Making Training Better: Error Augmentation Motor Learning in Stroke

Status: Unknown
Location: See location...
Intervention Type: Device, Diagnostic test, Behavioral
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Deficits in upper limb (UL) functional recovery persist in a large proportion of stroke survivors. Understanding how to obtain the best possible UL recovery is a major scientific, clinical and patient priority. We propose that UL motor recovery may be improved by training that focuses on remediating an individual's specific motor impairment. Our approach is based on evidence that deficits in the control of muscle activation thresholds (spatial thresholds) of the elbow in stroke underlie impairments such as disordered movement and spasticity. Our novel training program focuses on improving the individual's active elbow control range using error augmentation (EA) feedback. Since training intensity and lesion load are key factors in motor recovery that lack guidelines, we will also investigate effects of exercise dose and corticospinal tract (CST) injury on UL recovery. In this multicenter, double-blind, parallel-group, randomized controlled trial (RCT), patients with stroke will participate in an individualized intensive technology-assisted reaching training program, based on error augmentation (EA), in order to improve voluntary elbow function. They will practice robot-assisted reaching in a virtual reality (VR) game setting. We will identify if intensive training with feedback aimed at expanding the range of spatial threshold (ST) control at the elbow (experimental group) is better than intensive training with general feedback about task success (control group). We will also determine the patient-specific optimal therapy dose by comparing kinematic and clinical outcomes after 3, 6 and 9 weeks of intensive training, and again at 4 weeks after training to determine carry-over effects. We will quantify the severity of the participant's motor deficit, as the amount of cortico spinal tract (CST) injury due to the stroke (%CST injury) and relate training gains to their %CST injury. Results of this pragmatic trial will provide essential information for optimizing individualized post-stroke training programs and help determine optimal patient-specific training dosing to improve motor recovery in people with different levels of stroke severity. This type of research involving personalized, impairment-based feedback and dose-effective training has the potential to significantly improve rehabilitation for a greater number of post-stroke individuals and improve the health and quality of life of Canadians.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 40
Maximum Age: 75
Healthy Volunteers: f
View:

• First cortical/sub-cortical ischemic/hemorrhagic stroke less than 1 year previously

• Sub-acute stage

• Medically stable

• Not in treatment

• Arm paresis (Chedoke-McMaster Arm Scale of 2-6 out of 7

• Some voluntary elbow movement (30° per direction)

• Able to provide informed consent

Locations
Other Locations
Canada
CRIR
Montreal
Contact Information
Primary
Mindy F Levin, PhD
mindy.levin@mcgill.ca
450-688-9550
Time Frame
Start Date: 2020-09-01
Completion Date: 2023-08-31
Participants
Target number of participants: 54
Treatments
Experimental: Experimental - Error Augmented feedback (Restricted area)
Error augmented feedback. Random targets always INSIDE of workspace area.
Active_comparator: Control - General feedback (Full area)
General feedback about task success. Random target INSIDE or OUTSIDE of workspace area.
Related Therapeutic Areas
Sponsors
Leads: McGill University

This content was sourced from clinicaltrials.gov

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