This study plans to determine whether training can change abnormal flexion synergy in chronic stroke patients.
The aim of the current study is to investigate whether motor training in chronic stroke patients can change their abnormal flexion synergy. The investigators will study chronic stroke patients , who are defined as patients that sustained a stroke at least 6 months prior to our testing date. Three functional aspects of each finger will be tested: maximal voluntary contraction (MVC), finger dexterity, and hand posture. Prior to intervention, participants will have a baseline assessment including clinical tests, MVC, the individuation task, and the configuration task. Following the baseline assessment patients will receive intervention, training on the configuration task for 5 consecutive days. On the sixth day and as a one week follow-up after, subjects will have a post-intervention assessment containing the same tests performed in baseline. This design will allow us to determine speed and accuracy during the configuration task, the individuation index, and possible changes in abnormal flexion synergy. We initially registered the study as two arms (anodal tDCS and sham tDCS groups) but decided to make it one arm due to the number of participants we were able to recruit.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
20
Training the impaired hand on a configuration task
Kennedy Krieger Institute
Baltimore, Maryland, United States
Individuation Index
The relationship between forces (in Newton) in active vs passive fingers during a set of isolated finger movements. It is a measure of finger independence.
Time frame: Change from Baseline Individuation Index at 2 weeks
Action Research Arm Test (ARAT)
Assesses upper limb functioning in activities of daily living using observational methods. It is a 19 item measure divided into a 4-point ordinal scale ranging from: 3: Performs test normally 2: Completes test, but takes abnormally long or has great difficulty 1: Performs test partially 0: Can perform no part of test. Possible score range of 0 to 57; higher scores equal less impairment.
Time frame: Change from Baseline ARAT at 2 weeks
Fugl-Meyer (Motor Function - Upper Extremity Subscale)
Assesses functional mobility using observational methods. It is a 66 item measure. Its items are scored on a 3-point ordinal scale. 0: Cannot perform 1. performs partially 2. performs fully Possible score range from 0 - 66
Time frame: Change from Baseline Impairment Index at 2 weeks
Accuracy (Euclidian norm)
The deviation of each finger from a target amount of force generation during a set of finger movements.
Time frame: Change from Baseline Accuracy at 2 weeks
Execution Time
The time period from cue appearance to the first moment when finger forces reach the required target. Lower values equal faster execution time.
Time frame: Change from Baseline Execution Time at 2 weeks
Semmes Weinstein Monofilament Examination (SWME)
A quantitative method to systematically assess the threshold stimulus necessary for perception of light touch to deep pressure by using monofilaments of different sizes. Interpretation scale for monofilaments: 2.83 Normal 3.61 Diminished light touch 4.31 Diminished protective sensation 4.56 Loss of protective sensation 6.65 Deep pressure sensation only
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Time frame: Change from Baseline SWME at 2 weeks
Modified Ashworth scale
Tests resistance to passive movement about a joint with varying degrees of velocity in order to assess muscle spasticity. Scoring: 0 No increase in muscle tone 1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension. 1+ Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the Range of motion (ROM). 2 More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved. 3 Considerable increase in muscle tone, passive movement difficult. 4 Affected part(s) rigid in flexion or extension
Time frame: Change from Baseline Modified Ashworth Scale at 2 weeks