Upper Limb-based Movement Priming for Lower Limb Neuroplasticity & Motor Recovery in Stroke

Upper Limb-based Movement Priming for Lower Limb Neuroplasticity & Motor Recovery in Stroke

The goal of this clinical trial is to to determine the effect of movement-based priming using the upper limbs on lower limb neuroplasticity and behaviors in chronic stroke.

The main questions we aim to answer are:

1. What are the acute effect of UL-priming on lower limb neuroplasticity and motor behaviors in persons with stroke compared to other priming modalities?

2. What are the time effects of UL-priming on neuroplasticity and motor behavior in individuals with stroke?

   In this cross over study, participants will be involved in three priming sessions involving

   - UL-priming using rhythmic, symmetric, bilateral priming involving the movement of at least one major joint in the upper limbs.

   AND

   - Sham priming using auditory stimulation (1 Hz metronome).

   AND

   - Lower-limb movement-based priming using rhythmic, symmetric, dorsiflexion and plantarflexion movements.

   Researchers will compare outcome measures between the different priming sessions.

Inclusion Criteria:

• Single, monohemispheric stroke
• Chronic stroke (> 6 months prior)
• Residual hemiparetic gait deficits (e.g., abnormal gait pattern)
• Minimum score of stage 2 on the Chedoke Arm Impairment Scale which includes stage 2, task 3 (facilitated elbow flexion) as one of the stage 2 tasks.

Exclusion Criteria:

• Use of anti-spasticity medications
• Existence of other neurological disorders
• Have brainstem or cerebellar lesions.
• Score of ≥2 on the Modified Ashworth Scale.
• MMSE score of <21, to ensure they will follow instructions.
• Non-English-speaking individuals
• Bone, joint or soft tissue injury
• Uncontrolled medical conditions (such as uncontrolled hypertension, untreated cardiac disease, or untreated pulmonary disease)
• No Motor evoked potentials (MEPs) during TMS

TMS exclusion criteria

• Previous adverse reaction to TMS
• Skull abnormalities or fractures
• Concussion within the prior 6 months
• Unexplained, recurring headaches
• Implanted cardiac pacemaker
• Metal implants in the head or face
• History of seizures or epilepsy
• Use of medications that could alter cortical excitability or increase risk of seizure (e.g., antidepressants, antipsychotics, anxiolytics, anticonvulsants)
• Current pregnancy