Fast Arm Motor Skill Training in Chronic Stroke Survivors

NCT05013762 | Completed Results

• 2 other identifiers: HS-CG-20-00023R21NS120274
• Study Type: interventional
• Target: 44
• Locations: 1 country
• Sites: 1

Brief Summary

Every year, almost 800,000 people experience a stroke in the United States, which lead to upper-limb impairments, making recovery of motor function a priority in stroke rehabilitation. 1) The primary objective of this study is to determine whether fast arm movement training on a tracking task ("Speed-training"), in chronic stroke survivors with mild to moderate paresis, will generalize to improve arm function better than dose-equivalent accuracy training on the same task. 2) study the effect of intensive arm training on the recovery of anticipatory feedforward control. 3) Determine the involvement of cerebellar-cortical circuits in the recovery of arm movements due to speed training.

Conditions

Cerebrovascular Stroke

Keywords

Stroke; Physical therapy; neurorehabilitation; motor function; neuroplasticity; neuroimaging; MRI; TDI; Hemiparesis; occupational therapy; patient focused; motor learning; motor control; skill acquisition; skill training; motor recovery; task-oriented training; task-specific training; arm function; upper extremity; arm therapy; physical rehabilitation; arm rehabilitation

Outcome Measures

Primary Outcomes (6)

• Change in Arm Reaching Movement Time.

  Average movement time for 30 planar reaching movements to targets arrayed on a planar workspace. Negative changes indicate that participants moved faster to the targets following the intervention.

  Change from baseline (assessed during the week preceding the intervention) to 3 days post-intervention, representing an average interval of 12 days

• Change in Movement Smoothness

  Average movement smoothness for 30 planar reaching movements to target arrayed on a planar workspace. Smoothness is computed by number of peaks in hand tangential velocity profiles of arm-reaching movements. Negative changes indicate that participants had smoother movement to the targets following the intervention.

  Change from baseline (assessed during the week preceding the intervention) to 3 days post-intervention, representing an average interval of 12 days

• Change in Speed Accuracy Trade-off

  The speed-accuracy trade-off of reaching movements was assessed as a linear relationship between movement time and the Index of Difficulty : log ratio of the movement distance to target size. Negative changes indicate that participants are less affected by the index of difficulty, reflecting a better speed-accuracy trade-off.

  Change from baseline (assessed during the week preceding the intervention) to 3 days post-intervention, representing an average interval of 12 days

• Change in Arm Reaching Movement Time.

  Average movement time for 30 planar reaching movements to targets arrayed on a planar workspace. Negative changes indicate that participants moved faster to the targets following the intervention.

  We evaluated the change from baseline (assessed during the week preceding the intervention) to one month post-intervention, representing an average interval of 40 days.

• Change in Movement Smoothness

  Average movement smoothness for 30 planar reaching movements to target arrayed on a planar workspace. Smoothness is computed by number of peaks in hand tangential velocity profiles of arm-reaching movements. Negative changes indicate that participants had smoother movement to the targets following the intervention.

  We evaluated the change from baseline (assessed during the week preceding the intervention) to one month post-intervention, representing an average interval of 40 days.

• Change in Speed Accuracy Trade-off

  The speed-accuracy trade-off of reaching movements was assessed as a linear relationship between movement time and the Index of Difficulty : log ratio of the movement distance to target size. Negative changes indicate that participants are less affected by the index of difficulty, reflecting a better speed-accuracy trade-off.

  We evaluated the change from baseline (assessed during the week preceding the intervention) to one month post-intervention, representing an average interval of 40 days.

Secondary Outcomes (6)

• Change in Action Research Arm Test (ARAT)

  Change from baseline (assessed during the week preceding the intervention) to 3 days post-intervention, representing an average interval of 12 days

• Change in Upper Extremity Fugl-Meyer (UEFM)

  Change from baseline (assessed during the week preceding the intervention) to 3 days post-intervention, representing an average interval of 12 days

• Change in Box and Block Test Score (BBT)

  Change from baseline (assessed during the week preceding the intervention) to 3 days post-intervention, representing an average interval of 12 days

• Change in Action Research Arm Test (ARAT)

  We evaluated the change from baseline (assessed during the week preceding the intervention) to one month post-intervention, representing an average interval of 40 days.

• Change in Upper Extremity Fugl-Meyer (UEFM)

  We evaluated the change from baseline (assessed during the week preceding the intervention) to one month post-intervention, representing an average interval of 40 days.

Study Arms (2)

Speed-biased complex motor skill training

ACTIVE COMPARATOR

Participants will perform 400 complex movements per day over 4 days over a one-week period. The task requires participants to navigate their hand through a "track" projected on the surface of a table with a width of 5cm. Participants receive adaptive score based on their movement time. .

Behavioral: Fast intervention

Accuracy-biased complex motor skill training

OTHER

The accuracy-biased group receives a dose equivalent intervention with a emphasize on accuracy. The width of the track projected on the table is narrower (less than 2cm) and the adaptive score received are based on their accuracy to say within the boundary of the track.

Behavioral: Active Monitoring

Interventions

Fast intervention BEHAVIORAL

This intervention is based on recent body of evidence that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke.Participants will be rewarded for movements performed within a short amount of time.

Speed-biased complex motor skill training

Active Monitoring BEHAVIORAL

This is an observation-only group. The training received in this group will be dose equivalent to the active group.

