Action Selection and Arm Rehabilitation After Stroke

Study Overview
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Brief Summary
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After stroke, individuals often have persistent difficulty using the arm and hand in everyday functional tasks that reduces quality of life. Currently available rehabilitation techniques are not adequate and new protocols are needed that are based on an understanding of how brain regions work together to produce skilled movement. This research project aims to improve our understanding of how the brain controls movement after stroke and determine whether a period of motor practice that targets specific brain regions through the addition of action selection demands leads to improved arm function. We hypothesize that arm motor function and the ability to efficiently activate the action selection motor circuit during movement will improve after training.

Detailed Description
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Rehabilitation of arm impairment after stroke includes the repetitive practice of functional tasks. In healthy adults, planning plays a vital role in the control of skilled movement, however, the behavioral and neural correlates of planning have largely been unexplored in individuals recovering from stroke. Action selection is an important motor planning process that engages dorsal premotor cortex (PMd) in controls. While PMd activation is a commonly reported neural correlate of motor recovery after stroke, the role of PMd in action selection and motor training are not known. Therefore, the purpose of this study is to determine the effect of training that includes action selection demands on the behavioral and neural correlates of movement after stroke. Thirty-eight individuals in the chronic phase of stroke will be recruited. After completion of clinical measures of impairment and function, all participants with stroke will complete a motor action selection task and functional MRI followed by arm training. Arm training will consist of three weeks (15 sessions) of arm motor training (1.5 hours per session) that includes action selection demands on movement. Follow-up clinical testing will occur at the end of treatment and three weeks later.

Official Title
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Targeted Engagement of the Motor Action Selection Network During Arm Rehabilitation After Stroke

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: Arm Training with Action Selection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: At least 18 years old Had stroke at least 6 months ago Right-hand dominant prior to stroke Some continued arm and hand weakness Some ability to move the arm and hand that is weaker from the stroke Exclusion Criteria: Acute medical issues that would interfere with participation Another neurologic diagnosis that may impact movement (e.g. Parkinson's Disease) Cannot undergo MRI scanning Severe apraxia or hemispatial neglect Pain in the arm that interferes with movement Difficulty maintaining attention or following directions

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm Training with Action Selection<br>Task-oriented, functional arm training with the addition of action selection cues to practice. All participants receive the same arm training intervention. | Behavioral: Arm Training with Action Selection<br>* Treatment occurs in 1.5 hour sessions, 5 times a week for 3 weeks. In each treatment session, you will practice functional tasks with your weaker arm and hand. Additionally, you will be given cues on a computer screen that dictate your movement response (action selection). Practice will be scaled to match your current level of function and progressed over time as able.<br>* Other names: Arm rehabilitation;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Action Research Arm Test | Behavioral assessment of arm function. Scores range from 0 to 57 with a higher score equating to better function. | Change from baseline to end of treatment (3 weeks) | 
| Brain activation during functional MRI | Brain activation during movement will be captured with functional MRI. Analyses will investigate changes in magnitude of activation. | Change from baseline to end of treatment (3 weeks) | 
| Brain connectivity during functional MRI | Brain activation during movement will be captured with functional MRI. Analyses will investigate changes in connectivity between brain regions. | Change from baseline to end of treatment (3 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper Extremity Fugl-Meyer Motor Assessment |  | Change from baseline to end of treatment (3 weeks) | 
| Stroke Impact Scale Hand Domain |  | Change from baseline to end of treatment (3 weeks) | 
| Box & Blocks Test |  | Change from baseline to end of treatment (3 weeks) | 
| 9-Hole Peg Test |  | Change from baseline to end of treatment (3 weeks) | 
| Grip Strength |  | Change from baseline to end of treatment (3 weeks) | 
| Confidence in Arm and Hand Movements Questionnaire |  | Change from baseline to end of treatment (3 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Upper Extremity, Physical Therapy