MyoCI + Memory Reactivation for Stroke Recovery

Overseen By Marc W Slutzky, MD/PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northwestern University

Must not be taking: Spasticity treatment

Disqualifiers: Visual impairment, Aphasia, Arm pain, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 6 weeks

70 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new method to help stroke survivors improve arm movement. It combines a special type of training using a myoelectric computer interface (MyoCI) with targeted memory reactivation (TMR) during sleep. Participants will be divided into groups: some will receive TMR during all sleep stages, some only during slow-wave sleep, some at reduced frequency, and others will not receive TMR. This trial suits individuals who experienced a stroke affecting arm movement more than six months ago and can still voluntarily move their shoulder and elbow slightly. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance rehabilitation techniques for stroke survivors.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it does exclude those who have had spasticity treatment with medications or Botox in the last 3 months.

What prior data suggests that this combination of MyoCI and TMR is safe for stroke recovery?

Research has shown that targeted memory reactivation (TMR) can aid in relearning movements after a stroke. This method involves reactivating certain memories during sleep to enhance skills. Some studies have found that it can boost learning and recovery.

Regarding safety, TMR is generally well-tolerated. There is a very small risk of seizures, particularly with techniques like transcranial magnetic stimulation (TMS). However, this risk remains minimal, and many individuals have used TMR successfully without issues.

No specific safety concerns have been noted for the MyoCI treatment itself, suggesting it is likely safe, though additional data might be needed for full confirmation.

Overall, both TMR and MyoCI appear safe, with minimal risks reported. For those considering joining a trial, this information is encouraging. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about MyoCI paired with Memory Reactivation for stroke recovery because it offers a novel approach to enhancing brain recovery. Unlike traditional rehabilitation that focuses on physical exercises and therapy, this method uses Targeted Memory Reactivation (TMR) during sleep to potentially boost cognitive recovery. The trial explores different TMR techniques, including stimulation during all sleep stages, slow-wave sleep only, and reduced frequency sessions, which could provide new insights into optimizing recovery time and outcomes for stroke patients. This approach could complement existing therapies, offering a new avenue for speeding up and improving rehabilitation.

What evidence suggests that this trial's treatments could be effective for stroke recovery?

Previous studies have shown that a technique called targeted memory reactivation (TMR) can help stroke survivors improve motor skills. Participants who received TMR made fewer mistakes in movement tasks than those who did not, suggesting that TMR aids the brain in remembering and enhancing these skills during sleep. In this trial, participants will be assigned to different TMR treatment arms: TMR during every stage of sleep, TMR during slow-wave sleep only, and reduced frequency TMR. By reactivating certain memories during sleep, the brain may improve at tasks like moving an arm, which is often challenging after a stroke. Overall, research indicates that TMR can be a valuable tool in stroke recovery by enhancing learning and movement performance. ^{2 3 5 6 7}

Who Is on the Research Team?

Marc W Slutzky, MD/PhD

Principal Investigator

Northwestern University

Are You a Good Fit for This Trial?

This trial is for chronic stroke survivors aged 21 or older with severe to moderate arm motor impairment, who had their first stroke at least 6 months ago. Participants must have some voluntary shoulder and elbow movement but can't join if they have ferromagnetic implants, are in other studies, struggle with English due to aphasia, suffer from substantial pain or visual impairments that affect screen viewing, or have received spasticity treatment recently.

Inclusion Criteria

I can move my shoulder and elbow muscles on my own.

I am 21 years old or older.

I have severe to moderate difficulty moving my arms.

Exclusion Criteria

You have anesthesia or neglect in your affected arm, or difficulty paying attention to things on one side of your vision.

I have a visual impairment that prevents me from seeing the entire screen.

Inability to understand or follow commands in English due to aphasia or other reason

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo MyoCI training combined with TMR to improve arm motor function

6 weeks

Multiple sessions per week

Follow-up

Participants are monitored for changes in motor function and spasticity

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• MyoCI
• Targeted Memory Reactivation (TMR)

Trial Overview The study tests whether combining myoelectric computer interface (MyoCI) training with targeted memory reactivation (TMR) during sleep can improve arm function in people who've had a stroke. It looks at the effects of this combination over an extended period.

How Is the Trial Designed?

Group I: Slow-wave sleep (SWS) only TMR Experimental Treatment 1 Intervention

TMR during slow-wave sleep only

Group II: Reduced frequency TMR Experimental Treatment 1 Intervention

TMR during only subset of sessions

Group III: All phase TMR Experimental Treatment 1 Intervention

TMR during every stage of sleep

Group IV: Sham TMR Placebo Group 1 Intervention

Patients receive no TMR

Who Is Running the Clinical Trial?

Northwestern University

Lead Sponsor

Trials

1,674

Recruited

989,000+

Published Research Related to This Trial

BCI-triggered functional electrical stimulation therapy (BCI-FEST) was found to be a safe and feasible method for improving upper limb function in a 57-year-old man with severe hemiplegia after a stroke, with 80 therapy sessions conducted over several weeks.

