Stroke
Conditions
Keywords
Subacute stroke, Chronic stroke
Brief summary
The purpose of this study is to identify and establish how the area of the brain that controls motor function (motor cortex) of the non-affected hemisphere after stroke might serve as a new target for therapeutic interventions to improve motor performance after stroke.
Detailed description
It is well known that the motor area of one hemisphere of the brain (motor cortex) controls the movement of the opposite side of the body but the role of the motor cortex in the hemisphere spared by stroke (contralesional motor cortex) in motor performance during post stroke recovery is still unclear. It is also not clear whether the motor cortex of both hemispheres of the brain are involved, as movement becomes more complicated. Currently the role of the motor cortex on the same side of the body (referred to as ipsilateral motor cortex) in hand performance remains controversial. In most patients with stroke, only one side of the brain is affected by the stroke (affected hemisphere) resulting in weakness of half of the body opposite to the side of the stroke. Over the recent years, research has discovered that the side of the brain, that is spared by the stroke (non-affected hemisphere) may support recovery after stroke. However, there is also a question whether the non-affected hemisphere may interfere with the process of recovery. It is currently not known what factors influence the activity of non-affected hemisphere to either support or interfere with the recovery of stroke. A better understanding of those events is critical to development of optimal therapeutic strategies. For example, non-invasive stimulation of specific areas of the non-affected hemisphere may help to improve functional recovery following stroke. The objectives of this study are to define the factors that influence the activity in the non-affected hemisphere to either support or interfere with the recovery after stroke. The researchers will study the area of the brain that controls movements of the non-affected hemisphere as it relates to motor function post-stroke. Transcranial magnetic stimulation (TMS) is a device that allows non-invasive stimulation of the brain. When the brain is stimulated repetitively at a very low rate and low intensity for about 15 minutes, the stimulated brain area becomes less active. This effect lasts 10 minutes and is called a transient artificial lesion as it mimics the effects of transiently interfering with the function of the stimulated brain area. The study includes experiments that first identify the extent of stroke and brain areas involved in a motor task using functional MRI of the brain and TMS. The researchers will then determine the functional role of the contralesional motor cortex by studying the effect of low frequency and high frequency repetitive transcranial magnetic stimulation (rTMS) of primary motor cortex (M1) on interhemispheric inhibition (IHI) (resting and active) and motor cortex excitability (short interval intracortical excitability and corticospinal excitability) and behavior. The researchers will thereby also identify rTMS protocols that enhance motor performance in stroke patients. In this study the researchers will conduct experiments using repetitive TMS to downregulate the activity of the motor area and measures its effect on activity of motor cortex of both hemispheres. In addition to enrolling participants who have had a stroke, the researchers will enroll healthy participants as this collected data will provide normative values for task related changes in M1s and their interactions - a prerequisite to studying abnormalities in stroke patients during motor recovery. The measurements and interventions will occur at two time points in all participants with stroke (1 and 6 months post-stroke). The data will be compared to the results of healthy age matched controls, assessed at a single time point.
Interventions
Single-pulse Transcranial Magnetic Stimulation (TMS) is a brief magnetic pulse that is applied through a coil to the section of the head that overlays the motor cortex of the brain. Subjects will be comfortably seated in a dental chair surrounded by a frame that carries a coil holder to assist with the application of TMS to the brain. Single-pulse transcranial magnetic stimulation (TMS) will be administered at study visits.
DEVICEPaired-pulse Transcranial Magnetic Stimulation (ppTMS)
Paired-pulse Transcranial Magnetic Stimulation (ppTMS) is two brief sequential magnetic pulses that are applied through a coil to the section of the head that overlays the motor cortex of the brain. Subjects will be comfortably seated in a dental chair surrounded by a frame that carries a coil holder to assist with the application of TMS to the brain. Paired-pulse transcranial magnetic stimulation (ppTMS) will be administered at study visits.
