61 Clinical Trials for Various Conditions
In the past two decades, even as stroke cases increase around the world, advances in motor rehabilitation have been limited. Clinical trials of stroke rehabilitation have examined the therapeutic utility of several neuromodulatory devices to improve efficacy of motor training. However, there is limited knowledge on the effects of sensory-based priming techniques using repetitive peripheral magnetic stimulation (rPMS) post stroke. This project focuses on understanding the effect of rPMS on motor skill performance in persons with stroke.
The purpose of this study is to understand how the different regions of the brain affect our sense of limbs in space (proprioception) and in turn our hand movements (motor skill learning). This information might help us one day to generate better rehabilitation protocols to help patients with movement deficits.
The objective of this quasi-experimental study design was to examine effects of the coordinated-bilateral ball skills (CBBS) intervention on cognitive functions and aerobic fitness in elementary school students. The hypotheses of the study were: students in the intervention group will show a significant higher level of cognitive functions and aerobic fitness compared to the control students.
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.
Studies have shown that a period of sleep, even in the form of a daytime nap, after a period of training on a motor learning task can boost subsequent performance beyond that observed after an equal amount of time spent awake and resting. This leap in performance has been referred to as "off-line" motor learning because it occurs during a period of sleep in the absence of additional practice. Motor learning is an integral part of the physical and occupational therapy that patients receive after traumatic brain injury (TBI) in which various activities of daily living may need to be relearned. Targeted motor skills may include dressing (learning how to zip up a jacket or button a shirt), using a fork and knife to eat, or using technology (tapping touch screen on a cell phone or typing on a computer). Yet the potential of sleep in the form of a strategic nap as a therapeutic tool to maximize motor learning in rehabilitation therapies has not been fully realized. In addition, a growing body of research among healthy individuals has shown evidence of changes in the brain associated with enhanced performance among those who slept following training compared with those who spent the same amount of time awake. The neural mechanisms of "off-line" motor learning have not been studied among individuals with TBI. Using functional neuroimaging and measurement of brain waves, the current study will examine the mechanisms underlying this sleep-related enhancement of motor learning among individuals with TBI and determine how brain physiology may influence the magnitude of the effect. By understanding how this treatment works and identifying the factors that modulate its effectiveness we can identify which individuals will be most likely to benefit from a nap after training to improve motor learning after TBI. This can provide a more person-centered approach to treatment delivery that can maximize the effectiveness of a simple but potent behavioral intervention.
The investigators aim to identify the effect of a 12-week fundamental motor skills (FMS) (e.g., throwing, catching, running) intervention on the active participation in physical recreation activities and a variety of other factors (child behaviors, communication, and adaptive skills) and to identify patterns, benefits, constraints, and strategies to active participation in physical recreation activities among families of children with autism spectrum disorders (ASD) (pre-post) through in-person or via phone interviews with parents and children with ASD.
Infants with Down syndrome (DS) develop slower than their typically developing peers. Physical therapist (PT) supervised home programs have the potential to optimize gross motor development in a financially feasible way. An inexpensive orthotic garment (Hip Helpers®) is commonly employed by PTs as a home program supplement, but its effectiveness has not yet been investigated. The garment is worn as pliable shorts over a child's lower extremities to keep upper legs together, promoting a narrow base of support. This encourages activation of upright postural muscles to improve gross motor skill development. The purpose of this randomized controlled study is to investigate the impact of a home program using the Hip Helpers® orthotic garment on gross motor skill acquisition in infants with DS. We hypothesize that the addition of a structured home program using Hip Helpers®, supervised by a PT and implemented by parents, will increase the rate at which infants with DS acquire gross motor skills. Thirty-four participants, consisting of children who are at least three-months-old and are not yet able maintain sitting independently, will be randomly assigned to a control (n=17) or intervention group (n=17). PTs at pediatric therapy agencies will initiate the home program and administer the Gross Motor Function Measure-88 (GMFM-88) at regular intervals to monitor gross motor skill acquisition until the child is able to take three independent steps. Groups will be compared on the length of time elapsed between the acquisition of identified gross motor skills using independent t-tests. GMFM-88 scores will be compared between the two groups at different ages to identify trends using independent t-tests. The contribution of this project will be significant by informing physical therapists about the effectiveness of an inexpensive orthotic garment used in a supervised home program on gross motor outcomes in infants with DS.
