None listed
Conditions
Brief summary
One in two people experience loss in their ability to feel everyday objects through touch or know where their limbs are in space after a stroke. The loss impairs their ability to explore the environment, execute everyday tasks such as grasping and manipulating objects, and participate in previous activities. Patients vary in their ability to benefit from rehabilitation. Yet we do not have effective means of identifying individuals who may benefit nor how to select the most optimal therapy. This study will compare brain networks involved in recovery of touch sensation under two new training conditions, and in individuals with interruption to different parts of the network. Brain imaging will identify the functional and anatomical connections between regions involved in recovery. Knowledge of how brain networks adapt under these two training conditions is fundamental to guide individually tailored rehabilitation and to advance our understanding of core learning-based rehabilitation approaches. Our findings will guide therapists in choosing the best therapy for the right individual, based on knowledge of brain networks that have capacity to adapt.
Interventions
Stroke survivors will be assessed at least 3 months post stroke for clinical and imaging outcomes, then randomized into one of 3 treatment packages of 2X6-week intervention/no intervention phases.
Arm 1: The first package involves 6 weeks of no training followed by 6 weeks of transfer enhanced training of body sensation.
Arm 2: The second package involves 6 weeks of stimulus specific training of touch sensation followed by 6 weeks of transfer enhanced training of body sensation.
Arm 3: The t
Stroke survivors will be assessed at least 3 months post stroke for clinical and imaging outcomes, then randomized into one of 3 treatment packages of 2X6-week intervention/no intervention phases. Arm 1: The first package involves 6 weeks of no training followed by 6 weeks of transfer enhanced training of body sensation. Arm 2: The second package involves 6 weeks of stimulus specific training of touch sensation followed by 6 weeks of transfer enhanced training of body sensation. Arm 3: The third package involves 6 weeks of transfer enhanced training of body sensation, followed by 6 weeks of no training. Each training phase involves 15 training sessions at a rate of approximately 3 times per week and duration of 60 minutes per session. Training sessions are one on one with an experienced research therapist. Each participant has an individual training log, where the research therapist stores forms to record each session in order to monitor their progress. Stimulus specific training involves graded and repeated learning-based discrimination training of specific sensory stimuli, ie. texture grids. Transfer enhanced training involves learning-based discrimination training of a variety of sensory attributes, across a matrix of sensory tasks including common textures, limb positions and everyday objects. A variety of stimuli and learning conditions, tuition of training principles and feedback on the act of transfer to novel stimuli are used to facilitate transfer. Transfer enhanced training also involves application of training principles to 2 occupational tasks identified by the client.
Sponsors
National Stroke Research Institute
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 90 Years
Healthy volunteers
No
Inclusion criteria
Stroke patients: 1) first episode of cortical or sub-cortical stroke; 2) Somatosensory impairment clinically apparent or queried; 3) Medically stable; 4) able to give informed consent and comprehend simple instructions; 5) right hand dominant Healthy participants: 1) medically stable; 2) able to give informed consent and comprehend simple instructions; 3) right hand dominant
Exclusion criteria
Stroke patients: 1) Brainstem stroke; 2) Previous neurological dysfunction or medical history that impairs hand function or precludes MRI; 3) Peripheral neuropathy in the upper limbs; 4) Evidence of neglect on standard neuropsychological tests; 5) Not suitable for MRI. Healthy participants: 1) any history of neurological, psychiatric or somatosensory impairment; 2) previous neurological dysfunction or medical history that impairs hand function or precludes MRI.
Outcome results
None listed