Investigating How Sleep After Training Can Affect the Learning of a Motor Skill in Individuals With Brain Injury

NCT ID: NCT04810442

Last Updated: 2021-03-23

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 40 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2020-02-18
• Study Completion Date: 2022-03-31

Brief Summary

Studies have shown that a period of sleep, even in the form of a daytime nap, after a period of training on a motor learning task can boost subsequent performance beyond that observed after an equal amount of time spent awake and resting. This leap in performance has been referred to as "off-line" motor learning because it occurs during a period of sleep in the absence of additional practice. Motor learning is an integral part of the physical and occupational therapy that patients receive after traumatic brain injury (TBI) in which various activities of daily living may need to be relearned. Targeted motor skills may include dressing (learning how to zip up a jacket or button a shirt), using a fork and knife to eat, or using technology (tapping touch screen on a cell phone or typing on a computer). Yet the potential of sleep in the form of a strategic nap as a therapeutic tool to maximize motor learning in rehabilitation therapies has not been fully realized. In addition, a growing body of research among healthy individuals has shown evidence of changes in the brain associated with enhanced performance among those who slept following training compared with those who spent the same amount of time awake. The neural mechanisms of "off-line" motor learning have not been studied among individuals with TBI. Using functional neuroimaging and measurement of brain waves, the current study will examine the mechanisms underlying this sleep-related enhancement of motor learning among individuals with TBI and determine how brain physiology may influence the magnitude of the effect. By understanding how this treatment works and identifying the factors that modulate its effectiveness we can identify which individuals will be most likely to benefit from a nap after training to improve motor learning after TBI. This can provide a more person-centered approach to treatment delivery that can maximize the effectiveness of a simple but potent behavioral intervention.

Detailed Description

Procedural memory is vitally important to the efficacy of rehabilitation following Traumatic Brain Injury (TBI). Specifically, during rehabilitation, persons with TBI must re-learn many motor skills associated with activities of daily living to improve functional outcomes. Emerging research on neuroplasticity after brain damage is beginning to increase our understanding of motor learning principles and how they interact with the training that takes place in neurorehabilitation.

There is a strong body of evidence showing the importance of sleep in procedural learning among healthy individuals. Within this body of research on sleep and procedural learning, there is substantial evidence demonstrating sleep-dependent neuroplasticity. Participants trained on a motor learning task show improvements over the training period, as expected. However, when re-tested after a period of sleep, performance is significantly better than when retested after an equivalent period of time awake. The actual enhancement of a learned motor skill in the absence of additional practice trials suggests that one can decrease the time necessary for learning a motor skill by incorporating a daytime nap after a period of training. The implications of these findings can be ground-breaking when applied to brain injury rehabilitation where motor learning may be a major focus of physical and occupational therapies. There is evidence of a positive impact of sleep on procedural memory and rehabilitation progress among older individuals after stroke, and the investigators have pilot data showing a substantial positive effect of a post-training nap on motor learning in an acquired brain injury sample. However, the neural mechanisms involved in this process after traumatic brain injury are less understood.

Among healthy individuals, there are numerous studies examining neural biomarkers that can quantify the effect of sleep on motor learning. Studies have reported that changes in sleep physiology and neural activation after training correlate with the degree of improvement at post-intervention testing. Studies showed that, after a nap of 60-90 minutes, speed of performance was enhanced, and the degree of enhancement was associated with the duration of stage 2 non-rapid eye movement (NREM) sleep. This relationship with stage 2 NREM sleep has also been shown after a 20-minute nap. In addition, changes in neural activation in the striatum have been found to be more pronounced when individuals slept after training than when they remained awake. In another study in which a night of sleep occurred between training and retest, changes in striatal activity were correlated with performance gains on the motor learning task. This study also showed evidence of EEG changes during sleep after the training period in the amount of sleep-spindle activity, a waveform associated with stage 2 NREM sleep.

While our preliminary findings show evidence of off-line motor learning after a nap among individuals with acquired brain injury, research into the mechanisms of action driving this response among individuals with TBI is lacking. A better understanding of neurophysiology and its influence on the magnitude of the effect is a crucial step in determining which individuals would be likely to benefit from this behavioral intervention.

