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CompletedNCT04747587OPTISTROKEUpdated Dec 18, 2025

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

An interventional study of Reaching Session in Stroke, sponsored by Centre Hospitalier Universitaire de Nīmes. Completed at 2 sites in France. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-12-18.

Sponsored by Centre Hospitalier Universitaire de Nīmes · Not applicable, Interventional, and Other

Phase
Not applicable
Study type
Interventional
Enrollment
53
Allocation
Non-randomized
Ages
18 Years and older
Sex
All
01

Study 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.

02

Conditions studied

  • Stroke

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Keywords

  • Non-use
  • Compensation
  • Weakness
  • Optimal control
03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
Yes

Eligibility criteria

Inclusion Criteria:

Inclusion criteria specific to the stroke group:

  • 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

Inclusion criteria specific to the control group:

  • Subject who has never had a stroke
  • Subject without motor or orthopedic impairment of the upper limbs and in particular of the shoulder

General inclusion criteria:

  • Subject who has given free and informed consent.
  • Subject who signed the consent form.
  • Subject affiliated or beneficiary of a health insurance plan.

Exclusion criteria:

  • Pregnant, parturient or breastfeeding subject.
  • The subject is participating in a category 1 interventional study, or is in a period of exclusion determined by a previous study
  • 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
04

Study design

Phase
Not applicable
Primary purpose
Other
Allocation
Non-randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
53 participants (actual)

Study arms

  • Experimental
    Patients with stroke

    Other: Reaching Session

  • Experimental
    Controls

    Other: Reaching Session

Interventions

  • OtherReaching Session

    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

05

What researchers measure

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

    Time frame: Inclusion

Secondary outcomes

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

    PANU score (%): Physiological non-use considered as a decrease in PANU due to to the increase in the size of the target; A psychological non-use considered as absence of decrease in PANU, regardless of the condition

    Time frame: Inclusion

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

    PANU score (%) of force and precision

    Time frame: Inclusion

  3. Evaluate the level of neuromuscular activation during reaching

    % Voluntary Maximum Contraction (VMC) of anterior and intermediate part of the deltoid, biceps brachii and pectoralis major

    Time frame: Inclusion

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

    Weight-over-force ratio of the arm (Ratio between 0 \& + ∞)

    Time frame: Inclusion

  5. Time since stroke (acute, subacute or chronic phase)

    months

    Time frame: Inclusion

  6. Intensity of arm deficit

    Fugl-Meyer Upper Extremity score ) (score between 0 and 66)

    Time frame: Inclusion

  7. height of the target

    Evaluate changes in the proximal non-use after stroke on the paretic side according to the height of the target to be reached with PANU score (%) : A significant PANU (\> 7.5%) indicates non-use

    Time frame: Inclusion

06

Study locations

2 sites
  • CHU de Montpellier
    Montpellier, France
  • CHU de Nîmes
    Nîmes, France
07

References and documents

Publications

  • Faity G, Mottet D, Froger J, Delorme M. Neuromechanics of Nonuse and Compensation: Implications for Rehabilitation After Stroke. Neurorehabil Neural Repair. 2026 May 4:15459683261445442. doi: 10.1177/15459683261445442. Online ahead of print. PubMed 42080459 ↗

Individual participant data

Plan to share: Yes — Anonymised raw datasets and code used for the analysis will be available on reasonable request.

Supporting information: Analytic code

08

Registry details

Key details

Study ID
NCT04747587
Lead sponsor
Centre Hospitalier Universitaire de Nīmes
Responsible party
Sponsor
First posted
Feb 10, 2021
Start date
May 11, 2021
Primary completion
Apr 25, 2023
Completion
Apr 25, 2023
Last update
Dec 18, 2025

Study contacts

Jérôme Froger
principal investigator · Centre Hospitalier Universitaire de Nīmes

Oversight

FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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