Stroke survivors frequently show persistent gait deficits in their chronic stages even after years of intensive rehabilitation. This may be caused by diminished capability of re-acquiring motor skills post stroke. Thus, the overall purpose of this research project is to examine stroke survivors' capability of learning a novel leg task over 3 visits, 1-2 weeks apart. The capability of learning a new skill is then correlated with the individual's neurological functions (nerve activity and movement coordination) and her/his gait performance (gait speed, gait symmetry, and force production).
In this study, the investigators will compare effects of two types of 8-weeklong interventions: a) multimodal or b) general movement to facilitate social communication and motor skills of school-age children with Autism Spectrum Disorder (ASD). Recently, the investigators have identified cortical dysfunction patterns as markers of imitation/interpersonal synchrony difficulties in children with ASD using functional near-infrared spectroscopy. In this project, the investigators want to validate whether cortical markers can determine treatment responders and if such markers are sensitive to training-related changes. Following training, the investigators expect to see a variety of behavioral and neural changes in both groups. If the study aims are achieved, the investigators will validate the use of cortical markers as a treatment response measure. This research will build evidence for the use of various movement interventions for school-age children with ASD.
A recent systematic review found that therapeutic interventions that apply principles of motor learning with intense practice improve functional upper extremity movement in children with unilateral CP. Evidence of efficacy for any treatment approach aimed at improving motor function in bilateral CP (the most prevalent form) is lacking. Preliminary investigation suggests that intensive (90 hours) goal-directed, task-specific training provided in a 3-week day camp format can improve functional movement of both the upper (UE) and lower extremity (LE) and postural control in children with BCP. To date, HABIT-ILE has only been provided in a day camp setting over several weeks. Implementing the dosing schedule of this promising intensive approach in a hospital setting requires innovative resource allocation (space and staff); thus, examining alternative delivery models is imperative. The purpose of this study is to conduct a multi-center randomized control trial (RCT) to determine whether 90 hours of HABIT-ILE improves functional motor skills, activity and motivation in children with BCP when dosed in a camp format at 6-hours/day, 5 days/week for three weeks and 6-hours/day, one day/week for 15 weeks.
The goal of "PLAY" is to adapt and test a developmentally appropriate intervention delivered on a mobile app to parents, with the goal of teaching fundamental motor skill (FMS) proficiency to their preschool-aged children (ages 3 to 5 y). Seventy-two children (3 to 5 y of age) were randomized. Of these children, 36 parents were randomized to use the FMS app and 36 were randomized to use a version of the app that promotes unstructured PA as a comparator group. Parents in the FMS condition accessed instructional lessons, peer modeling videos, and activity breaks to deliver 720 minutes of targeted, structured FMS instruction time to their child over a 12-week period. Parents in the comparator arm used a version of the app that provides instructional lessons to promote the equivalent amount of unstructured PA for their child. Parents were asked to guide the intervention, as parental support, modeling, and co-participation predict children's engagement in PA.
Background: Our goal is to gain insight into early human motor skill learning by carrying out online substudies using online crowd-sourcing tools. Objective: To learn more about motor behavior in a large group of people using motor tasks, and questions. Eligibility: Adults ages 18 and older based in the U.S. who speak English Design: Participants will be recruited from a crowd-sourcing website like Amazon Mechanical Turk. Participants will do online tasks. They can use their own computers anywhere with Internet access. They will not need to directly interact with researchers. Participants will be asked for general data, like their age and gender. No personally identifiable data will be collected. Participants will see a list of tasks on their computer screen. They will be able to choose tasks they wish to do. They will get a description of the experiment, how long it takes, and how much compensation they will get. Participants will complete on their screen a motor behavioral task, a cognitive task, and/or a questionnaire. For example, they may be asked to press sequences of numbers on the keyboard or move the mouse when a stimulus appears on the screen. Experiments may last up to 1 hour. Participants can complete as many experiments as they wish. They can quit at any point.