Specific Aim 1-Behavioral Intervention: In a sample of individuals with TBI living in the community, demonstrate greater improvement on a motor sequence learning task after a daytime nap compared with an equivalent time spent awake and resting. This aim will also explore the individual differences in terms of demographics and injury characteristics contributing to the magnitude of the effect.

Hypothesis 1. Individuals exposed to a nap after a period of training on the motor sequence learning task will demonstrate greater improvement in speed and accuracy from the end of training to the post-nap retesting.

Research Question 1. How does the magnitude of the effect correlate with demographic factors and injury characteristics? Specific Aim 2-Functional Neuroimaging: To examine the neural correlates of off-line motor learning among individuals with TBI who were given a nap after training on the motor sequence learning task using functional MRI compared with a control group who received an equivalent period of time awake.

Hypothesis 2. Individuals in the nap group will show more pronounced changes in activation within the striatum and motor cortex compared with those who remained awake and resting.

Specific Aim 3-Sleep Physiology: To examine aspects of stage 2 sleep associated with performance gains (duration of stage 2 and degree of spindle activity) occurring during the nap period after training.

Hypothesis 3a. Among participants in the nap group, there will be a significant positive correlation between the degree of improvement and the duration of stage 2 sleep.

Hypothesis 3b. Among participants in the nap group, there will be a significant positive correlation between the degree of improvement and density of sleep spindles.

Conditions

Traumatic Brain Injury

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: BASIC_SCIENCE
• Blinding Strategy: NONE

Study Groups

Nap Group

This group will be involved with taking a nap in between the two scanning procedures.

Group Type: EXPERIMENTAL

Nap

Intervention Type: OTHER

45-minute nap between scanning procedures

No-Nap Group

This group will not be taking a nap in between the two scanning procedures, and instead will be silently watching a film for the 45 minute period.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Nap

45-minute nap between scanning procedures

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• I am between the ages of 18-65
• I have a diagnosis of a moderate to severe Traumatic Brain Injury
• I am at least 1 year post-injury
• I am a habitual napper (I nap at least once per week) or I am able to fall asleep in a comfortable reclining chair in a dimly lit room
• I am right handed
• I can read and speak English fluently

Exclusion Criteria

• I am pregnant
• I have had a prior stroke or neurological disease
• I have a history of significant psychiatric illness
• I am unable to demonstrate fine motor movements by touching each of my fingers to my thumb on the same hand
• I am taking dopaminergic medication.
• I have a significant alcohol or drug abuse history
• My vision is impaired - more than 20/60 in worst eye
• I have previous experience in playing a musical instrument
• I have been told by my doctor that it is unsafe for me to receive regular MRI
• I have non-titanium metal in my body or something in my body in which will keep me from being still in the MRI
• I have a movement disorder in which will keep me from being still in the MRI

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 65 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Kessler Foundation

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Anthony Lequerica, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Kessler Foundation

Locations

Kessler Foundation

East Hanover, New Jersey, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Anthony Lequerica, Ph.D.

Role: CONTACT

alequerica@kesslerfoundation.org

973-324-8454

Paige Rusnock, B.A.

Role: CONTACT

prusnock@kesslerfoundation.org

973-324-8436

Facility Contacts

Anthony Lequerica, Ph.D.

Role: primary

alequerica@kesslerfoundation.org

973-324-8454

Angela Spirou, M.A.

Role: backup

aspirou@kesslerfoundation.org

973-324-8394

References

Kleim JA. Neural plasticity and neurorehabilitation: teaching the new brain old tricks. J Commun Disord. 2011 Sep-Oct;44(5):521-8. doi: 10.1016/j.jcomdis.2011.04.006. Epub 2011 Apr 30.

Reference Type: BACKGROUND

PMID: 21600589 (View on PubMed)

Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol. 2006 Feb;19(1):84-90. doi: 10.1097/01.wco.0000200544.29915.cc.

Reference Type: BACKGROUND

PMID: 16415682 (View on PubMed)

Nudo RJ. Neural bases of recovery after brain injury. J Commun Disord. 2011 Sep-Oct;44(5):515-20. doi: 10.1016/j.jcomdis.2011.04.004. Epub 2011 Apr 30.

