Fast Arm Motor Skill Training (FAST)

University of Southern California

Status: Completed

Conditions: Cerebrovascular Stroke

Treatments: Behavioral: Active Monitoring; Behavioral: Fast intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT05013762

HS-CG-20-00023

Details and patient eligibility

About

Every year, almost 800,000 people experience a stroke in the United States, which lead to upper-limb impairments, making recovery of motor function a priority in stroke rehabilitation. 1) The primary objective of this study is to determine whether fast arm movement training on a tracking task ("Speed-training"), in chronic stroke survivors with mild to moderate paresis, will generalize to improve arm function better than dose-equivalent accuracy training on the same task. 2) study the effect of intensive arm training on the recovery of anticipatory feedforward control. 3) Determine the involvement of cerebellar-cortical circuits in the recovery of arm movements due to speed training.

Full description

About 65% of stroke survivors experience long-term limitations in upper extremity (UE) functions. In particular, limitations in arm reaching movements are prominent and correlate strongly with patients' impairment levels. Because activities of daily living often involve the UEs, retraining reach and grasp skills is critical for return to a full quality-of-life. Yet, the training parameters required for effective rehabilitation of UE function are not known. Recent evidence suggests that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke. Hence, fast movements generating large errors, would promote the restoration of the feedforward controllers and therefore improves arm movements and UE functions in individuals with chronic stroke. Because the cerebellum is involved in learning feedforward controllers from motor errors, the improvements would be proportional to the integrity of the cerebellar-cortical networks.

A double-blind quasi-randomized controlled study will be carried out in chronic post-stroke survivors. Participants will be assigned to either the speed-bias training group or a dose equivalent accuracy-bias training group (control) and will receive 4 days of training over a 1week period by a trained Occupational or physical therapist. Behavioral, EMG, and MRI data will be acquired within two weeks before, 3 days post, and one month after intervention.

Enrollment: 44 patients

Sex: All

Ages: 21+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• At least 6 months following an ischemic supratentorial stroke
• At least 21 years of age
• Exhibit residual capability to move the paretic UE (Upper Extremity Fugl- Meyer motor score >20/66)
• Able to follow a 2-step command (8th item on the MMSE test)
• Able to perform an unassisted arm reach movement of 25 cm ahead of the body within 5 seconds with trunk restraint
• Exhibit no greater than mild/moderate spasticity as assessed with a Modified Ashworth Score < 3

Exclusion criteria

• any neurologic diagnoses other than stroke
• peripheral movement restrictions, such as neuropathy
• orthopedic disorders affecting the paretic UE
• severe pain or sensory/proprioceptive impairment in the more affected UE
• visual neglect (more than 4% of lines left uncrossed on Albert's test).
• had a stroke directly affecting the cerebellum
• any contra-indications to MRI scanning
• mostly resolved impairments with an Upper Extremity Fugl- Meyer motor score >58/66

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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44 participants in 2 patient groups

Speed-biased complex motor skill training

Active Comparator group

Description:

Participants will perform 400 complex movements per day over 4 days over a one-week period. The task requires participants to navigate their hand through a "track" projected on the surface of a table with a width of 5cm. Participants receive adaptive score based on their movement time. .

Treatment:

Behavioral: Fast intervention

Accuracy-biased complex motor skill training

Other group

Description:

The accuracy-biased group receives a dose equivalent intervention with a emphasize on accuracy. The width of the track projected on the table is narrower (less than 2cm) and the adaptive score received are based on their accuracy to say within the boundary of the track.

Treatment:

Behavioral: Active Monitoring