Stroke
Conditions
Keywords
Muscle synergy, Intermuscular Coordination, Electromyogram-guided exercise, Motor neurorehabilitation, Stroke
Brief summary
The purposes of this study include: 1. \- To identify whether features of aberrant intermuscular coordination patterns can be used to predict motor impairment after stroke. 2. \- To test whether muscle synergies are malleable to a non-invasive EMG-guided exercise that induces changes in intermuscular coordination of upper extremity muscles after stroke.
Detailed description
Stroke is a leading cause of long-term disability in the United States. Of the more than 700,000 Americans who experience a stroke each year, two-thirds survive. 69% of patients who were admitted to a rehabilitation unit following stroke have mild to severe upper extremity dysfunction. Currently, there are more than seven million stroke survivors in the U.S., many of whom have long-term motor and sensory impairments, especially in the arm. The objective of this study involves both scientific and clinical aspects: For the first purpose, intermuscular coordination patterns emerging under isometric reaching and dynamic conditions will be identified to predict impairment of both non-motion or motion-involved task performance and severity of motor impairment after stroke. This aim will enroll 15 age-matched (age of 40-75 yo) healthy adults and 25 adult (age of 40-75 yo) stroke survivors. Each stroke participant will have two visit sessions while age-matched will have a single measurement session. For the second purpose, in total, 74 stroke survivors will perform an electromyographic signal-guided exercise through human-machine interaction to ameliorate motor impairment post-stroke by normalizing abnormal intermuscular coordination patterns in the arm after stroke, and improve motor impairment; also, assessment of the intermuscular coordination, UE Fugl-Meyer (FM), and Action Research Arm Test (ARAT) will be performed. Participants will have three visits per week for six weeks for training sessions. Finally, to test retention of the intervention effect, they will perform two assessment sessions one and three months after finishing the training.
Interventions
OTHERNeuromuscular coordination-guided rehabilitative training
During training exercise, post-stroke participants will be asked to match the targets on the screen. The experimental group will match them by activating a specific set of muscle. During assessment trials, a physical therapist or occupational therapist will rate the functional level of arm impairment using FMA and ARAT.
OTHERForce strengthening-guided rehabilitative training
During training exercise, post-stroke participants will be asked to match the targets on the screen. The active comparator group will match them by generating isometric force in a desired target direction. During assessment trials, a physical therapist or occupational therapist will rate the functional level of arm impairment using FMA and ARAT.
Sponsors
University of Houston
Korea Advanced Institute of Science and Technology
The University of Texas Health Science Center, Houston
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
for aged matched healthy group * Male or female whose age range between 40 and 75 * no known neurological injuries
Exclusion criteria
for aged matched healthy group * have an orthopedic disorder involving upper limbs; * have a history of any neurologic disease; * have any history of epilepsy of the potential participants and/or their family members; * are unable to consent; * are pregnant. Inclusion criteria for stroke group * male or female hemiparetic chronic stroke survivors; * age ranging between 40-75 year; * with single unilateral ischemic or hemorrhagic middle cerebral artery stroke; * neurologically stable for \>6 months; * have an expectation that current medication will be maintained without changes for at least 3 months. Stable use of anti-spasticity medication (e.g., baclofen, diazepam, tizanidine) is accepted; * without severe spasticity (Modified Ashworth (MA) \<4); * have not received botulinum toxin on the impaired arm within 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Fugl-Meyer Assessment (FMA) score | before any training, after the 6 weeks of training, respectively, and 1 and 3 months after the last training session, respectively | To measure severity of motor impairment after stroke, FMA will be performed in the human upper extremity. FMA is commonly used to assess severity of motor impairment and motor recovery. The maximum FMA upper extremity motor score is 66 (i.e., 0: complete motor impairment; 66: normal motor performance). Each item is scored on a 3-point scale (0 = cannot perform, 1 = performs partially, 2 = performs fully). |
| Change in Action Research Arm Test (ARAT) score | before any training, after the 6 weeks of training, respectively, and 1 and 3 months after the last training session, respectively | To measure motor function after stroke, ARAT will be performed in the human upper extremity. 19 Items comprising the ARAT are categorized into four subscales (grasp, grip, pinch, and gross movement) and arranged in order of decreasing difficulty, with the most difficult task examined first, followed by the least difficult task. Task performance is rated on a 4-point scale, ranging from 0 (no movement) to 3 (movement performed normally). |
| Change in intermuscular coordination patterns | before any training, after the 6 weeks of training, respectively, and 1 and 3 months after the last training session, respectively | EMGs will be recorded from 12 muscles. To assess whether muscle-synergy guided and/or force-guided exercise induce changes in the composition of intermuscular coordination patterns, non-negative matrix factorization will be applied to EMGs to identify and compare ICoPs. The features from EMG are muscle synergy (motor module) composition and activation profiles. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Brain imaging data recording | before any training, after the 6 weeks of training, respectively, and 1 and 3 months after the last training session, respectively | A non-invasive electroencephalography (EEG) measurement setup will be employed to collect the EEG signal, specifically, thirty-two EEG electrodes will be placed on the scalp, and EEG signals will be measured during an isometric assessment. From EEG, cortico-muscular connectivity, cortico-cortical connectivity, and spectral power features will be extracted. |
Countries
United States
Contacts
CONTACTJinsook Roh, PhD
CONTACTManuel A Portilla-Jiménez, MS, BME
PRINCIPAL_INVESTIGATORJinsook Roh, PhD
University of Houston
Outcome results
None listed