Clinical trial NCT06598150: Mapping Corticoreticulospinal Motor Control in Chronic Hemiparetic Stroke
Official title: Mapping Corticoreticulospinal Motor Control Using Brainstem and Spinal Cord fMRI in Chronic Hemiparetic Stroke
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Stroke
Hemiparesis
Keywords: functional magnetic resonance imaging
Lead sponsor: Northwestern University
Sponsor class: OTHER
Collaborators: name: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
First posted: 2024-09-19
Enrollment: 32
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: BASIC_SCIENCE

Brief summary: This study uses functional magnetic resonance imaging to map neural activity throughout the central nervous system during a shoulder abduction task to characterize what motor pathways are being used post-stroke.

Detailed description: Nearly 85% of stroke survivors experience significant unilateral impairment in upper extremity motor control, typically caused by damage to the corticospinal (CST) and corticoreticular (CRT) tracts (i.e., the corticofugal tracts). Alternative neural pathways, such as the contralesional cortico-reticulospinal tract (CRST), can be recruited to achieve movement of the affected arm and hand, but may have undesirable consequences. For example, the diffuse, bilateral branching of reticulospinal neurons can produce abnormal muscle co-activations (synergies) in the paretic limb, and involuntary mirror movements (associated reactions) between limbs. Together, these effects create stereotypical movement patterns post-stroke, and there is growing interest in novel \&#34;anti-synergy\&#34; interventions to enhance usage of residual CST systems rather than strengthening the CRST. Imaging has the potential to become an invaluable tool for evaluating whether rehabilitative strategies can preferentially access CST versus CRST pathways. However, current functional imaging research has focused on cortical activity, and must theoretically infer what pathway is used. Structural MRI directly assesses changes in white matter pathways, but it is limited to detecting long-term plasticity. To guide new interventions, there is a critical need to directly evaluate what descending motor pathways are active during movement. Thus, the overall objective of this study is to generate a novel fMRI dataset in participants with post-stroke hemiparesis, capturing neural activity during an innovative isometric shoulder abduction task, evaluating differences when abducting the paretic versus non-paretic arm. The investigators will acquire multi-echo fMRI data in individuals with post-stroke hemiparesis and age-matched controls, hypothesizing that increased reliance on the CRST will cause distinct activation patterns during shoulder abduction with the paretic limb, and that this will correlate with individual upper-extremity impairment (Upper-Extremity Fugl-Meyer Assessment). This work is significant because it will provide direct evidence of descending contralesional motor pathway involvement in post-stroke hemiparesis, and demonstrate the utility of neuroimaging for optimizing movements to preferentially engage specific systems and promote desired neural plasticity following injury.

Eligibility criteria: Inclusion Criteria:

* Adults aged at least 18y
* Able to perform shoulder abduction task (confirmed during screening and initial examination)
* Safe to undergo MRI
* Able to follow visual instructions using MRI-compatible vision correction goggles
* No brainstem or cerebellar lesions
* No severe concurrent medical problems (e.g. cardiorespiratory impairment)
* Cognitive/attentional capacity to focus on a task
* Able to communicate in English or Spanish

Additional inclusion criteria for stroke participants:

* Have sustained only one unilateral subcortical, ischemic lesion in the territory supplied by the Middle Cerebral Artery (confirmed by clinical or radiological reports) at least one year prior to participation in this project
* Paresis confined to one side, with moderate-to-severe motor impairment of the upper limb (Upper Extremity Fugl-Meyer score between 10 and 45).

Exclusion Criteria:

* MRI contraindications
* Severe claustrophobia
* Pregnant women
* Prisoners
* Vulnerable populations
* Diagnosis/history of:
* multiple sclerosis
* brain tumor
* brain radiation
* traumatic brain injury
* dementia
* Parkinson\&#39;s disease
* emphysema
* chronic obstructive pulmonary disease
* obstructive sleep apnea
* Concurrent enrollment in an intervention study
* Concurrent use of medications known to suppress central nervous system activity

Primary outcomes:
measure: BOLD activation
timeFrame: 3 days to 3 months
Secondary outcomes:
Other outcomes:
Locations:
city: Chicago
country: United States
facility: Northwestern University
state: Illinois
Study officials:
affiliation: Northwestern University
name: Molly G Bright, DPhil
role: PRINCIPAL_INVESTIGATOR
References: