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

30 Participants Needed

Trial Summary

What is the purpose of this trial?

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 chronic stroke. The main questions we aim to answer are: 1. What are the acute effect of UL-priming on lower limb neuroplasticity and motor behaviors in persons with stroke compared to other priming modalities? 2. What are the time effects of UL-priming on neuroplasticity and motor behavior in individuals with stroke? In this cross over study, participants will be involved in three priming sessions involving - UL-priming using rhythmic, symmetric, bilateral priming involving the movement of at least one major joint in the upper limbs. AND - Sham priming using auditory stimulation (1 Hz metronome). AND - Lower-limb movement-based priming using rhythmic, symmetric, dorsiflexion and plantarflexion movements. Researchers will compare outcome measures between the different priming sessions.

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 data supports the effectiveness of the treatment Movement Priming for Stroke Recovery?

Research shows that bilateral motor priming, which involves using both sides of the body, can help improve motor function in stroke patients. Studies have found that this type of priming, when combined with specific training, can enhance recovery of the affected limb and improve overall motor performance. ^{1 2 3 4 5}

Is movement priming safe for humans?

Movement priming techniques, including those involving the lower and upper limbs, have been studied in stroke rehabilitation and are generally considered safe for humans. However, most techniques are still primarily used in research settings and may not be widely available in clinical practice. ^{2 3 4 5 6}

How is the Movement Priming for Stroke Recovery treatment different from other treatments?

This treatment is unique because it uses movement priming, which involves specific exercises or stimuli to prepare the brain for rehabilitation, potentially enhancing neuroplasticity (the brain's ability to reorganize itself) and improving motor recovery after a stroke. It includes various forms like lower limb-based, upper limb-based, and stimulation-based priming, which are cost-effective and can be integrated with other therapies to optimize recovery. ^{1 2 3 4 6}

Research Team

Sangeetha Madhavan, PT, PhD

Principal Investigator

University of Illinois at Chicago

Eligibility Criteria

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

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)

Treatment Details

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.

Participant Groups

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+

Findings from Research

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 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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Bilateral priming accelerates recovery of upper limb function after stroke: a randomized controlled trial. [2022]

2. England 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. [2023]

3. England 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. [2020]

4. England pubmed.ncbi.nlm.nih.gov

Game-based movement facilitates acute priming effect in stroke. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Movement-Based Priming: Clinical Applications and Neural Mechanisms. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Motor priming in neurorehabilitation. [2022]