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Clinical Trial Summary

This is a pilot study to collect data to support a VA grant submission to study fMRI and neurophysiological predictors of hand function and recovery during a robotic intervention in people with hand impairments due to stroke or spinal cord injury.

Clinical Trial Description

The loss of arm and hand function after cervical spinal cord injury (SCI) limits independence and increases the cost of care. As a result, Veterans with tetraplegia prioritize restoration of hand and arm function over all other rehabilitation goals. Similar to SCI, stroke of supraspinal areas involved in motor control results in acute movement deficits in more than 85% of survivors. Despite advances in treatment and rehabilitation, 50% of stroke survivors have persistent hand impairment. The loss of hand function and dexterity limits the ability to perform many activities of daily living, and thus limits independence. Since motor deficits are often permanent after SCI and stroke, new strategies are needed to restore dexterous hand function.

Advances in functional imaging have enabled the measurement of finger-related activation patterns in somatosensory cortex, but little is known about how these representational patterns are impacted when hand function is lost. Prior studies of gross movements have reported reorganization of cortical activity after injury. The investigators aim to improve dexterous hand function by increasing our understanding of finger-related cortical reorganization after lesions to the spinal or supraspinal structures. This understanding could allow discrimination between adaptive and maladaptive patterns underlying hand function and guide restorative therapies. Additionally, imaging biomarkers of injury often track with functional recovery.

The investigators will use advanced functional magnetic resonance imaging (fMRI) techniques and behavioral paradigms to measure finger-related cortical representations in people with hand impairments. Participants will undergo a rehabilitation intervention to improve dexterity and drive adaptive plasticity in finger-related cortical representations. The intervention involves action observation-guided, goal-directed fine motor tasks with assistance provided to individual fingers through a motorized exoskeleton. ;

Study Design

Related Conditions & MeSH terms

NCT number NCT03833518
Study type Interventional
Source VA Pittsburgh Healthcare System
Contact Debbie Harrington
Phone 412-383-1355
Status Not yet recruiting
Phase N/A
Start date March 2019
Completion date September 2023

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