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StrokeNCT01569607

Structurally Reorganizing Motor Cortex in Stroke Patients Through Hebbian-type Stimulation

A study testing Repetitive Transcranial Magnetic Stimulation (rTMS) in people with Stroke, run by Cathrin Buetefisch at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Stroke is a leading cause of morbidity in the United States but identification of treatment strategies to improve outcome is limited by the incomplete understanding of the mechanisms of recovery. Read more about this study

Who is it for?
Ages 18 to 85 years
Conditions the study is for
Stroke
What is being tested?
Repetitive Transcranial Magnetic Stimulation (rTMS)
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
48 participants
Where
1 siteUnited States
Study dates
8 Mar 2012to 26 Aug 2016
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age 18-85
  • Single cerebral ischemic infarction > 6 month affecting the primary motor output system of the hand at a cortical (M1) level as defined by MRI of the brain
  • At the time of cerebral infarct a motor deficit of hand of MRC of <4- of wrist and finger extension/flexion movement
  • Good 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
  • No other neurological disorder
Show all 11Show fewer
  • No intake of CNS active drugs
  • Ability to give informed consent
  • Ability to meet criteria of inclusion experiment
  • No major cognitive impairment
  • No contraindication to TMS or MRI

Who cannot join

None listed.

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Emory University School of Medicine

    Atlanta, Georgia, 30322

Other trials in United States

About this study

Stroke is a leading cause of morbidity in the United States but identification of treatment strategies to improve outcome is limited by the incomplete understanding of the mechanisms of recovery. Motor cortex (M1) reorganization 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 Specific Aim 1, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances functional M1 reorganization in lesioned M1 of stroke patients.

Read more

In Specific Aim 2, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances structural cortical reorganization in lesioned M1 of stroke patients and to explore whether these structural changes are related to the training induced functional cortical reorganization.

The overall goal of this project is to determine the effect of Hebbian- type stimulation on both, functional and structural brain reorganization, thereby obtaining indirect evidence for the neuronal substrate underlying training related improvement and maintenance of motor function in stroke patients. This knowledge may have a substantial positive impact on treatment for stroke patients that may significantly improve recovery and could move the field of neuro-rehabilitation forward.

Read the detailed description

Stroke is a leading cause of morbidity in the United States but identification of treatment strategies to improve outcome is limited by the incomplete understanding of the mechanisms of recovery. Motor cortex (M1) reorganization 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. Non-invasive cortical stimulation can enhance the beneficial effects of motor training on performance and functional plasticity of motor cortex. Among the different approaches used in these studies, Hebbian-type M1 stimulation is particularly intriguing, as it seems to be more effective when compared to random M1 stimulation. There is emerging evidence that motor training or cortical stimulation related improvement of function are associated with increases in the grey matter of targeted brain areas. While there is therefore some evidence supporting structural reorganization in human M1 in response to motor learning and cortical stimulation, the mechanisms underlying these changes and their relationship to functional plasticity are not known. A better understanding of the sequences of events is critical to development of optimal therapeutic interventions to improve recovery following stroke.

In Specific Aim 1, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances functional M1 reorganization in lesioned M1 of stroke patients.

In Specific Aim 2, investigators will determine if repeated exposure to training combined with Hebbian-type M1 stimulation enhances structural cortical reorganization in lesioned M1 of stroke patients and to explore whether these structural changes are related to the training induced functional cortical reorganization.

The overall goal of this project is to determine the effect of Hebbian- type stimulation on both, functional and structural brain reorganization, thereby obtaining indirect evidence for the neuronal substrate underlying training related improvement and maintenance of motor function in stroke patients. This knowledge may have a substantial positive impact on treatment for stroke patients that may significantly improve recovery and could move the field of neuro-rehabilitation forward.

Conditions
Stroke
Being tested
Repetitive Transcranial Magnetic Stimulation (rTMS), Sham stimulation
Keywords
Neurophysiology, Transcranial Magnetic Stimulation (TMS), Neurology, Stroke, Physical Medicine and Rehabilitation
Medical subject headings
Stroke

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Repetitive Transcranial Magnetic Stimulation (rTMS)Device

    Training sessions for 5 days in a row

  • Sham stimulationDevice

    Sham stimulation

Study groups in NCT01569607
Study groupRoleWhat they receive
Hebbian-type StimulationExperimentalParticipants will be randomized to receive motor training with Hebbian-type stimulation.
Receives: Device: Repetitive Transcranial Magnetic Stimulation (rTMS)
Sham StimulationSham comparatorParticipants will be randomized to receive sham stimulation.
Receives: Device: Sham stimulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary Motor Cortex (M1) Excitability Derived From Stimulus Response Curve

    Motor evoked potential (MEP) amplitudes were measured prior to treatment (baseline), one week after the treatment (post-training 1), and 4 weeks after treatment (post-training 2).The MEP is elicited by transcranial magnetic stimulation (TMS) at increased intensity. Its amplitude is measured from peak to peak and expressed in millivolts (mV). Measured MEP amplitudes were plotted against the intensity to create a stimulus response curve (SRC). Long-lasting increases in MEP amplitude indicate increases in motor cortex excitability and are associated with motor learning.

