Operant Conditioning of Spinal Reflexes and Motor Evoked Potentials

Status: Recruiting
Location: See location...
Intervention Type: Other
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Emerging evidence demonstrates that animals and people can exert control over the level of excitability in spinal and corticospinal neural circuits that contribute to movement. This discovery has important implications, as it represents a new strategy to improve motor control in people of all ability levels, including those with neurological conditions. Operant conditioning is a well-studied mechanism of learning, in which the modification of a behavior can be brought about by the consequence of the behavior, and reinforcement causes behaviors to become more frequent. In recent years, operant conditioning has been applied to spinally-mediated reflex responses in mice, rats, monkeys and people. By electrically stimulating a peripheral nerve, recording the muscle response, and rewarding responses that are within a desirable range, it is possible to increase or decrease the neural circuit's excitability. This may alter the level of resting muscle tone and spasticity, as well the muscle's contribution to planned movements and responses to unexpected events. Operant conditioning of spinal reflexes has been applied to a lower limb muscle in healthy people and those with spinal cord injuries. In this project, we will expand the use of operant conditioning to muscles of the upper limb, demonstrating feasibility and efficacy in healthy people and people post-stroke. We will determine whether operant conditioning can be used to decrease excitability of spinal reflexes that activate a wrist flexor muscle. Additionally, in a separate group of healthy people, we will determine whether operant conditioning can be used in a similar way to increase corticospinal excitability. We will stimulate the motor cortex with transcranial magnetic stimulation to elicit motor evoked potentials in the same wrist flexor muscle, and will reward responses that exceed a threshold value. We will examine the effects of these interventions on motor control at the wrist, using an innovative custom-designed cursor-tracking task to quantify movement performance. We will determine whether changes in spinal reflex excitability or corticospinal excitability alter motor control. The overall goal of this research is to develop a new, evidence-based strategy for rehabilitation that will improve recovery of upper limb function in people after stroke.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 21
Maximum Age: 90
Healthy Volunteers: t
View:

• Able and willing to provide informed consent

• Normal function of both upper extremities

• Generally in good health

• Able and willing to provide informed consent

• Subcortical ischemic stroke OR incomplete spinal cord injury, diagnosed by a neurologist at least 3 months before enrollment

• Upper limb sensorimotor impairment on one or both sides, as indicated by a score of 10 to 56 out of 66 points on the Fugl-Meyer Assessment of the Upper Extremity

• Cognitive ability that is normal or only mildly impaired, as indicated by a score of 9 or less on the Short Blessed Test

• Normal receptive and expressive language abilities, as indicated by a score of 0 on the Best Language item of the National Institutes of Health Stroke Scale

Locations
United States
Iowa
University of Iowa
RECRUITING
Iowa City
Contact Information
Primary
Stacey L DeJong, PhD, PT
stacey-dejong@uiowa.edu
319-335-6842
Backup
Kim A Streeby
kimberly-streeby@uiowa.edu
319-384-4735
Time Frame
Start Date: 2018-06-08
Estimated Completion Date: 2024-06-30
Participants
Target number of participants: 60
Treatments
Experimental: H-reflex conditioning - Healthy
Operant conditioning of H-reflexes in healthy volunteers
Experimental: H-reflex conditioning - Stroke
Operant conditioning of H-reflexes in people post-stroke
Experimental: MEP conditioning - Healthy
Operant conditioning of motor evoked potentials in healthy volunteers
Experimental: MEP conditioning - Stroke
Operant conditioning of motor evoked potentials in people post-stroke
Related Therapeutic Areas
Sponsors
Leads: Stacey Dejong
Collaborators: National Center of Neuromodulation for Rehabilitation, Roy J. Carver Charitable Trust

This content was sourced from clinicaltrials.gov