HABIT-ILE in Adults With Chronic Stroke (HABIT-ILE Stroke)

Changes in finger force tracking dexterity

By using a finger force manipulandum (DEXTRAIN), which records the forces (in Newtons) applied by the fingers on pistons, we calculate the ability to control and release the force applied by the fingers during a tracking task.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in multifinger tapping dexterity

By using the DEXTRAIN, we assess the independent finger movements while simultaneous tapping with different finger configurations (two fingers or one finger) in response to visual instructions during a finger tapping task. The percentage of errors are considered.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in cortical thickness of the brain's gray matter

Regional brain cortical thickness is acquired from high resolution 3D T1-weighted structural imaging data. For each investigated region, mean cortical metrics (in millimeters) are assessed between the pial surface and the white/grey boundary.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in Fractional Anisotropy (FA) of the corticospinal tract from the motor cortex to the cerebellar peduncle

FA is a scalar value (no unit) between 0 and 1 that describes the degree of anisotropy of white matter water molecules. It is measured non-invasively via brain MRI using diffusion tensor imaging (DTI), a modality of Diffusion-Weighted Imaging (DWI). Increased values indicate a higher directionality of the tissue structure.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes on the Axial, Radial and Mean Diffusivity (AD, RD, MD) of the corticospinal tract from the motor cortex to the cerebellar peduncle

AD, RD and MD are values ranging from 0 to 3.10-3 \[mm2/s\] that describe the degree of axial, radial and mean molecular diffusion of white matter water molecules. It is measured non-invasively via brain MRI using diffusion tensor imaging (DTI), a modality of Diffusion-Weighted Imaging (DWI). An increased MD can be considered to be an indicator of white matter damage.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes on the metrics of the corticospinal tract from the motor cortex to the cerebellar peduncle using the NODDI model

The orientation dispersion index (ODI), intracellular volume fraction (ICVF) and the fraction of the isotropic compartment (ISOF) are scalar values ranging from 0 to 1 (no units) that describe the orientation of neural fibers, and the volume fraction of the intracellular and isotropic compartment. It is measured non-invasively via brain MRI using the Neurite Orientation Dispersion and Density Imaging (NODDI) model combined with a Diffusion-Weighted Imaging (DWI) sequence. The results reflects the overall coherence of the fibers, with zero representing highly coherent structures, hence less dispersion of the fibers.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes on the metrics of the corticospinal tract from the motor cortex to the cerebellar peduncle using the DIAMOND model

By representing each voxel of the brain as the sum of multiple compartments (representing either a neural fiber population or an isotropic diffusion), the volume fraction and the heterogeneity of each compartment can be estimated. These metrics (ranging from 0 to 1, no unit) are measured non-invasively via brain MRI using the Distribution of 3D Anisotropic Microstructural environments in Diffusion-compartment imaging (DIAMOND) model combined with a Diffusion-Weighted Imaging (DWI) sequence. The results reflects the overall heterogeneity of the fibers, with zero representing more homogeny structures, hence less dispersion of the fibers.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in resting-state functional connectivity

Resting-state functional magnetic resonance imaging (rs-fMRI) evaluates the regional interactions that occur during the resting or task-negative state. The magnitude of the brain activation during rs-fMRI will be assessed

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in brain white matter microstructure (WM-μs) using the Microstructure Fingerprinting model

Using a multiple-compartment approach, the signal obtained from a voxel can be estimated as the sum of multiple fiber populations, each presenting a specific fraction ('frac', ranging from 0 to 1, no unit), fiber volume fraction ('fvf', ranging from 0 to 1, no unit) and diffusivity ('diff', in \[mm2/s\]). On top of those fiber populations, isotropic compartments can also be represented with a specific fraction (frac) and diffusivity (diff). These metrics are measured non-invasively via brain MRI using the Microstructure Fingerprinting model combined with a Diffusion-Weighted Imaging (DWI) sequence.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in upper extremities sensorimotor functions assess by the Fugl-Meyer Assessment (FMA-UE)

The FMA-UE assess reflex activity, movement control and muscle strength in the upper extremity of people with post-stroke hemiplegia. Maximum score is 66 points (Higher scores indicates better functioning levels)

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in upper extremities motor functions assess by the Wolf Motor Function Test (WMFT)

The WMFT measures quantitative motor ability through 17 timed and functional tasks. Uses a 6-point ordinal scale (from 0= "does not attempt with the involved arm" to 5= "arm does participate; movement appears to be normal"). Maximum score is 75 (Higher scores indicates better functioning levels)

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in unimanual dexterity assessed by the Box & Block test (BBT)

