The Role of Auditory Feedback in Guiding Upper Extremity Movements

Study Overview
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Brief Summary
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Stroke is one of the leading causes of disability, with an estimated prevalence of 50,000 cases per year in Canada. Less than half of stroke patients regain use of their arm and hand. There is currently no intervention regime that is the gold standard, despite the variety of therapeutic techniques used to treat the upper extremity post-stroke. The use of external feedback to improve motor learning is a technique that has been less studied but shows promise. Therefore, the purpose of this proof of principle study it to test whether different auditory feedback frequencies can facilitate reaching ability in people with stroke. In addition brain scans will be collected that will enable us to determine how stroke severity may impact on one's ability to improve with this technique. We hypothesize that patients who receive less feedback (50% alternate) will have enhanced learning relative to the patients who receive more feedback (100%).

Conditions
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Stroke

Intervention / Treatment
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* Behavioral: Auditory Feedback 100%
* Behavioral: Auditory Feedback 50% alternate


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Unilateral first time MCA ischemic stroke Stroke patients should have some movement of shoulder/elbow (no movement of hand - e.g. hand, fingers - is OK) > 2 months post between 30-85 years Exclusion Criteria: prior stroke severe comprehension (or cognitive) deficit that compromises informed consent or understanding of instructions contraindications to MRI (e.g. claustrophobia, metal implants) neurodegenerative or psychiatric disease apraxia auditory deficits that would impair testing prior musculoskeletal injury to back or upper extremity (including shoulder subluxation from stroke) skin conditions that would preclude taping of goniometers

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Patients<br>Patients will receive: Auditory Feedback 100% Auditory Feedback 50% alternate | Behavioral: Auditory Feedback 100%<br>* Patients will receive constant auditory feedback across training trials.<br>Behavioral: Auditory Feedback 50% alternate<br>* Patients will receive alternating auditory feedback (1 trial auditory feedback; 1 trial no auditory feedback) across trials<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in movement error from baseline |  | participants will be followed for the duration of the study, an expected 3 hours per day for 2 weeks (5 days per week/10 days total) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in range of motion |  | participants will be followed for the duration of the study, an expected 3 hours per day for 2 weeks (5 days per week/10 days total) | 
| Change in movement duration |  | participants will be followed for the duration of the study, an expected 3 hours per day for 2 weeks (5 days per week/10 days total) |