DEVICELow-frequency Repetitive Transcranial Magnetic Stimulation (rTMS)
Low-frequency Repetitive Transcranial Magnetic Stimulation (rTMS) is a sequence of brief magnetic pulses that are applied at 0.1 Hz frequency at low intensity through an air-cooled coil to the section of the head that overlays the motor cortex of the brain. Subjects will be comfortably seated in a dental chair surrounded by a frame that carries a coil holder to assist with the application of TMS to the brain. Low-frequency repetitive transcranial magnetic stimulation (rTMS) will be administered at study visits.
DEVICESham Motor Cortex Stimulation
Sham motor cortex stimulation will be applied at study visits.
Sponsors
National Institutes of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Emory University
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
for all Participants * The ability to provide informed consent * Ages 40 to 80 years old * Male or female Additional Inclusion Criteria for Stroke Patients: * One cerebral ischemic infarction less than 1 month affecting the primary motor output system of the hand at a cortical (M1) level as defined by magnetic resonance imaging (MRI) of the brain * Paresis of the hand for more than 3 days after their cerebral infarction Additional Inclusion Criteria for Healthy Subjects: * Normal MRI of the brain * Normal neuropsychological testing * Normal neurological examination
Exclusion criteria
for Stroke Patients: * Neurological disorders other than stroke * Aphasia that prevents following instructions or inability to communicate effectively with the study team * Dementia * Moderate or severe depression * Contraindication to transcranial magnetic stimulation (TMS) and/or MRI * Use of central nervous system (CNS) active drugs that block plasticity
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Motor Function Assessed by the Jebsen Test | 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke) | The Jebsen Test assesses weighted and non-weighted hand function among participants who have had a stroke. Subjects are assessed through writing, turning over 3 by 5 inch cards, picking up small common objects, simulated feeding, stacking checkers, picking up large objects, and picking up large heavy objects. Patients are required to perform all of the subtests with both the right and left hands. Time to complete each task is recorded and normalized to healthy age and sex matched control subjects. The score ranges from 0 to 1 with 0 being normal. |
| Mean Motor Evoked Potential (MEP) Amplitudes Assessed by Stimulus Response Curve (SRC) of the Contralesional M1 | 1 month post-stroke (subacute stroke) or single study visit for healthy controls, 6 months post-stroke (chronic stroke) | Change in mean motor evoked potential (MEP) amplitudes at each stimulus intensity will be calculated. The sum of these means is calculated as the area under the curve. |
| Presence of MEP in Response to TMS of the Ipsilesional M1 | 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke) | The presence of motor evoked potential (MEP) in response to maximum TMS applied to ipsilesional M1 was determined in participants with stroke. |
| Lesion Volume | 1 month post-stroke (subacute stroke) | Normalized stroke lesion volume was determined at the one-month time point using structural MRI of the brain. |
| Corticospinal Tract (CST) Lesion | 1 month post-stroke (subacute stroke) | Corticospinal tract (CST) lesion load will be determined at the one-month time point using structural MRI of the brain. The lesion size is expressed as percentage of the entire CST. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | 1 month post-stroke (subacute stroke) or single study visit for healthy controls, 6 months post-stroke (chronic stroke) | SICI in the contralesional M1 will be measured using paired pulse TMS at an interstimulus interval (ISI) of 2 milliseconds (ms). Cortical stimulation intensity was delivered at 60% and 80% of the motor threshold (MT). SICI is expressed as the ratio between the mean MEP amplitude in response to a single TMS and the mean MEP amplitude in response to a paired pulse TMS. A ratio of 1 means no inhibition, a ratio smaller than 1 means inhibition, and a ratio greater than 1 means facilitation. |
| Motor Function Assessed by Time to Complete the Wolf Motor Function Test (WMFT) | 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke) | Upper extremity motor ability among participants who had a stroke was evaluated with the Wolf Motor Function Test (WMFT). The test consists of 17 items (6 joint-segment movements, 9 integrative functional movements and 2 strength items). The items are rated on a 6-point functional ability scale (FAS) where 0 is no attempt is made to use the more affected arm and 5 is a normal appearance of movement execution. The time taken to complete each task will be recorded up to 120 seconds. The mean time to complete all tasks will be used to evaluate motor ability. |
