Operant conditioning to improve rehabilitation after stroke

Examining the Effects of Operant Conditioning of Wrist Extensor MEP on Arm Intermuscular Coordination After Stroke

This study is testing if a special training method can help stroke survivors improve their arm and hand movements by looking at how their muscles work together.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 20 (estimated)
• Ages: 40 Years to 75 Years
• Sex: All
• Sponsor: University of Houston (Academic / other)
• Locations: 1 site (Houston, Texas)
• Trial ID: NCT05020080 on ClinicalTrials.gov

What this trial studies

This study aims to investigate how operant conditioning can enhance motor control and coordination in the upper extremities of stroke survivors. It will assess the relationship between muscle synergies and motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) in individuals who have experienced a stroke. The study will involve both healthy adults and chronic stroke survivors, focusing on the effects of conditioning on corticospinal plasticity and intermuscular coordination. By analyzing EMG signals from multiple upper extremity muscles during specific tasks, the research seeks to identify potential improvements in motor function post-stroke.

Who should consider this trial

Good fit: Ideal candidates include hemiparetic chronic stroke survivors aged 40-75 with moderate-to-severe impairments and weak wrist extension.

Not a fit: Patients with orthopedic disorders involving the upper limbs or those with a history of neurological diseases may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could lead to significant improvements in motor function and quality of life for stroke survivors.

How similar studies have performed: Previous studies have shown promise in using operant conditioning and MEPs to enhance motor function in similar populations, indicating potential for success in this approach.

Eligibility criteria

Inclusion criteria for aged matched healthy group

* Male or female whose age range between 40 and 75
* no known neurological injuries

Exclusion criteria for aged matched healthy group

* have an orthopedic disorder involving upper limbs;
* have a history of any neurologic disease;
* have any history of epilepsy of the potential participants and/or their family members;
* had an adverse reaction to TMS;
* are unable to consent;
* are pregnant.

Inclusion criteria for stroke group

* male or female hemiparetic chronic stroke survivors;
* age ranging between 40-75 year;
* with single unilateral ischemic or hemorrhagic middle cerebral artery stroke;
* neurologically stable for \>6 months;
* have an expectation that current medication will be maintained without changes for at least 3 months. Stable use of anti-spasticity medication (e.g., baclofen, diazepam, tizanidine) is accepted;
* with moderate-to-severe impairments (FMA\<45/66);
* with weak wrist extension (i.e., \<4 by manual muscle strength test);
* eligible to receive transcranial magnetic stimulation (TMS), and extensor carpi radialis (ECR) motor evoked potential (MEP) must be present in the more affected arm;
* without severe spasticity (Modified Ashworth (MA) \<4);
* have not received botulinum toxin on the impaired arm within 3 months.

Exclusion criteria for stroke group

* have an orthopedic disorder involving upper limbs;
* have no measurable MEP elicited in the ECR;
* unable to produce any voluntary ECR EMG activity;
* cognitive impairment sufficient to interfere with informed consent or successful completion of the protocol (Montreal Cognitive Assessment (MoCA) score \< 26);
* a history of another neurologic disease;
* a history of vertigo;
* a history of vestibular or cochlear dysfunction;
* have a history of convulsion or a seizure;
* anesthesia of joint position sense in upper limbs;
* are pregnant or have a chance that they might be (self-reported);
* have metal in the brain/skull (except titanium; e.g. splinters, fragments, clips, etc.);
* have cochlear implants;
* have an implanted neurostimulator (DBS, epidural/subdural, VNS);
* have a cardiac pacemaker or intracardiac lines or metal in the body;
* have a medication infusion device;
* are taking any medications to treat mental illness;
* have spinal or ventricular derivations;
* had an adverse reaction to TMS.

Where this trial is running

Houston, Texas

• University of Houston — Houston, Texas, United States (Recruiting)

Study contacts

• Principal investigator: Jinsook Roh, Ph.D. — University of Houston
• Study coordinator: Jinsook Roh, PhD

Conditions Stroke; operant conditioning; motor evoked potential; transcranial magnetic stimulation; muscle synergy; motor control; motor coordination