Movement Priming for Stroke Recovery

Overseen By Sangeetha Madhavan, PT, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Illinois at Chicago

Must not be taking: Antidepressants, Antipsychotics, Anxiolytics, Anticonvulsants

Disqualifiers: Other neurological disorders, Brainstem lesions, Uncontrolled conditions, others

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

Compensation: Varies

Number of Visits: 9

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore how different movement exercises can improve leg functions and brain adaptability in people who have had a stroke. Participants will engage in various movement-based priming sessions, including exercises focused on upper limb movement (Upper limb-based movement priming or UL-priming) and listening to rhythmic sounds (Sham priming), to determine which is most effective. It targets individuals who experienced a stroke over six months ago and have difficulty walking as a result. As an unphased trial, this study offers participants a unique opportunity to contribute to innovative research that could enhance rehabilitation strategies for stroke survivors.

Will I have to stop taking my current medications?

The trial requires that participants do not use anti-spasticity medications and medications that could alter brain activity or increase seizure risk, like antidepressants, antipsychotics, anxiolytics, and anticonvulsants.

What prior data suggests that this movement-based priming technique is safe for stroke recovery?

Research shows that upper limb-based movement priming (UL-priming) is generally safe and well-tolerated by stroke survivors. Studies have examined its use with other therapies and found no major safety issues. Participants in these studies typically handle the treatment well, with no serious side effects reported.

For lower limb-based movement priming (LL-priming), research also supports its safety. Studies suggest that this type of movement therapy is not only affordable but also safe for many people. It requires no special equipment and has proven practical and acceptable for stroke survivors.

Both UL-priming and LL-priming treatments are gentle and focus on rhythmic movements. So far, studies have shown that these methods are safe and well-tolerated by stroke survivors. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Movement Priming techniques for stroke recovery because they explore innovative ways to enhance rehabilitation. Unlike traditional therapies focusing solely on repetitive exercises or medication, these methods use rhythmic, bilateral movements to stimulate and prime the nervous system, potentially improving motor function. Specifically, the treatments include upper limb-priming, which involves moving major joints like the shoulder and elbow, and lower limb-priming, which focuses on foot movements. This approach could lead to more effective recovery by directly engaging the body's natural movement patterns, offering a fresh angle compared to standard physical therapy.

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

Research shows that exercises focusing on arm movements, known as Upper limb-based movement priming (UL-priming), can significantly aid in recovering movement after a stroke. Studies have found that individuals using UL-priming experienced better balance in brain activity related to movement compared to those who did not use it. This suggests that UL-priming might also enhance leg movement by boosting the brain's ability to change and adapt. Participants in this trial may receive UL-priming as part of their treatment.

For exercises focusing on leg movements, known as Lower limb-based movement priming (LL-priming), research has found that it increases brain activity related to movement. One study noted a 25% increase in activity on the affected side of the brain after using LL-priming. This suggests LL-priming may also improve movement and recovery in stroke patients. Participants in this trial may receive LL-priming as part of their treatment. ^{1 5 6 7 8}

Who Is on the Research Team?

Sangeetha Madhavan, PT, PhD

Principal Investigator

University of Illinois at Chicago

Are You a Good Fit for This Trial?

This trial is for individuals who have had a single stroke affecting one side of the brain at least 6 months ago and are experiencing walking difficulties. They must be able to perform certain arm movements and not be taking specific medications that affect the brain's activity or increase seizure risk. People with severe cognitive impairment, other neurological disorders, uncontrolled medical conditions, or those who can't follow instructions due to language barriers cannot participate.

Inclusion Criteria

I had a stroke affecting one side of my brain.

I have difficulty walking due to partial paralysis.

I had a stroke more than 6 months ago.

Exclusion Criteria

I have a history of seizures or epilepsy.

I have tumors in my brainstem or cerebellum.

You have a score of 2 or higher on the Modified Ashworth Scale.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Priming Sessions

Participants undergo three priming sessions: UL-priming, sham priming, and LL-priming

1 week

3 visits (in-person)

Immediate Follow-up

Participants are assessed for changes in muscle strength and corticomotor excitability immediately after each priming session

1 day

3 visits (in-person)

Short-term Follow-up

Participants are monitored for changes in muscle strength and gait speed at 30 and 60 minutes after priming

1 day

2 visits (in-person)

Long-term Follow-up

Participants are assessed for changes in muscle strength and corticomotor excitability 24 hours after priming

1 day

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Lower limb-based movement priming (LL-priming)
• Sham priming
• Stimulation-based priming (Stim priming)
• Upper limb-based movement priming (UL-priming)

Trial Overview The study tests how upper limb movement (UL-priming) affects recovery in lower limbs compared to sham priming (just listening to a metronome), electrical brain stimulation (tDCS), or lower limb exercise. Participants will try each method in separate sessions, and researchers will measure changes in their leg function and brain activity.

How Is the Trial Designed?

Group I: Upper limb-based movement priming (UL-priming) Experimental Treatment 1 Intervention

The upper limb priming task will include rhythmic, bilateral priming involving the movement of at least one major joint in the upper limbs (shoulder, elbow, wrist).