| Peak Velocity During Wrist Extension Movement | 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke) | Stroke patients are asked to rapidly execute 7 ballistic wrist extension movements following an auditory cue. A 2-dimensional gyrometer is mounted on the dorsum of the hand to measure wrist extension movements. Electromyography (EMG) activity will be recorded on the extensor carpi ulnaris (ECU) muscle, a muscle that supports wrist extension movements. |
| Motor Function Assessed by Grip Strength During the Wolf Motor Function Test (WMFT) | 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke) | During the grip strength assessment of the WMFT, participants grip a dynamometer with as much strength as possible. There are three trials of gripping with a minute rest interval between trials. The mean kilograms of strength exerted during the three trials is calculated. |
| Use of Paretic Arm Assessed by the Motor Activity Log (MAL) | 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke) | In stroke patients, the everyday use of the paretic (the more affected) arm will be measured using the Motor Activity Log (MAL). The MAL is a subjective measure of semi- structured interview to examine a) how much and b) how well the subject uses their more-affected arm outside of the laboratory setting. Total scores range from 0 (no use of the more-affected arm) to 5 (use is as good as before stroke). |
| CST Subpathway Originating in M1 Lesion Load | 1 month post-stroke (subacute stroke) | CST sub M1 lesion volume will be determined at the one- month time point using structural MRI of the brain. The lesion load is expressed as percentage of the entire CST. |
| Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | 1 month post-stroke (subacute stroke) or single study visit for healthy controls, 6 months post-stroke (chronic stroke) | Functional Magnetic Resonance Imaging (fMRI) will be used to determine hand movement related activity in the motor cortex of the brain in all subjects. Blood oxygenation level dependent (BOLD) response during execution of the motor task will be compared to rest. The subacute stroke and chronic stroke time points are compared to single study visit of healthy controls. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited at Emory University in Atlanta, Georgia, USA. Participant enrollment began in July 2015 and all follow-up assessments were completed by February 4, 2021.
Pre-assignment details
Individuals provided consent to participate and were enrolled into study arms based on their health status (prior stroke or health control). After enrolling, 24 individuals with stroke and 3 healthy controls did not meet eligibility criteria and did not participate in any study assessments. Participants with stroke were assessed one and six months after their stroke, while healthy controls participated in a single assessment.
Participants by arm
| Arm | Count |
|---|---|
| Stroke Patients Participants with stroke underwent assessment of their upper extremity and hand motor function, MRI of their brain, single pulse transcranial magnetic stimulation (TMS), paired pulse transcranial stimulation (ppTMS), and low frequency repetitive transcranial magnetic stimulation (rTMS) at one month and six months post stroke. | 42 |
| Healthy Controls Healthy control participants underwent MRI, single pulse transcranial magnetic stimulation (TMS), paired pulse transcranial stimulation (ppTMS), and low frequency repetitive transcranial magnetic stimulation (rTMS). | 31 |
| Total | 73 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 9 | 0 |
| Overall Study | Screen fail; these participants did not take part in the 1 month assessment | 24 | 3 |
| Overall Study | Withdrawal by Subject | 1 | 0 |
Baseline characteristics
| Characteristic | Stroke Patients | Healthy Controls | Total |
|---|---|---|---|
| Age, Continuous | 58.83 years STANDARD_DEVIATION 9.43 | 61.68 years STANDARD_DEVIATION 8.65 | 60.94 years STANDARD_DEVIATION 9.21 |
| Age, Customized Age, categorical 40 - 80 | 42 Participants | 31 Participants | 73 Participants |
| Age, Customized Age, categorical Less than 40 | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 0 Participants | 2 Participants |
| Race (NIH/OMB) Black or African American | 24 Participants | 8 Participants | 32 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants | 19 Participants | 21 Participants |
| Race (NIH/OMB) White | 14 Participants | 4 Participants | 18 Participants |
| Region of Enrollment United States | 42 Participants | 31 Participants | 73 Participants |
| Sex: Female, Male Female | 23 Participants | 17 Participants | 40 Participants |
| Sex: Female, Male Male | 19 Participants | 14 Participants | 33 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 42 | 0 / 31 |
| other Total, other adverse events | 14 / 42 | 1 / 31 |
| serious Total, serious adverse events | 0 / 42 | 0 / 31 |
Outcome results
Primary
Corticospinal Tract (CST) Lesion
Corticospinal tract (CST) lesion load will be determined at the one-month time point using structural MRI of the brain. The lesion size is expressed as percentage of the entire CST.
