Novel Spatial-Motor Approaches to Improve Spatial Neglect and Walking Deficits Post-Stroke
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Spatial Neglect
- Sponsor
- Emory University
- Enrollment
- 65
- Locations
- 3
- Primary Endpoint
- Change in intracortical excitability [paired pulse transcranial Magnetic Stimulation (TMS)]
- Status
- Recruiting
- Last Updated
- 6 months ago
Overview
Brief Summary
The purpose of this study is to understand how prism adaptation training with and without electrical stimulation changes visuospatial behavior, motor system neurophysiology, and walking dysfunction.
Detailed Description
Spatial Neglect (SN) is defined as pathological asymmetric spatial behavior causing functional disability and occurs in greater than 50% of individuals with right hemisphere stroke. SN post-stroke is associated with increased fall risk, increased hospital length of stay, poorer rehabilitation outcomes, and severe long-term disability. Prism adaptation therapy (PAT) is an evidence-based treatment for SN after stroke, however, the effects of SN on gait are not well known. Neuromuscular electrical stimulation delivered via surface electrodes is a common therapeutic adjunct in stroke rehabilitation, including for SN and gait training. However, the additive therapeutic effects of combining electrical stimulation and PAT, as well as the effects of motor training on gait deficits associated with SN are poorly understood. Furthermore, although there is limited literature examining the effects of electrical stimulation on corticospinal tract output (CST), there is an inadequate understanding of the neural mechanisms of PAT and the combinatorial effects of PAT with electrical stimulation. To parse out the neural mechanisms of PAT and electrical stimulation on the visuospatial system, researchers will first examine the effects of PAT with or without electrical stimulation in neurologically unimpaired adults, researchers will then compare results to individuals with stroke with spatial neglect. The primary objective is to study the effects of PAT on visuospatial behavior and motor cortical excitability in able-bodied individuals (young and older), and on spatial neglect, motor cortical neurophysiology, and walking function in individuals post-stroke. The long-term goal of this project is to develop novel, effective, and personalized rehabilitation protocols targeting SN deficits and gait dysfunction to reduce disability in stroke survivors. The rationale of this project is to explore and generate data regarding future novel combinatorial motor-spatial retraining approaches that will enhance the rehabilitation approach of SN and gait performance in individuals post-stroke.
Investigators
Trisha Kesar
Associate Professor
Emory University
Eligibility Criteria
Inclusion Criteria
- •Young Adults Able Bodied (YAB) Individuals
- •18-30 years
- •Able-Bodied (healthy without any physical disability or neurological disorder)
- •Older Adults Able-Bodied Individuals (OAB)
- •45-90 years
- •Able-Bodied (healthy without any physical disability or neurological disorder)
- •Individuals with right hemisphere stroke (40-90 years)
- •\>3 months following stroke.
- •Presence of Aiming SN
- •Ability to walk \>10m with or without assistive devices.
Exclusion Criteria
- •Young Adults Able Bodied (YAB) Individuals and Older Adults Able-Bodied Individuals (OAB)
- •History or evidence of orthopedic or physical disability
- •History or evidence of neurological pathology
- •Pregnancy (female)
- •Uncontrolled hypertension
- •Cardiac pacemaker or other implanted electronic system
- •Presence of skin conditions preventing electrical stimulation setup
- •Impaired sensation in the left upper limb.
- •Bruises or cuts at the stimulation electrode placement site
- •Concurrent enrollment in rehabilitation or another investigational study.
Outcomes
Primary Outcomes
Change in intracortical excitability [paired pulse transcranial Magnetic Stimulation (TMS)]
Time Frame: Pre-training and immediately after training session
Primary Motor Cortex (M1) and TMS from the hand muscles (first dorsal interossei) and the ankle (soleus) will be measured using Computer software (Biopac) that will record the muscle's responses to TMS pulses (MEPs) through electromyography (EMG) sensors attached to the skin of the legs and/or arms.
Change in visuospatial pointing behavior
Time Frame: Pre-training and immediately after training session
Measured by the neuropsychological laboratory pointing behavior with the Kessler Foundation Neglect Assessment Process (KF-NAP) tool. Patients are asked to point with their eyes closed towards the center (proprioceptive pointing) and eyes open towards a target (visuo-proprioceptive pointing) on a standing calibrated board unaffected hand). The test is scored by measuring the deviation from 0 (midline). Pre-PAT and post-PAT measures are compared, there is no minimum or maximum score. A more negative score (Pre to Post) means improvement in visuospatial alignment (Improved left spatial neglect) in people post-stroke.
Change in corticospinal excitability (single pulse TMS)
Time Frame: Pre-training and immediately after training session
Change in corticospinal excitability measured by the change from baseline in motor evoked potentials (MEP) amplitude responses from the hand muscles (first dorsal interossei) and the ankle (soleus) will be measured using Computer software (Biopac) that will record the muscle's responses to TMS pulses (MEPs) through electromyography (EMG) sensors attached to the skin of the legs and/or arms.
Secondary Outcomes
- Change in the Catherine Bergego Scale (CBS)(Pre-training and immediately after training session)
- Change in weight-bearing asymmetry(Pre-training and immediately after training session)
- Change in computerized line bisection task(Pre-training and immediately after training session)
- Change in spatial neglect deficits(Pre-training and immediately after training session)