Group II: Lower limb-based movement priming (LL-priming) Active Control 1 Intervention

Participants will perform rhythmic, symmetric, bilateral plantarflexion and dorsiflexion movements.

Group III: Sham priming Placebo Group 1 Intervention

Participants will listen to a 1 Hz metronome for 20 minutes as a form of auditory stimulation during the sham priming session.

Who Is Running the Clinical Trial?

University of Illinois at Chicago

Lead Sponsor

Trials

653

Recruited

1,574,000+

Published Research Related to This Trial

In a study of 57 patients recovering from their first ischemic stroke, those who underwent bilateral priming with active-passive movements were three times more likely to reach their upper limb recovery plateau by 12 weeks compared to those receiving standard electric stimulation.

Bilateral priming not only accelerated upper limb recovery but also improved corticomotor excitability, suggesting that this method may enhance brain function related to movement recovery after a stroke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bilateral priming accelerates recovery of upper limb function after stroke: a randomized controlled trial. Stinear, CM., Petoe, MA., Anwar, S., et al.[2022]

This clinical trial will assess whether combining moderate-high intensity aerobic exercise with modified constraint-induced movement therapy (m-CIMT) can enhance manual dexterity in 62 individuals with chronic hemiparesis after stroke.

The study aims to provide insights into the effectiveness of motor priming through aerobic exercise before intensive task training, potentially improving upper limb recovery outcomes in stroke rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial. da Silva, ESM., Santos, GL., Catai, AM., et al.[2020]

Game-based ankle movement priming significantly increased corticomotor excitability in the brain areas controlling the affected leg of stroke survivors by 25%, indicating a positive neuromodulatory effect.

Despite the increase in corticomotor excitability, there was no observed improvement in motor performance during ankle movements, suggesting that while priming may enhance brain activity, it does not immediately translate to better movement accuracy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Game-based movement facilitates acute priming effect in stroke. Lim, H., Iyer, PC., Luciano, C., et al.[2021]

This study involves 76 participants with moderate to severe stroke, testing a 5-week protocol of bilateral motor priming combined with task-specific training to improve motor function in the affected limb.

The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function, which will help determine the effectiveness of this cost-effective priming technique compared to a control group receiving electrical stimulation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial. Stoykov, ME., Biller, OM., Wax, A., et al.[2023]

Motor priming can enhance neuroplasticity in the motor cortex, leading to improved motor performance, making it a promising approach in neurorehabilitation.

Understanding different motor priming methods, such as stimulation-based priming and motor imagery, is crucial for therapists to optimize rehabilitation outcomes and tailor interventions to specific clinical needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Motor priming in neurorehabilitation. Stoykov, ME., Madhavan, S.[2022]

Movement-based priming is a novel approach in rehabilitation that targets the motor cortex to enhance behavior change and improve motor control, which is less studied compared to other priming methods.

This type of priming includes techniques like bilateral motor priming, unilateral priming, and aerobic exercise, and it has potential clinical benefits that warrant further exploration in rehabilitation settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Movement-Based Priming: Clinical Applications and Neural Mechanisms. Stoykov, ME., Corcos, DM., Madhavan, S.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6238643/

Movement-Based Priming: Clinical Applications and ... Movement-based priming includes, but is not limited to, bilateral motor priming, unilateral priming, and aerobic exercise.

2. sciencedirect.com sciencedirect.com/science/article/pii/S1836955324000833

Motor imagery priming improves activity and impairment ... In stroke rehabilitation, motor imagery priming implemented prior to task-specific training has a very small to large effect on activity and motor impairment ...

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/33190568/

Game-based movement facilitates acute priming effect in ... Results: Ipsilesional corticomotor excitability increased by 25% after game-based movement priming (p = 0.02) while changes were not observed after the control ...

4. withpower.com withpower.com/trial/phase-stroke-5-2023-e37cb

Movement Priming for Stroke Recovery · Info for Participants The goal of this clinical trial is to to determine the effect of movement-based priming using the upper limbs on lower limb neuroplasticity and behaviors in ...

5. archives-pmr.org archives-pmr.org/article/S0003-9993(20)30566-9/fulltext

Game-based Unilateral Movement Facilitates Acute ... Conclusions. Game-based ankle movement priming demonstrated a significant acute priming effect on the ipsilesional lower limb motor cortex. These data provide ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT05919043

Upper Limb-based Movement Priming for Lower ... The goal of this clinical trial is to to determine the effect of movement-based priming using the upper limbs on lower limb neuroplasticity and behaviors in ...

7. frontiersin.org frontiersin.org/journals/rehabilitation-sciences/articles/10.3389/fresc.2022.775496/full

Feasibility and Acceptability of Game-Based Cortical ... Our results indicate that a remotely supervised game-based priming and functional lower limb exercise program is feasible and acceptable for stroke survivors ...

8. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/ejn.16069

Non‐paretic leg movements can facilitate cortical drive to ... Non-paretic leg movements can be used as a priming modality, especially for those who are contraindicated to other priming paradigms (eg, brain stimulation)