Fatiguing Arm Exercise Following Stroke
1 de junio de 2020 actualizado por: VA Office of Research and Development
Neural Mechanisms Mediating Interlimb Transfer Following Stroke
This study investigates the effects of sub-maximal exercise to task-failure (e.g., fatigue) with the less involved, or so-called non-paretic hand, in people who have experienced a stroke.
In previous work the investigators found that non-paretic hand exercise to task-failure increased excitability of the motor cortex in the more involved hemisphere and produced behavioral improvements in the unexercised paretic hand.
Importantly, the magnitude of increased brain excitability is greater than what has been observed following brain stimulation with either repetitive transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) and lasts longer.
This approach could be implemented in the clinical setting and could be accessible to a greater number of people than brain stimulation.
The investigators' goals in the current study are to: repeat previous findings in a different group of participants and investigate the neural mechanisms that produce brain and behavioral facilitation in order to inform development of this approach for clinical implementation.
Descripción general del estudio
Descripción detallada
The long-term goal is to restore upper extremity (UE) motor function following stroke. The overall objective of this proposal is to improve the investigators' understanding of neural mechanisms contributing to inter-limb and inter-hemispheric transfer following non-paretic limb exercise to task failure. The investigators will use transcranial magnetic stimulation to probe acute adaptations in cortical excitability, intracortical and inter-hemispheric circuits that accompany behavioral facilitation of the paretic hand.
The work proposed in this two year project will enable the investigators to obtain three data elements critical to complete the working hypothesis:
- . Changes in intracortical and interhemispheric inhibition in both hemispheres following non-paretic limb exercise to task-failure.
- . Behavioral effects using a motor task involving manipulation and dexterity.
- . Determine the persistence and consistency of neural and behavioral facilitation.
Tipo de estudio
Intervencionista
Inscripción (Actual)
15
Fase
- No aplica
Contactos y Ubicaciones
Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.
Ubicaciones de estudio
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Florida
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Gainesville, Florida, Estados Unidos, 32608
- North Florida/South Georgia Veterans Health System, Gainesville, FL
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Criterios de participación
Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.
Criterio de elegibilidad
Edades elegibles para estudiar
18 años y mayores (Adulto, Adulto Mayor)
Acepta Voluntarios Saludables
No
Géneros elegibles para el estudio
Todos
Descripción
Inclusion Criteria:
- individuals at least 6 months post-stroke in the cortical or sub-cortical distribution with residual upper-extremity hemiparesis
- Non-Veteran Participants are eligible
Exclusion Criteria:
- multiple strokes
- strokes in both hemispheres
- brainstem/medullary/cerebellar stroke
- seizure disorder
- metal implants in head or neck
- pacemaker or other implanted device
- inability to produce any measurable grip force
Plan de estudios
Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Ciencia básica
- Asignación: N / A
- Modelo Intervencionista: Asignación de un solo grupo
- Enmascaramiento: Ninguno (etiqueta abierta)
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
|
Experimental: Task-failure, Extended Session
Repeated sub-maximal gripping exercise with the less affected hand to task-failure - followed by repeated measurements (5) during recovery period
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participants perform repeated gripping with visual feedback to task failure
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Short Intracortical Inhibition (SICI)
Periodo de tiempo: baseline, post task-failure (minutes to an hour), every 45 min up to 3.5 hours post-task-failure (7 points total)
|
SICI is a neurophysiologic measure of intra-cortical inhibition, obtained using transcranial magnetic stimulation (TMS) measured here in the ipsilesional hemisphere (IH) at each point to determine how it is modulated in response to task-failure.
SICI is quantified as a ratio where values <1 reflect inhibition and >1 disinhibition or relative excitation.
In health, SICI is ~0.5.
Thus if SICI = 0.8, while <1 it would indicate less inhibition than expected in health.
Transient change in SICI from 0.8 to 1.1 over the course of this experimental paradigm would reflect a period of relative excitation in response to the exercise paradigm.
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baseline, post task-failure (minutes to an hour), every 45 min up to 3.5 hours post-task-failure (7 points total)
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SICI Ratio
Periodo de tiempo: Baseline, pre-exercise of 8 repeated sessions
|
SICI is a neurophysiologic measure of intra-cortical inhibition, obtained using transcranial magnetic stimulation (TMS) measured here in the ipsilesional hemisphere (IH) at each point to determine how it is modulated in response to task-failure.
SICI is quantified as a ratio where values <1 reflect inhibition and >1 disinhibition or relative excitation.
In health, SICI is ~0.5.
Thus if SICI = 0.8, while <1 it would indicate less inhibition than expected in health.
Transient change in SICI from 0.8 to 1.1 over the course of this experimental paradigm would reflect a period of relative excitation in response to the exercise paradigm.
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Baseline, pre-exercise of 8 repeated sessions
|
Otras medidas de resultado
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Box and Blocks Test (BBT)
Periodo de tiempo: baseline, post task-failure (requires variable timeline from minutes to an hour), every 45 min up to 3.5 hours post-task-failure (7 points total)
|
The BBT measures motor function/dexterity, scored as the number of blocks transferred in 1 minute.
Here function of the paretic hand was measured at each time point: baseline, post-task failure, 45min post, 90min post, 135min post, 180min post, 225min post-task failure to determine the change in paretic hand BBT performance following exercise to task-failure.
Scores are numeric ranging from 0 (no blocks transferred) to whatever the participant is able to achieve.
Healthy age-matched adults without motor disability score in the range of 60 (+/- 10) blocks transferred in 1 minute.
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baseline, post task-failure (requires variable timeline from minutes to an hour), every 45 min up to 3.5 hours post-task-failure (7 points total)
|
|
Box and Blocks Test (BBT)
Periodo de tiempo: baseline, pre-exercise of 8 repeated sessions
|
The BBT measures motor function/dexterity, scored as the number of blocks transferred in 1 minute.
Here function of the paretic hand was measured prior to exercise at each of 8 repeated sessions conducted twice weekly for 4 weeks to determine the change in paretic hand BBT performance following repeated sessions of exercise to task-failure.
Scores are numeric ranging from 0 (no blocks transferred) to whatever the participant is able to achieve.
Healthy age-matched adults without motor disability score in the range of 60 (+/- 10) blocks transferred in 1 minute.
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baseline, pre-exercise of 8 repeated sessions
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Colaboradores e Investigadores
Aquí es donde encontrará personas y organizaciones involucradas en este estudio.
Patrocinador
Investigadores
- Investigador principal: Carolynn Patten, PhD, North Florida/South Georgia Veterans Health System, Gainesville, FL
Fechas de registro del estudio
Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.
Fechas importantes del estudio
Inicio del estudio (Actual)
1 de febrero de 2016
Finalización primaria (Actual)
21 de mayo de 2018
Finalización del estudio (Actual)
21 de mayo de 2018
Fechas de registro del estudio
Enviado por primera vez
14 de octubre de 2016
Primero enviado que cumplió con los criterios de control de calidad
20 de junio de 2017
Publicado por primera vez (Actual)
21 de junio de 2017
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
4 de junio de 2020
Última actualización enviada que cumplió con los criterios de control de calidad
1 de junio de 2020
Última verificación
1 de junio de 2020
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- N1759-P
Plan de datos de participantes individuales (IPD)
¿Planea compartir datos de participantes individuales (IPD)?
NO
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
No
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
No
producto fabricado y exportado desde los EE. UU.
No
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .
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