    Measured: Baseline, Post-Training 1 (1 Week), Post-Training 2 (4 Weeks)

Secondary outcomes (8)
  1. Mean Time to Completion for Jebsen Hand Function Test (JTT)

    The JTT provides a standardized and objective evaluation of fine and gross motor hand function using simulated activities of daily living assessing the speed of performance. Total score is the sum of time taken for each sub-test, which were normalized to standard scores (also expressed in seconds).Total scores range from +1 to -1 where -1 indicates best function.

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  2. Mean Peak Acceleration of Wrist Extension Movements

    Mean peak acceleration was measured at baseline, one week after the treatment (post-training 1), and four weeks after the treatment (post-training 2). Increases in the mean peak acceleration of the trained wrist extension movements indicate motor learning. Acceleration was measured in g; a symbol for the average acceleration produced by gravity at the Earth's surface.

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  3. Mean Reaction Time of Wrist Extension Movements

    Subjects will be asked to perform 7 auditory-cued ballistic wrist extensions before and after motor training. Electromyographic (EMG) activity recorded during the ballistic wrist extensions will be used to measure reaction time. Reaction time is the length of time between the auditory cue and the onset of the movement-related EMG burst of the extensor carpi ulnaris muscle. A longer time indicated longer time to reaction.

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  4. Mean Motor Activity Log (MAL) Score: Amount Subtest

    Individuals are asked to rate amount of movement during 30 daily functional tasks. Items are scored on a 0 to 6-point ordinal scale as follows:

    0 = The weaker arm was not used at all for that activity (never)

    1 = Occasionally used weaker arm, but only very rarely (very rarely)

    2= Sometimes used weaker arm, but did the activity most of the time with stronger arm (rarely)

    3 = Used weaker arm about half as much as before the stroke (half pre-stroke)

    4 = Used weaker arm almost as much as before the stroke (3/4 pre-stroke)

    5 = The ability to use the weaker arm for that activity was as good as before the stroke (normal)

    Total scores range from 0 to 140; 0 indicating the least movement 140 indicating the most movement. The scores were converted into percentage scores where higher percent score indicate more movement and lower percent score less movement.

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  5. Mean Motor Activity Log (MAL): How Well Subtest

    Individuals are asked to rate quality of movement during 30 daily functional tasks. Items are scored on a 6-point ordinal scale as follows:

    0=The weaker arm was not used at all for that activity (never); 1=The weaker arm was moved during that activity, but was not helpful (very poor); 2=The weaker arm was of some use during the activity, but needed help from the stronger arm or moved very slowly or with difficulty (poor); 3=The weaker arm was used for the purpose indicated, but movements were slow or were made with only some effort (fair); 4=The movements made by the weaker arm were almost normal, but were not quite as fast or accurate as normal (almost normal); 5=The ability to use the weaker arm for that activity was as good as before the stroke (normal)

    Total scores range from 0 to 140; 0 indicating the least movement and 140 indicating the most movement.

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  6. Mean Wolf Motor Function Test (WMFT) Total Time

    The Wolf Motor Function Test (WMFT) is a quantitative index of upper extremity motor ability examinable through the use of timed and functional tasks. There are 15 timed tasks included with a time cap of 120 seconds. The max amount of time to completion is 1800 seconds if all tasks are failed. The time in seconds were summed across all the tasks to obtain the total duration. Values in the table represent the time taken in seconds to successfully complete all 15 tasks).

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  7. Mean Wolf Motor Function Test Functional Ability (WMFT-FS) Scale Score

    The WMFT is a 17 item scale that quantifies upper extremity (UE) motor ability through timed and functional tasks. The items are rated on a 6-point scale.Total scores can range from 17 to 102. Lower scores indicate debilitating mobility (such as no or limited functionality), while higher score indicate greater mobility (such as slow movement and normal movement).

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

  8. Mean Wolf Motor Function Test (WMFT) Grip Strength

    Participants attempt to grip the dynamometer with greatest grip strength possible. The test should be conducted 3 times with a 1-minute rest between trials. The mean of grip strength exerted (kg) on 3 trials is then calculated.

    Measured: Baseline, Post-Training (1 Week), Post-Training (4 Weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted3 Apr 2012 (estimated)
  2. Study start8 Mar 2012
  3. Primary completion26 Aug 2016
  4. Study completion26 Aug 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
48 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01569607
Sponsor's protocol ID
IRB00052053
Other IDs
R21HD067906-01A1, SRMC21
Status last verified
Dec 2017
First submitted
30 Mar 2012
Last updated
16 Jan 2018
Data monitoring committee
No

Publications

  • Revill KP, Haut MW, Belagaje SR, Nahab F, Drake D, Buetefisch CM. Hebbian-Type Primary Motor Cortex Stimulation: A Potential Treatment of Impaired Hand Function in Chronic Stroke Patients. Neurorehabil Neural Repair. 2020 Feb;34(2):159-171. doi: 10.1177/1545968319899911. Epub 2020 Jan 24.

    PubMed 31976804

Questions about this trial

What is this clinical trial studying?

A study testing Repetitive Transcranial Magnetic Stimulation (rTMS) in people with Stroke, run by Cathrin Buetefisch at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 0 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 16 Jan 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 16 Jan 2018). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary Motor Cortex (M1) Excitability Derived From Stimulus Response Curve (time frame: Baseline, Post-Training 1 (1 Week), Post-Training 2 (4 Weeks)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01569607, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 16 Jan 2018.

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Clinical Trial NCT01569607 | AzTrials