Learning in Stroke

Neural Circuitries of Motor Learning as a Target to Modulate Sensorimotor Recovery After Stroke

After a stroke, plasticity occurs in the brain from microscopic to network level with positive but also negative consequences for functional recovery. Why post-stroke plasticity takes a beneficial or a maladaptive direction is still incompletely understood. Because the biological mechanisms underlying sensorimotor learning parallel those observed during recovery, learning mechanisms could be potential modifiers of post-stroke neuroplasticity and have a discrete mal-/adaptive impact on the recovery of sensorimotor function. This project seeks to further the understanding of the link between brain circuits that control the integration of new information during procedural learning in the injured brain and those circuits that are involved in adaptive plastic changes during recovery of sensorimotor function post-stroke. The project's methodological approach will allow the characterization of procedural learning-related neural network dynamics based on functional magnetic resonance imaging (MRI) in human volunteers with and without neurologically impairment post-stroke. Through multivariate integration of behavioral and biological descriptors of sensorimotor recovery, the project will investigate the association between motor learning-related network dynamics and descriptors of recovery.

Study Overview

• Status: Completed
• Conditions: Stroke; Sensorimotor Impairment
• Intervention / Treatment: Behavioral: Visuomotor learning task

• Study Type: Observational
• Enrollment (Actual): 40
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • South Carolina
    • Charleston, South Carolina, United States, 29425
      • Medical University of South Carolina

Participation Criteria

Eligibility Criteria

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

• Sampling Method: Non-Probability Sample

Study Population

Stroke survivors (>6 months) after their index lesion, ≥18 years of age. Healthy adults (≥18 years of age).

Description

INCLUSION CRITERIA

For all participants:

• adult volunteers (age ≥18 years)
• right-hand dominance as defined by the Edinburgh Handedness Inventory

Stroke-specific inclusion criteria:

• ischemic or hemorrhagic lesion
• subcortical or cortical tissue involvement
• chronic phase (>6 months) after their index lesion
• voluntary whole-hand grip force (MRC, Medical Research Council scale for muscle force ≥2)
• repeated release (standardized as a reduction of 50% of maximum voluntary contraction measured with a dynamometer)

EXCLUSION CRITERIA

For all participants:

• Presence of any MRI risk factors
• substance use disorder
• psychotic disorders

Stroke-group specific exclusion criteria:

• Primary intracerebral hematoma
• subarachnoid hemorrhage
• bi-hemispheric or cerebellar strokes
• other concomitant neurological disorders affecting upper extremity motor function
• documented history of dementia before or after stroke
• severe aphasia, particularly of receptive nature (NIHSS Language subsection ≥2), affecting their ability to understand the purpose of the study and give informed consent
• uncontrolled hypertension despite treatment
• intake of tricyclic anti-depressants or neuroleptic medication.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
control group	Behavioral: Visuomotor learning task; Participants undergo functional magnetic resonance imaging during the performance of the visuomotor learning task. The visuomotor learning task involves holding a device in the hand that measures the strength of the grip when squeezing the 'gripper'.
stroke group	Behavioral: Visuomotor learning task; Participants undergo functional magnetic resonance imaging during the performance of the visuomotor learning task. The visuomotor learning task involves holding a device in the hand that measures the strength of the grip when squeezing the 'gripper'.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Learning Rate as Indexed by Change in the Precision of Visuomotor Grip Force Adjustment (i.e., Reduction of Precision Error in Force Adjustment)	Isometric whole-hand grip force is captured continuously with grip-force transducers (at 1000Hz) and adjusted relative to the individual maximum voluntary contraction. Precision of force adjustment is based on the recorded muscle force monitored during task performance and defined as the actual force exerted by the participant relative to the target force (measurement unit: precision in %), with positive values indicating over- and negative values indicating undershoot. Learning rate from before to after learning will be defined as the difference in precision between before as compared to after one single learning session. Precision error was calculated as the percentage deviation of the actual grip force from the target force, averaged across trials before and after the learning task. A reduction in force error indexes a behavioral advantage of force adjustment over time and is thus interpreted as learning.	Pre Learning Session and Post Learning Session (approximately 90 minutes)
Change in Blood-oxygen-level-dependent (BOLD) Signal Derived Multi-voxel Brain Activation	Learning-related BOLD-signal-derived brain activation relative to motor performance.	Pre Learning Session and Post Learning Session (approximately 90 minutes)

Collaborators and Investigators

• Sponsor: Medical University of South Carolina
• Collaborators: National Institute of General Medical Sciences (NIGMS)

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2022
• Primary Completion (Actual): March 31, 2024
• Study Completion (Actual): September 30, 2025

Study Registration Dates

• First Submitted: August 9, 2022
• First Submitted That Met QC Criteria: August 20, 2022
• First Posted (Actual): August 23, 2022

Study Record Updates

• Last Update Posted (Estimated): October 20, 2025
• Last Update Submitted That Met QC Criteria: October 10, 2025
• Last Verified: October 1, 2025

More Information

Terms related to this study

• Keywords: maladaptive plasticity; procedural learning
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Stroke
• Other Study ID Numbers: 00116626; 5P20GM109040-10 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

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

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