Examining How Motor Rehabilitation Promotes Brain Reorganization Following Stroke, an MRI Study
Primary Purpose
Stroke, Hemiparesis
Status
Active
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
CI therapy
Sponsored by
About this trial
This is an interventional treatment trial for Stroke focused on measuring motor, stroke, hemiparesis, rehabilitation, constraint induced movement therapy, CI therapy
Eligibility Criteria
Inclusion Criteria:
- Males or females 18 years of age and over
- Experienced a stroke resulting in mild to moderate hemiparesis (some residual motor function, e.g. able to pick up a washcloth placed flat on a table) at least 6 months prior to enrollment. Suggested active range of motion criteria for this level of impairment include: 45° shoulder abduction and flexion, 20° elbow extension, 20° wrist extension, and 10° extension of thumb and fingers.
- Preserved ability to comprehend and participate in basic elements of the therapy
Exclusion Criteria:
- Concurrent participation in other experimental trials for treatment of motor dysfunction
- Having received botulinum toxin injection within the past 3 months
- Previous intensive rehabilitation in the chronic phase post-stroke
- Serious/uncontrolled medical problems (e.g., dementia, severe pain, end-stage or degenerative diseases)
- Kidney disease as evidenced by eGFR<60
- Anemia
- Sickle cell disease
- History of kidney transplant
- Other evidence/history of renal disease
- Pregnancy
- Implanted metallic parts of implanted electronic devices, including pacemakers, defibrillators, aneurism clip or implant medication pump that are MRI incompatible
- An implanted brain stimulator
- Permanent tattoo (e.g., eye liner) containing metallic coloring
- Claustrophobia precluding MRI
Sites / Locations
- The Ohio State University
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Immediate CI therapy
Delayed CI therapy
Arm Description
Outcomes
Primary Outcome Measures
Brain structure
Assessed via dynamic susceptibility contrast MRI, diffusion tensor MRI, MRI-based myelin mapping, T1-weighted MRI
Secondary Outcome Measures
Motor function
Assessed via Wolf Motor Function Test, Action Research Arm Test, Motor Activity Log
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT01725919
Brief Title
Examining How Motor Rehabilitation Promotes Brain Reorganization Following Stroke, an MRI Study
Official Title
Examining Mechanisms of Neuroplasticity Following Motor Rehabilitation in Stroke
Study Type
Interventional
2. Study Status
Record Verification Date
March 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
July 2012 (undefined)
Primary Completion Date
June 30, 2017 (Actual)
Study Completion Date
December 2024 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ohio State University
4. Oversight
Data Monitoring Committee
No
5. Study Description
Brief Summary
Constraint-induced movement therapy (CI therapy) is a highly efficacious treatment for residual motor disability in chronic stroke. Its effectiveness is believed to be due, at least in part, to the therapy's ability to aid the brain in "rewiring itself." For example, CI therapy produces increases in the amount of grey matter (the parts of the brain where neuron cell bodies are most closely clustered) in certain areas of the human brain (Gauthier et al., 2008). The cellular and molecular mechanisms that are responsible for this increase in grey matter volume are not known, however. Thus, it is unclear how the therapy helps brains "rewire" themselves. This study aims to better understand the timecourse and cellular/molecular nature of brain changes during CI therapy. Because there is currently no way to directly measure cellular/molecular changes in the brain noninvasively, this study will infer what is happening on a microstructural level using new MRI techniques (three dimensional pictures of the brain). For example, by charting the timecourse of grey matter changes during CI therapy, and cross-comparing this to what is known about the timecourses of different cellular/molecular processes, the investigators can gain a greater understanding of what cellular processes may be responsible for increases in grey matter. The investigators will gain additional information about which cellular processes are important for rehabilitation-induced improvement by measuring larger-scale changes (e.g., amount of blood flow through different brain areas) that accompany cellular changes. The investigators are hopeful that by better understanding how CI therapy can change the brain, the effectiveness of rehabilitation can be improved upon. For example, insight into the mechanisms of rehabilitation-induced brain change may suggest particular drug targets to increase brain plasticity. This study will help us better understand how the brain repairs itself after injury.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stroke, Hemiparesis
Keywords
motor, stroke, hemiparesis, rehabilitation, constraint induced movement therapy, CI therapy
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
31 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Immediate CI therapy
Arm Type
Experimental
Arm Title
Delayed CI therapy
Arm Type
Active Comparator
Intervention Type
Behavioral
Intervention Name(s)
CI therapy
Intervention Description
constraint induced movement therapy
Primary Outcome Measure Information:
Title
Brain structure
Description
Assessed via dynamic susceptibility contrast MRI, diffusion tensor MRI, MRI-based myelin mapping, T1-weighted MRI
Time Frame
Participants will be followed for 4-6 weeks. Change in brain structure at mid-treatment (after 1 week of CI therapy), post-treatment (after 2 weeks of therapy), and at 2-week follow-up will be measured.
Secondary Outcome Measure Information:
Title
Motor function
Description
Assessed via Wolf Motor Function Test, Action Research Arm Test, Motor Activity Log
Time Frame
Participants will be followed for 4-6 weeks. Change in motor function at mid-treatment (after 1 week of CI therapy), post-treatment (after 2 weeks of therapy), and at 2-week follow-up will be measured.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Males or females 18 years of age and over
Experienced a stroke resulting in mild to moderate hemiparesis (some residual motor function, e.g. able to pick up a washcloth placed flat on a table) at least 6 months prior to enrollment. Suggested active range of motion criteria for this level of impairment include: 45° shoulder abduction and flexion, 20° elbow extension, 20° wrist extension, and 10° extension of thumb and fingers.
Preserved ability to comprehend and participate in basic elements of the therapy
Exclusion Criteria:
Concurrent participation in other experimental trials for treatment of motor dysfunction
Having received botulinum toxin injection within the past 3 months
Previous intensive rehabilitation in the chronic phase post-stroke
Serious/uncontrolled medical problems (e.g., dementia, severe pain, end-stage or degenerative diseases)
Kidney disease as evidenced by eGFR<60
Anemia
Sickle cell disease
History of kidney transplant
Other evidence/history of renal disease
Pregnancy
Implanted metallic parts of implanted electronic devices, including pacemakers, defibrillators, aneurism clip or implant medication pump that are MRI incompatible
An implanted brain stimulator
Permanent tattoo (e.g., eye liner) containing metallic coloring
Claustrophobia precluding MRI
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yousef Hannawi, MD
Organizational Affiliation
Ohio State University
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
12. IPD Sharing Statement
Citations:
PubMed Identifier
31504952
Citation
Rafiei MH, Kelly KM, Borstad AL, Adeli H, Gauthier LV. Predicting Improved Daily Use of the More Affected Arm Poststroke Following Constraint-Induced Movement Therapy. Phys Ther. 2019 Dec 16;99(12):1667-1678. doi: 10.1093/ptj/pzz121.
Results Reference
derived
PubMed Identifier
30246613
Citation
Kelly KM, Borstad AL, Kline D, Gauthier LV. Improved quality of life following constraint-induced movement therapy is associated with gains in arm use, but not motor improvement. Top Stroke Rehabil. 2018 Oct;25(7):467-474. doi: 10.1080/10749357.2018.1481605. Epub 2018 Sep 22.
Results Reference
derived
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Examining How Motor Rehabilitation Promotes Brain Reorganization Following Stroke, an MRI Study
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