Interhemispheric Connectivity and Compensation

Interhemispheric Communication and Compensation in Peripheral Nerve Injury

The goal of this study is to determine which parts of the brain make it possible for some people to move skillfully with their left non-dominant hand.

Study Overview

• Status: Completed
• Conditions: Healthy; Peripheral Nerve Injury Upper Limb
• Intervention / Treatment: Other: STEGA-MRI

Detailed Description

This is a one-visit study, in which right-handed participants (individuals with unilateral peripheral nerve injury to the right upper limb, and healthy controls) will complete surveys and perform movement tasks. Movement tasks will be performed inside and outside a magnetic resonance imaging (MRI) scanner.

Some participants will also receive transcranial magnetic stimulation (TMS) to briefly interfere with these putative brain networks.

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Missouri
    • St Louis, Missouri, United States, 63108
      • Washington University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

This study contains two groups: typical controls and patients. Participants will be matched by age and sex between the two groups. No randomization will occur.

A. Inclusion criteria (all participants):

1. Age ≥ 18
2. English speaking and reading
3. Able to fit in Prisma scanner bore (60 cm diameter)
4. Right hand dominant (self report, and Edinburgh handedness ≥ +40)

B. Inclusion criteria (patients only):

1. Chronic unilateral upper extremity peripheral nerve injury to the right side

   • "Chronic" defined as ≥ 6 months since injury
   • "Upper extremity" defined as hand, arm, or shoulder (including e.g. brachial plexus)
   • "Injury" defined as localized cause (e.g. mechanical/tumor, not distributed pathology), including compression

2. Some impairment to writing, requiring both of:

   • Difficulty writing, as determined by score 2+ (Mild+) on "How much difficulty have you had in the last week with writing?" (From Disabilities of the Arm, Shoulder, and Hand survey question #2)
   • Box and Blocks motor performance ≥1 standard deviation below the mean of age-matched healthy adults (Mathiowetz et al. 1985, AJOT).

C. Exclusion criteria (all participants)

1. Currently intoxicated or otherwise non-compliant
2. Chronic pain diagnosis unrelated to the nerve injury
3. Uncorrected visual impairment that interferes with ability to see drawings in MRI
4. Motor function diagnoses that affect function of the left hand, now or in past 2 years

5. Motor function diagnoses currently affecting the right hand, unrelated to the nerve injury

   • This is not meant to exclude a single event with complex consequences (e.g. nerve and tendon)
   • This is not meant to exclude multiple nerve injuries in the same arm, if each one is eligible (II.B.1)
   • This is meant to exclude e.g. injury and unrelated musculoskeletal disorder in same arm
6. Upper extremity surgery, including peripheral nerve surgery, within last 2 months
7. Contraindication for MRI

8. Contraindication for transcranial magnetic stimulation (TMS)

   • May exclude from TMS only (since not all participants undergo TMS), or exclude from full study
9. Amputation affecting any part of thumb, index, or middle fingers (including higher level, e.g. whole hand)
10. History of chronic cocaine use (based on medical record or volunteered; will not actively inquire)

11. Diagnosis of schizophrenia or other rare psychiatric disorder

    • This is not meant to exclude depression or anxiety

12. History of major neurological diagnosis, e.g. stroke, traumatic brain injury, Alzheimer's, Parkinson's

    • This is not meant to exclude concussion UNLESS < 6 months ago, or post-concussion syndrome (diagnosed or self-report)

D. Exclusion criteria (controls only)

1. Motor function diagnoses that affect function of either hand, now or in past 2 years

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Basic Science
• 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: Movement task; All participants perform the STEGA-MRI (standardized tracing evaluation & grapheme assessment - MRI) precision drawing task during fMRI scanning. Motor assessments outside the MRI do not qualify as interventions.	Other: STEGA-MRI; Precision drawing task (movement assessment)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
BOLD (blood oxygen level dependent) signal in ROIs (regions of interest)	BOLD signal in key ROIs (primary motor and posterior parietal cortex). ROI selection may be revisited after preliminary data review (35 participants)	Day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Drawing smoothness	Velocity smoothness in STEGA-MRI (Standardized Tracing Evaluation and Grapheme Assessment - MRI version) task	Day 1
Hand choice	Percentage of grasps made with right hand	Day 1

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: National Institute of Neurological Disorders and Stroke (NINDS)
• Investigators: Principal Investigator: Benjamin A Philip, PhD, Washington University School of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): December 9, 2021
• Primary Completion (Actual): August 1, 2025
• Study Completion (Actual): August 1, 2025

Study Registration Dates

• First Submitted: December 25, 2021
• First Submitted That Met QC Criteria: January 11, 2022
• First Posted (Actual): January 26, 2022

Study Record Updates

• Last Update Posted (Estimated): October 9, 2025
• Last Update Submitted That Met QC Criteria: October 7, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: functional magnetic resonance imaging; movement; functional laterality; laterality of motor control
• Additional Relevant MeSH Terms: Nervous System Diseases; Wounds and Injuries; Neuromuscular Diseases; Peripheral Nervous System Diseases; Trauma, Nervous System; Peripheral Nerve Injuries
• Other Study ID Numbers: 202009183; R01NS114046-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

For participants who consent to us sharing their data with other researchers, we will share all anonymized data (behavioral, survey, and MRI), including data dictionaries.

Note that this clinical trial is a "prospective basic science study involving human participants;" i.e., a study that falls within the NIH definition of clinical trial while also meeting the definition of basic research.

• IPD Sharing Time Frame: Will become available after summary data are published. Will remain available indefinitely.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No