Action Selection and Arm Rehabilitation After Stroke

NCT ID: NCT02785419

Last Updated: 2021-07-23

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 32 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-12-08
• Study Completion Date: 2020-12-31

Brief Summary

After stroke, individuals often have persistent difficulty using the arm and hand in everyday functional tasks that reduces quality of life. Currently available rehabilitation techniques are not adequate and new protocols are needed that are based on an understanding of how brain regions work together to produce skilled movement. This research project aims to improve our understanding of how the brain controls movement after stroke and determine whether a period of motor practice that targets specific brain regions through the addition of action selection demands leads to improved arm function. We hypothesize that arm motor function and the ability to efficiently activate the action selection motor circuit during movement will improve after training.

Detailed Description

Rehabilitation of arm impairment after stroke includes the repetitive practice of functional tasks. In healthy adults, planning plays a vital role in the control of skilled movement, however, the behavioral and neural correlates of planning have largely been unexplored in individuals recovering from stroke. Action selection is an important motor planning process that engages dorsal premotor cortex (PMd) in controls. While PMd activation is a commonly reported neural correlate of motor recovery after stroke, the role of PMd in action selection and motor training are not known. Therefore, the purpose of this study is to determine the effect of training that includes action selection demands on the behavioral and neural correlates of movement after stroke. Thirty-eight individuals in the chronic phase of stroke will be recruited. After completion of clinical measures of impairment and function, all participants with stroke will complete a motor action selection task and functional MRI followed by arm training. Arm training will consist of three weeks (15 sessions) of arm motor training (1.5 hours per session) that includes action selection demands on movement. Follow-up clinical testing will occur at the end of treatment and three weeks later.

Conditions

Stroke

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arm Training with Action Selection

Task-oriented, functional arm training with the addition of action selection cues to practice. All participants receive the same arm training intervention.

Group Type: EXPERIMENTAL

Arm Training with Action Selection

Intervention Type: BEHAVIORAL

Treatment occurs in 1.5 hour sessions, 5 times a week for 3 weeks. In each treatment session, you will practice functional tasks with your weaker arm and hand. Additionally, you will be given cues on a computer screen that dictate your movement response (action selection). Practice will be scaled to match your current level of function and progressed over time as able.

Interventions

Arm Training with Action Selection

Treatment occurs in 1.5 hour sessions, 5 times a week for 3 weeks. In each treatment session, you will practice functional tasks with your weaker arm and hand. Additionally, you will be given cues on a computer screen that dictate your movement response (action selection). Practice will be scaled to match your current level of function and progressed over time as able.

Intervention Type: BEHAVIORAL

Other Intervention Names

Functional task practice; Arm rehabilitation

Eligibility Criteria

Inclusion Criteria

• At least 18 years old
• Had stroke at least 6 months ago
• Right-hand dominant prior to stroke
• Some continued arm and hand weakness
• Some ability to move the arm and hand that is weaker from the stroke

Exclusion Criteria

• Acute medical issues that would interfere with participation
• Another neurologic diagnosis that may impact movement (e.g. Parkinson's Disease)
• Cannot undergo MRI scanning
• Severe apraxia or hemispatial neglect
• Pain in the arm that interferes with movement
• Difficulty maintaining attention or following directions

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of South Carolina

OTHER

Sponsor Role: lead

Responsible Party

Jill Stewart, PT, PhD

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

University of South Carolina

Columbia, South Carolina, United States

Countries

United States

Other Identifiers

Pro00032516

Identifier Type: -

Identifier Source: org_study_id