Reference Type: BACKGROUND

PMID: 21600588 (View on PubMed)

Smith C, MacNeill C. Impaired motor memory for a pursuit rotor task following Stage 2 sleep loss in college students. J Sleep Res. 1994 Dec;3(4):206-213. doi: 10.1111/j.1365-2869.1994.tb00133.x.

Reference Type: BACKGROUND

PMID: 10607127 (View on PubMed)

Walker MP, Brakefield T, Morgan A, Hobson JA, Stickgold R. Practice with sleep makes perfect: sleep-dependent motor skill learning. Neuron. 2002 Jul 3;35(1):205-11. doi: 10.1016/s0896-6273(02)00746-8.

Reference Type: BACKGROUND

PMID: 12123620 (View on PubMed)

Walker MP, Stickgold R, Alsop D, Gaab N, Schlaug G. Sleep-dependent motor memory plasticity in the human brain. Neuroscience. 2005;133(4):911-7. doi: 10.1016/j.neuroscience.2005.04.007.

Reference Type: BACKGROUND

PMID: 15964485 (View on PubMed)

Walker MP. Sleep-dependent memory processing. Harv Rev Psychiatry. 2008;16(5):287-98. doi: 10.1080/10673220802432517.

Reference Type: BACKGROUND

PMID: 18803104 (View on PubMed)

Walker MP, Stickgold R. Sleep, memory, and plasticity. Annu Rev Psychol. 2006;57:139-66. doi: 10.1146/annurev.psych.56.091103.070307.

Reference Type: BACKGROUND

PMID: 16318592 (View on PubMed)

Milner CE, Fogel SM, Cote KA. Habitual napping moderates motor performance improvements following a short daytime nap. Biol Psychol. 2006 Aug;73(2):141-56. doi: 10.1016/j.biopsycho.2006.01.015. Epub 2006 Mar 15.

Reference Type: BACKGROUND

PMID: 16540232 (View on PubMed)

Korman M, Doyon J, Doljansky J, Carrier J, Dagan Y, Karni A. Daytime sleep condenses the time course of motor memory consolidation. Nat Neurosci. 2007 Sep;10(9):1206-13. doi: 10.1038/nn1959. Epub 2007 Aug 12.

Reference Type: BACKGROUND

PMID: 17694051 (View on PubMed)

Siengsukon CF, Boyd LA. Sleep enhances implicit motor skill learning in individuals poststroke. Top Stroke Rehabil. 2008 Jan-Feb;15(1):1-12. doi: 10.1310/tsr1501-1.

Reference Type: BACKGROUND

PMID: 18250068 (View on PubMed)

Nishida M, Walker MP. Daytime naps, motor memory consolidation and regionally specific sleep spindles. PLoS One. 2007 Apr 4;2(4):e341. doi: 10.1371/journal.pone.0000341.

Reference Type: BACKGROUND

PMID: 17406665 (View on PubMed)

Backhaus J, Junghanns K. Daytime naps improve procedural motor memory. Sleep Med. 2006 Sep;7(6):508-12. doi: 10.1016/j.sleep.2006.04.002. Epub 2006 Aug 23.

Reference Type: BACKGROUND

PMID: 16931152 (View on PubMed)

Debas K, Carrier J, Orban P, Barakat M, Lungu O, Vandewalle G, Hadj Tahar A, Bellec P, Karni A, Ungerleider LG, Benali H, Doyon J. Brain plasticity related to the consolidation of motor sequence learning and motor adaptation. Proc Natl Acad Sci U S A. 2010 Oct 12;107(41):17839-44. doi: 10.1073/pnas.1013176107. Epub 2010 Sep 27.

Reference Type: BACKGROUND

PMID: 20876115 (View on PubMed)

Fogel S, Albouy G, King BR, Lungu O, Vien C, Bore A, Pinsard B, Benali H, Carrier J, Doyon J. Reactivation or transformation? Motor memory consolidation associated with cerebral activation time-locked to sleep spindles. PLoS One. 2017 Apr 19;12(4):e0174755. doi: 10.1371/journal.pone.0174755. eCollection 2017.

Reference Type: BACKGROUND

PMID: 28422976 (View on PubMed)

Other Identifiers

R-1061-19

Identifier Type: -

Identifier Source: org_study_id