Upper Limb-based Movement Priming for Lower Limb Neuroplasticity & Motor Recovery in Stroke
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 17
- Locations
- 1
- Primary Endpoint
- Spinal H-reflex excitability using peripheral nerve stimulation (PNS)
Study Overview
Brief Summary
The goal of this clinical trial is to to determine the effect of movement-based priming using the upper limbs on lower limb neuroplasticity and behaviors in chronic stroke.
The main questions we aim to answer are:
- What are the acute effect of UL-priming on lower limb neuroplasticity and motor behaviors in persons with stroke compared to other priming modalities?
- What are the time effects of UL-priming on neuroplasticity and motor behavior in individuals with stroke?
In this cross over study, participants will be involved in three priming sessions involving
- UL-priming using rhythmic, symmetric, bilateral priming involving the movement of at least one major joint in the upper limbs.
AND
- Sham priming using auditory stimulation (1 Hz metronome).
AND
- Lower-limb movement-based priming using rhythmic, symmetric, dorsiflexion and plantarflexion movements.
Researchers will compare outcome measures between the different priming sessions.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Crossover
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Eligibility Criteria
- Ages
- 40 Years to 90 Years (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Single, monohemispheric stroke
- •Chronic stroke (> 6 months prior)
- •Residual hemiparetic gait deficits (e.g., abnormal gait pattern)
- •Minimum score of stage 2 on the Chedoke Arm Impairment Scale which includes stage 2, task 3 (facilitated elbow flexion) as one of the stage 2 tasks.
Exclusion Criteria
- •Use of anti-spasticity medications
- •Existence of other neurological disorders
- •Have brainstem or cerebellar lesions.
- •Score of ≥2 on the Modified Ashworth Scale.
- •MMSE score of <21, to ensure they will follow instructions.
- •Non-English-speaking individuals
- •Bone, joint or soft tissue injury
- •Uncontrolled medical conditions (such as uncontrolled hypertension, untreated cardiac disease, or untreated pulmonary disease)
- •No Motor evoked potentials (MEPs) during TMS
- •TMS exclusion criteria
- •Previous adverse reaction to TMS
- •Skull abnormalities or fractures
- •Concussion within the prior 6 months
- •Unexplained, recurring headaches
- •Implanted cardiac pacemaker
- •Metal implants in the head or face
- •History of seizures or epilepsy
- •Use of medications that could alter cortical excitability or increase risk of seizure (e.g., antidepressants, antipsychotics, anxiolytics, anticonvulsants)
- •Current pregnancy
Arms & Interventions
Lower limb-based movement priming (LL-priming)
Participants will perform rhythmic, symmetric, bilateral plantarflexion and dorsiflexion movements.
Intervention: Lower limb-based movement priming (LL-priming) (Other)
Upper limb-based movement priming (UL-priming)
The upper limb priming task will include rhythmic, bilateral priming involving the movement of at least one major joint in the upper limbs (shoulder, elbow, wrist).
Intervention: Upper limb-based movement priming (UL-priming) (Other)
Sham priming
Participants will listen to a 1 Hz metronome for 20 minutes as a form of auditory stimulation during the sham priming session.
Intervention: Sham priming (Other)
Outcomes
Primary Outcomes
Spinal H-reflex excitability using peripheral nerve stimulation (PNS)
Time Frame: Change from baseline to immediately after priming and to 24 hours after priming.
Peripheral nerve stimulation (PNS) will be used to assess the H reflexes excitability from the soleus muscles.
Corticomotor excitability using transcranial magnetic stimulation (TMS)
Time Frame: Change from baseline to immediately after priming and to 24 hours after priming.
Single-pulse transcranial magnetic stimulation (TMS) will be used to assess the corticomotor excitability from the tibialis anterior and soleus muscles.
Muscle Strength
Time Frame: Change from baseline to immediately after priming and to 24 hours after priming.
An estimate of maximum ankle muscle force will be obtained for three trials of dorsiflexion and plantarflexion contractions using a force transducer and EMG.
Secondary Outcomes
No secondary outcomes reported
Investigators
Sangeetha Madhavan
Professor, Physical Therapy
University of Illinois at Chicago