Time frame: 1 month post-stroke (subacute stroke)
Population: This analysis includes participants with stroke who completed this assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Stroke Patients | Corticospinal Tract (CST) Lesion | 5.7 percent of CST | Standard Deviation 6.77 |
Primary
Lesion Volume
Normalized stroke lesion volume was determined at the one-month time point using structural MRI of the brain.
Time frame: 1 month post-stroke (subacute stroke)
Population: This analysis includes participants with stroke who completed this assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Stroke Patients | Lesion Volume | 19745 cubic mm | Standard Deviation 32285 |
Primary
Mean Motor Evoked Potential (MEP) Amplitudes Assessed by Stimulus Response Curve (SRC) of the Contralesional M1
Change in mean motor evoked potential (MEP) amplitudes at each stimulus intensity will be calculated. The sum of these means is calculated as the area under the curve.
Time frame: 1 month post-stroke (subacute stroke) or single study visit for healthy controls, 6 months post-stroke (chronic stroke)
Population: This analysis includes participants completing the assessment at the indicated time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Mean Motor Evoked Potential (MEP) Amplitudes Assessed by Stimulus Response Curve (SRC) of the Contralesional M1 | Subacute stroke or single visit for healthy controls | 0.67 mV | Standard Deviation 0.75 |
| Stroke Patients | Mean Motor Evoked Potential (MEP) Amplitudes Assessed by Stimulus Response Curve (SRC) of the Contralesional M1 | Chronic stroke | 0.39 mV | Standard Deviation 0.63 |
| Healthy Controls | Mean Motor Evoked Potential (MEP) Amplitudes Assessed by Stimulus Response Curve (SRC) of the Contralesional M1 | Subacute stroke or single visit for healthy controls | 0.63 mV | Standard Deviation 0.85 |
Primary
Motor Function Assessed by the Jebsen Test
The Jebsen Test assesses weighted and non-weighted hand function among participants who have had a stroke. Subjects are assessed through writing, turning over 3 by 5 inch cards, picking up small common objects, simulated feeding, stacking checkers, picking up large objects, and picking up large heavy objects. Patients are required to perform all of the subtests with both the right and left hands. Time to complete each task is recorded and normalized to healthy age and sex matched control subjects. The score ranges from 0 to 1 with 0 being normal.
Time frame: 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke)
Population: This analysis includes participants who completed this assessment at the indicated study visit.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Motor Function Assessed by the Jebsen Test | More affected hand - subacute stroke | 0.49 score on a scale | Standard Deviation 0.32 |
| Stroke Patients | Motor Function Assessed by the Jebsen Test | Less affected hand - subacute stroke | 0.14 score on a scale | Standard Deviation 0.1 |
| Stroke Patients | Motor Function Assessed by the Jebsen Test | More affected hand - chronic stroke | 0.35 score on a scale | Standard Deviation 0.31 |
| Stroke Patients | Motor Function Assessed by the Jebsen Test | Less affected hand - chronic stroke | 0.11 score on a scale | Standard Deviation 0.09 |
Primary
Presence of MEP in Response to TMS of the Ipsilesional M1
The presence of motor evoked potential (MEP) in response to maximum TMS applied to ipsilesional M1 was determined in participants with stroke.
