Targeting Motor Areas for Customized Transcranial Magnetic Stimulation in Motor Rehabilitation Treatment of Chronic Stroke Patients
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 入组人数
- 70
- 主要终点
- Change in Stimulus Response Curve parameters
研究概览
简要总结
The goal of the study is to determine the effect of repetitive transcranial magnetic stimulation (rTMS) over the premotor cortex on training-related improvements in motor performance and associated neural plasticity.
详细描述
Occlusion of the middle cerebral artery is the most common cause of stroke. Because the middle cerebral artery supplies blood to the motor cortices, middle cerebral artery stroke often impacts the integrity of the motor cortex and its associated corticospinal projections. Less than half of all individuals post-stroke regain complete motor function. Because motor deficits, especially of the upper extremities, can dampen the quality of life, there is an urgent need to improve current rehabilitation programs to allow more stroke survivors to achieve higher functional gains.
Motor training is an important part of recovery after stroke. During motor training, patients practice performing a movement and become better at performing the trained movement over time. Repetitive transcranial magnetic stimulation (rTMS), which uses magnetism to excite neurons near the surface of the brain, may further improve performance. There is evidence that the premotor cortex may be a more effective target than the primary motor cortex for rTMS for some stroke survivors. In the current study, the investigator will determine the effect of rTMS over the premotor cortex on training-related improvements in motor performance in adults who experienced a stroke more than 6 months ago.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Crossover
- 主要目的
- Treatment
- 盲法
- Double (Participant, Outcomes Assessor)
盲法说明
Subjects will be blinded to the type of TMS that they receive on each day.
入排标准
- 年龄范围
- 30 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Have the ability to give informed, written consent
- •Be aged 30-80 years old
- •Have a single ischemic infarction affecting the primary motor system
- •Have intact cognitive abilities
- •No current depression
- •No neurological disease
- •No contradictions to TMS
- •No history of seizures or epilepsy
- •No implanted medical device
- •No metal in neck or head
- •No history of migraine headaches
- •No intake of medication that lowers seizure threshold
排除标准
- 未提供
结局指标
主要结局
Change in Stimulus Response Curve parameters
时间窗: Before, 0 mins after, 30 mins after and 60 mins after motor training.
To measure organization of a motor region in the primary motor cortex supporting wrist movement, a Stimulus Response Curve (SRC) will be collected before and after motor training. SRC is a set of motor evoked potentials (MEP) that characterizes input-output parameters of the primary motor cortex and associated corticospinal tract. A change in the SRC parameters after training will reflect a change in the organization of the primary motor cortex.
Change in wrist velocity
时间窗: Before, 0 mins after, 30 mins after, and 60 mins after motor training.
The subjects will be asked to perform 7 isometric wrist extensions before and after motor training. Wrist velocity will be measured by a gyroscope taped to the dorsum of the wrist that was used during motor training. An increase in the maximum velocity that persists at least an hour after training is indicative of motor learning.
次要结局
- Change in reaction time(Before, 0 mins after, 30 mins after and 60 mins after motor training.)
- Change in Short interval intracortical inhibition (SICI) of the primary motor cortex(Before, 0 mins after, 30 mins after, and 60 mins after motor training.)
- Change in Resting Motor Threshold(Before, 0 mins after, 30 mins after, and 60 mins after motor training.)
- Change in task accuracy(During motor training (will compare first block to last block).)
- Change in wrist force(Before, 0 mins after, 30 mins after, and 60 mins after motor training.)
研究者
Cathrin Buetefisch
Professor
Emory University