Cortical Biomarkers of Hand Function and Recovery After Injury

Veterans Affairs (VA) Pittsburgh Healthcare System

Status: Terminated

Conditions: Spinal Cord Injuries; Stroke

Treatments: Other: Functional MRI for stroke and spinal cord injury; Other: Transcranial magnetic stimulation (TMS) for stroke and spinal cord injury; Other: Rehabilitation using motorized glove for stroke and spinal cord injury

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT03833518

Pro00002855

Details and patient eligibility

About

This is a pilot study to collect data to support a VA grant submission to study fMRI and neurophysiological predictors of hand function and recovery during a robotic intervention in people with hand impairments due to stroke or spinal cord injury.

Full description

The loss of arm and hand function after cervical spinal cord injury (SCI) limits independence and increases the cost of care. As a result, Veterans with tetraplegia prioritize restoration of hand and arm function over all other rehabilitation goals. Similar to SCI, stroke of supraspinal areas involved in motor control results in acute movement deficits in more than 85% of survivors. Despite advances in treatment and rehabilitation, 50% of stroke survivors have persistent hand impairment. The loss of hand function and dexterity limits the ability to perform many activities of daily living, and thus limits independence. Since motor deficits are often permanent after SCI and stroke, new strategies are needed to restore dexterous hand function.

Advances in functional imaging have enabled the measurement of finger-related activation patterns in somatosensory cortex, but little is known about how these representational patterns are impacted when hand function is lost. Prior studies of gross movements have reported reorganization of cortical activity after injury. The investigators aim to improve dexterous hand function by increasing our understanding of finger-related cortical reorganization after lesions to the spinal or supraspinal structures. This understanding could allow discrimination between adaptive and maladaptive patterns underlying hand function and guide restorative therapies. Additionally, imaging biomarkers of injury often track with functional recovery.

The aim is to improve dexterous hand function by increasing our understanding of finger-related cortical reorganization after lesions to the spinal or supraspinal structures. This understanding could allow discrimination between adaptive and maladaptive patterns underlying hand function and guide restorative therapies. Additionally, imaging biomarkers of injury often track with functional recovery.

Enrollment: 1 patient

Sex: All

Ages: 18 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Normal or corrected to normal vision
• Hand impairment due to spinal cord injury or stroke
• Weakness of fingers
• One year after stroke or spinal cord injury
• Some proprioception (can feel when finger is moved, without seeing)
• Minimal spasticity

Exclusion criteria

• Implanted metal with is unsafe for MRI
• Pregnant or expecting to become pregnant
• History of hand surgery which is under evaluation
• Cognitive or language issues that would interfere with following directions
• Other neurological disorder that would affect movement
• History of seizure or epilepsy
• Body weight > 300 pounds

Trial design

Primary purpose: Basic Science

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

---

1 participants in 1 patient group

Hand impairment due to stroke or spinal cord injury

Experimental group

Description:

Individuals who have experienced a sub-cortical stroke or a cervical spinal cord injury resulting in loss of hand function.

Treatment:

Other: Transcranial magnetic stimulation (TMS) for stroke and spinal cord injury

Other: Rehabilitation using motorized glove for stroke and spinal cord injury

Other: Functional MRI for stroke and spinal cord injury