Structurally Reorganizing Motor Cortex in Stroke Patients Through Hebbian-type Stimulation
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke is a leading cause of morbidity in the United States but identification of treatment
      strategies to improve outcome is limited by the incomplete understanding of the mechanisms of
      recovery. Motor cortex (M1) reorganization plays a major-role in the recovery of motor
      deficits post-stroke; hence the importance for further development of rehabilitative
      strategies that utilize this potential for recovery.

      In Specific Aim 1, investigators will determine if repeated exposure to training combined
      with Hebbian-type M1 stimulation enhances functional M1 reorganization in lesioned M1 of
      stroke patients.

      In Specific Aim 2, investigators will determine if repeated exposure to training combined
      with Hebbian-type M1 stimulation enhances structural cortical reorganization in lesioned M1
      of stroke patients and to explore whether these structural changes are related to the
      training induced functional cortical reorganization.

      The overall goal of this project is to determine the effect of Hebbian- type stimulation on
      both, functional and structural brain reorganization, thereby obtaining indirect evidence for
      the neuronal substrate underlying training related improvement and maintenance of motor
      function in stroke patients. This knowledge may have a substantial positive impact on
      treatment for stroke patients that may significantly improve recovery and could move the
      field of neuro-rehabilitation forward.
    

Detailed description: 
      Stroke is a leading cause of morbidity in the United States but identification of treatment
      strategies to improve outcome is limited by the incomplete understanding of the mechanisms of
      recovery. Motor cortex (M1) reorganization plays a major-role in the recovery of motor
      deficits post-stroke; hence the importance for further development of rehabilitative
      strategies that utilize this potential for recovery. Non-invasive cortical stimulation can
      enhance the beneficial effects of motor training on performance and functional plasticity of
      motor cortex. Among the different approaches used in these studies, Hebbian-type M1
      stimulation is particularly intriguing, as it seems to be more effective when compared to
      random M1 stimulation. There is emerging evidence that motor training or cortical stimulation
      related improvement of function are associated with increases in the grey matter of targeted
      brain areas. While there is therefore some evidence supporting structural reorganization in
      human M1 in response to motor learning and cortical stimulation, the mechanisms underlying
      these changes and their relationship to functional plasticity are not known. A better
      understanding of the sequences of events is critical to development of optimal therapeutic
      interventions to improve recovery following stroke.

      In Specific Aim 1, investigators will determine if repeated exposure to training combined
      with Hebbian-type M1 stimulation enhances functional M1 reorganization in lesioned M1 of
      stroke patients.

      In Specific Aim 2, investigators will determine if repeated exposure to training combined
      with Hebbian-type M1 stimulation enhances structural cortical reorganization in lesioned M1
      of stroke patients and to explore whether these structural changes are related to the
      training induced functional cortical reorganization.

      The overall goal of this project is to determine the effect of Hebbian- type stimulation on
      both, functional and structural brain reorganization, thereby obtaining indirect evidence for
      the neuronal substrate underlying training related improvement and maintenance of motor
      function in stroke patients. This knowledge may have a substantial positive impact on
      treatment for stroke patients that may significantly improve recovery and could move the
      field of neuro-rehabilitation forward.
    

Intervention name(s): Repetitive Transcranial Magnetic Stimulation (rTMS); Sham stimulation
Intervention type(s): Device; Device
Intervention description(s): Training sessions for 5 days in a row; Sham stimulation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment
Keywords: Neurophysiology; Transcranial Magnetic Stimulation (TMS); Neurology; Stroke; Physical Medicine and Rehabilitation