Using Real-time fMRI Neurofeedback and Motor Imagery to Enhance Motor Timing and Precision in Cerebellar Ataxia

Study Overview
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Brief Summary
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The aim of the research is to improve motor function in people with cerebellar ataxia by using neuroimaging methods and mental imagery to exercise motor networks in the brain. The relevance of this research to public health is that results have the potential to reduce motor deficits associated with cerebellar atrophy, thereby enhancing the quality of life and promoting independence.

Official Title
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Using Real-time Functional Magnetic Resonance Imaging (fMRI) Neurofeedback and Motor Imagery to Enhance Motor Timing and Precision in Cerebellar Ataxia

Conditions
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Cerebellar Ataxia, Spinocerebellar Ataxias, Cerebellar Degeneration

Intervention / Treatment
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* Device: Neurofeedback treatment
* Behavioral: At-home therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-100 years of age At least 8th-grade education Right-handedness Clinical diagnosis of progressive, degenerative cerebellar ataxia by a movement disorder specialist (cerebellar ataxia of unknown etiology, and spinocerebellar ataxias with and without genetic confirmation) Exclusion Criteria: History of Axis I psychiatric disorders (including alcohol and drug dependence) Severe or unstable medical disorder, neurological disorders, such as stroke or epilepsy History of head injury that resulted in a loss of consciousness greater than 5 minutes and/or neurological sequelae Any condition that is contraindicated for the MRI environment (e.g., metal in the body, pacemaker, claustrophobia) Currently pregnant Clinical diagnosis of multiple system atrophy (MSA) or Friedrich's ataxia (FA) Eligible subjects may be asked to refrain from medications that affect the central nervous system that would also make data difficult to interpret (e.g., sedatives) for an appropriate period of time prior to scanning Participants will be excluded if the participants do not have a home computer with internet available to complete the 3-week at-home component of the study protocol

