Since stroke remains the leading cause of long-term disability in the United States, researchers and clinicians are faced with the challenge to develop innovative and improved stroke rehabilitation approaches. While most stroke survivors experience some early movement return through spontaneous recovery of partially damaged neural networks, substantive long-term recovery relies upon activity-dependent neuroplasticity. Intensive movement therapies tap into such neuroplastic mechanisms and result in dramatic motor skill improvements. Several studies using constraint-induced therapy (CIT), for example, demonstrate significant gains in the amount and quality of use in the stroke-affected upper limb, which are paralleled by changes in the excitability and organization of the stroke-damaged motor cortex. Combining an adjunctive treatment with CIT provides a testable means to facilitate larger improvements in motor skill than what is seen in the intensive therapy alone. These adjuncts should target neurophysiological mechanisms to recovery. Repetitive transcranial magnetic stimulation (rTMS) represents a powerful and innovative adjunct to stroke rehabilitation. rTMS studies demonstrate its ability to enhance motor learning and motor system activation in neurologically intact and clinical populations. The driving rationale supporting the use of rTMS is that it can increase the stroke survivor's potential for recovery by ameliorating depressed physiological function in the motor nervous system. This randomized clinical trial will compare rTMS+CIT vs. sham-rTMS+CIT to investigate the benefits of rTMS through the following aims: 1) Determine the behavioral and motor control benefits of using rTMS as an adjunct to constraint induced therapy (CIT) in survivors of stroke, and 2) Determine the influence of rTMS on neurophysiological correlates of post-stroke recovery of motor skill. Outcome measures will be in 3 domains: functional, kinematic motion analysis, and physiological. This project will investigate the potential benefit of magnetic brain stimulation as a means to improve the therapeutic process towards improved motor control and greater recovery of functional movement. We anticipate that the results of this study will aid clinical researchers and practitioners in making the rehabilitation process more effective for survivors of stroke. . This project will investigate the potential benefit of magnetic brain stimulation as a means to improve the therapeutic process towards improved motor control and greater recovery of functional movement. We anticipate that the results of this study will aid clinical researchers and practitioners in making the rehabilitation process more effective for survivors of stroke. ? ? ?
| Malcolm, Matt P; Vaughn, Heather N; Greene, David P (2015) Inhibitory and excitatory motor cortex dysfunction persists in the chronic poststroke recovery phase. J Clin Neurophysiol 32:251-6 |
| Massie, Crystal L; Malcolm, Matthew P (2012) Instructions emphasizing speed improves hemiparetic arm kinematics during reaching in stroke. NeuroRehabilitation 30:341-50 |
| Malcolm, Matthew P; Lavine, Andrea; Kenyon, Gary et al. (2008) Repetitive transcranial magnetic stimulation interrupts phase synchronization during rhythmic motor entrainment. Neurosci Lett 435:240-5 |
| Malcolm, Matthew P; Triggs, William J; Light, Kathye E et al. (2007) Repetitive transcranial magnetic stimulation as an adjunct to constraint-induced therapy: an exploratory randomized controlled trial. Am J Phys Med Rehabil 86:707-15 |
