Using Real-time fMRI Neurofeedback and Motor Imagery to Enhance Motor Timing and Precision in Cerebellar Ataxia
Study Details
Study Description
Brief Summary
The aim of the research is to improve motor function in people with cerebellar ataxia by using neuroimaging methods and mental imagery to "exercise" motor networks in the brain. The relevance of this research to public health is that results have the potential to reduce motor deficits associated with cerebellar atrophy, thereby enhancing the quality of life and promoting independence.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Real time neurofeedback with task Participants will undergo a real-time fMRI scan during which two distinct tasks will be performed. |
Device: Neurofeedback treatment
During the fMRI scan, the tasks consist of:
Overt finger tapping in time with a flashing cue.
Motor imagery (of finger tapping).
During overt finger tapping, feedback will consist of a slider bar that indicates tapping accuracy to target speed (1 or 4Hz). During motor imagery, neurofeedback will consist of a slider bar that indicates the success of recruiting predicted brain regions (consistent with those engaged during overt tapping).
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| Other: Overt tapping and/or motor imagery practice Participants will undergo an overt tapping task at baseline. Participants are assigned to a group where the participants will then perform respective motor and/or imagery tasks at home for 3 weeks. |
Behavioral: At-home therapy
Participants are assigned to groups where the participants will practice each day for 3 weeks at-home.
Group 1: Imagery only.
Group 2: Overt finger tapping only.
Group 3: Imagery plus overt finger tapping.
During imagery, participants will view the task while imagining that the participants are finger tapping in time with the flashing cue, using the imagery strategies identified during participants' previous neurofeedback session. During overt tapping, participants will finger tap in time with the flashing cue. A final assessment of overt tapping will be performed the day after therapy ends.
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Outcome Measures
Primary Outcome Measures
- Change in overt tapping accuracy as assessed by finger tapping to a flashing cue at 1Hz speed [Baseline and MRI duration, up to 1 hour]
During the MRI session, accuracy on overt tapping will be measured by the distance of the actual tapping rate vs. target rate (1Hz). Accuracy at baseline will be compared to that of final assessment, which will take place before and after neurofeedback training, respectively. The difference in accuracy between the two tests create a delta measure (i.e., fewer errors in the final vs. baseline tests). This delta accuracy will indicate the magnitude of tapping accuracy improvements. Root mean squared error (RMSE) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 1 tap for 1Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task.
- Change in overt tapping accuracy as assessed by finger tapping to a flashing cue at 4Hz speed [Baseline and MRI duration, up to 1 hour]
During the MRI session, accuracy on overt tapping will be measured by the distance of the actual tapping rate vs. target rate (4Hz). Accuracy at baseline will be compared to that of final assessment, which will take place before and after neurofeedback training, respectively. The difference in accuracy between the two tests create a delta measure (i.e., fewer errors in the final vs. baseline tests). This delta accuracy will indicate the magnitude of tapping accuracy improvements. RMSE (root mean squared error) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 4 taps for 4Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task.
- Change in at-home overt tapping accuracy as assessed by finger tapping to a flashing cue at 1Hz speed [Baseline and At-home sessions (10 minutes/day), up to 23 days]
Accuracy at baseline will be compared to that of final assessment, which will take place before and after the 3-week at-home practice sessions, respectively. The delta measure will indicate the magnitude of tapping accuracy improvements. Groups will be compared to examine differences in delta as a function of practice condition (imagery only, tapping only, or imagery plus tapping). At-home tapping performance will be compared to MRI tapping performance. RMSE (root mean squared error) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 1 tap for 1Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task.
- Change in at-home overt tapping accuracy as assessed by finger tapping to a flashing cue at 4Hz speed [Baseline and At-home sessions (10 minutes/day), up to 23 days]
Accuracy at baseline will be compared to that of final assessment, which will take place before and after the 3-week at-home practice sessions, respectively. The delta measure will indicate the magnitude of tapping accuracy improvements. Groups will be compared to examine differences in delta as a function of practice condition (imagery only, tapping only, or imagery plus tapping). At-home tapping performance will be compared to MRI tapping performance. RMSE (root mean squared error) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 4 taps for 4Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task.
Secondary Outcome Measures
- The correlation between MRI BOLD and finger tapping accuracy to a flashing cue at 1Hz as assessed by a correlation coefficient [MRI duration, up to 1 hour]
This will assess the correlation between MRI Blood Oxygen Level Dependence (BOLD) and finger tapping accuracy by a correlation coefficient. The correlation coefficient ranging from -1 to 1, where the closer the coefficient is to -1 indicates a negative association and the closer the coefficient is to 1 indicates a strong positive association.
- The correlation between MRI BOLD and finger tapping accuracy to a flashing cue at 4Hz as assessed by a correlation coefficient [MRI duration, up to 1 hour]
This will assess the correlation between MRI BOLD (Blood Oxygen Level Dependence) and finger tapping accuracy by a correlation coefficient. The correlation coefficient ranging from -1 to 1, where the closer the coefficient is to -1 indicates a negative association and the closer the coefficient is to 1 indicates a strong positive association.
- The correlation between the KVIQ and imagery accuracy of the slider bar from target on the MRI task as assessed by a correlation coefficient [Up to 1.5 hours]
The Kinesthetic and Visual Imagery Questionnaire (KVIQ), overall score ranging from 0-100, where higher scores reflect more vivid imagery) will assess imagery vividness. This will be correlated with the image accuracy measures described in Secondary Outcome Measure 5'.
- The correlation between the ICARS and imagery accuracy of the slider bar from target on the MRI task as assessed by a correlation coefficient [Up to 1.5 hours]
The International Cooperative Ataxia Rating Scale (ICARS), overall score ranging from 0-100, where higher scores indicate more severe neurological impairment) will assess neurological impairments. This will be correlated with image accuracy measures described in 'Secondary Outcome Measure 5'.
Eligibility Criteria
Criteria
Inclusion Criteria:
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18-100 years of age
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At least 8th-grade education
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Right-handedness
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Clinical diagnosis of progressive, degenerative cerebellar ataxia by a movement disorder specialist (cerebellar ataxia of unknown etiology, and spinocerebellar ataxias with and without genetic confirmation)
Exclusion Criteria:
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History of Axis I psychiatric disorders (including alcohol and drug dependence)
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Severe or unstable medical disorder, neurological disorders, such as stroke or epilepsy
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History of head injury that resulted in a loss of consciousness greater than 5 minutes and/or neurological sequelae
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Any condition that is contraindicated for the MRI environment (e.g., metal in the body, pacemaker, claustrophobia)
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Currently pregnant
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Clinical diagnosis of multiple system atrophy (MSA) or Friedrich's ataxia (FA)
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Eligible subjects may be asked to refrain from medications that affect the central nervous system that would also make data difficult to interpret (e.g., sedatives) for an appropriate period of time prior to scanning
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Participants will be excluded if the participants do not have a home computer with internet available to complete the 3-week at-home component of the study protocol
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Johns Hopkins University School of Medicine | Baltimore | Maryland | United States | 21205 |
Sponsors and Collaborators
- Johns Hopkins University
- Virginia Polytechnic Institute and State University
- National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
- Principal Investigator: Cherie Marvel, PhD, Johns Hopkins University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- IRB00300264
- R21NS125546