Synchronized Brain and Hand Stimulation to Improve Hand Function After Stroke
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Stroke
- Sponsor
- Amit Sethi
- Enrollment
- 10
- Locations
- 1
- Primary Endpoint
- Percent Change in Box and Block Test
- Status
- Completed
- Last Updated
- 9 months ago
Overview
Brief Summary
Among the 795,000 individuals who sustain a stroke annually in the United States, 65% continue to experience moderate-to-severe impairments in one hand six months or more, which limits their ability to perform daily tasks. Currently there is dearth of understanding of the mechanisms of motor recovery after stroke. Understanding the mechanisms can potentially lead to the development of interventions to improve motor performance after stroke. The proposed study will examine how synchronously pairing brain and hand stimulation repeatedly affects the plasticity of the brain and motor performance after stroke. The knowledge gained from this study can be useful to develop interventions to improve hand movement after moderate-severe stroke.
Investigators
Amit Sethi
Assistant Professor
University of Pittsburgh
Eligibility Criteria
Inclusion Criteria
- •Male or female (either right or left handed) with unilateral hemiparesis after stroke;
- •Stroke onset of at least six months prior to the time of participation;
- •Ability to elicit motor evoked potential in the Extensor digitorum communis (EDC) muscle
- •Ability to grasp, as indicated by a score of at least 1 (out of 2) on the finger mass flexion and cylindrical grasp items of Upper Extremity Fugl-Meyer scale
- •age between 18-80 years
Exclusion Criteria
- •Presence of severe aphasia , measured by cognitive and/or language impairments that preclude the ability to follow simple instructions;
- •Excessive spasticity of wrist and finger muscles, defined as a Modified Ashworth Score more than or equal to 3, which may limit the ability to open the hand/fingers;
- •Diagnosis of neurological disorders other than stroke, which may confound the results;
- •Has touch and proprioceptive sensory deficits determined via a score of 0 on the position sense section (section H) of the Fugl Meyer Upper Extremity assessment proprioception, which may limit the ability to report excessive amount of tingling due to hand stimulation
- •History of seizure or epilepsy as the effects of TMS are not tested in individuals with seizures or epilepsy;
- •Orthopaedic/musculoskeletal conditions (eg, arthritis) affecting the upper extremity, which may limit the ability to move the affected hand
- •Presence of metallic implants in the head or neck for TMS;
- •Currently or planning to become pregnant, as the effects of TMS are not tested not pregnant women;
- •Difficulty maintaining alertness or remaining still for MRI;
- •Ferromagnetic metallic implants, pacemakers, other implanted devices, or ventilators (for MRI);
Outcomes
Primary Outcomes
Percent Change in Box and Block Test
Time Frame: Baseline to 6 weeks
The Box and Block Test (BBT) measures unilateral gross manual dexterity and the ability to release objects. It is a quick, simple and inexpensive test. It can be used with a wide range of populations, including clients with stroke. The BBT is composed of a wooden box divided in two compartments by a partition and 150 blocks. The BBT administration consists of asking the participants to move, one by one, the maximum number of blocks from one compartment of a box to another of equal size, within 60 seconds. The box is oriented lengthwise and placed at the client's midline, with the compartment holding the blocks oriented towards the hand being tested. Participants first perform this test with their unaffected hand in order to practice and register baseline scores. Additionally, a 15-second trial period is permitted at the beginning of each side. Before the trial, after the standardized instructions are given to participants are advised that their fingertips must cross the partition when
Secondary Outcomes
- Percent Change in Motor Evoked Potential(Baseline to 6 weeks)
- Average Percent Change in Hand Force(Baseline to 6 weeks)