Time frame: 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke)
Population: This analysis includes participants who completed the assessment at the indicated time point.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Stroke Patients | Presence of MEP in Response to TMS of the Ipsilesional M1 | Chronic stroke | Not Present | 3 Participants |
| Stroke Patients | Presence of MEP in Response to TMS of the Ipsilesional M1 | Subacute stroke | Not Present | 11 Participants |
| Stroke Patients | Presence of MEP in Response to TMS of the Ipsilesional M1 | Subacute stroke | Present | 24 Participants |
| Stroke Patients | Presence of MEP in Response to TMS of the Ipsilesional M1 | Chronic stroke | Present | 22 Participants |
Secondary
CST Subpathway Originating in M1 Lesion Load
CST sub M1 lesion volume will be determined at the one- month time point using structural MRI of the brain. The lesion load is expressed as percentage of the entire CST.
Time frame: 1 month post-stroke (subacute stroke)
Population: This analysis includes participants with stroke who completed this assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Stroke Patients | CST Subpathway Originating in M1 Lesion Load | 5.07 percentage of the entire CST | Standard Deviation 6.48 |
Secondary
Motor Function Assessed by Grip Strength During the Wolf Motor Function Test (WMFT)
During the grip strength assessment of the WMFT, participants grip a dynamometer with as much strength as possible. There are three trials of gripping with a minute rest interval between trials. The mean kilograms of strength exerted during the three trials is calculated.
Time frame: 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke)
Population: This analysis includes participants completing the assessment at the indicated time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Motor Function Assessed by Grip Strength During the Wolf Motor Function Test (WMFT) | Less affected side - subacute stroke | 28.95 kilograms | Standard Deviation 10.88 |
| Stroke Patients | Motor Function Assessed by Grip Strength During the Wolf Motor Function Test (WMFT) | More affected side - subacute stroke | 15.25 kilograms | Standard Deviation 15.7 |
| Stroke Patients | Motor Function Assessed by Grip Strength During the Wolf Motor Function Test (WMFT) | Less affected side - chronic stroke | 29.94 kilograms | Standard Deviation 8.06 |
| Stroke Patients | Motor Function Assessed by Grip Strength During the Wolf Motor Function Test (WMFT) | More affected side - chronic stroke | 17.03 kilograms | Standard Deviation 12.68 |
Secondary
Motor Function Assessed by Time to Complete the Wolf Motor Function Test (WMFT)
Upper extremity motor ability among participants who had a stroke was evaluated with the Wolf Motor Function Test (WMFT). The test consists of 17 items (6 joint-segment movements, 9 integrative functional movements and 2 strength items). The items are rated on a 6-point functional ability scale (FAS) where 0 is no attempt is made to use the more affected arm and 5 is a normal appearance of movement execution. The time taken to complete each task will be recorded up to 120 seconds. The mean time to complete all tasks will be used to evaluate motor ability.
Time frame: 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke)
Population: This analysis includes participants who completed this assessment at the indicated study visit.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Motor Function Assessed by Time to Complete the Wolf Motor Function Test (WMFT) | Less affected side - subacute stroke | 7.11 seconds | Standard Deviation 9.49 |
| Stroke Patients | Motor Function Assessed by Time to Complete the Wolf Motor Function Test (WMFT) | More affected side - subacute stroke | 36.82 seconds | Standard Deviation 7.55 |
| Stroke Patients | Motor Function Assessed by Time to Complete the Wolf Motor Function Test (WMFT) | Less affected side - chronic stroke | 3.42 seconds | Standard Deviation 4.86 |
| Stroke Patients | Motor Function Assessed by Time to Complete the Wolf Motor Function Test (WMFT) | More affected side - chronic stroke | 18.44 seconds | Standard Deviation 4.81 |
Secondary
Peak Velocity During Wrist Extension Movement
Stroke patients are asked to rapidly execute 7 ballistic wrist extension movements following an auditory cue. A 2-dimensional gyrometer is mounted on the dorsum of the hand to measure wrist extension movements. Electromyography (EMG) activity will be recorded on the extensor carpi ulnaris (ECU) muscle, a muscle that supports wrist extension movements.
