Stroke
Conditions
Keywords
Stroke, Neuromodulation, Transcranial magnetic stimulation, Upper extremity, Rehabilitation and Occupational Therapy
Brief summary
Stroke remains the primary cause of long-term neurological disabilities. Effective rehabilitation solutions are essential to alleviate the burden poststroke survivors impose on hospitals and community services. Following unilateral stroke, interhemispheric balance is disrupted. Prior studies have extensively documented that exaggerated interhemispheric inhibitory flow from the contralesional to the ipsilesional hemisphere prevents maximal functional recovery in poststroke survivors. Therefore, we aimed to test the modulatory effects of a Hebbian-type plasticity induction paradigm using corticocortical paired associative stimulation (ccPAS) over the bilateral motor cortex. This approach aims to reverse the abnormal inhibitory flow from the contralesional to the ipsilesional hemisphere and assess its clinical benefits on upper extremity motor recovery in patients with stroke. In this randomized controlled trial, we hypothesize that Hebbian-type ccPAS would be more effective than sham ccPAS and conventional single-site inhibitory rTMS delivered to the contralesional hemisphere at improving hemiplegic upper limb motor functionality and modulating interhemispheric activity to an equilibrium state among patients with stroke. This approach seeks to address diseases related to brain network impairments, such as stroke. This project will provide insights into the recovery mechanisms activated following neurological diseases from the perspective of the Hebbian learning rules of associative plasticity.
Interventions
DEVICETranscranial magnetic stimulation - dual coil
The dual coil stimulation will be applied using two MagPro X100 stimulators connected to two vertically oriented figure-of-eight coils designed for bilateral hemispheric stimulation.
DEVICETranscranial magnetic stimulation
Single coil TMS will be performed using a TMS stimulator and the same stimulation coil (MC-B65-HO).
Sponsors
The Hong Kong Polytechnic University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Diagnosis with monohemispheric ischemic subcortical stroke (with intact corpus callosum), with stroke onset ≥6 months, 2. Age 40-75 years. 3. Residual upper limb function between levels 3-6, according to the Functional Test for the Hemiplegic Upper Extremity (FTHUE), indicating mildly to moderately impaired upper limb motor function. 4. Capable of providing informed written consent.
Exclusion criteria
1. any contraindications for TMS (screened using the safety checklist by Rossi) 2. Diagnosis of any concomitant neurological diseases other than stroke. 3. Signs of cognitive impairment, defined as a Montreal cognitive assessment Hong Kong version score \<21/22 out of 30 . 4. Severe spasticity in the hemiparetic upper limb muscles, with a Modified Ashworth score \>2.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The Fugl-Meyer Assessment-Upper Extremity Scores | Baseline | The Fugl-Meyer Assessment-Upper Extremity Scores (FMA-UE) is the gold standard for assessing poststroke upper limb motor control. It is used to determine the movement, coordination, and reflex action of the affected upper limb in poststroke people. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Interhemispheric signal propagation (ISP) in TMS-evoked potential | Baseline | ISP measured using concurrent TMS-evoked potential is set as another outcome for measuring the interhemispheric inhibitory flow between the bilateral M1s. TMS-evoked activity will be defined as the local mean field power (LMFP) of six channels surrounding the M1 (Left: C1, C3, C5, CP1, CP3, CP5; Right: C2, C4, C6, CP2, CP4, CP6) in a specific time frame. Because of the approximately 10 ms of transcallosal conduction, the LMFP from 50 to 130 ms is rectified for the stimulated M1 and from 60 to 140 ms for the non-stimulated M1. A higher ISP value indicates a higher inhibitory flow from the non-stimulated M1 to the stimulated M1. |
| Interhemispheric signal propagation (ISP) in TMS-evoked potential. | At 3-month | ISP measured using concurrent TMS-evoked potential is set as another outcome for measuring the interhemispheric inhibitory flow between the bilateral M1s. TMS-evoked activity will be defined as the local mean field power (LMFP) of six channels surrounding the M1 (Left: C1, C3, C5, CP1, CP3, CP5; Right: C2, C4, C6, CP2, CP4, CP6) in a specific time frame. Because of the approximately 10 ms of transcallosal conduction, the LMFP from 50 to 130 ms is rectified for the stimulated M1 and from 60 to 140 ms for the non-stimulated M1. A higher ISP value indicates a higher inhibitory flow from the non-stimulated M1 to the stimulated M1. |
Contacts
Primary ContactJack Jiaqi Zhang, PhD
Outcome results
None listed