Structurally Reorganizing Motor Cortex in Stroke Patients Through Hebbian-type Stimulation
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Enrollment
- 48
- Locations
- 1
- Primary Endpoint
- Primary Motor Cortex (M1) Excitability Derived From Stimulus Response Curve
Study Overview
Brief Summary
Stroke is a leading cause of morbidity in the United States but identification of treatment strategies to improve outcome is limited by the incomplete understanding of the mechanisms of recovery. Motor cortex (M1) reorganization plays a major-role in the recovery of motor deficits post-stroke; hence the importance for further development of rehabilitative strategies that utilize this potential for recovery.
In Specific Aim 1, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances functional M1 reorganization in lesioned M1 of stroke patients.
In Specific Aim 2, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances structural cortical reorganization in lesioned M1 of stroke patients and to explore whether these structural changes are related to the training induced functional cortical reorganization.
The overall goal of this project is to determine the effect of Hebbian- type stimulation on both, functional and structural brain reorganization, thereby obtaining indirect evidence for the neuronal substrate underlying training related improvement and maintenance of motor function in stroke patients. This knowledge may have a substantial positive impact on treatment for stroke patients that may significantly improve recovery and could move the field of neuro-rehabilitation forward.
Detailed Description
Stroke is a leading cause of morbidity in the United States but identification of treatment strategies to improve outcome is limited by the incomplete understanding of the mechanisms of recovery. Motor cortex (M1) reorganization plays a major-role in the recovery of motor deficits post-stroke; hence the importance for further development of rehabilitative strategies that utilize this potential for recovery. Non-invasive cortical stimulation can enhance the beneficial effects of motor training on performance and functional plasticity of motor cortex. Among the different approaches used in these studies, Hebbian-type M1 stimulation is particularly intriguing, as it seems to be more effective when compared to random M1 stimulation. There is emerging evidence that motor training or cortical stimulation related improvement of function are associated with increases in the grey matter of targeted brain areas. While there is therefore some evidence supporting structural reorganization in human M1 in response to motor learning and cortical stimulation, the mechanisms underlying these changes and their relationship to functional plasticity are not known. A better understanding of the sequences of events is critical to development of optimal therapeutic interventions to improve recovery following stroke.
In Specific Aim 1, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances functional M1 reorganization in lesioned M1 of stroke patients.
In Specific Aim 2, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances structural cortical reorganization in lesioned M1 of stroke patients and to explore whether these structural changes are related to the training induced functional cortical reorganization.
The overall goal of this project is to determine the effect of Hebbian- type stimulation on both, functional and structural brain reorganization, thereby obtaining indirect evidence for the neuronal substrate underlying training related improvement and maintenance of motor function in stroke patients. This knowledge may have a substantial positive impact on treatment for stroke patients that may significantly improve recovery and could move the field of neuro-rehabilitation forward.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Investigator)
Eligibility Criteria
- Ages
- 18 Years to 85 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age 18-85
- •Single cerebral ischemic infarction > 6 month affecting the primary motor output system of the hand at a cortical (M1) level as defined by MRI of the brain
- •At the time of cerebral infarct a motor deficit of hand of MRC of <4- of wrist and finger extension/flexion movement
- •Good recovery of hand function as defined by MRC of 4 or 4+ of wrist- and finger extension/flexion movements
- •Ability to perform wrist extension movements
- •No other neurological disorder
- •No intake of CNS active drugs
- •Ability to give informed consent
- •Ability to meet criteria of inclusion experiment
- •No major cognitive impairment
- •No contraindication to TMS or MRI
Exclusion Criteria
- Not provided
Arms & Interventions
Hebbian-type Stimulation
Participants will be randomized to receive motor training with Hebbian-type stimulation.
Intervention: Repetitive Transcranial Magnetic Stimulation (rTMS) (Device)
Sham Stimulation
Participants will be randomized to receive sham stimulation.
Intervention: Sham stimulation (Device)
Outcomes
Primary Outcomes
Primary Motor Cortex (M1) Excitability Derived From Stimulus Response Curve
Time Frame: Baseline, Post-Training 1 (1 Week), Post-Training 2 (4 Weeks)
Motor evoked potential (MEP) amplitudes were measured prior to treatment (baseline), one week after the treatment (post-training 1), and 4 weeks after treatment (post-training 2).The MEP is elicited by transcranial magnetic stimulation (TMS) at increased intensity. Its amplitude is measured from peak to peak and expressed in millivolts (mV). Measured MEP amplitudes were plotted against the intensity to create a stimulus response curve (SRC). Long-lasting increases in MEP amplitude indicate increases in motor cortex excitability and are associated with motor learning.
Secondary Outcomes
- Mean Time to Completion for Jebsen Hand Function Test (JTT)(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Peak Acceleration of Wrist Extension Movements(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Reaction Time of Wrist Extension Movements(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Wolf Motor Function Test (WMFT) Grip Strength(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Motor Activity Log (MAL) Score: Amount Subtest(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Motor Activity Log (MAL): How Well Subtest(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Wolf Motor Function Test Functional Ability (WMFT-FS) Scale Score(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
- Mean Wolf Motor Function Test (WMFT) Total Time(Baseline, Post-Training (1 Week), Post-Training (4 Weeks))
Investigators
Cathrin Buetefisch
Dr. Cathrin Buetefisch, MD, PhD
Emory University