Using Real-time fMRI Neurofeedback and Motor Imagery to Enhance Motor Timing and Precision in Cerebellar Ataxia

Johns Hopkins University

Status: Completed

Conditions: Spinocerebellar Ataxias; Cerebellar Degeneration; Cerebellar Ataxia

Treatments: Device: Real-time fMRI with neurofeedback of motor imagery

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05436262

R21NS125546 (U.S. NIH Grant/Contract)

IRB00300264

Details and patient eligibility

About

The aim of the research is to improve motor function in people with cerebellar ataxia by using neuroimaging methods and mental imagery to "exercise" motor networks in the brain. The relevance of this research to public health is that results have the potential to reduce motor deficits associated with cerebellar atrophy, thereby enhancing the quality of life and promoting independence.

Enrollment: 21 patients

Sex: All

Ages: 18 to 100 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• 18-100 years of age
• At least 8th-grade education
• Right-handedness
• Clinical diagnosis of progressive, degenerative cerebellar ataxia by a movement disorder specialist (cerebellar ataxia of unknown etiology, and spinocerebellar ataxias with and without genetic confirmation)

Exclusion criteria

• History of Axis I psychiatric disorders (including alcohol and drug dependence)
• Severe or unstable medical disorder, neurological disorders, such as stroke or epilepsy
• History of head injury that resulted in a loss of consciousness greater than 5 minutes and/or neurological sequelae
• Any condition that is contraindicated for the MRI environment (e.g., metal in the body, pacemaker, claustrophobia)
• Currently pregnant
• Clinical diagnosis of multiple system atrophy (MSA) or Friedrich's ataxia (FA)
• Eligible subjects may be asked to refrain from medications that affect the central nervous system that would also make data difficult to interpret (e.g., sedatives) for an appropriate period of time prior to scanning
• Participants will be excluded if the participants do not have a home computer with internet available to complete the 3-week at-home component of the study protocol

Trial design

Primary purpose: Basic Science

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: None (Open label)

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21 participants in 2 patient groups

Real time neurofeedback with task and at-home finger tapping practice sessions

Experimental group

Description:

Participants will undergo a real-time fMRI scan during which two distinct tasks will be performed. Neurofeedback treatment: During the fMRI scan, the tasks consist of: 1. Overt finger tapping in time with a flashing cue. 2. Motor imagery (of finger tapping). During overt finger tapping, feedback will consist of a slider bar that indicates tapping accuracy to target speed (1 or 4Hz). During motor imagery, neurofeedback will consist of a crosshair that flashes to indicate the success of recruiting predicted brain regions (consistent with those engaged during overt tapping). At-home therapy: Participants are assigned to one of two groups where participants will practice each day 17 sessions total at-home. Group 1: Overt finger tapping on 17 daily sessions. Participants will finger tap in time with the flashing cue.

Treatment:

Device: Real-time fMRI with neurofeedback of motor imagery

Real time neurofeedback with task and at-home motor imagery practice sessions

Experimental group

Description:

Participants will undergo a real-time fMRI scan during which two distinct tasks will be performed. Neurofeedback treatment: During the fMRI scan, the tasks consist of: 1. Overt finger tapping in time with a flashing cue. 2. Motor imagery (of finger tapping). During overt finger tapping, feedback will consist of a slider bar that indicates tapping accuracy to target speed (1 or 4Hz). During motor imagery, neurofeedback will consist of a crosshair that flashes to indicate the success of recruiting predicted brain regions (consistent with those engaged during overt tapping). At-home therapy: Participants are assigned to one of two groups where participants will practice each day 17 sessions total at-home. Group 2: Motor imagery only on 13 daily sessions, and overt finger tapping only on 4 daily sessions.

Treatment:

Device: Real-time fMRI with neurofeedback of motor imagery