Upper Limb-based Movement Priming for Lower Limb Neuroplasticity & Motor Recovery in Stroke
Study Details
Study Description
Brief Summary
The goal of this clinical trial is to to determine the effect of movement-based priming using the upper limbs on lower limb neuroplasticity and behaviors in chronic stroke.
The main questions we aim to answer are:
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What are the acute effect of UL-priming on lower limb neuroplasticity and motor behaviors in persons with stroke compared to other priming modalities?
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What are the time effects of UL-priming on neuroplasticity and motor behavior in individuals with stroke?
In this cross over study, participants will be involved in three priming sessions involving
- UL-priming using rhythmic, bilateral priming involving the movement of at least one major joint in the upper limbs.
AND
- Sham priming using auditory stimulation (1 Hz metronome).
AND
- Stimulation-based priming using anodal transcranial direct current stimulation (tDCS).
OR
- Lower-limb movement-based priming using aerobic exercise on a treadmill or recumbent stepper.
Researchers will compare outcome measures between the different priming sessions.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Upper limb-based movement priming (UL-priming) The upper limb priming task will include rhythmic, bilateral priming involving the movement of at least one major joint in the upper limbs (shoulder, elbow, wrist). |
Other: Upper limb-based movement priming (UL-priming)
Repetitive upper limb movements administered to the beat of a metronome.
|
| Active Comparator: Stimulation-based priming (Stim priming) Participants will receive facilitatory transcranial direct current stimulation (tDCS) through a constant current stimulator. |
Other: Stimulation-based priming (Stim priming)
Noninvasive brain stimulation.
|
| Active Comparator: Lower limb-based movement priming (LL-priming) Participants will perform high-intensity interval-based aerobic exercise on a treadmill or recumbent stepper. |
Other: Lower limb-based movement priming (LL-priming)
Aerobic exercise using a treadmill or recumbent stepper.
|
| Sham Comparator: Sham priming Participants will listen to a 1 Hz metronome for 20 minutes as a form of auditory stimulation during the sham priming session. |
Other: Sham priming
Auditory stimulation.
|
Outcome Measures
Primary Outcome Measures
- Corticomotor excitability using transcranial magnetic stimulation (TMS) [Change from baseline to immediately after priming, to 30 minutes after priming, and to 60 minutes after priming.]
Single-pulse transcranial magnetic stimulation (TMS) will be used to assess the corticomotor excitability from the tibialis anterior muscles.
- Spinal H-reflex excitability using peripheral nerve stimulation (PNS) [Change from baseline to immediately after priming, to 30 minutes after priming, and to 60 minutes after priming.]
Peripheral nerve stimulation (PNS) will be used to assess the H reflexes excitability from the soles muscles.
- Motor control [Change from baseline to immediately after priming, to 30 minutes after priming, and to 60 minutes after priming.]
Motor control will be assessed by making participants track a computer-generated sinusoidal target during an ankle tracking task with ankle dorsiflexion and plantarflexion in a custom-built ankle-tracking device.
Secondary Outcome Measures
- Gait speed [Change from baseline to immediately after priming, to 30 minutes after priming, and to 60 minutes after priming.]
Self-selected and fastest gait speed will be measured as the average of 3 trials of the 10-meter walk test (10MWT).
- Muscle strength [Change from baseline to immediately after priming, to 30 minutes after priming, and to 60 minutes after priming.]
An estimate of maximum ankle muscle force will be obtained for three trials of dorsiflexion and plantarflexion contractions using a force transducer.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Single, monohemispheric stroke
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Chronic stroke (> 6 months prior)
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Residual hemiparetic gait deficits (e.g., abnormal gait pattern)
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Minimum score of stage 2 on the Chedoke Arm Impairment Scale which includes stage 2, task 3 (facilitated elbow flexion) as one of the stage 2 tasks.
Exclusion Criteria:
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Use of anti-spasticity medications
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Existence of other neurological disorders
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Have brainstem or cerebellar lesions.
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Score of ≥2 on the Modified Ashworth Scale.
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MMSE score of <21, to ensure they will follow instructions.
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Non-English-speaking individuals
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Bone, joint or soft tissue injury
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Dizziness or angina during physical activity
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Uncontrolled medical conditions (such as uncontrolled hypertension, untreated cardiac disease, or untreated pulmonary disease)
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Failure to pass the Physical Activity Readiness Questionnaire (PAR-Q)
TMS exclusion criteria
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Previous adverse reaction to TMS
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Skull abnormalities or fractures
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Concussion within the prior 6 months
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Unexplained, recurring headaches
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Implanted cardiac pacemaker
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Metal implants in the head or face
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History of seizures or epilepsy
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Use of medications that could alter cortical excitability or increase risk of seizure (e.g., antidepressants, antipsychotics, anxiolytics, anticonvulsants)
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Current pregnancy
tDCS exclusion criteria
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Skin hypersensitivity
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History of contact dermatitis
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History of allodynia and/or hyperalgesia
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Any other skin or scalp condition that could be aggravated by tDCS
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Previous adverse reactions to tDCS
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Brain Plasticity Lab | Chicago | Illinois | United States | 60612 |
Sponsors and Collaborators
- University of Illinois at Chicago
Investigators
- Principal Investigator: Sangeetha Madhavan, PT, PhD, University of Illinois at Chicago
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2023-0070