Neural Correlates of Observational Motor Learning in Chronic Stroke Patients
Colección de datos
Trastornos Cerebrovasculares+3
+ Enfermedades del Sistema Nervioso Central
+ Enfermedades Cardiovasculares
Resumen
Fecha de inicio: 25 de mayo de 2004
Fecha en la que se inscribió al primer participante.In normal subjects, the learning of new hand movements initially relies on the automatic ability to elaborate a motor plan from the simple observation of movements performed by others. The improvement of motor performance during practice also relies on a correct visuomotor processing of visual feedback and it has been demonstrated that the repeated observation of a gesture, named observational training is sufficient to induce motor learning. However, it is not known if stroke patients process visuomotor information in the same manner as normal subjects. Objectives: The purpose of this protocol is to determine the pattern of brain activations related to motor learning induced by observational training in stroke patients as compared to normal volunteers. We hypothesize that observational motor learning in stroke patients will rely on an increased activity in premotor cortex as compared to normal volunteers. Study population: This protocol will include chronic stroke patients with subcortical lesions and good motor recovery from an initial upper-limb paresis, and a control population of age and gender matched normal volunteers. Design: We will conduct a functional MRI (fMRI) experiment assessing observational training of finger sequences. Three conditions of finger sequences will be compared: 1) a sequence visually trained during the fMRI session, 2) a non-trained sequence (control 1), and 3) a sequence visually trained before the fMRI session (control 2). The fMRI session will be split into 3 separate runs. The first run will assess brain activity related to the motor performance of the 3 finger sequences. The second run will explore the brain activity during observational training of the sequence. The third run will re-assess the brain activity related to the motor performance of the 3 finger sequences. Outcome measures: The endpoint measure of the experiment will be an increase in the number of activated voxels in premotor cortex during the motor learning induced by observational training in the stroke patients as compared to normal volunteers.
Protocolo
Esta sección proporciona detalles del plan del estudio, incluyendo cómo está diseñado y qué se está evaluando.Se reclutarán 60 pacientes
Número total de participantes que el ensayo clínico espera reclutar.Elegibilidad
Los investigadores buscan pacientes que cumplan ciertos criterios, conocidos como criterios de elegibilidad: estado general de salud o tratamientos previos.Cualquier sexo
Sexo biológico de los participantes elegibles para inscribirse.De 18 a 75 años
Rango de edades de los participantes que pueden unirse al estudio.Voluntarios sanos no permitidos
Indica si personas sanas, sin la condición que se estudia, pueden participar.Condiciones
Patología
Criterios
* INCLUSION CRITERIA: We will include PATIENTS: 1. Who are aged 18 to 75, 2. With a single thromboembolic non-hemorrhagic hemispheric lesions, 3. With at least a 3 months period since the stroke, 4. Who initially had a severe motor paresis (below MRC grade 2), 5. Who subsequently recovered to the point that they can perform the motor tasks of this study, 6. With no history of other neurological and psychiatric illness, 7. Who are right-handed (before the stroke history). As a control group, we will include NORMAL VOLUNTEERS, 1. Who are age- and gender matched to stroke PATIENTS, 2. Who can perform the motor tasks of this study, 3. With no history of other neurological and psychiatric illness, 4. Who are right-handed. EXCLUSION CRITERIA: 1. PATIENTS with more than one stroke in the medial cerebral artery territory. 2. PATIENTS with bilateral motor impairment. 3. PATIENTS with cerebellar or brainstem lesions. 4. PATIENTS and NORMAL VOLUNTEERS unable to perform the task. 5. PATIENTS and NORMAL VOLUNTEERS with history of severe alcohol or drug abuse, psychiatric illness like severe depression, poor motivational capacity, or severe language disturbances, particularly of receptive nature or with serious cognitive deficits (defined as equivalent to a mini-mental state exam score of 23 or less). 6. PATIENTS and NORMAL VOLUNTEERS with severe uncontrolled medical problems (e.g. cardiovascular disease, severe rheumatoid arthritis, active joint deformity of arthritic origin, active cancer or renal disease, any kind of end-stage pulmonary or cardiovascular disease, or a deteriorated condition due to age, uncontrolled epilepsy or others). 7. PATIENTS and NORMAL VOLUNTEERS with increased intracranial pressure (as evaluated by clinical examination). 8. PATIENTS and NORMAL VOLUNTEERS with unstable cardiac arrhythmia. 9. PATIENTS and NORMAL VOLUNTEERS with h/o hyperthyroidism or individuals receiving drugs acting primarily on the central nervous system. 10. PATIENTS and NORMAL VOLUNTEERS with more than moderate to severe microangiopathy (as assessed by multiple peri-ventricular T2 hyperintensity on the pre-experimental anatomical MRI), polyneuropathy (as assessed by clinical examination), diabetes mellitus (medical record), or ischemic peripheral disease (as assessed by clinical examination). 11. PATIENTS and NORMAL VOLUNTEERS who are or who have been good skilled piano or string instruments players. 12. PATIENTS and NORMAL VOLUNTEERS who is on medication with the potential to influence nervous system function, who has a history of surgery with metallic implants or a known history of metallic particles in the eye, a cardiac pacemaker, intracardiac lines, neural stimulators, cochlear implants. 13. PATIENTS and NORMAL VOLUNTEERS who are pregnant. 14. PATIENTS and NORMAL VOLUNTEERS with significant visual loss/deficits. 15. PATIENTS and NORMAL VOLUNTEERS with MRI contraindications.
Centros del Estudio
Estos son los hospitales, clínicas o centros de investigación donde se lleva a cabo el estudio. Puedes encontrar la ubicación más cercana a ti y su estado de reclutamiento.Este estudio tiene una ubicación
National Institutes of Health Clinical Center, 9000 Rockville Pike
Bethesda, United StatesVer ubicación