Neurobiological Principles Applied to the Rehabilitation of Stroke Patients

Completed

Phase N/A Results

Update History

18 Oct '17
The Summary of Purpose was updated.
New
The purpose of this study is to use (Transcranial Magnetic Stimulation) TMS or drugs to improve learning of movement skills and the adaptation processes in patients after stroke. Once investigators have determined the improving effect of TMS and the drugs on learning of movement skills, the study team may be able to provide information that improves rehabilitative treatment and helps to improve recovery after stroke.
Old
Enhance motor cortex reorganization with noradrenergic drugs and non-invasive repetitive transcranial magnetic stimulation.
The description was updated.
New
Previous studies have shown, that when patients learn a new motor movement, it may cause a change in the way the nerves act in the area of the brain that controls movement. This change is called use-dependent plasticity. The ability of that part of the brain, called the motor cortex (M1), to reorganize plays a major role in the recovery of motor deficits post-stroke; hence the importance for further development of rehabilitative strategies that utilize this potential for recovery. In this proposed study, investigators will further examine influences of use-dependent plasticity in the non-injured M1 of healthy subjects and injured M1 of stroke subjects using a combination of non-invasive cortical stimulation, medication, and exercise techniques. In Aim 1, investigators will test the effect of drugs that interact specifically with different neurotransmitter systems on use-dependent plasticity in intact M1 of healthy humans. In Aim 2, investigators will identify the parameters for non-invasive transcranial magnetic stimulation (TMS) of M1 that are most effective to enhance use-dependent plasticity in intact healthy human M1. In Aim 3, investigators will test the drugs and rTMS protocols that were demonstrated to be most effective to enhance use- dependent plasticity in the Specific Aim 1 and 2 and apply them to participants who have experienced a stroke. Results from this study will help to inform future research about the efficacy of plasticity enhancing methods in injured M1 of stroke patients.
Old
Previous studies have shown, that when patients learn a new motor movement, it may cause a change in the way the nerves act in the area of the brain that controls movement. This change is called use-dependent plasticity. The ability of that part of the brain, called the motor cortex (M1), to reorganize plays a major role in the recovery of motor deficits post-stroke; hence the importance for further development of rehabilitative strategies that utilize this potential for recovery. In this proposed study we will further examine influences of use-dependent plasticity in the non-injured M1 of healthy subjects and injured M1 of stroke subjects using a combination of non-invasive cortical stimulation, medication, and exercise techniques. In Specific Aim 1, we will test the effect of drugs that interact specifically with different neurotransmitter systems on use-dependent plasticity in intact M1 of healthy humans. In Specific Aim 2, we will identify the parameters for non-invasive TMS stimulation of M1 that are most effective to enhance use-dependent plasticity in intact healthy human M1. Specific Aim 3 will assess the efficacy of plasticity enhancing methods developed in non-injured M1 healthy subjects (Specific Aims 1 & 2) in injured M1 of stroke patients. Our proposal links science to neurorehabilitation practice in stroke patients by applying principles known to enhance practice dependent plasticity in intact human M1 to injured M1 of stroke patients to enhance motor recovery. These newly designed rehabilitation strategies could potentially reduce the morbidity and disability of stroke and, thus, reduce dramatically the costs for long-term ambulatory and nursing home care. The positive impact on the field of neurorehabilitation will be considerable.
The minimum age criteria for eligibility was updated to "18 Years."
The eligibility criteria were updated.
New
Aims 1 and 2 Inclusion Criteria: - Normal neurological examination - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease - Abnormal MRI of brain - Abnormal neuropsychological testing - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS Aim 3: Inclusion Criteria: - Cerebral ischemic infarction more than 6 months prior to entering the study - Single lesion as defined by MRI of the brain affecting the primary motor output system of the hand at a cortical (M1) level or subcortical level, or unilateral, and supratentorial in absence of history of a previous symptomatic stroke within 3 months of the current stroke - Dense paresis of the hand for more than three days after cerebral infarction (MRC of < 4- of wrist- and finger extension/flexion movements) - Good functional recovery of hand function as defined by MRC of 4 or 4+ of wrist- and finger extension/flexion movements - Ability to perform wrist extension movements - Ability to meet criteria of inclusion experiment - Ability to give informed consent - Ability of TMS to elicit a measurable MEP of > 100 μV and an increase in MEP amplitude with increasing stimulus intensity (up to 100% of MSO) of at least 20% over MEP amplitude at MT Exclusion Criteria: - History or neurological or psychiatric disease, including bipolar disorder - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS
Old
For Specific Aims 1 and 2 Inclusion Criteria: - Aged 55 to 80 years - Normal neurological examination - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease - Abnormal MRI of brain - Abnormal neuropsychological testing - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS Specific Aim 3: Inclusion Criteria: - Aged 55 to 80 years - Cerebral ischemic infarction more than 12 months prior to entering the study - Single lesion as defined by MRI of the brain affecting the primary motor output system of the hand at a cortical (M1) level - Dense paresis of the hand for more than three days after cerebral infarction - Good functional recovery of hand function as defined by the ability to perform selective movements of the finger at the time of the study - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease, including bipolar disorder - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS
14 Oct '17
The description was updated.
New
Previous studies have shown, that when patients learn a new motor movement, it may cause a change in the way the nerves act in the area of the brain that controls movement. This change is called use-dependent plasticity. The ability of that part of the brain, called the motor cortex (M1), to reorganize plays a major role in the recovery of motor deficits post-stroke; hence the importance for further development of rehabilitative strategies that utilize this potential for recovery. In this proposed study we will further examine influences of use-dependent plasticity in the non-injured M1 of healthy subjects and injured M1 of stroke subjects using a combination of non-invasive cortical stimulation, medication, and exercise techniques. In Specific Aim 1, we will test the effect of drugs that interact specifically with different neurotransmitter systems on use-dependent plasticity in intact M1 of healthy humans. In Specific Aim 2, we will identify the parameters for non-invasive TMS stimulation of M1 that are most effective to enhance use-dependent plasticity in intact healthy human M1. Specific Aim 3 will assess the efficacy of plasticity enhancing methods developed in non-injured M1 healthy subjects (Specific Aims 1 & 2) in injured M1 of stroke patients. Our proposal links science to neurorehabilitation practice in stroke patients by applying principles known to enhance practice dependent plasticity in intact human M1 to injured M1 of stroke patients to enhance motor recovery. These newly designed rehabilitation strategies could potentially reduce the morbidity and disability of stroke and, thus, reduce dramatically the costs for long-term ambulatory and nursing home care. The positive impact on the field of neurorehabilitation will be considerable.
Old
Previous studies have shown, that when patients learn a new motor movement, it may cause a change in the way the nerves act in the area of the brain that controls movement. This change is called use-dependent plasticity. The ability of that part of the brain, called the motor cortex (M1), to reorganize plays a major role in the recovery of motor deficits post-stroke; hence the importance for further development of rehabilitative strategies that utilize this potential for recovery. In this proposed study we will further examine influences of use-dependent plasticity in the non-injured M1 of healthy subjects and injured M1 of stroke subjects using a combination of non-invasive cortical stimulation, medication, and exercise techniques. In Specific Aim 1, we will test the effect of drugs that interact specifically with different neurotransmitter systems on use-dependent plasticity in intact M1 of healthy humans. In Specific Aim 2, we will identify the parameters for non-invasive TMS stimulation of M1 that are most effective to enhance use-dependent plasticity in intact healthy human M1. Specific Aim 3 will assess the efficacy of plasticity enhancing methods developed in non-injured M1 healthy subjects (Specific Aims 1 & 2) in injured M1 of stroke patients. Our proposal links science to neurorehabilitation practice in stroke patients by applying principles known to enhance practice dependent plasticity in intact human M1 to injured M1 of stroke patients to enhance motor recovery. These newly designed rehabilitation strategies could potentially reduce the morbidity and disability of stroke and, thus, reduce dramatically the costs for long-term ambulatory and nursing home care. The positive impact on the field of neurorehabilitation will be considerable.
The gender criteria for eligibility was updated to "All."
The eligibility criteria were updated.
New
For Specific Aims 1 and 2 Inclusion Criteria: - Aged 55 to 80 years - Normal neurological examination - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease - Abnormal MRI of brain - Abnormal neuropsychological testing - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS Specific Aim 3: Inclusion Criteria: - Aged 55 to 80 years - Cerebral ischemic infarction more than 12 months prior to entering the study - Single lesion as defined by MRI of the brain affecting the primary motor output system of the hand at a cortical (M1) level - Dense paresis of the hand for more than three days after cerebral infarction - Good functional recovery of hand function as defined by the ability to perform selective movements of the finger at the time of the study - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease, including bipolar disorder - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS
Old
For Specific Aims 1 and 2 Inclusion Criteria: - Aged 55 to 80 years - Normal neurological examination - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease - Abnormal MRI of brain - Abnormal neuropsychological testing - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS Specific Aim 3: Inclusion Criteria: - Aged 55 to 80 years - Cerebral ischemic infarction more than 12 months prior to entering the study - Single lesion as defined by MRI of the brain affecting the primary motor output system of the hand at a cortical (M1) level - Dense paresis of the hand for more than three days after cerebral infarction - Good functional recovery of hand function as defined by the ability to perform selective movements of the finger at the time of the study - Ability to meet criteria of inclusion experiment - Ability to give informed consent. Exclusion Criteria: - History or neurological or psychiatric disease, including bipolar disorder - Intake of CNS active drugs - History of seizure disorder - History of migraine headaches - History of anaphylaxis or allergic reactions - Contraindication to TMS
20 May '16
A location was updated in Atlanta.
New
The overall status was removed for Emory University School of Medicine.
9 Dec '11
The Summary of Purpose was updated.
New
Enhance motor cortex reorganization with noradrenergic drugs and non-invasive repetitive transcranial magnetic stimulation.
Old
The purpose of this study is to continue to understand areas of the brain while using Transcranial Magnetic Stimulation (TMS).