Accuracy-biased complex motor skill training

Eligibility Criteria

• Age: 21 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• At least 6 months following an ischemic supratentorial stroke
• At least 21 years of age
• Exhibit residual capability to move the paretic UE (Upper Extremity Fugl- Meyer motor score \>20/66)
• Able to follow a 2-step command (8th item on the MMSE test)
• Able to perform an unassisted arm reach movement of 25 cm ahead of the body within 5 seconds with trunk restraint
• Exhibit no greater than mild/moderate spasticity as assessed with a Modified Ashworth Score \< 3

You may not qualify if:

• any neurologic diagnoses other than stroke
• peripheral movement restrictions, such as neuropathy
• orthopedic disorders affecting the paretic UE
• severe pain or sensory/proprioceptive impairment in the more affected UE
• visual neglect (more than 4% of lines left uncrossed on Albert's test).
• had a stroke directly affecting the cerebellum
• any contra-indications to MRI scanning
• mostly resolved impairments with an Upper Extremity Fugl- Meyer motor score \>58/66

Sponsors & Collaborators

• University of Southern California: lead
• Casa Colina Hospital and Centers for Healthcare: collaborator
• National Institute of Neurological Disorders and Stroke (NINDS): collaborator

Study Sites (1)

Casa Colina Hospital and Centers for Healthcare

Pomona, California, 91769, United States

Location

Related Publications (9)

• Lang CE, Strube MJ, Bland MD, Waddell KJ, Cherry-Allen KM, Nudo RJ, Dromerick AW, Birkenmeier RL. Dose response of task-specific upper limb training in people at least 6 months poststroke: A phase II, single-blind, randomized, controlled trial. Ann Neurol. 2016 Sep;80(3):342-54. doi: 10.1002/ana.24734. Epub 2016 Aug 16.

  PMID: 27447365 BACKGROUND

• Winstein C, Kim B, Kim S, Martinez C, Schweighofer N. Dosage Matters. Stroke. 2019 Jul;50(7):1831-1837. doi: 10.1161/STROKEAHA.118.023603. Epub 2019 Jun 5.

  PMID: 31164067 BACKGROUND

• Park H, Kim S, Winstein CJ, Gordon J, Schweighofer N. Short-Duration and Intensive Training Improves Long-Term Reaching Performance in Individuals With Chronic Stroke. Neurorehabil Neural Repair. 2016 Jul;30(6):551-61. doi: 10.1177/1545968315606990. Epub 2015 Sep 24.

  PMID: 26405046 BACKGROUND

• Kantak S, McGrath R, Zahedi N, Luchmee D. Behavioral and neurophysiological mechanisms underlying motor skill learning in patients with post-stroke hemiparesis. Clin Neurophysiol. 2018 Jan;129(1):1-12. doi: 10.1016/j.clinph.2017.10.010. Epub 2017 Nov 8.

  PMID: 29127826 BACKGROUND

• Pantano P, Baron JC, Samson Y, Bousser MG, Derouesne C, Comar D. Crossed cerebellar diaschisis. Further studies. Brain. 1986 Aug;109 ( Pt 4):677-94. doi: 10.1093/brain/109.4.677.

  PMID: 3488093 BACKGROUND

• Kawato M, Gomi H. A computational model of four regions of the cerebellum based on feedback-error learning. Biol Cybern. 1992;68(2):95-103. doi: 10.1007/BF00201431.

  PMID: 1486143 BACKGROUND

• Gribble PL, Ostry DJ. Compensation for interaction torques during single- and multijoint limb movement. J Neurophysiol. 1999 Nov;82(5):2310-26. doi: 10.1152/jn.1999.82.5.2310.

  PMID: 10561408 BACKGROUND

• Maeda RS, Cluff T, Gribble PL, Pruszynski JA. Feedforward and Feedback Control Share an Internal Model of the Arm's Dynamics. J Neurosci. 2018 Dec 5;38(49):10505-10514. doi: 10.1523/JNEUROSCI.1709-18.2018. Epub 2018 Oct 24.

  PMID: 30355628 BACKGROUND

• Darmon Y, Kantak S, Cone H, Fullmer N, Ouellette D, Winstein C, Rosario ER, Schweighofer N. Speed-Biased Training Temporarily Improves Motor Performance of the Paretic Arm Compared to Accuracy-Biased Training in Chronic Stroke Survivors: The Phase 1 FAST Randomized Clinical Trial. Neurorehabil Neural Repair. 2025 Jul;39(7):542-554. doi: 10.1177/15459683251331582. Epub 2025 May 10.

  PMID: 40346836 DERIVED

MeSH Terms

Conditions

Stroke; Paresis

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Results Point of Contact

• Title: Dr. Nicolas Schweighofer
• Organization: Division of Biokinesiology & Physical Therapy, University of Southern California

schweigh@usc.edu

(323) 442-2900

Study Officials

• Nicolas Schweighofer, PhD

  University of Southern California

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Assessments will be done by a blinded and standardized clinical researcher
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Biokinesiology and Physical Therapy

Study Record Dates

• First Submitted: July 2, 2021
• First Posted: August 19, 2021
• Study Start: June 15, 2021
• Primary Completion: September 1, 2023
• Study Completion: November 27, 2023
• Last Updated: June 26, 2026
• Results First Posted: June 26, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)