Fast Arm Motor Skill Training
- Conditions
- Cerebrovascular Stroke
- Interventions
- Behavioral: Active MonitoringBehavioral: Fast intervention
- Registration Number
- NCT05013762
- Lead Sponsor
- University of Southern California
- Brief Summary
Every year, almost 800,000 people experience a stroke in the United States, which lead to upper-limb impairments, making recovery of motor function a priority in stroke rehabilitation. 1) The primary objective of this study is to determine whether fast arm movement training on a tracking task ("Speed-training"), in chronic stroke survivors with mild to moderate paresis, will generalize to improve arm function better than dose-equivalent accuracy training on the same task. 2) study the effect of intensive arm training on the recovery of anticipatory feedforward control. 3) Determine the involvement of cerebellar-cortical circuits in the recovery of arm movements due to speed training.
- Detailed Description
About 65% of stroke survivors experience long-term limitations in upper extremity (UE) functions. In particular, limitations in arm reaching movements are prominent and correlate strongly with patients' impairment levels. Because activities of daily living often involve the UEs, retraining reach and grasp skills is critical for return to a full quality-of-life. Yet, the training parameters required for effective rehabilitation of UE function are not known. Recent evidence suggests that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke. Hence, fast movements generating large errors, would promote the restoration of the feedforward controllers and therefore improves arm movements and UE functions in individuals with chronic stroke. Because the cerebellum is involved in learning feedforward controllers from motor errors, the improvements would be proportional to the integrity of the cerebellar-cortical networks.
A double-blind quasi-randomized controlled study will be carried out in chronic post-stroke survivors. Participants will be assigned to either the speed-bias training group or a dose equivalent accuracy-bias training group (control) and will receive 4 days of training over a 1week period by a trained Occupational or physical therapist. Behavioral, EMG, and MRI data will be acquired within two weeks before, 3 days post, and one month after intervention.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 44
- At least 6 months following an ischemic supratentorial stroke
- At least 21 years of age
- Exhibit residual capability to move the paretic UE (Upper Extremity Fugl- Meyer motor score >20/66)
- Able to follow a 2-step command (8th item on the MMSE test)
- Able to perform an unassisted arm reach movement of 25 cm ahead of the body within 5 seconds with trunk restraint
- Exhibit no greater than mild/moderate spasticity as assessed with a Modified Ashworth Score < 3
- any neurologic diagnoses other than stroke
- peripheral movement restrictions, such as neuropathy
- orthopedic disorders affecting the paretic UE
- severe pain or sensory/proprioceptive impairment in the more affected UE
- visual neglect (more than 4% of lines left uncrossed on Albert's test).
- had a stroke directly affecting the cerebellum
- any contra-indications to MRI scanning
- mostly resolved impairments with an Upper Extremity Fugl- Meyer motor score >58/66
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Accuracy-biased complex motor skill training Active Monitoring The accuracy-biased group receives a dose equivalent intervention with a emphasize on accuracy. The width of the track projected on the table is narrower (less than 2cm) and the adaptive score received are based on their accuracy to say within the boundary of the track. Speed-biased complex motor skill training Fast intervention Participants will perform 400 complex movements per day over 4 days over a one-week period. The task requires participants to navigate their hand through a "track" projected on the surface of a table with a width of 5cm. Participants receive adaptive score based on their movement time. .
- Primary Outcome Measures
Name Time Method Change in arm reaching movement time. Change from baseline to 1 month post-intervention Average movement time for 30 planar reaching movements to target arrayed on a planar workspace.
Change in speed Accuracy Trade-off Change from baseline to 1 month post-intervention The investigators will compute the "Fitts" slope between "index of difficulty" of reaching movements and movement time, for targets at 3 distances and of 4 diameters.
Change in movement smoothness Change from baseline to 1 month post-intervention Average movement smoothness for 30 planar reaching movements to target arrayed on a planar workspace. Smoothness is computed by number of peaks in hand tangential velocity profiles of arm-reaching movements.
- Secondary Outcome Measures
Name Time Method Change in Box and Block test score (BBT) Change from baseline to 1 month post-intervention The Box and Block Test (BBT) measures unilateral gross manual dexterity.
Change in Upper Extremity Fugl-Meyer (UEFM) Change from baseline to 1 month post-intervention A test of motor function for the arm that is most affected by the stroke.
Change in Action Research Arm Test (ARAT) Change from baseline to 1 month post-intervention The ARAT assess specific changes in limb function among individuals who sustained a stroke.
Trial Locations
- Locations (1)
Casa Colina Hospital and Centers for Healthcare
🇺🇸Pomona, California, United States