Understanding brain function in skilled left-hand movement
Interhemispheric Communication and Compensation in Peripheral Nerve Injury
This study is trying to understand how the brain helps people use their left hand skillfully, especially looking at those with right-hand injuries and healthy individuals.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 147 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Washington University School of Medicine Academic / other |
| Locations | 1 site (Saint Louis, Missouri) |
| Trial ID | NCT05207878 on ClinicalTrials.gov |
What this trial studies
This study aims to explore the brain regions involved in enabling some individuals to skillfully use their left non-dominant hand. Participants, including right-handed individuals with chronic peripheral nerve injury in their right upper limb and healthy controls, will complete surveys and perform movement tasks both inside and outside an MRI scanner. Some participants will also undergo transcranial magnetic stimulation (TMS) to temporarily disrupt specific brain networks during these tasks. The goal is to identify the neural mechanisms that support motor control and compensation in the non-dominant hand.
Who should consider this trial
Good fit: Ideal candidates include right-handed adults aged 18 and older with chronic unilateral peripheral nerve injury to the right upper limb.
Not a fit: Patients with injuries not meeting the chronicity or specific criteria, or those who are not right-handed, may not benefit from this study.
Why it matters
Potential benefit: If successful, this study could enhance our understanding of brain plasticity and lead to improved rehabilitation strategies for individuals with upper limb nerve injuries.
How similar studies have performed: While studies on brain connectivity and motor control exist, this specific approach combining TMS and fMRI in this context is relatively novel.
Eligibility criteria
Show full inclusion / exclusion criteria
This study contains two groups: typical controls and patients. Participants will be matched by age and sex between the two groups. No randomization will occur.
A. Inclusion criteria (all participants):
1. Age ≥ 18
2. English speaking and reading
3. Able to fit in Prisma scanner bore (60 cm diameter)
4. Right hand dominant (self report, and Edinburgh handedness ≥ +40)
B. Inclusion criteria (patients only):
1. Chronic unilateral upper extremity peripheral nerve injury to the right side
* "Chronic" defined as ≥ 6 months since injury
* "Upper extremity" defined as hand, arm, or shoulder (including e.g. brachial plexus)
* "Injury" defined as localized cause (e.g. mechanical/tumor, not distributed pathology), including compression
2. Some impairment to writing, requiring both of:
* Difficulty writing, as determined by score 2+ (Mild+) on "How much difficulty have you had in the last week with writing?" (From Disabilities of the Arm, Shoulder, and Hand survey question #2)
* Box and Blocks motor performance ≥1 standard deviation below the mean of age-matched healthy adults (Mathiowetz et al. 1985, AJOT).
C. Exclusion criteria (all participants)
1. Currently intoxicated or otherwise non-compliant
2. Chronic pain diagnosis unrelated to the nerve injury
3. Uncorrected visual impairment that interferes with ability to see drawings in MRI
4. Motor function diagnoses that affect function of the left hand, now or in past 2 years
5. Motor function diagnoses currently affecting the right hand, unrelated to the nerve injury
* This is not meant to exclude a single event with complex consequences (e.g. nerve and tendon)
* This is not meant to exclude multiple nerve injuries in the same arm, if each one is eligible (II.B.1)
* This is meant to exclude e.g. injury and unrelated musculoskeletal disorder in same arm
6. Upper extremity surgery, including peripheral nerve surgery, within last 2 months
7. Contraindication for MRI
8. Contraindication for transcranial magnetic stimulation (TMS)
* May exclude from TMS only (since not all participants undergo TMS), or exclude from full study
9. Amputation affecting any part of thumb, index, or middle fingers (including higher level, e.g. whole hand)
10. History of chronic cocaine use (based on medical record or volunteered; will not actively inquire)
11. Diagnosis of schizophrenia or other rare psychiatric disorder
* This is not meant to exclude depression or anxiety
12. History of major neurological diagnosis, e.g. stroke, traumatic brain injury, Alzheimer's, Parkinson's
* This is not meant to exclude concussion UNLESS \< 6 months ago, or post-concussion syndrome (diagnosed or self-report)
D. Exclusion criteria (controls only)
1. Motor function diagnoses that affect function of either hand, now or in past 2 years
Where this trial is running
Saint Louis, Missouri
- Washington University School of Medicine — Saint Louis, Missouri, United States (Recruiting)
Study contacts
- Principal investigator: Benjamin A Philip, PhD — Washington University School of Medicine
- Study coordinator: Benjamin A Philip, PhD
- Email: bphilip@wustl.edu
- Phone: (314) 286-1634
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.