- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05381740
A Novel Brain Stimulation for Bimanual Motor Function and Control in Chronic Stroke
The long-term goal of this project is to develop and test upper Iimb rehabilitation interventions that can improve bimanual motor function, or the ability to use both arms and hands together, for stroke survivors with moderate to severe impairment.
This study will utilize a novel method of non-invasive brain stimulation in conjunction with upper limb training given for 12 visits over a period of 6 weeks.
The study will include the following site visits:
- Eligibility Screening and Informed Consent Visit
- Baseline testing (4 visits total): 1 visit each for MRI, upper limb and bimanual motor function test, bimanual motor control, and neurophysiology related to control of the upper limbs
- Repeat baseline testing (4 visits total) of MRI, upper limb and bimanual motor function test, bimanual motor control, and neurophysiology related to control of the upper limbs
- 12 intervention visits during which patients will receive upper limb therapy in conjunction with non-invasive brain stimulation
- Repeat testing (4 visits total) of MRI, upper limb and bimanual motor function test, bimanual motor control, and neurophysiology related to control of the upper limbs
- A follow-up visit 1 month after the completion of interventions
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Estimated)
Phase
- Early Phase 1
Contacts and Locations
Study Contact
- Name: Kyle J. O'Laughlin, MS
- Phone Number: 216-445-6728
- Email: olaughk@ccf.org
Study Contact Backup
- Name: Xin Li, MD, PhD
- Phone Number: 216-445-6728
- Email: LIX10@ccf.org
Study Locations
-
-
Ohio
-
Cleveland, Ohio, United States, 44195
- Recruiting
- Lerner Research Institute, Cleveland Clinic Foundation
-
Contact:
- Xin Li, MD, PhD
- Phone Number: 216-445-6728
- Email: LIX10@ccf.org
-
Contact:
- Morgan Widina, BS
- Phone Number: 866-449-1394
- Email: widinam@ccf.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age 18-90 yrs
- ≥6 months since first clinical stroke
- Impairment of the paretic hand, indicated by a score of <= 11 out of 14 on the hand section of UEFM
- Sufficient range of motion in the wrist and fingers for functional task practice: have at least 10 degrees active wrist extension, 10 degrees active thumb abduction/extension, and 10 degrees active extension in at least 2 additional digits
- Sufficient active shoulder and elbow movement to volitionally position the paretic hand in the workspace for table-top task practice
Exclusion Criteria:
- Brainstem or cerebellar stroke
- Bilateral strokes or multiple strokes affecting sensorimotor structures
- Cognitive impairment (Mini-Mental State Examination <24)
- Severe impairment of the paretic hand that limits functional task practice (UEFM hand score < 4 out of 14)
- Severe spasticity (Modified Ashworth Scale >3) or upper limb contracture
- Occupational therapy or upper limb Botox completed ≤ 2 months prior
- Contraindications to TMS or MRI (e.g. metal implant in head, seizure history, cardiac pacemaker)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: cHMC rTMS + Upper Limb Training Training
Real Repetitive Transcranial Magnetic Stimulation given to facilitate the Contralesional Higher Motor Cortices+ Upper Limb Training
|
Participants in this arm will receive rTMS-based facilitation of the contralesional higher motor cortices located in the non-stroke hemisphere before the start of each rehabilitation session.
High-frequency rTMS (5Hz) will be delivered using 42 10 second trains of 50 pulses each (total 2100 pulses) for a period of 22 minutes.
Immediately after the completion of rTMS, participants will undergo therapist-guided upper limb therapy for a total of one hour.
Participants will receive these interventions 2 days a week for 6 weeks for a total of 12 sessions.
|
Sham Comparator: Sham rTMS + Upper Limb Training Training
Sham Repetitive Transcranial Magnetic Stimulation over Contralesional Higher Motor Cortices+ Upper Limb Training
|
Participants in this arm will receive sham rTMS given over the contralesional higher motor cortices located in the non-stroke hemisphere before the start of each rehabilitation session.
Immediately after the completion of sham rTMS, participants will undergo therapist-guided upper limb therapy for a total of one hour.
Participants will receive these interventions 2 days a week for 6 weeks for a total of 12 sessions.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Bimanual Assessment Measure (BAM)
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Measure of the functional ability to perform 11 bimanual tasks scoring the spontaneous role of the affected hand, timing, and quality of movement.
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Bimanual Grip Force Modulation Task
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Measure the ability to produce and maintain differing levels of force using hand dynamometers.
This measurement represents patient's ability to perform independent tasks with each hand.
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Change in ABILHAND
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
ABILHAND assesses the participant's perception of bimanual ability by rating the difficulty of performing 23 bimanual activities without assistance on a 3 point ordinal scale (impossible, difficult, easy) This test has excellent reliability (ICC = 0.85-0.91).
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Change in Upper Extremity Fugyl-Meyer Score (UEFM)
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Impairment will be measured using UEFM, one of the most widely used assessments in stroke.
UEFM will serve as our primary outcome because it is sensitive to discerning the effects of rTMS/rehabilitation, and has excellent reliability (ICC= 0.97), consistency (Cronbach's α= 0.84) and validity.
