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Trial registered on ANZCTR
Registration number
ACTRN12614000022662
Ethics application status
Not yet submitted
Date submitted
29/10/2013
Date registered
9/01/2014
Date last updated
9/01/2014
Type of registration
Prospectively registered
Titles & IDs
Public title
Yawn induced limb movements in stroke patients with arm weakness
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Scientific title
Establishing the neuro-anatomical basis for extrapyramidal yawning movements observed in stroke patients with arm weakness
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Secondary ID [1]
283480
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nil
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Universal Trial Number (UTN)
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Trial acronym
Yawning Induced Movements in Stroke Study ( YIMSS)
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Stroke
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Yawning Induced Movements in an otherwise paralysed limb
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Condition category
Condition code
Neurological
290789
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0
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Other neurological disorders
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Stroke
290994
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0
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Ischaemic
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Intervention/exposure
Study type
Observational
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Patient registry
True
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Target follow-up duration
6
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Target follow-up type
Months
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Description of intervention(s) / exposure
Observation Study:
1. Observe incidence of YIMS (yawning induced movements in stroke survivors) - subjects will be asked to complete regular surveys noting how frequently they observed autonomous movements associated with yawning.
2. Clinical survey upon admission to tertiary hospital for stroke for up to 6 months following a first stroke
3. Subjects will complete a survey upon admission and at 2 weeks, 1 and 3 and 6 months to determine their individual functional level and incidence of yawning induced movements
4. Subjects will be given a survey kit with the two week and 1,3 and 6 month survey forms, information pack and return prepaid envelopes
5. Investigators provide a reminder phone call prior to each survey to improve adherence
6.As secondary aim, wish to compare neuroanatomical stroke lesions between patients with YIMs against those without YIMs. Identifying these lesions will involve going through Head imaging taken during the diagnosis of stoke and potential fMRI in future studies
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Intervention code [1]
288191
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Not applicable
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Comparator / control treatment
N/A - This is an observational study
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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1. Determine Incidence of Yawning Induced Arm Movements in stroke survivors
Incidence will be determined by participant observation and recollection.
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Assessment method [1]
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Timepoint [1]
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At admission and at 2 weeks, 1 month, 3 months and 6 months
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Secondary outcome [1]
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1. Establish (if possible) neuroanatomical correlations between subjects with YIMs compared to subjects without YIMs
This will be assessed through comparison of head imaging done at time of diagnosis and possibly fMRI as a separate study in the future
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Assessment method [1]
305284
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Timepoint [1]
305284
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1. Secondary time point for each patient is 6 months
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Eligibility
Key inclusion criteria
Age >18
Cerebrovascular Accident (aka Stroke) presenting in 3-13 days
Stroke associated with motor deficit (paralysis) of the upper limbs
Able to give consent/assent
Family member able to give assent on behalf of patient
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
Severe stroke or co-morbidities that make early death more likely
Previous Stroke
Significant movement disorders ( Parkinson’s Disease, Multiple Sclerosis, Motor Neuron Disease)
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Study design
Purpose
Natural history
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Duration
Longitudinal
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Selection
Defined population
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Timing
Prospective
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Statistical methods / analysis
Predicted sample size of 200-300 subjects
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/02/2014
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Actual
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Date of last participant enrolment
Anticipated
31/01/2015
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Actual
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
300
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Recruitment hospital [1]
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Sir Charles Gairdner Hospital - Nedlands
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Recruitment postcode(s) [1]
7521
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6009 - Nedlands
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Funding & Sponsors
Funding source category [1]
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Self funded/Unfunded
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Name [1]
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Address [1]
288186
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Country [1]
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Australia
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Primary sponsor type
Individual
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Name
Dr Benjamin Mulo
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Address
Sir Charles Gairdner Hospital
Department of Neurology
Hospital Avenue
Nedlands 6009
Western Australia, Australia
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
286911
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Country [1]
286911
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Other collaborator category [1]
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None
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Name [1]
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N/A
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Address [1]
277673
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N/A
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Country [1]
277673
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Australia
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Ethics approval
Ethics application status
Not yet submitted
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Ethics committee name [1]
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SCGH Human Ethics Research Committee
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Ethics committee address [1]
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SCGH HREC Sir Charles Gairdner Hospital Hospital Avenue Nedlands 6009 Western Australia
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Ethics committee country [1]
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Australia
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Date submitted for ethics approval [1]
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01/11/2013
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Approval date [1]
290096
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Ethics approval number [1]
290096
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Summary
Brief summary
For many years the phenomenon of involuntary movements provoked by yawning, has been observed in stroke patients with paralysed limbs, particularly the arm. More than a hundred years ago, an analysis suggested that removal of inhibitory pathways, unmasked the associated movements of yawning and limb movements, which had an evolutionary link related back to the swim bladder and pectoral fins of fish. In healthy individuals, yawning is often accompanied by generalised stretching, which may include elevation of the arms, known as pandiculation. The paralysed arm of stroke patients can be seen to move during a yawn, often bringing the hand towards the mouth, before suddenly dropping again at the end of the yawn. Walusinski coined this, “parakinesia brachialis oscitans”. The observation appears to have been regarded as a curiosity, with some texts almost derisively regarding it as something that could potentially give false hope to stroke patients. There has been some investigation into the neural basis of yawning in healthy subjects, with interest in the possible involvement of the mirror neurone pathways, and other regions distant to the motor cortex, including the ventromedial posterior prefrontal cortex. Movement of the paralysed limb during yawning in patients with pyramidal tract lesions, has been suggested to provide evidence for an independent “emotional motor” system, separate to the corticospinal motor tracts. Recruitment of these areas and pathways might provide a potential mechanism for recovery of motor function after stroke, particularly in the arm. There may thus be some potential for somehow utilising arm movements associated with yawning to stimulate upper limb recovery. Another fascinating aspect of yawning, is the common observation that witnessing yawning in others may result in another individual yawning; so called “contagious” yawning. This does not appear to be related to hypoxia or hypercarbia8. Some 42-55% of humans witnessing images of subjects yawning, will yawn themselves and the act of thinking of yawning may provoke yawning. 33% of adult chimpanzees yawned in response to seeing videos of other chimps yawning, possibly inferring advanced self awareness and empathy in this species. It is possible, therefore that yawning could be “evoked”, and thus used as a potential means for stimulating upper limb movements in paralysed patients. The exciting potential could be that yawning could thus be utilised as a neurorehabilitation therapy The primary purpose of the study is determine the incidence of Yawning Induced Movements in stroke survivors. We hope to use this data to guide the development of future studies with the aim of determining if these movements can have an application in the rehabilitation of stroke survivors
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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A/Prof David Blacker
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Address
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Department of Neurology
Sir Charles Gairdner Hospital
Hospital Avenue
Nedlands 6009
Western Australia
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Country
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Australia
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Phone
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+61 8 9346 3333
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Benjamin Mulo
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Address
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Department of Neurology
Sir Charles Gairdner Hospital
Hospital Avenue
Nedlands 6009
Western Australia
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Country
43951
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Australia
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Phone
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+61 8 9346 3333
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Name
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Benjamin Mulo
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Address
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Department of Neurology
Sir Charles Gairdner Hospital
Hospital Avenue
Nedlands 6009
Western Australia
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Country
43952
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Australia
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Phone
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+61 8 9346 3333
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Fax
43952
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Email
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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