Predictors of Response in Chronic Stroke

  • STATUS
    Recruiting
  • participants needed
    2
  • sponsor
    VA Pittsburgh Healthcare System
Updated on 19 February 2024
transcranial magnetic stimulation
stroke
MRI
arm exercise
chronic stroke
arm exercises

Summary

This study will validate a predictive model that uses demographics, functional status, neurophysiology, neuroanatomy, and other potential biomarkers to predict the likelihood of a clinically significant change in impairment at the end of a robot assisted therapy intervention.The study will include magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS), and an arm exercise program consisting of robot-assisted exercise combined with functional arm exercise called transition to task training (TTT).

Description

After informed consent, a baseline neurological exam, medical records review, MRI of the brain, TMS, questionnaires, cognitive testing, robot evaluations, and arm function testing will occur. Baseline testing will occur in the first 4-6 weeks of participation including two separate sessions approximately 1 week a part to examine arm strength, range of motion, and ability to perform functional tasks, with one additional session if needed to verify stability between results. Additionally, one robot evaluation will be completed.

The intervention phase consists of 12 weeks of robot and transition to task arm exercise training (TTT). Interventions will occur approximately 3 times per week for 12 weeks for a total of 36 visits. Additional time and visits will be allowed with visits occurring 4 times per week or up to 6 additional weeks (not to exceed 18 weeks) if scheduling conflicts arise. The intervention sessions will be one hour in duration.

During the hour-long intervention, 45 minutes of robotic intervention will be followed by 15 minutes of TTT. The training will be sequential with 12 sessions focused on the wrist, followed by 12 sessions on the shoulder-elbow and the final 12 sessions alternating between the wrist and elbow-shoulder.

After the final training session, subjects will return after a 12 week retention period. At various time points during and after the intervention phase there will be additional arm function testing, robot evaluations, questionnaires, MRI and TMS sessions for re-assessment.

Details
Condition Brain Diseases, CNS disorder, Cerebrovascular accident, nervous system disorder, Cardiovascular Disease
Age 21-100 years
Treatment Robot + TTT exercise
Clinical Study IdentifierNCT04283253
SponsorVA Pittsburgh Healthcare System
Last Modified on19 February 2024

Eligibility

Yes No Not Sure

Inclusion Criteria

Clinically defined, unilateral, hemiparetic stroke with radiologic exclusion of other possible diagnosis
Stroke onset at least 6 months before enrollment
Present with Mild/Moderate to Severe arm dysfunction (based on Fugl-Meyer scores of 10 to 45)
Be medically stable to participate in the study
Be English speaking

Exclusion Criteria

Unable to give informed consent
Have a serious complicating medical illness that would preclude participation
Contractures or orthopedic problems limiting range of joint motion in the potential study arm
Visual loss such that the subject would not be able to see the test patterns on the robot computer monitor
Botulinum toxin to study arm within four months of study enrollment or if received during the study period
Unable to comply with requirements of the study
Participants with a history of a seizure will not be precluded from the study, but will not be enrolled in the TMS portions
Participants with electromagnetic exclusions (metal implants in the cranium, implanted electronic devices etc.) will not be precluded from the study but will be excluded from the MRI and TMS portions
Have a serious complicating medical illness that would preclude participation
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If you are confirmed eligible after full screening, you will be required to understand and sign the informed consent if you decide to enroll in the study. Once enrolled you may be asked to make scheduled visits over a period of time.

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Complete your scheduled study participation activities and then you are done. You may receive summary of study results if provided by the sponsor.

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