Protocol Number: 04-N-0203

Title:

Neural Correlates of Observational Motor Learning in Chronic Stroke Patients

Number:

04-N-0203

Summary:

This study will determine how people who have had a stroke learn to perform a movement by observation, as compared with people who have not had a stroke. Normally, a person learns a new hand movement automatically by observing the movement performed by others. Improvement with practice also relies on visual feedback. This "observational training" - i.e., the repeated observation of a movement - is sufficient for normal individuals to learn a movement. This study will examine brain activity related to motor learning in stroke patients and in healthy control subjects to see whether stroke patients process visual-motor information the same way normal subjects do.

Normal volunteers and stroke patients between 18 and 75 years of age may be eligible for this study. Patients must have had paralysis on one side of the body due to a stroke that occurred at least 3 months before entering the study. Candidates who have not had a recent health screening will have a clinical and neurological examination.

Participants undergo the following procedures:

- Brain magnetic resonance imaging (MRI), if one has not been done recently. This test uses a strong magnetic field and radio waves to obtain images of body organs and tissues. The subject lies on a table that can slide in and out of the cylindrical scanner and wears earplugs to muffle loud noises caused by switching of magnetic fields. Scanning time varies from 20 minutes to 3 hours, with most sessions lasting 45 to 90 minutes.

- Task training. The subject practices the task to be performed during functional MRI (see below). The subject makes finger tapping movements, then watches finger movements on a video screen for several minutes, during which time the movie stops from time to time without warning. When the movie stops, the subject must reproduce the last finger movement that appeared on the screen. During this session, the electrical signals of the subject's forearm muscles are recorded at the skin surface. This session lasts up to 3 hours.

- Functional MRI. The subject undergoes MRI scanning while performing the same tasks done in the training session. This session lasts about 3 hours.

Sponsoring Institute:

National Institute of Neurological Disorders and Stroke (NINDS)

Recruitment Detail

Type: Active Accrual Of New Subjects

Gender: Male & Female

Referral Letter Required: No

Population Exclusion(s): Children

Eligibility Criteria:

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.

Special Instructions: Currently Not Provided

Keywords:

Brain Plasticity

Functional MRI

Finger Movement

Rehabilitation

Improvement

Stroke

Motor Recovery

Observation

fMRI

Recruitment Keywords:

Stroke

Healthy Volunteer

HV

Conditions:

Investigational Drug(s):

None

Investigational Device(s):

None

Contacts:

Patient Recruitment and Public Liaison Office
Building 61
10 Cloister Court
Bethesda, Maryland 20892-4754
Toll Free: 1-800-411-1222
TTY: 301-594-9774 (local),1-866-411-1010 (toll free)
Fax: 301-480-9793

Electronic Mail:prpl@mail.cc.nih.gov

Citations:

Bonita R, Solomon N, Broad JB. Prevalence of stroke and stroke-related disability. Estimates from the Auckland stroke studies. Stroke. 1997 Oct;28(10):1898-902. PMID: 9341692

Boyd LA, Winstein CJ. Implicit motor-sequence learning in humans following unilateral stroke: the impact of practice and explicit knowledge. Neurosci Lett. 2001 Jan 26;298(1):65-9.

PMID: 11154837

Byrne RW, Russon AE. Learning by imitation: a hierarchical approach. Behav Brain Sci. 1998 Oct;21(5):667-84; discussion 684-721. Review. PMID: 10097023

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