Altered Connections in the Spinal Cord to Reduce Hand Impairment After Stroke

Stroke Clinical Trial

Official title: Spinal Plasticity to Reduce Hand Impairment After Stroke

Status Not yet recruiting

Clinical Trial Summary

The purpose of the study is to induce plasticity in corticospinal-motoneuronal synapses serving an intrinsic hand muscle of the hemiparetic limb in humans with stroke. Neurologically-intact controls are included to verify that an effect was present in absence of stroke. Outcome measures in controls also provide a reference point that help us to understand the size of the effect and mechanisms mediating the effect in the neurologically-intact system.

Clinical Trial Description

Stroke is a leading cause of serious long-term disability in the United States with 795,000 individuals suffering a new or recurrent stroke each year. In most cases, disability is associated with incomplete motor recovery of the paretic limb. Even with intensive therapy, full recovery is often not achieved. Thus, there is a need for mechanistic approaches that drive the impaired neuronal targets of retraining to fully harness the corticospinal system's adaptive capacity.

The goals of this study are to leverage principles of spike timing-dependent plasticity (STDP) via non-invasive stimulation techniques to strengthen corticospinal transmission. Few studies have targeted the cortex after stroke in humans, and none have targeted the corticospinal-motoneuronal synapse in the spinal cord. This study, therefore, is a novel approach to studying neuroplasticity after stroke. Previous work in humans with incomplete spinal cord injury demonstrates that the resulting plasticity transiently enhances motor output, indicating that there is also therapeutic potential.

This study will attempt to induce bi-directional STDP in corticospinal-motoneuronal synapses serving an intrinsic hand muscle of the hemiparetic limb. Control experiments will be completed to provide evidence of the neurophysiological mechanism(s) mediating the effect and to examine behavioral effects.

Individuals who are at least 6 months post first-ever subcortical stroke and have at least partial range of motion of the paretic index finger will be recruited to participate. ;

Related Conditions & MeSH terms

• Central Nervous System Haemorrhage
• Cerebrovascular Accident
• Hemiparesis
• Hemorrhage
• Paresis
• Post-stroke
• Stroke

• NCT number: NCT03638570
• Study type: Interventional
• Source: University of Pittsburgh
• Contact: Debbie Harrington
• Phone: 412-383-1355
• Email: debbie.harrington@pitt.edu
• Status: Not yet recruiting
• Phase: N/A
• Start date: October 2018
• Completion date: October 2022