The Influence of Cortical Lateralization on Selective Motor Control of the Arm Swing During Independent Walking After Stroke.

Not Applicable

Recruiting

• Conditions: Stroke, Ischemic; Healthy
• Interventions: Other: Walking on a treadmill

• Registration Number: NCT06442579
• Lead Sponsor: University Hospital, Ghent

Brief Summary

The upper limbs play an essential role for safe and efficient walking in healthy persons and persons post-stroke. Nevertheless, in current post-stroke gait rehabilitation (research) the upper limbs are barely targeted. To address this gap, my project aims to investigate the selective motor control of the upper limbs during walking and the contribution of the cortical activity to the arm swing in independent walkers after stroke.

To gain insight in the direct effects of stroke on the arm swing, the primary motor control of the arm swing will be evaluated by determining muscle synergies (i.e group of muscles working together as a task-specific functional unit). Additionally, the cortical activity (EEG-analysis) during walking of persons post-stroke will be compared to healthy controls and the relationship between stroke-induced changes in cortical activity and arm swing deviations will be assessed. Furthermore, I will evaluate whether improvements in cortical activity relate to improvements in primary motor control of the arm swing.

This innovative project will be the first to investigate the direct coupling between the cortex and the muscle synergies in persons post-stroke during independent walking to investigate the arm swing. These fundamental insights in the primary motor control of the arm swing and the contribution of the cortical activity will allow to develop targeted interventions aiming to improve arm swing and as such optimize post-stroke gait rehabilitation.

Research questions:

1. How can muscle synergies explain arm swing alterations in independent walkers after stroke?

2. How do stroke-induced changes in cortical activity relate to arm swing deviations in persons after stroke?

3. Are changes in primary motor control of the upper limb during walking related to normalization of brain activity in independent walkers after stroke?

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2024-05-29
• Study First Submitted QC: 2024-05-29
• Study First Posted: 2024-06-04
• Status Verified: 2024-07
• Study Start: 2024-07-09
• Last Update Submitted: 2025-05-06
• Last Update Posted: 2025-05-11
• Primary Completion: 2026-12-30
• Study Completion: 2027-09-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 84

Inclusion Criteria

• First-ever, ischemic and cerebral stroke
• Maximum one-year post-stroke
• Able to walk at least 10 minutes (FAC ≥ 3)
• Presence of upper limb paresis (NIHSS item 5a/b > 0)

Exclusion Criteria

• Other neurological disorders

Healthy controls

Inclusion criteria:

• Older than 18 years
• Able to walk at least 10 minutes

Exlusion criteria:

• Pregnancy

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Stroke	Walking on a treadmill	Persons with a unilateral first ever ischemic stroke
Control	Walking on a treadmill	Age and gender matched healthy controls

Primary Outcome Measures

Name	Time	Method
Weight of muscle synergies	Single point of assessment 3 months after inclusion (only for stroke survivors)	The number or distribution of muscle weightings within a synergy during walking in stroke survivors after a follow-up period of three months.; The distribution of muscle activation averages over one gait cycle measured by surface EMG of following muscles: * tibialis anterior,; * gastrocnemius lateralis; * soleus; * vastus medialis; * vastus lateralis; * rectus femoris; * biceps femoris; * gluteus medius; * erector spinae; * latissimus dorsi; * anterior deltoid; * posterior deltoid; * biceps brachii; * triceps brachii
Brain symmetry index (BSI)	Single point of assessment 3 months after inclusion (only for stroke survivors)	The amount of cortical lateralization during walking in stroke survivors after a follow-up period of three months. The score ranges from -1 to +1 with BSI = 0 reprenting perfect symmetry. Positive values represent higher power in the right hemishere compared to the left hemisphere, vice versa for negative values. For left side lesions, BSI was multiplied by -1.
Number of muscle synergies	Single point of assessment 3 months after inclusion (only for stroke survivors)	The number of muscle synergies needed to account for 90% variance in muscle activity measured by surface EMG during walking in stroke survivors after a follow-up period of three months. Following muscles will be examined: * tibialis anterior,; * gastrocnemius lateralis; * soleus; * vastus medialis; * vastus lateralis; * rectus femoris; * biceps femoris; * gluteus medius; * erector spinae; * latissimus dorsi; * anterior deltoid; * posterior deltoid; * biceps brachii; * triceps brachii

Secondary Outcome Measures

Name	Time	Method
Cortico-synergy coherence	Single point of assessment 3 months after inclusion (only for stroke survivors)	The amount of coherence (i.e phase locking) between the muscle synergies and cortical activity during walking in stroke survivors after a follow-up period of three months. Higher values (0-1) indicate a better linear association.
Upper limb kinematics	Single point of assessment 3 months after inclusion (only for stroke survivors)	Movements of the upper limb during walking measured by 3D kinematics and expressed as angles (°)

Trial Locations

Locations (1)

Ghent University Hospital; 🇧🇪 Ghent, Oost-Vlaanderen, Belgium