Heart-Brain Retraining for Stroke Rehabilitation
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The purpose of this study is to gain a better understanding of how different types of
      exercise can help people after a stroke. The investigators want to study if different types
      of exercise will improve the use of arm and hand function after a stroke.
    

Detailed description: 
      Stroke is the leading cause of disability in the United States with approximately 795,000 new
      or recurrent strokes per year. An estimated two thirds of patients post-stroke cannot
      incorporate the affected upper extremity (UE) into their activities of daily living. In
      addition, stroke survivors experience a 60% decrease in cardiovascular capacity, which
      contributed to disability and diminished quality of life. Developing rehabilitation
      techniques to optimize motor recovery while improving cardiovascular endurance would benefit
      the stroke population.

      Animal studies using a forced exercise (FE) paradigm, in which the rodent is exercised on a
      motorized treadmill at a rate greater than its voluntary rate, indicate an endogenous
      increase in neurotrophic factors such as brain-derived neurotrophic factor (BDNF) and
      glial-derived neurotrophic factor (GDNF). These neurotrophic factors are thought to underlie
      neuroplasticity and motor learning. It is hypothesized that patients with stroke, due to
      decreased motor cortical output, cannot sustain high rates of voluntary exercise necessary to
      trigger the endogenous release of neurotrophic factors; therefore, forced-exercise is
      necessary to augment their voluntary efforts and will be superior to voluntary exercise in
      facilitating motor recovery. When coupled with repetitive task practice (RTP) of the UE, an
      effective form of UE rehabilitation, FE will prime the brain for neuroplasticity. We have
      developed a safe and effective method of delivering forced-exercise to Parkinson's disease
      (PD) patients (NIH R21HD056316). Clinical and imaging data with PD patients indicate
      forced-exercise, but not voluntary exercise, triggers a neurophysiologic response in the
      central nervous system resulting in global improvements in motor and non-motor functioning
      and increased cortical and subcortical activation. The aim of this project is to conduct a
      preliminary trial to compare the effects of forced to voluntary exercise when coupled with
      RTP in promoting the recovery of motor function in patients with stroke.
    

Intervention name(s): Repetitive Task Practice (RTP); Voluntary cycling + RTP; Assisted cycling + RTP
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): This group will preform arm and hand therapy.; This group will preform arm and hand therapy and cycle on a bike.; This group will preform arm and hand therapy and cycle on a bike.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Stroke; Exercise; Rehabilitation; Neuroplasticity; Task Practice