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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: Basic Science
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Real time neurofeedback with task<br>Participants will undergo a real-time fMRI scan during which two distinct tasks will be performed. | Device: Neurofeedback treatment<br>* During the fMRI scan, the tasks consist of: Overt finger tapping in time with a flashing cue. Motor imagery (of finger tapping). During overt finger tapping, feedback will consist of a slider bar that indicates tapping accuracy to target speed (1 or 4Hz). During motor imagery, neurofeedback will consist of a slider bar that indicates the success of recruiting predicted brain regions (consistent with those engaged during overt tapping).<br>|
| Other: Overt tapping and/or motor imagery practice<br>Participants will undergo an overt tapping task at baseline. Participants are assigned to a group where the participants will then perform respective motor and/or imagery tasks at home for 3 weeks. | Behavioral: At-home therapy<br>* Participants are assigned to groups where the participants will practice each day for 3 weeks at-home. Group 1: Imagery only. Group 2: Overt finger tapping only. Group 3: Imagery plus overt finger tapping. During imagery, participants will view the task while imagining that the participants are finger tapping in time with the flashing cue, using the imagery strategies identified during participants' previous neurofeedback session. During overt tapping, participants will finger tap in time with the flashing cue. A final assessment of overt tapping will be performed the day after therapy ends.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in overt tapping accuracy as assessed by finger tapping to a flashing cue at 1Hz speed | During the MRI session, accuracy on overt tapping will be measured by the distance of the actual tapping rate vs. target rate (1Hz). Accuracy at baseline will be compared to that of final assessment, which will take place before and after neurofeedback training, respectively. The difference in accuracy between the two tests create a delta measure (i.e., fewer errors in the final vs. baseline tests). This delta accuracy will indicate the magnitude of tapping accuracy improvements. Root mean squared error (RMSE) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 1 tap for 1Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task. | Baseline and MRI duration, up to 1 hour | 
| Change in overt tapping accuracy as assessed by finger tapping to a flashing cue at 4Hz speed | During the MRI session, accuracy on overt tapping will be measured by the distance of the actual tapping rate vs. target rate (4Hz). Accuracy at baseline will be compared to that of final assessment, which will take place before and after neurofeedback training, respectively. The difference in accuracy between the two tests create a delta measure (i.e., fewer errors in the final vs. baseline tests). This delta accuracy will indicate the magnitude of tapping accuracy improvements. RMSE (root mean squared error) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 4 taps for 4Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task. | Baseline and MRI duration, up to 1 hour | 
| Change in at-home overt tapping accuracy as assessed by finger tapping to a flashing cue at 1Hz speed | Accuracy at baseline will be compared to that of final assessment, which will take place before and after the 3-week at-home practice sessions, respectively. The delta measure will indicate the magnitude of tapping accuracy improvements. Groups will be compared to examine differences in delta as a function of practice condition (imagery only, tapping only, or imagery plus tapping). At-home tapping performance will be compared to MRI tapping performance. RMSE (root mean squared error) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 1 tap for 1Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task. | Baseline and At-home sessions (10 minutes/day), up to 23 days | 
| Change in at-home overt tapping accuracy as assessed by finger tapping to a flashing cue at 4Hz speed | Accuracy at baseline will be compared to that of final assessment, which will take place before and after the 3-week at-home practice sessions, respectively. The delta measure will indicate the magnitude of tapping accuracy improvements. Groups will be compared to examine differences in delta as a function of practice condition (imagery only, tapping only, or imagery plus tapping). At-home tapping performance will be compared to MRI tapping performance. RMSE (root mean squared error) is the measure for both the baseline and post-treatment behavioral tasks. RMSE will be based on the actual number of taps per second relative to the expected number of taps per second (e.g., 4 taps for 4Hz). Then post treatment RMSE minus baseline RMSE will determine a delta RMSE. A higher RMSE signifies greater error. For the delta measure, it is expected, lower scores reflect greater improvement on the task. | Baseline and At-home sessions (10 minutes/day), up to 23 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The correlation between MRI BOLD and finger tapping accuracy to a flashing cue at 1Hz as assessed by a correlation coefficient | This will assess the correlation between MRI Blood Oxygen Level Dependence (BOLD) and finger tapping accuracy by a correlation coefficient. The correlation coefficient ranging from -1 to 1, where the closer the coefficient is to -1 indicates a negative association and the closer the coefficient is to 1 indicates a strong positive association. | MRI duration, up to 1 hour | 
| The correlation between MRI BOLD and finger tapping accuracy to a flashing cue at 4Hz as assessed by a correlation coefficient | This will assess the correlation between MRI BOLD (Blood Oxygen Level Dependence) and finger tapping accuracy by a correlation coefficient. The correlation coefficient ranging from -1 to 1, where the closer the coefficient is to -1 indicates a negative association and the closer the coefficient is to 1 indicates a strong positive association. | MRI duration, up to 1 hour | 
| The correlation between the KVIQ and imagery accuracy of the slider bar from target on the MRI task as assessed by a correlation coefficient | The Kinesthetic and Visual Imagery Questionnaire (KVIQ), overall score ranging from 0-100, where higher scores reflect more vivid imagery) will assess imagery vividness. This will be correlated with the image accuracy measures described in Secondary Outcome Measure 5'. | Up to 1.5 hours | 
| The correlation between the ICARS and imagery accuracy of the slider bar from target on the MRI task as assessed by a correlation coefficient | The International Cooperative Ataxia Rating Scale (ICARS), overall score ranging from 0-100, where higher scores indicate more severe neurological impairment) will assess neurological impairments. This will be correlated with image accuracy measures described in 'Secondary Outcome Measure 5'. | Up to 1.5 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cerebellar Ataxia, Spinocerebellar Ataxias, Cerebellar Diseases, Neurodegenerative Diseases, Cerebellum, Gait, Balance, Movement Disorders