Action Selection and Arm Rehabilitation After Stroke

Targeted Engagement of the Motor Action Selection Network During Arm Rehabilitation After Stroke

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.

Study Overview

• Status: Completed
• Conditions: Stroke
• Intervention / Treatment: Behavioral: Arm Training with Action Selection

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.

• Study Type: Interventional
• Enrollment (Actual): 32
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • South Carolina
    • Columbia, South Carolina, United States, 29208
      • University of South Carolina

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: 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.

Behavioral: 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.; Other Names: Functional task practice; Arm rehabilitation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Action Research Arm Test	Behavioral assessment of arm function. Scores range from 0 to 57 with a higher score equating to better function.	Change from baseline to end of treatment (3 weeks)
Brain activation during functional MRI	Brain activation during movement will be captured with functional MRI. Analyses will investigate changes in magnitude of activation.	Change from baseline to end of treatment (3 weeks)
Brain connectivity during functional MRI	Brain activation during movement will be captured with functional MRI. Analyses will investigate changes in connectivity between brain regions.	Change from baseline to end of treatment (3 weeks)

Secondary Outcome Measures

Outcome Measure	Time Frame
Upper Extremity Fugl-Meyer Motor Assessment	Change from baseline to end of treatment (3 weeks)
Stroke Impact Scale Hand Domain	Change from baseline to end of treatment (3 weeks)
Box & Blocks Test	Change from baseline to end of treatment (3 weeks)
9-Hole Peg Test	Change from baseline to end of treatment (3 weeks)
Grip Strength	Change from baseline to end of treatment (3 weeks)
Confidence in Arm and Hand Movements Questionnaire	Change from baseline to end of treatment (3 weeks)

Collaborators and Investigators

• Sponsor: University of South Carolina

Study record dates

Study Major Dates

• Study Start (Actual): December 8, 2015
• Primary Completion (Actual): December 1, 2020
• Study Completion (Actual): December 1, 2020

Study Registration Dates

• First Submitted: May 9, 2016
• First Submitted That Met QC Criteria: May 24, 2016
• First Posted (Estimate): May 27, 2016

Study Record Updates

• Last Update Posted (Actual): July 23, 2021
• Last Update Submitted That Met QC Criteria: July 16, 2021
• Last Verified: July 1, 2021

More Information

Terms related to this study

• Keywords: Rehabilitation; Physical Therapy; Upper Extremity
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Stroke
• Other Study ID Numbers: Pro00032516