Modulating Interaction of Motor Learning Networks in Rehabilitation of Stroke
Condition: Stroke; Stroke, Chronic; Stroke, Middle Cerebral Artery With Infarction
MeSH terms: Stroke; Infarction, Middle Cerebral Artery; Infarction
Study type: Interventional

Summary: 
      This study uses a form on non-invasive brain stimulation called transcranial magnetic
      stimulation to understand 1) understand how the brain learns post-stroke and 2) assess
      non-invasive brain stimulation as an addition to current stroke rehabilitation approaches. In
      two study arms the investigators will compare the effect of active transcranial magnetic
      stimulation paired with motor practice with placebo (or sham) transcranial magnetic
      stimulation paired with the same motor practice.
    

Detailed description: 
      Stroke is the leading cause of permanent disability in the United States. In the absence of
      treatments to restore the lost tissue, clinical scientists have focused upon repetitive
      forced used of the paretic limb to promote neural reorganization in preserved tissue and
      reduce disability. However, forced use interventions are time intensive and the extent of
      functional recovery is variable. One potential contributor to this variability is the
      potential trade-off between compensatory cognitive motor control strategies and the extent of
      procedural learning that can occur. Compensatory strategies adopted by patients may produce
      quick short-term increases in performance but retard slower sustained improvements by
      interfering with development of procedural learning. Consistent with this hypothesis, the
      investigators' previous work documents an increased reliance upon dorsolateral prefrontal
      cortex during performance of learned skills post-stoke. However, the investigators' previous
      work also demonstrates that the effect of increased activity in dorsolateral prefrontal
      cortex may limit reorganization in important areas involved in the consolidation of practice
      thereby limiting functional recovery post-stroke.

      Transcranial magnetic stimulation offers a unique opportunity to investigate the relationship
      between dorsolateral prefrontal cortex activity and consolidation of motor
      practice/rehabilitaion post-stroke. Here the investigators' objective is to determine whether
      suppression of the contralesional dorsolateral prefrontal cortex, with continuous theta burst
      transcranial magnetic brain stimulation (cTBS), a form of transcranial magnetic stimulation,
      prior to motor practice enhances brain reorganization in critical areas and leads to greater
      sustained improvements in motor ability over time.

      The proposed work will enhance the understanding of motor learning post-stroke and provide
      preliminary evidence for the benefits of dorsolateral prefrontal cTBS as an adjunct to
      current rehabilitation interventions.
    

Intervention name(s): Active continuous theta burst stimulation (cTBS); Placebo (Sham) continuous theta burst stimulation; Motor Practice
Intervention type(s): Device; Device; Behavioral
Intervention description(s): Active cTBS over dorsolateral prefrontal cortex that has an effect upon dorsolateral prefrontal cortex brain activity.; Sham stimulation over dorsolateral prefrontal cortex that looks and sounds like active cTBS but does not have any effect upon dorsolateral prefrontal cortex brain activity.; Upper limb reaching task to be practiced. Practice will be paired with Active/Sham stimulation. Twenty trials will occur before Active/Sham stimulation. 40 trials will be practiced after Active/Sham stimulation.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Basic Science
Keywords: Transcranial Magnetic Stimulation; Motor Impairment; Rehabilitation; Motor Learning