Time frame: 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke)
Population: This analysis includes participants with stroke who completed this assessment at the indicated study visit.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - subacute stroke - rTMS pre | 700.54 radian per second (rad/sec) | Standard Deviation 248.34 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - subacute stroke - rTMS post | 686.24 radian per second (rad/sec) | Standard Deviation 305.79 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - subacute stroke - sham pre | 641.29 radian per second (rad/sec) | Standard Deviation 280.48 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - subacute stroke - sham post | 628.23 radian per second (rad/sec) | Standard Deviation 264.45 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - subacute stroke - rTMS pre | 389.08 radian per second (rad/sec) | Standard Deviation 313.69 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - subacute stroke - rTMS post | 373.75 radian per second (rad/sec) | Standard Deviation 294.01 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - subacute stroke - sham pre | 413.10 radian per second (rad/sec) | Standard Deviation 317.41 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - subacute stroke - sham post | 398.41 radian per second (rad/sec) | Standard Deviation 301.56 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - chronic stroke - rTMS pre | 659.25 radian per second (rad/sec) | Standard Deviation 266.67 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - chronic stroke - rTMS post | 630.80 radian per second (rad/sec) | Standard Deviation 276.1 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - chronic stroke - sham pre | 670.80 radian per second (rad/sec) | Standard Deviation 269.49 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | Less affected side - chronic stroke - sham post | 653.85 radian per second (rad/sec) | Standard Deviation 257.5 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - chronic stroke - rTMS pre | 430.58 radian per second (rad/sec) | Standard Deviation 286.32 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - chronic stroke - rTMS post | 415.61 radian per second (rad/sec) | Standard Deviation 290.76 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - chronic stroke - sham pre | 444.48 radian per second (rad/sec) | Standard Deviation 288.84 |
| Stroke Patients | Peak Velocity During Wrist Extension Movement | More affected side - chronic stroke - sham post | 440.02 radian per second (rad/sec) | Standard Deviation 294.17 |
Secondary
Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI)
Functional Magnetic Resonance Imaging (fMRI) will be used to determine hand movement related activity in the motor cortex of the brain in all subjects. Blood oxygenation level dependent (BOLD) response during execution of the motor task will be compared to rest. The subacute stroke and chronic stroke time points are compared to single study visit of healthy controls.
Time frame: 1 month post-stroke (subacute stroke) or single study visit for healthy controls, 6 months post-stroke (chronic stroke)
Population: This analysis includes participants completing the assessment at the indicated time point.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Ipsilesional - chronic stroke | 0.68 Percent signal change | Standard Deviation 0.52 |
| Stroke Patients | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Ipsilesional - subacute stroke | 1.33 Percent signal change | Standard Deviation 1.1 |
| Stroke Patients | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Contralesional - subacute stroke | 0.14 Percent signal change | Standard Deviation 0.41 |
| Stroke Patients | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Contralesional - chronic stroke | 0.03 Percent signal change | Standard Deviation 0.27 |
| Healthy Controls | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Contralateral Right - single visit for healthy controls | 1.59 Percent signal change | Standard Deviation 0.82 |
| Healthy Controls | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Ipsilateral Left - single visit for healthy controls | 0.27 Percent signal change | Standard Deviation 0.55 |
| Healthy Controls | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Ipsilateral Right - single visit for healthy controls | 0.17 Percent signal change | Standard Deviation 0.36 |
| Healthy Controls | Primary Motor Cortex (M1) Activity, Assessed by Functional Magnetic Resonance Imaging (fMRI) | Contralateral Left - single visit for healthy controls | 1.59 Percent signal change | Standard Deviation 0.75 |
Secondary
Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS)
SICI in the contralesional M1 will be measured using paired pulse TMS at an interstimulus interval (ISI) of 2 milliseconds (ms). Cortical stimulation intensity was delivered at 60% and 80% of the motor threshold (MT). SICI is expressed as the ratio between the mean MEP amplitude in response to a single TMS and the mean MEP amplitude in response to a paired pulse TMS. A ratio of 1 means no inhibition, a ratio smaller than 1 means inhibition, and a ratio greater than 1 means facilitation.