Multiple Sclerosis (MS) is characterized by episodic attacks in which there are sharp declines in physical function. Although neurorehabilitation is the most promising clinical strategy for motor recovery in patients with MS, treatment responsiveness and outcomes are mixed. This is perhaps because each individual with MS has a different capacity to improve with rehabilitation, and this capacity may be based on a variety of baseline factors, such as disease duration, motivation, cognitive status and integrity of underlying brain structures. A better understanding of what "key ingredients" facilitate relearning of motor skills during neurorehabilitation is critically needed. Much of the focus of rehabilitation is on relearning motor skills. The initial stage of learning a motor skills often requires explicit concentration on the details of the movement. As one becomes more proficient in the motor skill, it becomes less attention-demanding and more automatic. Those who can perform motor skills more automatically will be better able to manage the additional demands of a secondary task; thus, capacity for dual-task performance can be used as an index of automaticity. Individuals with MS experience demyelination that impacts brain areas critical for motor learning. However, the specific clinical and pathological variables that facilitate capacity for motor learning in people with MS have not been identified. Identification of such variables could be leveraged to determine a patient's capacity to benefit from neurorehabilitation at the outset and potentially to maximize motor learning during rehabilitation for people with MS. Thus, there is an urgent need to determine the key ingredients most strongly associated with successful relearning of motor skills in MS patients. Our long-term goal is to develop individualized rehabilitation for persons with MS. Our overall objective in this application is to identify clinical and pathological variables associated with successful relearning of motor skills. Our central hypothesis, based on preliminary data, is that the ability to learn to make new movements automatically occurs over a dynamic range and is a function of available cognitive processing speed and the integrity of corticospinal tract and superior cerebellar peduncles. We will test these hypotheses by recruiting 146 individuals with relapsing-remitting MS to participate in a mechanistic trial not designed to be a therapeutic intervention. Participants will complete baseline testing (including neuroimaging, cognitive testing and dual-task performance) followed by 4 consecutive days of training on a challenging balance task. After a 2-day washout period, participants will return for post-testing (including dual-task performance on a dual-balance and working memory task). The rationale for the proposed research is that identification of key ingredients associated with the capacity for motor skill acquisition would allow for more targeted rehabilitation programming, thereby improving patient outcomes and reducing health care expenses. At the completion of the proposed research, we expect to understand more about the capacity for individuals with MS to improve with motor skill training, and some of the key ingredients that help predict successful shift toward task automaticity, one critical component of successful neurorehabilitation. The results of this proposal will facilitate the development of predictors of motor recovery, needed to improve rehabilitation outcomes for individuals with MS and other neurodegenerative diseases.
This study evaluates the relationship between seated posture and fine motor performance in a drawing task in people with stroke and in healthy control subjects.
This study examined how well elementary students demonstrated motor skill competency as a result of participating in the evidence-based quality physical education program and investigated relationships between levels of health-related physical fitness and physical activity in school-aged children.
The purpose of this study is to learn more about developmental behaviors and to examine changes in developmental progress related to motor activities among a group of infants who received open heart surgery within the first three months of life.
Training Executive, Attention and Motor Skills (TEAMS) is a new research program for preschool children with Attention-Deficit/Hyperactivity Disorder (ADHD) that attempts to use game-like activities and physical exercise to promote the growth of neural processes that underlie the core features of the disorder (e.g., hyperactivity, impulsivity) as well as associated areas of difficulty (e.g., socialization, motor skills). These activities are implemented at home and in supervised playgroups at no cost to families and are coupled with extensive parental education about ADHD symptoms and associated impairments.
This study will compare brain changes in people with Parkinson's disease with those of normal control subjects while they learn motor skills. People with Parkinson's disease sometimes have trouble learning new skills, but it is not known why. This study will use repetitive transcranial magnetic stimulation (rTMS), nerve conduction studies, and electroencephaolography (EEG) to look for differences in the way the brain changes with learning in people with Parkinson's disease. Healthy normal volunteers and people with Parkinson's disease who are between 21 and 80 years of age may be eligible for this study. Participants undergo the following procedures in five visits to the NIH Clinical Center: Visit 1 Medical and neurological examination. Visit 2 Motor training. Participants perform a pinching movement once every other second, timed to a metronome, during rTMS. For TMS, a wire coil is held on the subject's scalp. A brief electrical current is passed through the coil, creating a magnetic pulse that stimulates the brain. The subject hears a click and may feel a pulling sensation on the skin under the coil. There may be a twitch in the muscles of the face, arm or leg. rTMS involves repeated magnetic pulses delivered in short bursts of impulses. Visits 3 and 4 Brain physiology studies using rTMS, nerve conduction studies (electrical nerve stimulation) and EEG. A nerve at the subject's wrist is stimulated with electrical impulses to measure the speed with which nerves conduct electrical impulses and the strength of the connection between the nerve and the muscle. rTMS is performed for 20 minutes. The EEG measures the electrical activity of the brain (brain waves). For this test, electrodes (metal discs) are placed on the scalp with a conductive gel and the brain waves are recorded while the subject moves his or her thumb briskly for 20 minutes. Visit 5 Subjects undergo rTMS for 20 minutes and have an EEG. ...
