Premotor Cortex: A New Target for Stroke Motor Rehabilitation

Recruiting

Phase N/A Results N/A

Trial Description

The goal of the study is to determine the effect of repetitive transcranial magnetic stimulation (rTMS) over the premotor cortex on training-related improvements in motor performance and associated neural plasticity.

Detailed Description

Motor training is an important part of recovery after stroke. During motor training, stroke patients practice performing a movement and become better at performing the trained movement over time. Repetitive transcranial magnetic stimulation (rTMS), which uses magnetism to excite neurons near the surface of the brain, may further improve performance. Healthy adults made larger training-related improvements in their motor performance when they received rTMS over the primary motor cortex during motor training. There is evidence that the premotor cortex may be a more effective target than the primary motor cortex for rTMS for some stroke survivors. In the current study, the investigator will determine the effect of rTMS over the premotor cortex on training-related improvements in motor performance in healthy adults.

Conditions

Interventions

  • Motor Training Other
    Intervention Desc: During motor training, participants will quickly extend their hand at a pace of one extension every 5 seconds (0.2Hz) in response to an auditory cue.
    ARM 1: Kind: Experimental
    Label: Single motor training only
    Description: For a pilot experiment, healthy, right-handed subjects will complete one testing session. During the testing session, subjects will complete motor training. The results of this experiment will determine the motor training protocol used in the main experiment.
    ARM 2: Kind: Experimental
    Label: Repetitive TMS during motor training
    Description: Healthy, right-handed subjects will complete five testing sessions. During each testing session, subjects will complete motor training while receiving one of five repetitive transcranial magnetic stimulation (rTMS) protocols. Subjects will receive a different rTMS protocol at each testing session. By the end of the study, each subject will have received all rTMS protocols.
  • RTMS over Premotor Cortex (Contralateral Hemisphere) Device
    Intervention Desc: Location of rTMS: premotor cortex Frequency of rTMS: 0.1 Hz Time of rTMS: 50 milliseconds before the onset of movement-related EMG Device: MagStim Super Rapid 2 Transcranial Magnetic Stimulator
    ARM 1: Kind: Experimental
    Label: Repetitive TMS during motor training
    Description: Healthy, right-handed subjects will complete five testing sessions. During each testing session, subjects will complete motor training while receiving one of five repetitive transcranial magnetic stimulation (rTMS) protocols. Subjects will receive a different rTMS protocol at each testing session. By the end of the study, each subject will have received all rTMS protocols.
  • RTMS over Premotor Cortex (Ipsilateral Hemisphere) Device
    Intervention Desc: Location of rTMS: premotor cortex Frequency of rTMS: 0.1 Hz Time of rTMS: 50 milliseconds before the onset of movement-related EMG Device: Super Rapid 2 Transcranial Magnetic Stimulator
    ARM 1: Kind: Experimental
    Label: Repetitive TMS during motor training
    Description: Healthy, right-handed subjects will complete five testing sessions. During each testing session, subjects will complete motor training while receiving one of five repetitive transcranial magnetic stimulation (rTMS) protocols. Subjects will receive a different rTMS protocol at each testing session. By the end of the study, each subject will have received all rTMS protocols.
  • RTMS (Control 1) Device
    Intervention Desc: Location of rTMS: premotor cortex Frequency of rTMS: 0.1 Hz Time of rTMS: 400 milliseconds after the onset of movement-related EMG Device: Super Rapid 2 Transcranial Magnetic Stimulator
    ARM 1: Kind: Experimental
    Label: Repetitive TMS during motor training
    Description: Healthy, right-handed subjects will complete five testing sessions. During each testing session, subjects will complete motor training while receiving one of five repetitive transcranial magnetic stimulation (rTMS) protocols. Subjects will receive a different rTMS protocol at each testing session. By the end of the study, each subject will have received all rTMS protocols.
  • RTMS (Control 2) Device
    Intervention Desc: Location of rTMS: somatosensory cortex Frequency of rTMS: 0.1 Hz Time of rTMS: 50 milliseconds before the onset of movement-related EMG Device: Super Rapid 2 Transcranial Magnetic Stimulator
    ARM 1: Kind: Experimental
    Label: Repetitive TMS during motor training
    Description: Healthy, right-handed subjects will complete five testing sessions. During each testing session, subjects will complete motor training while receiving one of five repetitive transcranial magnetic stimulation (rTMS) protocols. Subjects will receive a different rTMS protocol at each testing session. By the end of the study, each subject will have received all rTMS protocols.
  • RTMS (Control 3) Device
    Intervention Desc: Location of rTMS: premotor cortex Frequency of rTMS: 0.1 Hz Time of rTMS: 50 milliseconds before the onset of movement-related EMG Device: Super Rapid 2 Transcranial Magnetic Stimulator with Sham Coil
    ARM 1: Kind: Experimental
    Label: Repetitive TMS during motor training
    Description: Healthy, right-handed subjects will complete five testing sessions. During each testing session, subjects will complete motor training while receiving one of five repetitive transcranial magnetic stimulation (rTMS) protocols. Subjects will receive a different rTMS protocol at each testing session. By the end of the study, each subject will have received all rTMS protocols.

Trial Design

  • Allocation: Randomized
  • Masking: Double Blind (Subject, Investigator)
  • Purpose: Treatment
  • Endpoint: Safety/Efficacy Study
  • Intervention: Parallel Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Change in wrist acceleration Baseline, post-motor training (1 minute, 30 minutes and 60 minutes after completion of motor training) No
Primary Change in stimulus response curve (SRC) Baseline, post-motor training (1 minute, 30 minutes and 60 minutes after completion of motor training) No
Primary Change in short interval intracortical inhibition (SICI) Baseline, post-motor training (1 minute, 30 minutes and 60 minutes after completion of motor training) No
Secondary Change in wrist force Baseline, post-motor training (1 minute, 30 minutes and 60 minutes after completion of motor training) No
Secondary Change in reaction time Baseline and post-motor training (1 minute, 30 minutes and 60 minutes after completion of motor training) No
Secondary Change in task accuracy Baseline and post-motor training (1 minute after completion of motor training) No

Sponsors