Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol
Background. Despite intensive rehabilitation efforts, most stroke survivors have persistent functional disability of the paretic arm and hand. These motor impairments may be due in part to maladaptive changes in structural and functional connections between brain regions. The following early stage c...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-01-01
|
| Series: | Neural Plasticity |
| Online Access: | http://dx.doi.org/10.1155/2018/9875326 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832558814765776896 |
|---|---|
| author | Michael R. Borich Steven L. Wolf Andrew Q. Tan Jacqueline A. Palmer |
| author_facet | Michael R. Borich Steven L. Wolf Andrew Q. Tan Jacqueline A. Palmer |
| author_sort | Michael R. Borich |
| collection | DOAJ |
| description | Background. Despite intensive rehabilitation efforts, most stroke survivors have persistent functional disability of the paretic arm and hand. These motor impairments may be due in part to maladaptive changes in structural and functional connections between brain regions. The following early stage clinical trial study protocol describes a noninvasive brain stimulation approach to target transcallosally mediated interhemispheric connections between the ipsi- and contralesional motor cortices (iM1 and cM1) using corticocortical paired associative stimulation (ihPAS). This clinical trial aims to characterize ihPAS-induced modulation of interhemispheric connectivity and the effect on motor skill performance and learning in chronic stroke survivors. Methods/Design. A repeated-measures, cross-over design study will recruit 20 individuals post-stroke with chronic mild–moderate paretic arm impairment. Each participant will complete an active ihPAS and control ihPAS session. Assessments of cortical excitability and motor skill performance will be conducted prior to and at four time points following the ihPAS intervention. The primary outcome measures will be: TMS-evoked interhemispheric motor connectivity, corticomotor excitability, and response time on a modified serial reaction time task. Discussion/Conclusion. The findings from this single-site early stage clinical trial will provide foundational results to inform the design of larger-scale, multisite clinical trials to evaluate the therapeutic potential of ihPAS-based neuromodulation for upper limb recovery after stroke. This trial is registered with NCT02465034. |
| format | Article |
| id | doaj-art-95081b4116e54e6bb4eab4cd614ea0d7 |
| institution | Kabale University |
| issn | 2090-5904 1687-5443 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Neural Plasticity |
| spelling | doaj-art-95081b4116e54e6bb4eab4cd614ea0d72025-02-03T01:31:30ZengWileyNeural Plasticity2090-59041687-54432018-01-01201810.1155/2018/98753269875326Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study ProtocolMichael R. Borich0Steven L. Wolf1Andrew Q. Tan2Jacqueline A. Palmer3Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322, USADivision of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322, USADivision of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322, USADivision of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322, USABackground. Despite intensive rehabilitation efforts, most stroke survivors have persistent functional disability of the paretic arm and hand. These motor impairments may be due in part to maladaptive changes in structural and functional connections between brain regions. The following early stage clinical trial study protocol describes a noninvasive brain stimulation approach to target transcallosally mediated interhemispheric connections between the ipsi- and contralesional motor cortices (iM1 and cM1) using corticocortical paired associative stimulation (ihPAS). This clinical trial aims to characterize ihPAS-induced modulation of interhemispheric connectivity and the effect on motor skill performance and learning in chronic stroke survivors. Methods/Design. A repeated-measures, cross-over design study will recruit 20 individuals post-stroke with chronic mild–moderate paretic arm impairment. Each participant will complete an active ihPAS and control ihPAS session. Assessments of cortical excitability and motor skill performance will be conducted prior to and at four time points following the ihPAS intervention. The primary outcome measures will be: TMS-evoked interhemispheric motor connectivity, corticomotor excitability, and response time on a modified serial reaction time task. Discussion/Conclusion. The findings from this single-site early stage clinical trial will provide foundational results to inform the design of larger-scale, multisite clinical trials to evaluate the therapeutic potential of ihPAS-based neuromodulation for upper limb recovery after stroke. This trial is registered with NCT02465034.http://dx.doi.org/10.1155/2018/9875326 |
| spellingShingle | Michael R. Borich Steven L. Wolf Andrew Q. Tan Jacqueline A. Palmer Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol Neural Plasticity |
| title | Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol |
| title_full | Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol |
| title_fullStr | Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol |
| title_full_unstemmed | Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol |
| title_short | Targeted Neuromodulation of Abnormal Interhemispheric Connectivity to Promote Neural Plasticity and Recovery of Arm Function after Stroke: A Randomized Crossover Clinical Trial Study Protocol |
| title_sort | targeted neuromodulation of abnormal interhemispheric connectivity to promote neural plasticity and recovery of arm function after stroke a randomized crossover clinical trial study protocol |
| url | http://dx.doi.org/10.1155/2018/9875326 |
| work_keys_str_mv | AT michaelrborich targetedneuromodulationofabnormalinterhemisphericconnectivitytopromoteneuralplasticityandrecoveryofarmfunctionafterstrokearandomizedcrossoverclinicaltrialstudyprotocol AT stevenlwolf targetedneuromodulationofabnormalinterhemisphericconnectivitytopromoteneuralplasticityandrecoveryofarmfunctionafterstrokearandomizedcrossoverclinicaltrialstudyprotocol AT andrewqtan targetedneuromodulationofabnormalinterhemisphericconnectivitytopromoteneuralplasticityandrecoveryofarmfunctionafterstrokearandomizedcrossoverclinicaltrialstudyprotocol AT jacquelineapalmer targetedneuromodulationofabnormalinterhemisphericconnectivitytopromoteneuralplasticityandrecoveryofarmfunctionafterstrokearandomizedcrossoverclinicaltrialstudyprotocol |