Stroke Clinical Trial
Official title:
Targeting Motor Areas for Customized Transcranial Magnetic Stimulation in Motor Rehabilitation Treatment of Chronic Stroke Patients
The goal of the study is to determine the effect of repetitive transcranial magnetic stimulation (rTMS) over the premotor cortex on training-related improvements in motor performance and associated neural plasticity.
Status | Not yet recruiting |
Enrollment | 70 |
Est. completion date | February 2025 |
Est. primary completion date | February 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 30 Years to 80 Years |
Eligibility | Inclusion Criteria: - Have the ability to give informed, written consent - Be aged 30-80 years old - Have a single ischemic infarction affecting the primary motor system - Have intact cognitive abilities - No current depression - No neurological disease - No contradictions to TMS - No history of seizures or epilepsy - No implanted medical device - No metal in neck or head - No history of migraine headaches - No intake of medication that lowers seizure threshold Exclusion Criteria: - none |
Country | Name | City | State |
---|---|---|---|
United States | Emory Hospital | Atlanta | Georgia |
Lead Sponsor | Collaborator |
---|---|
Emory University |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in wrist velocity | The subjects will be asked to perform 7 isometric wrist extensions before and after motor training. Wrist velocity will be measured by a gyroscope taped to the dorsum of the wrist that was used during motor training. An increase in the maximum velocity that persists at least an hour after training is indicative of motor learning. | Before, 0 mins after, 30 mins after, and 60 mins after motor training. | |
Primary | Change in Stimulus Response Curve parameters | To measure organization of a motor region in the primary motor cortex supporting wrist movement, a Stimulus Response Curve (SRC) will be collected before and after motor training. SRC is a set of motor evoked potentials (MEP) that characterizes input-output parameters of the primary motor cortex and associated corticospinal tract. A change in the SRC parameters after training will reflect a change in the organization of the primary motor cortex. | Before, 0 mins after, 30 mins after and 60 mins after motor training. | |
Secondary | Change in wrist force | The subjects will be asked to perform 7 isometric wrist extensions before and after motor training. A force transducer will record the maximum force produced during the wrist extensions. | Before, 0 mins after, 30 mins after, and 60 mins after motor training. | |
Secondary | Change in reaction time | Subjects will be asked to perform 7 auditory-cued ballistic wrist extensions before and after motor training. Electromyographic (EMG) activity recorded during the ballistic wrist extensions will be used to measure reaction time. Reaction time is the length of time between the auditory cue and the onset of the movement-related EMG burst of the extensor carpi ulnaris muscle. | Before, 0 mins after, 30 mins after and 60 mins after motor training. | |
Secondary | Change in task accuracy | Task accuracy will be determined by the number of successful trials over the number of total trials. A trial will be considered successful when the subject moves a cursor from the home position into a target box by modulating the acceleration of their wrist. An increase in task accuracy after training will indicate motor learning. | During motor training (will compare first block to last block). | |
Secondary | Change in Short interval intracortical inhibition (SICI) of the primary motor cortex | Short interval intracortical inhibition (SICI) is an inhibitory phenomenon in the motor cortex. To test for SICI, a sub-threshold conditioning stimulus (CS) will precede a supra-threshold test stimulus (TS) by 2 milliseconds. The amplitude of a conditioned TS-evoked MEP will be expressed as a percent of the amplitude of an unconditioned TS-evoked MEP (% MEP). A decrease in the % MEP after training would indicate a increase in SICI. An increase in the % MEP after training would indicate a decrease in SICI. | Before, 0 mins after, 30 mins after, and 60 mins after motor training. | |
Secondary | Change in Resting Motor Threshold | Parametric Estimation by Sequential Testing (PEST) will be used to determine the Resting Motor Threshold (rMT). The mathematical algorithm implemented by PEST will determine the rMT with fewer TMS pulses than the traditional method. | Before, 0 mins after, 30 mins after, and 60 mins after motor training. |
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