Mechanisms of Arm Recovery in Stroke Patients With Hand Paralysis

Study Overview
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Brief Summary
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This study examines the effect of non-invasive brain stimulation targeting different brain areas on movement of the affected arm post-stroke. Participants will receive stimulation to each of 3 different brain areas combined with a session of arm exercise.

Detailed Description
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Small improvements in affected arm movement can be made with intensive physical practice. These improvements could potentially be enhanced by combining non-invasive brain stimulation with practice. To develop such an intervention, it is necessary to understand which brain areas should be stimulated in which types of patients. It is probably more beneficial to target one side of the brain vs. the other, for example, depending on the characteristics of the stroke. This study will examine the effect of stimulating one side of the brain vs. the other on the amount of improvement that occurs from physically practicing functional arm movements.

Official Title
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Mechanisms of Arm Recovery in Stroke Patients With Hand Paralysis

Conditions
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Stroke, Hemiparesis, Cerebral Vascular Accident, Stroke, Ischemic

Intervention / Treatment
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* Procedure: Unaffected Transcranial Magnetic Stimulation
* Procedure: Affected Transcranial Magnetic Stimulation
* Procedure: Control Transcranial Magnetic Stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: More than 6 months post-stroke Loss of voluntary finger movement in the affected hand Some voluntary movement of affected shoulder and/or elbow Exclusion Criteria: Brainstem or cerebellar stroke Severe cognitive or language deficits Epilepsy or other seizure disorder Central nervous system disease or disorder other than stroke

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 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
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Each participant will receive stimulation targeting each brain area. The order in which the stimulation sites are targeted for each participant is randomized and there is a washout period of several weeks between each treatment.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Unaffected Hemisphere<br>Application of Unaffected Transcranial Magnetic Stimulation to unaffected hemisphere site prior to physical practice | Procedure: Unaffected Transcranial Magnetic Stimulation<br>* Non-invasive brain stimulation to unaffected hemisphere site prior to practice<br>|
| Experimental: Affected Hemisphere<br>Application of Affected Transcranial Magnetic Stimulation to affected hemisphere site prior to physical practice | Procedure: Affected Transcranial Magnetic Stimulation<br>* Non-invasive brain stimulation to affected hemisphere site prior to practice<br>|
| Active Comparator: Control Site<br>Application of Control Transcranial Magnetic Stimulation to control site prior to practice | Procedure: Control Transcranial Magnetic Stimulation<br>* Non-invasive brain stimulation to control site prior to practice<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in movement time | Percentage change in time it takes to move the arm a standardized distance | Baseline and 1 Day | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in maximum reaching distance | Percentage change in maximum distance participant is able to reach | Baseline and 1 Day | 
| Change in hand path kinematics | Percentage change in temporal and spatial movement of the hand during reaching | Baseline and 1 Day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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arm, rehabilitation, non-invasive brain stimulation, transcranial magnetic stimulation, upper extremity