Significant clinical improvements were observed, including notable increases in scores on various functional tests, indicating that BCI-FEST can effectively enhance motor function and daily task performance in individuals with neurological injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Restoration of Upper Limb Function After Chronic Severe Hemiplegia: A Case Report on the Feasibility of a Brain-Computer Interface-Triggered Functional Electrical Stimulation Therapy. Jovanovic, LI., Kapadia, N., Lo, L., et al.[2021]

Myoelectric computer interface (MCI) training significantly reduced abnormal co-activation of arm muscles in 32 chronic stroke survivors, leading to improved arm function and kinematics after 6 weeks of training.

The benefits of MCI training persisted for at least one month after the training ended, indicating its potential as a lasting intervention for enhancing arm function post-stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of myoelectric computer interface training on arm kinematics and function after stroke. Tomic, G., Mugler, EM., Singh, A., et al.[2020]

A pilot study using a myoelectric-computer interface (MCI) showed that both healthy individuals and stroke survivors could learn to reduce muscle co-contraction, which is a barrier to improved motor function after a stroke.

Three out of five stroke survivors demonstrated some improvement in arm function after MCI training, indicating that this approach could be a promising and cost-effective method for stroke rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Myoelectric computer interfaces to reduce co-contraction after stroke. Wright, ZA., Rymer, WZ., Slutzky, MW.[2021]

The MyoCI training paradigm significantly reduced arm impairment in stroke survivors, with improvements observed in the Fugl-Meyer Assessment scores after 6 and 10 weeks of training, indicating its efficacy in enhancing motor recovery.

MyoCI was well-tolerated with no adverse events reported, and it effectively decreased abnormal muscle co-activation, leading to improvements in spasticity and elbow range-of-motion, benefiting both moderately and severely impaired patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial. Mugler, EM., Tomic, G., Singh, A., et al.[2020]

The study demonstrated that combining a brain-computer interface (BCI) with functional electrical stimulation (FES) is feasible for motor learning in a 43-year-old woman who was 10 months post-stroke, leading to significant improvements in her ability to control finger movements.

After nine training sessions, the participant achieved volitional control of isolated index finger extension, indicating that this combined approach may effectively aid in motor recovery after stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of a new application of noninvasive Brain Computer Interface (BCI): a case study of training for recovery of volitional motor control after stroke. Daly, JJ., Cheng, R., Rogers, J., et al.[2016]

A study involving 32 stroke survivors who underwent 6 weeks of MyoCI training showed that the training effectively reduced abnormal muscle co-activation in targeted arm muscles, leading to improved motor function.

While the overall number and composition of muscle synergies did not change significantly, the training increased the disparity of muscle weights within synergies for those who responded, indicating a more refined control of muscle coordination in the affected arm.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Myoelectric interface training enables targeted reduction in abnormal muscle co-activation. Seo, G., Kishta, A., Mugler, E., et al.[2023]

Myoelectric computer interface (MCI) training effectively reduced abnormal muscle coactivation in both healthy participants and stroke survivors, indicating its potential as a rehabilitation tool.

Among the stroke survivors, 3 out of 5 showed a measurable improvement in arm function, as evidenced by a 3-point increase in the Fugl-Meyer Motor Assessment score, highlighting the efficacy of MCI in retraining muscle activation patterns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing Abnormal Muscle Coactivation After Stroke Using a Myoelectric-Computer Interface: A Pilot Study. Wright, ZA., Rymer, WZ., Slutzky, MW.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12426868/

Enhancing Motor Learning in People With Stroke Via ... Participants who received TMR demonstrated a greater overall reduction in absolute and variable spatial errors relative to the NoTMR control group. Both groups ...

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/34591529/

Enhancing motor learning in people with stroke via memory ... Results: Participants who received TMR demonstrated a greater overall reduction in absolute and variable spatial errors relative to the NoTMR ...

3. ahajournals.org ahajournals.org/doi/10.1161/STROKEAHA.122.041497

Cognitive Recovery After Stroke: Memory One study found improvement between 3 months and 1 year poststroke in both carriers and noncarriers: ε4 carriers demonstrated improvement in ...

4. faculty.wcas.northwestern.edu faculty.wcas.northwestern.edu/paller/JN2021.pdf

Memory Reactivation during Sleep Improves Execution of a ... Our results not only implicate sleep in skill learning but also pinpoint a benefit for motor execution using a method for modifying memory storage during sleep.

5. bmjopen.bmj.com bmjopen.bmj.com/content/14/2/e077442

Sleep and motor learning in stroke (SMiLES) The aim of the present study is to understand whether measures of motor consolidation mediate the relationship between sleep and clinical motor outcomes post ...

6. nature.com nature.com/articles/s42003-024-06723-3

Activity-dependent transcriptional programs in memory ... The expression of neuronal activity-dependent genes are predictive of recovery and occupy a molecular latent space unique to motor recovery.

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1074742721000824

Whole-body procedural learning benefits from targeted ... Targeted memory reactivation (TMR) applied in REM sleep improves whole-body procedural learning. Dreaming about kinesthetic aspects of procedural learning also ...