Altered Connections in the Spinal Cord to Reduce Hand Impairment After Stroke
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 3/2/2019 |
| Start Date: | February 4, 2019 |
| End Date: | October 31, 2023 |
| Contact: | Debbie E Harrington, BS |
| Email: | debbie.harrington@pitt.edu |
| Phone: | (412) 383-1355 |
Plasticity in the Spinal Cord to Enhance Motor Retraining After Stroke
The goals of this study are to leverage principles of spike timing-dependent plasticity
(STDP) via non-invasive stimulation techniques to strengthen corticospinal transmission. Few
studies have targeted the cortex after stroke in humans, and none have targeted the
corticospinal-motoneuronal synapse in the spinal cord. This study, therefore, is a novel
approach to studying neuroplasticity after stroke. Previous work in humans with incomplete
spinal cord injury demonstrates that the resulting plasticity transiently enhances motor
output, indicating that there is also therapeutic potential.
(STDP) via non-invasive stimulation techniques to strengthen corticospinal transmission. Few
studies have targeted the cortex after stroke in humans, and none have targeted the
corticospinal-motoneuronal synapse in the spinal cord. This study, therefore, is a novel
approach to studying neuroplasticity after stroke. Previous work in humans with incomplete
spinal cord injury demonstrates that the resulting plasticity transiently enhances motor
output, indicating that there is also therapeutic potential.
Stroke is a leading cause of serious long-term disability in the United States with 795,000
individuals suffering a new or recurrent stroke each year. In most cases, disability is
associated with incomplete motor recovery of the paretic limb. Even with intensive therapy,
full recovery is often not achieved. Thus, there is a need for mechanistic approaches that
drive the impaired neuronal targets of retraining to fully harness the corticospinal system's
adaptive capacity.
This study will attempt to induce bi-directional STDP in corticospinal-motoneuronal synapses
serving an intrinsic hand muscle of the hemiparetic limb. Control experiments will be
completed to provide evidence of the neurophysiological mechanism(s) mediating the effect and
to examine behavioral effects.
Individuals who are at least 6 months post first-ever subcortical stroke and have at least
partial range of motion of the paretic index finger will be invited to participate.
individuals suffering a new or recurrent stroke each year. In most cases, disability is
associated with incomplete motor recovery of the paretic limb. Even with intensive therapy,
full recovery is often not achieved. Thus, there is a need for mechanistic approaches that
drive the impaired neuronal targets of retraining to fully harness the corticospinal system's
adaptive capacity.
This study will attempt to induce bi-directional STDP in corticospinal-motoneuronal synapses
serving an intrinsic hand muscle of the hemiparetic limb. Control experiments will be
completed to provide evidence of the neurophysiological mechanism(s) mediating the effect and
to examine behavioral effects.
Individuals who are at least 6 months post first-ever subcortical stroke and have at least
partial range of motion of the paretic index finger will be invited to participate.
Inclusion Criteria:
- Between the ages of 18 and 75 years old
- Subjects must show an understanding of the study goals and have the ability to follow
simple directions as judged by the investigators.
- Must be a U. S. Veteran
- Diagnosis of first ever subcortical stroke
- Stroke onset of at least six months prior to the time of participation
- Some residual muscle activity in the first dorsal interosseous muscle (Score of 1 or
greater on MRC Scale)
- Subjects must show an understanding of the study goals and have the ability to follow
simple directions as judged by the investigators.
- Must be a U. S. Veteran
Exclusion Criteria:
- History of seizure or epilepsy
- Metallic implants in the head or neck
- Ferromagnetic metallic implants, pacemakers, other implanted devices, or ventilators
(for subjects undergoing MRI)
- Pregnant or expecting to become pregnant
- Difficulty maintaining alertness and/or remaining still
- Body weight > 300 lbs due to MRI scanner dimensions (for subjects undergoing MRI)
- Hemispatial neglect, aphasia, or cognitive or language impairment that would impact
testing and would interfere with the ability to follow simple instructions, as judged
by the investigators
- Diagnosis of neurological disorder(s) other than stroke influence movement
We found this trial at
1
site
Pittsburgh, Pennsylvania 15240
Principal Investigator: Michael A. Urbin, PhD
Phone: 412-383-1355
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