UEFM has a score ranging from 0-66 (0 meaning there is no movement of the paretic arm, and 66 meaning there is no functional limitation of the paretic arm.)
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Change in Wolf Motor Function Test (WMFT)
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Functional ability to use the paretic upper limb in a variety of tasks will be assessed using WMFT.
Time to complete each task will be noted and converted to rate (60/Performance Time (sec)), optimized for measurement in moderately/severely-impaired patients.
Grip strength will also be recorded with WMFT.
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks) and after end of 1 month of follow-up.
|
Change Resting State Functional Magnetic Resonance Imaging(rsfMRI)
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks)
|
Functional connectivity will assess the connectivity between cHMC and iM1 using temporal correlation of blood oxygneation level-dependent (BOLD) signal given as z-scores.
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks)
|
Change in excitability of cortical and corticospinal physiology (TMS)
Time Frame: Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks)
|
Transcranial magnetic stimulation will be used to test crossed and uncrossed output from both hemispheres and will be measured as motor evoked potentials(MEPS) of the Extensor Digitorum Communis (EDC).
|
Baseline (0 weeks and 2 weeks), after intervention(up to 7 weeks)
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Ela Plow, PhD, The Cleveland Clinic
Publications and helpful links
General Publications
- Haaland KY, Mutha PK, Rinehart JK, Daniels M, Cushnyr B, Adair JC. Relationship between arm usage and instrumental activities of daily living after unilateral stroke. Arch Phys Med Rehabil. 2012 Nov;93(11):1957-62. doi: 10.1016/j.apmr.2012.05.011. Epub 2012 May 24.
- Sankarasubramanian V, Machado AG, Conforto AB, Potter-Baker KA, Cunningham DA, Varnerin NM, Wang X, Sakaie K, Plow EB. Inhibition versus facilitation of contralesional motor cortices in stroke: Deriving a model to tailor brain stimulation. Clin Neurophysiol. 2017 Jun;128(6):892-902. doi: 10.1016/j.clinph.2017.03.030. Epub 2017 Mar 21.
- Liao WW, Whitall J, Wittenberg GF, Barton JE, McCombe Waller S. Not all brain regions are created equal for improving bimanual coordination in individuals with chronic stroke. Clin Neurophysiol. 2019 Aug;130(8):1218-1230. doi: 10.1016/j.clinph.2019.04.711. Epub 2019 May 13.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 22-074
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Stroke
-
University Hospital, GhentRecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Stroke HemorrhagicBelgium
-
Moleac Pte Ltd.RecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, CryptogenicSingapore, Philippines
-
Moleac Pte Ltd.Not yet recruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, Cryptogenic
-
IRCCS San Camillo, Venezia, ItalyRecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke HemorrhagicItaly
-
Vanderbilt University Medical CenterPatient-Centered Outcomes Research Institute; University of Alabama at BirminghamEnrolling by invitationStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Engagement, Patient | Stroke HemorrhagicUnited States
-
University of MinnesotaAmerican Occupational Therapy FoundationRecruitingStroke | Stroke Sequelae | Stroke Hemorrhagic | Stroke IschemicUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Michael Smith Foundation for...RecruitingStroke | Stroke, Ischemic | Stroke Hemorrhagic | Chronic StrokeCanada
-
University of CincinnatiMedical University of South Carolina; University of California, Los Angeles; University...RecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke HemorrhagicUnited States
-
Turkish Stroke Research and Clinical Trials NetworkElectroCore INC; Turkish Neurological SocietyCompletedStroke | Stroke, Ischemic | Stroke, Acute | Stroke, HemorrhagicTurkey
-
University of LiegeCompletedStroke, Acute | Stroke Hemorrhagic | Stroke, ComplicationBelgium
Clinical Trials on Novel rTMS Approach
-
The Cleveland ClinicAmerican Heart AssociationCompleted
-
Denise Hodgson-ZingmanCompletedCardiomyopathies | Conditioning | Heart RateUnited States
-
BaycrestCompletedTraumatic Brain Injury | Acquired Brain Injury | Cerebrovascular Accident (CVA)Canada
-
The Cleveland ClinicEunice Kennedy Shriver National Institute of Child Health and Human Development...RecruitingStroke | Hemiplegia | Hemiparesis | Cerebrovascular Accident (CVA)United States
-
Hvidovre University HospitalAalborg University; University College CopenhagenActive, not recruitingApophysitis | Osgood-Schlatter Disease | Osteochondrosis; Tibia | Physeal InjuryDenmark
-
Centre Integre Universitaire de Sante et Services...Canadian Institutes of Health Research (CIHR)Not yet recruitingHyperkalemia, Diminished Renal ExcretionCanada
-
Kafrelsheikh UniversityRecruitingDental Implant Failed | Implant ComplicationEgypt
-
University of North Carolina, Chapel HillNational Institutes of Health (NIH)Completed
-
Charite University, Berlin, GermanyRecruitingPulmonary Valve InsufficiencyGermany
-
Chang Gung Memorial HospitalMinistry of Science and Technology, TaiwanRecruiting