This study will test a spinal cord reflex called reciprocal inhibition before, during, and after learning a motor skill to see if the reflex becomes stronger by learning the movement. People learn new motor skills throughout their lives. At first, performing a new skilled movement such as riding a bicycle takes effort and is clumsy, but with practice, it becomes relatively automatic. The motor cortex (a part of the brain) is very active when a new skilled movement is learned, but becomes less active when the movement is over-learned. This study will determine whether the spinal cord helps coordinate the pattern of activity between groups of muscles once a motor skill is learned. Healthy volunteers between 21 and 65 years of age may be eligible for this study. Candidates are screened with a medical history and neurological examination. Participants are divided into two groups. Group 1 has movement training sessions only and Group 2 has both movement training sessions and physiology sessions, as follows: Movement training sessions For 15 minutes every weekday, participants practice moving their wrist back and forth to make a cursor on the computer screen follow a target. Activity of the arm muscles is monitored with surface electrodes taped to the skin. The sessions continue until the participant can perform the movement well. Group 1 participants return to the clinic a week after the last session to perform the movement again to see if their skill level has changed. Each session lasts about 20 to 30 minutes. Physiology sessions In three separate sessions, the reflex for reciprocal inhibition is measured before and at several times during the movement task. This is done with nerve conduction studies. A probe placed on the skin delivers a low-intensity electrical stimulus. Wires taped to the skin record the nerve impulses. To measure reciprocal inhibition, several dozen stimuli are given to two nerves in combinations. Each session lasts 2 to 3 hours.
This study will examine how dopamine, a brain chemical, affects motor training. Taken by mouth, dopamine can enhance motor training, especially during rehabilitation after brain damage. The study will also examine whether Sinemet, a drug containing a precursor of dopamine, can improve motor training. Healthy normal volunteers and stroke patients between 18 and 80 years of age may be eligible for this study. Healthy volunteers must be right-handed. Stroke patients must have had a stroke that caused weakness in one hand, from which they have recovered enough to be able to move the thumb in different directions. Participants will have up to three study sessions, as follows: Prestudy 1 (MRI, TMS with motor training) * Session 1: Magnetic resonance imaging (MRI) of the brain. This procedure uses a strong magnetic field and radio waves to show structural and chemical changes in tissues. During the scan, the patient lies on a table in a narrow cylinder containing a magnetic field. He or she can communicate with the staff administering the test at all times. * Session 2: Transcranial magnetic stimulation (TMS) - The subject sits in a comfortable chair with the right forearm held still at the side and the head held still by an aluminum frame. A magnetic coil is placed over the head, and a small probe is attached to the thumb to measure thumb movement. Magnetic pulses are occasionally delivered over the scalp, likely inducing a mild thumb movement. After this test, the subject takes a tablet of either Sinemet or placebo (a look-alike pill with no active ingredient). Fifty minutes after taking the pill, the subject undergoes motor training that involves performing brisk thumb movements at a rate of 1 movement per second. At the end of the training, TMS is repeated. * Session 3: Identical to session 2, except subjects who took Sinemet in session 2 now take placebo, and vice versa. Prestudy 2 (MRI, PET without motor training, no TMS) * Session 1: MRI of the brain if the subject has not had one within the last 12 months. * Session 2: Positron emission tomography (PET) scanning - This procedure provides information on brain chemistry and function. First, the subject is given either Sinemet or placebo. The subject lies on a bed in a doughnut-shaped machine with a custom-molded plastic mask placed over the face and head to support the head and hold it still during the scanning. A catheter (plastic tube) is placed in each arm-one to inject \[11C\]raclopride-a radioactive substance that competes with dopamine for binding in certain parts of the brain and can be detected by the PET scanner-and one to draw blood samples for measuring the level of Sinemet in the blood. * Session 3: Identical to session 2, except subjects who took Sinemet in session 2 now take placebo, and vice versa. Main Study (MRI, TMS, PET with motor training) * Session 1: MRI of the brain, if one has not been done within the last 12 months. * Session 2: TMS, followed by administration of Sinemet or placebo and PET scanning with motor training. The subject lies quietly during the first half of the PET session and performs brisk thumb movements during the second half. After completing the PET scan, the subject undergoes TMS again. * Session 3: Identical to session 2, except subjects who took Sinemet in session 2 now take placebo, and vice versa.
The aim of this study is to determine if an 8 week fine motor intervention program will lead to improve fine motor skills as measured by a standardized assessment (PDMS-3) in pre- and post-test.