The BBT assess unimanual dexterity by quantifying the maximum of wooden blocks transferred from one space to the other during 1 minute (Higher scores indicate better performance)

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in the Six Minutes' Walk Test (6MWT)

The 6MWT assess endurance while walking 6 minutes without pause. More distance walked (in meters) indicate better performance

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in Canadian Occupational Performance Measure (COPM)

In this interview, patients set up 5 activities considered difficult in daily life. These are then assessed, in a 1 to 10 scale, regarding the patient's self-perception of performance and satisfaction of it. The total score is the average of the scores for perception and satisfaction separately (score from 1 to 10)

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in the Stroke Impact Scale (SIS)

Self-reported questionnaire assessing multidimensional repercussions of the Stroke (strength, hand function, daily life activities, mobility, communication, emotion, memory, thinking and participation). Domains are scored on a metric of 0 to 100 (higher scores indicate better self-reported health)

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in activities of daily living assessed by ACTIVLIM-Stroke Questionnaire

The ACTIVLIM-Stroke questionnaire measures a patient's ability to perform daily activities requiring the use of the upper and/or lower extremities through 20 items specific to patients after stroke. It ranges from - 6 to +6 logits (higher score means better performance).

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in activities of daily living assessed by ABILHAND Questionnaire

The ABILHAND questionnaire specific to patients with chronic stroke measures a patient's manual ability to manage daily activities that require the use of the upper extremities, whatever the strategies involved, through 23 items. It ranges from -6 to +6 logits (higher score means better performance).

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in the modified Rankin Scale (mRS) for neurologic disability

mRS measures the degree of disability or dependence in the daily activities of people who have suffered a stroke or other causes of neurological disability. The 6 levels of disability goes from 0 ("no disability/no symptoms") to 5 ("disability requiring constant care for all needs"), being 6 "death".

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in visual neglect assessed by the Bells Test

The Bells Test is a cancellation test that allows for a quantitative and qualitative assessment of visual neglect in the near extra personal space. The patient score is based on the amount of time they take to complete the task, and the number of correct items (35 bells) they identify.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes on the visuospatial short term working memory assessed by the "Corsi block-tapping test"

The test requires the patient to observe and then repeat in order a sequence of blocks "tapped". The task starts with a sequence of 2 blocks and gradually increases in length up to nine blocks. The test measures both the number of correct sequences and the longest sequence remembered. This number is known as the "Corsi Span", and averages about 5 for normal human subjects.

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in the Montreal Cognitive Assessment (MoCA) test

The MoCA is a brief screening instrument originally designed to identify mild cognitive impairments in elderly patients attending a memory clinic. MoCA evaluates different domains (visuospatial abilities, executive functions, short-term memory recall, attention, concentration, working memory, language, and orientation to time and space) having a total of 30 points (higher scores indicate better self-reported health)

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in inhibitory control assessed by the Stroop Color and Word Test (SCWT)

The SCWT is extensively used to assess the ability to inhibit cognitive interference occurring when the processing of a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute. The reaction time and the amount of errors are measured during incongruent and congruent tasks (lower reaction times and less errors indicates better performance).

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in executive functions assessed by the Trail Making Test (TMT)

The TMT provides information on visual search, scanning, speed of processing, mental flexibility and executive functions using two subtasks, link numbers in increasing order and link letters and numbers in increasing order. The reaction time and the amount of errors are measured during the subtasks (lower reaction times and less errors indicates better performance).

Time frame: baseline, 3 weeks and 13 weeks after baseline

Changes in the Wechsler Adult Intelligence Scale (WAIS-III)

The WAIS-III provided scores for Verbal intelligence quotient (IQ), Performance IQ, and Full Scale IQ, along with four secondary indices (Verbal Comprehension, Working Memory, Perceptual Organization, and Processing Speed). The six Verbal Scale (Vocabulary, Similarities, Arithmetic, Digit Span, Information, and Comprehension) and five Performance Scale (Picture Completion, Digit Symbol (Coding), Block Design, Matrix Reasoning, and Picture Arrangement) subtests are combined to calculate the Full Scale IQ. After each subtest is scored, raw point totals are converted to scaled scores according to the examinee's age range (mean= 10; standard deviation=3). Sums of scaled scores then are computed separately for the six Verbal Scale subtests, five Performance Scale subtests, and all 11 subtests which constitute the Full Scale. The sums are converted to deviation IQs. The IQs generated have a mean of 100 and a standard deviation of 15 at all age levels.

Time frame: baseline, 3 weeks and 13 weeks after baseline