Paresis Clinical Trial
Official title:
Effects of Unilateral and Bilateral Training on Motor Function in Chronic Stroke
This study will compare the effectiveness of unilateral versus bilateral exercise training
for recovering movement abilities in chronic stroke patients. After a stroke, some people
have improved their movement ability by exercising the arm affected by the stroke. Others
have improved by exercising both arms together. This study will compare these two kinds of
exercise to see which might work best.
Healthy volunteers and people who have had a stroke more than 6 months ago may be eligible
for this study. Stroke patients must have some weakness in their stroke-affected arm. All
participants must be 18 years of age or older. Candidates are screened with a clinical and
neurological examination. Women who can become pregnant have a pregnancy test. Stroke
patients have a magnetic resonance imaging (MRI) study of the brain if they have not had one
in the last year.
Participants undergo the following tests and procedures:
MRI: This procedure uses a magnetic field and radio waves to produce images of body tissues
and organs. The subject lies on a table that slides into the scanner (a narrow cylinder),
wearing earplugs to muffle loud knocking sounds that occur during the scanning process. The
procedure lasts about 45 minutes, during which time the subject must lie still for up to 30
minutes.
Testing sessions: There are six test sessions - two to familiarize the subject with the
reaching test, two to do the reaching test plus transcranial magnetic stimulation (TMS)
before and after an exercise session, and two to do the reaching test plus TMS one day after
the exercise session. The sessions are on consecutive days, with a 1-week break after session
3. The procedures involved are:
- Reaching test: The subject responds as quickly as possible to a "GO" signal presented on
a computer monitor by performing a reaching movement with his or her arm. The activity
from the arm muscles is recorded using surface electrodes. During this test, a
questionnaire is used to determine the subject's attention, fatigue, and mood.
- TMS: For this test, a wire coil is held on the scalp, and a brief electrical current is
passed through the coil, creating a magnetic pulse that stimulates the brain. During the
stimulation, the subject may be asked to tense certain muscles slightly or perform other
simple actions. The stimulation may cause a twitch in muscles of the face, arm, or leg,
and the subject may hear a click and feel a pulling sensation on the skin under the
coil. The effect of TMS on the muscles is detected with small metal disk electrodes
taped onto the skin of the arms. The subject performs the reaching test while TMS is
delivered at various times after getting the "GO" signal.
- Arm exercises: The subject is seated in front of an exercise device that has two handles
that slide forward and backward along a set of tracks. The subject is asked to slide
either one or both handles back and forth repeatedly, alternating 5 minutes of arm
exercise with 5 minutes of rest for 30 minutes.
Objective:
It has been proposed that individuals with stroke may benefit to a greater degree by training
with both arms simultaneously than by training with the paretic arm alone. The purpose of
this protocol is to identify the extent and the mechanisms of paretic arm performance
improvement after a single session of bilateral arm training compared to a single session of
unilateral paretic arm training in individuals with moderate-severity chronic stroke.
Study population:
The study population will consist of individuals with chronic stroke.
Design:
A single-blinded, counterbalanced, crossover design will be used.
Outcome measures:
Endpoint measures will include paretic arm peak acceleration and disinhibition of the
stroke-affected cortical hemisphere as measured by transcranial magnetic stimulation (TMS) in
the context of a reaching task. These measures will be compared after a unilateral vs. a
bilateral arm training session in individuals with chronic stroke.
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