Transcranial Magnetic Stimulation in Stroke Motor Rehabilitation Treatment

Not yet 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

Occlusion of the middle cerebral artery is the most common cause of stroke. Because the middle cerebral artery supplies blood to the motor cortices, middle cerebral artery stroke often impacts the integrity of the motor cortex and its associated corticospinal projections. Less than half of all individuals post-stroke regain complete motor function. Because motor deficits, especially of the upper extremities, can dampen the quality of life, there is an urgent need to improve current rehabilitation programs to allow more stroke survivors to achieve higher functional gains.
Motor training is an important part of recovery after stroke. During motor training, 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. 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 adults who experienced a stroke more than 6 months ago.

Conditions

Interventions

  • Repetitive TMS over contralateral premotor cortex. Device
    Intervention Desc: Repetitive Transcranial magnetic stimulation (rTMS) will be applied over contralateral premotor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.
    ARM 1: Kind: Experimental
    Label: Repetitive TMS over contralateral premotor cortex
    Description: Location of repetitive Transcranial Magnetic Stimulation (rTMS): contralateral premotor cortex.
  • Repetitive TMS over ipsilateral premotor cortex. Device
    Intervention Desc: Repetitive Transcranial magnetic stimulation (rTMS) will be applied over ipsilateral premotor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.
    ARM 1: Kind: Experimental
    Label: Repetitive TMS over ipsilateral premotor cortex
    Description: Location of repetitive Transcranial Magnetic Stimulation (rTMS): ipsilateral premotor cortex.
  • Repetitive TMS over contralateral primary motor cortex. Device
    Intervention Desc: Repetitive Transcranial magnetic stimulation (rTMS) will be applied over contralateral primary motor cortex during motor training. TMS uses magnetism to excite neurons near the surface of the brain.Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.
    ARM 1: Kind: Experimental
    Label: Repetitive TMS over contralateral primary motor cortex
    Description: Location of repetitive Transcranial Magnetic Stimulation (rTMS): contralateral primary motor cortex.
  • Sham Repetitive TMS over contralateral premotor cortex. Device
    Intervention Desc: Sham rTMS will be applied over contralateral premotor cortex. TMS uses magnetism to excite neurons near the surface of the brain. Frequency of rTMS: 0.1 Hz; time of rTMS: 50 milliseconds before the onset of movement-related electromyography (EMG); device: Super Rapid 2 Transcranial Magnetic Stimulator.
    ARM 1: Kind: Experimental
    Label: Sham repetitive TMS over contralateral premotor cortex
    Description: Location of Sham repetitive Transcranial Magnetic Stimulation (rTMS): contralateral premotor cortex.
  • Single TMS over extensor carpi ulnaris spot of motor cortex Device
    Intervention Desc: Single-pulse TMS will be applied over the extensor carpi ulnaris (ECU) hotspot of primary motor cortex (M1) during motor training.TMS uses magnetism to excite neurons near the surface of the brain. TMS pulses will be applied at different strengths (30%-80% maximum stimulator output) and record subsequent activity of the ECU muscle using electromyography (EMG).
    ARM 1: Kind: Experimental
    Label: Single TMS over extensor carpi ulnaris spot of motor cortex
    Description: Location of single-pulse Transcranial Magnetic Stimulation (sTMS): extensor carpi ulnaris (ECU) hotspot of primary motor cortex (M1).

Outcomes

Type Measure Time Frame Safety Issue
Primary Change in wrist velocity Before, 0 mins after, 30 mins after, and 60 mins after motor training.
Primary Change in Stimulus Response Curve parameters Before, 0 mins after, 30 mins after and 60 mins after motor training.
Secondary Change in wrist force Before, 0 mins after, 30 mins after, and 60 mins after motor training.
Secondary Change in reaction time Before, 0 mins after, 30 mins after and 60 mins after motor training.
Secondary Change in task accuracy During motor training (will compare first block to last block).
Secondary Change in Short interval intracortical inhibition (SICI) of the primary motor cortex Before, 0 mins after, 30 mins after, and 60 mins after motor training.
Secondary Change in Resting Motor Threshold Before, 0 mins after, 30 mins after, and 60 mins after motor training.

Sponsors