Time frame: 1 month post-stroke (subacute stroke) or single study visit for healthy controls, 6 months post-stroke (chronic stroke)
Population: This analysis includes participants completing the assessment at the indicated study visit.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation 60% MT, Post - subacute stroke, or healthy control visit | 0.92 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.52 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation (CS) 80% MT, Pre - subacute stroke, or healthy control visit | 1.00 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.55 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation 60% MT, Post - chronic stroke | 0.89 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.99 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation (CS) 80% MT, Pre - chronic stroke | 0.99 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.46 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation (CS) 80%, Post - chronic stroke | 1.09 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.46 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 60% MT, Pre - subacute stroke, or healthy control visit | 0.92 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.7 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 60% MT, Post - subacute stroke, or healthy control visit | 0.76 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.57 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 80% MT, Pre - subacute stroke, or healthy control visit | 0.93 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.53 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 80% MT, Post - subacute stroke, or healthy control visit | 0.79 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.36 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation 60% MT, Pre - subacute stroke, or healthy control visit | 0.84 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.65 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation (CS) 80%, Post - subacute stroke, or healthy control visit | 0.84 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.58 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 60% MT, Pre - chronic stroke | 0.95 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.68 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 60% MT, Post - chronic stroke | 0.89 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.43 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 80% MT, Pre - chronic stroke | 1.12 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.69 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 80% MT, Post - chronic stroke | 0.83 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.54 |
| Stroke Patients | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation 60% MT, Pre - chronic stroke | 0.92 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.71 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation (CS) 80% MT, Pre - subacute stroke, or healthy control visit | 0.88 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.82 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 60% MT, Post - subacute stroke, or healthy control visit | 0.73 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.32 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation (CS) 80%, Post - subacute stroke, or healthy control visit | 0.77 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.52 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation 60% MT, Post - subacute stroke, or healthy control visit | 0.99 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.42 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 80% MT, Pre - subacute stroke, or healthy control visit | 0.73 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.68 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | rTMS Cortex Stimulation 60% MT, Pre - subacute stroke, or healthy control visit | 0.98 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.64 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 60% MT, Pre - subacute stroke, or healthy control visit | 1.00 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.56 |
| Healthy Controls | Short Interval Cortical Inhibition (SICI) Measured by Repeated Transcranial Magnetic Stimulation (rTMS) | Sham Cortex Stimulation 80% MT, Post - subacute stroke, or healthy control visit | 0.56 ratio of MEP amplitude with TMS pulses | Standard Deviation 0.35 |
Secondary
Use of Paretic Arm Assessed by the Motor Activity Log (MAL)
In stroke patients, the everyday use of the paretic (the more affected) arm will be measured using the Motor Activity Log (MAL). The MAL is a subjective measure of semi- structured interview to examine a) how much and b) how well the subject uses their more-affected arm outside of the laboratory setting. Total scores range from 0 (no use of the more-affected arm) to 5 (use is as good as before stroke).
Time frame: 1 month post-stroke (subacute stroke), 6 months post-stroke (chronic stroke)
Population: This analysis includes participants with stroke who completed the assessment during the indicated study visit.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Stroke Patients | Use of Paretic Arm Assessed by the Motor Activity Log (MAL) | Amount of use, subacute stroke | 2.044 score on a scale | Standard Deviation 1.654 |
| Stroke Patients | Use of Paretic Arm Assessed by the Motor Activity Log (MAL) | Quality of movement, subacute stroke | 1.939 score on a scale | Standard Deviation 1.593 |
| Stroke Patients | Use of Paretic Arm Assessed by the Motor Activity Log (MAL) | Amount of use, chronic stroke | 3.266 score on a scale | Standard Deviation 1.625 |
| Stroke Patients | Use of Paretic Arm Assessed by the Motor Activity Log (MAL) | Quality of movement, chronic stroke | 3.275 score on a scale | Standard Deviation 1.597 |