Fast Arm Motor Skill Training

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

44 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-06-15

Study Completion Date

2023-11-27

Brief Summary

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Every year, almost 800,000 people experience a stroke in the United States, which lead to upper-limb impairments, making recovery of motor function a priority in stroke rehabilitation. 1) The primary objective of this study is to determine whether fast arm movement training on a tracking task ("Speed-training"), in chronic stroke survivors with mild to moderate paresis, will generalize to improve arm function better than dose-equivalent accuracy training on the same task. 2) study the effect of intensive arm training on the recovery of anticipatory feedforward control. 3) Determine the involvement of cerebellar-cortical circuits in the recovery of arm movements due to speed training.

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Detailed Description

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About 65% of stroke survivors experience long-term limitations in upper extremity (UE) functions. In particular, limitations in arm reaching movements are prominent and correlate strongly with patients' impairment levels. Because activities of daily living often involve the UEs, retraining reach and grasp skills is critical for return to a full quality-of-life. Yet, the training parameters required for effective rehabilitation of UE function are not known. Recent evidence suggests that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke. Hence, fast movements generating large errors, would promote the restoration of the feedforward controllers and therefore improves arm movements and UE functions in individuals with chronic stroke. Because the cerebellum is involved in learning feedforward controllers from motor errors, the improvements would be proportional to the integrity of the cerebellar-cortical networks.

A double-blind quasi-randomized controlled study will be carried out in chronic post-stroke survivors. Participants will be assigned to either the speed-bias training group or a dose equivalent accuracy-bias training group (control) and will receive 4 days of training over a 1week period by a trained Occupational or physical therapist. Behavioral, EMG, and MRI data will be acquired within two weeks before, 3 days post, and one month after intervention.

Conditions

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Cerebrovascular Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Assessments will be done by a blinded and standardized clinical researcher

Study Groups

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Speed-biased complex motor skill training

Participants will perform 400 complex movements per day over 4 days over a one-week period. The task requires participants to navigate their hand through a "track" projected on the surface of a table with a width of 5cm. Participants receive adaptive score based on their movement time. .

Group Type ACTIVE_COMPARATOR

Fast intervention

Intervention Type BEHAVIORAL

This intervention is based on recent body of evidence that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke.Participants will be rewarded for movements performed within a short amount of time.

Accuracy-biased complex motor skill training

The accuracy-biased group receives a dose equivalent intervention with a emphasize on accuracy. The width of the track projected on the table is narrower (less than 2cm) and the adaptive score received are based on their accuracy to say within the boundary of the track.

Group Type OTHER

Active Monitoring

Intervention Type BEHAVIORAL

This is an observation-only group. The training received in this group will be dose equivalent to the active group.

Interventions

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Fast intervention

This intervention is based on recent body of evidence that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke.Participants will be rewarded for movements performed within a short amount of time.

Intervention Type BEHAVIORAL

Active Monitoring

This is an observation-only group. The training received in this group will be dose equivalent to the active group.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* At least 6 months following an ischemic supratentorial stroke
* At least 21 years of age
* Exhibit residual capability to move the paretic UE (Upper Extremity Fugl- Meyer motor score \>20/66)
* Able to follow a 2-step command (8th item on the MMSE test)
* Able to perform an unassisted arm reach movement of 25 cm ahead of the body within 5 seconds with trunk restraint
* Exhibit no greater than mild/moderate spasticity as assessed with a Modified Ashworth Score \< 3

Exclusion Criteria

* any neurologic diagnoses other than stroke
* peripheral movement restrictions, such as neuropathy
* orthopedic disorders affecting the paretic UE
* severe pain or sensory/proprioceptive impairment in the more affected UE
* visual neglect (more than 4% of lines left uncrossed on Albert's test).
* had a stroke directly affecting the cerebellum
* any contra-indications to MRI scanning
* mostly resolved impairments with an Upper Extremity Fugl- Meyer motor score \>58/66

Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No