves first performing a nerve transfer called Bertelli S-PIN, which aims to restore active opening of the hand by rerouting nerves to paralyzed muscles. This is followed by tendon transfer surgeries to restore strong finger and thumb flexion for grip. The traditional approach uses tendon transfers alone to restore grip without active hand opening. Both procedures involve specific surgical techniques and rehabilitation protocols, including immobilization and training phases to enhance muscle strength and function. Participants will be assessed through various tests, including the Cylinder test to measure hand function and grip strength assessments using devices like the JAMAR dynamometer and Pinch Gauge. Quality of life and satisfaction with surgery will also be evaluated using validated questionnaires. The study includes patients aged 15 to 55 with recent cervical spinal cord injuries and will monitor outcomes one year after surgery to determine the effectiveness of the procedures in improving hand function and independence.