Physical and Mental Practice for Bimanual Coordination Rehabilitation
Condition: Traumatic Brain Injury; Weakness, Muscle; Coordination Impairment
MeSH terms: Muscle Weakness; Brain Injuries; Brain Injuries, Traumatic; Ataxia
Study type: Interventional

Summary: 
      Traumatic Brain Injury (TBI)patients often suffer from loss of muscle strength in the hand
      and foot, decrease in coordination and high muscle tone (spasticity). In this study,
      investigators seek to compare how two different training programs can improve the
      coordination and symptoms of fatigue in individuals with movement deficits secondary to TBI.
      Using brain imaging, the study will also investigate changes in brain structure and activity
      associated with hand movement.
    

Detailed description: 
      Moderate and severe Traumatic Brain Injury (TBI) commonly causes upper extremity physical
      impairments that persist even after years of injury; these deficits are attributed to damage
      in brain structure and changes in structural and functional connectivity. Bimanual
      coordination deficits and muscle weakness have a significant impact on TBI survivors'
      well-being, and conventional therapy did not provide high success in treating these two
      issues. The investigators relate this lag in efficiency to two main reasons: 1) absence of
      outcome measures to quantify these deficits in a clinical setting, and 2) mental and
      cognitive fatigue and short attention span in TBI survivors, which limits the feasibility to
      enroll TBI survivors in intensive training protocols.

      The investigators long-term goal is to provide effective rehabilitation training to help TBI
      survivors in regaining proper bimanual coordination of hand movement and higher hand muscles'
      strength. Mental practice includes motor imagery and action observation, and neural imaging
      studies have shown that both motor imagery and action observation share similar neural
      mechanism as movement execution. In addition, interventional studies have shown success in
      combining physical and mental practice to improve motor function of stroke survivors, and it
      does not induce muscle fatigue.

      Hence, the first aim of this pilot study is to compare the therapeutic efficacy of combining
      physical practice with mental practice (motor imagery and action observation) (MP) versus
      physical practice only with action observation (PP) alone to improve hand bimanual
      coordination and muscle strength of TBI survivors. Twenty subjects will be randomly and
      equally assigned to either of two training groups. Maximum Voluntary Contraction (MVC),
      Reaction Time (RT), and Percent of Error in Matching (PEM) a Target will be used as primary
      outcome measures in addition to functional-based measures (Wolf Motor Function Test WMFT). In
      addition, activation maps (functional MRI data) will be established for the brain neural
      networks before and after training. The investigator's second aim is to study if either or
      both interventions (MP and PP) induce reorganization in brain activity and in functional (at
      rest) and effective (during a task) connectivity.
    

Intervention name(s): Hand coordination and mental practice; Hand coordination and action observation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 20 chronic (>1year) moderate to severe TBI patients, with upper extremity movement deficits, will be randomly and equally assigned to two groups.
In the experimental group, participants undergo 5 weeks (3 hrs/week) of physical practice training combined with mental practice (MP group).; In the control group 2, participants undergo 5 weeks (3 hrs/week) of physical training (PP group).
Other intervention name(s): experimental group; control group
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment