Clinical Trial: Modulating Interaction of Motor Learning Networks in Rehabilitation of Stroke

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Modulating Interaction of Motor Learning Networks in Rehabilitation of Stroke

Brief Summary: This study uses a form on non-invasive brain stimulation called transcranial magnetic stimulation to understand 1) understand how the brain learns post-stroke and 2) assess non-invasive brain stimulation as an addition to current stroke rehabilitation approaches. In two study arms the investigators will compare the effect of active transcranial magnetic stimulation paired with motor practice with placebo (or sham) transcranial magnetic stimulation paired with the same motor practice.

Detailed Summary:

Stroke is the leading cause of permanent disability in the United States. In the absence of treatments to restore the lost tissue, clinical scientists have focused upon repetitive forced used of the paretic limb to promote neural reorganization in preserved tissue and reduce disability. However, forced use interventions are time intensive and the extent of functional recovery is variable. One potential contributor to this variability is the potential trade-off between compensatory cognitive motor control strategies and the extent of procedural learning that can occur. Compensatory strategies adopted by patients may produce quick short-term increases in performance but retard slower sustained improvements by interfering with development of procedural learning. Consistent with this hypothesis, the investigators' previous work documents an increased reliance upon dorsolateral prefrontal cortex during performance of learned skills post-stoke. However, the investigators' previous work also demonstrates that the effect of increased activity in dorsolateral prefrontal cortex may limit reorganization in important areas involved in the consolidation of practice thereby limiting functional recovery post-stroke.

Transcranial magnetic stimulation offers a unique opportunity to investigate the relationship between dorsolateral prefrontal cortex activity and consolidation of motor practice/rehabilitaion post-stroke. Here the investigators' objective is to determine whether suppression of the contralesional dorsolateral prefrontal cortex, with continuous theta burst transcranial magnetic brain stimulation (cTBS), a form of transcranial magnetic stimulation, prior to motor practice enhances brain reorganization in critical areas and leads to greater sustained improvements in motor ability over time.

The proposed work will enhance the unde
Sponsor: University of Michigan

Current Primary Outcome: Persistent change in response time [ Time Frame: 3 weeks ]

Comparison of time to complete a sequential series of upper limb movements pre and post multisession intervention. Response times prior to any application of cTBS will be compared to a retention test (in the absence of cTBS) ~48 hours after the end of the intervention will be compared across the active and sham cTBS arms.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Transfer to Functional Motor Ability [ Time Frame: 3 weeks ]
    Comparison of the change in time to complete the Jebsen-Taylor Hand Function Test will be compared across group to assess how well the practice specific intervention tasks transfers to activities of daily living. Change in time to complete the Jebsen test will be derived as the difference from pre- to a post-test ~48 hours after the end of the intervention.
  • Short-term change in response time [ Time Frame: 60 minutes ]
    Comparison of time to complete a sequential series of upper limb movements pre and post activie/sham cTBS within the same session. Response times prior to the application of cTBS on a given session will be compared to responses times in the period following cTBS on the same day.
  • Persistent Motor Cortical Excitability Change [ Time Frame: 3 Weeks ]
    Comparison of the change in single pulse TMS recruitment curve slope across group. To quantify the persistent change in cortical excitability recruitment curves prior to the intervention will be compared to those elicited ~48 hours following the end of the intervention.


Original Secondary Outcome: Same as current

Information By: University of Michigan

Dates:
Date Received: March 16, 2017
Date Started: April 1, 2016
Date Completion: March 31, 2018
Last Updated: March 29, 2017
Last Verified: March 2017