The goal of this clinical trial is to evaluate whether a home-based mHealth intervention can improve adherence to the 24-Hour Movement Guidelines in preschool-aged children (3-4 years old) who currently meet 0 or 1 of the guidelines for physical activity, sedentary behavior, and sleep. The main questions it aims to answer are: * Can the intervention increase the proportion of children meeting all three 24-Hour Movement Guidelines (physical activity, screen-time, and sleep)? * Is the intervention feasible for parents to implement, as measured by a parent feedback survey? Researchers will compare an intervention group to a waitlist control group to assess whether the intervention leads to increased guideline adherence. Parents and Participants: * Children will wear an accelerometer to track physical activity and sleep patterns. * Parents will use a mobile app that delivers weekly lessons and behavior-related goals to encourage healthy movement behaviors in their children. * Parents will complete questionnaires on their child's movement behaviors and development at baseline, 6 weeks, and 12 weeks. * Additionally, children will undergo motor skills assessments, and parents will provide feedback on cognitive development and behavioral changes.
Manual wheelchairs (MWCs) are widely used by children with physical disabilities, yet many of these children are unable to use their wheelchair independently. Instead, they depend on others to push them. This dependency results in limited opportunities to decide what they want to do and where they want to go, leading to learned helplessness, social isolation, decreased participation, and restricted involvement in physical activities. Furthermore, unsafe MWC use increases the risk of injury, as highlighted by the 44,300 children treated each year in emergency departments for MWC-related injuries. While independent MWC mobility can positively influence quality of life, MWC skills training must also be provided to promote safe, independent MWC use. The effectiveness of MWC training programs for adults is well established, yet the current standard-of-care does not include MWC skills training for children and research regarding the efficacy of pediatric MWC skills training programs is limited. Skills on Wheels seeks to address these gaps and provide pilot data for a future large-scale, multi-site research project involving a randomized controlled trial. Aim 1 is to explore the influence of Skills on Wheels on children's MWC skills and confidence in their MWC use. Aim 2 is to investigate the influence of Skills on Wheels on children's psychosocial skills, social participation, and adaptive behavior.
Barriers to keeping and maintaining fitness as a young person with a disability exist across many domains of access to community locations such as fitness centers, so looking outside of these establishments may be necessary to advance fitness. This study is aimed at piloting a program that would address some of these barriers by hosting a modified after school running program with an underserved population in an accessible way. There is a second option to participate outside of school.
The purpose of this study was to see if a brief delay in cord clamping for 30 to 45 seconds would result in higher hematocrit levels, fewer transfusions, healthier lungs, and better motor function at 40 wks and 7 months of age.
This study will examine the parts of the brain that use visual information to perform movements. Patients with certain brain lesions tend to have difficulty in processing visually presented objects. This study will look at the brain mechanisms underlying the visuo-motor integration. Healthy normal volunteers between 20 and 60 years of age are eligible for this study. People who have had a severe head injury with loss of consciousness or any other mental or neurological disorder diagnosed by a doctor may not participate. Candidates will be screened with a medical history, a physical examination focusing on finger movements, and a questionnaire. Participants' brain activity will be recorded using two techniques - magnetoencephalography(MEG) and magnetic resonance imaging (MRI) - while they watch pictures of various objects flashed on a screen. MEG is a procedure to record magnetic field changes produced by brain activity. During the recording, the subject sits comfortably in an armchair in a dimly lit room and watches pictures presented on a screen. About 50 pictures are shown per session. There are about five sessions, separated by 3-minute breaks. Functional MRI involves taking pictures of the brain using MRI while the subject performs a task. MRI uses a strong magnetic field and radio waves to obtain images of body organs and tissues. The MRI scanner is a metal cylinder surrounded by a magnetic field. The subject lies still on a table that can slide in and out of the scanner. During the scan, he or she looks at pictures in six test blocks of 1 minute each, with 30-second breaks between blocks.
Background: Many tasks people do every day require a series of individual movements. Control over these movements is called motor skills. But even highly skilled people can make mistakes. Researchers have found that they can predict when a person will make a mistake 0.1 second before it happens. Now, they want to find out if they can increase that time up to 1 second-long enough to warn the person and prevent the mistake. Objective: To see if motor skill errors can be detected up to 1 second before they occur. Eligibility: Right-handed healthy adults aged 18 to 35. Design: Participants will have 2 to 5 study visits. Each visit will be 1 to 2 hours. They will have a physical and neurological exam. They will have 1 or 2 magnetic resonance imaging (MRI) scans. They will lie on a table that slides into a large cylinder. The MRI uses strong magnets to capture images of the inside of the body, including the brain. They will have another scan, called magnetoencephalography (MEG). Small metal disks attached to wires will be taped to their head. Participants will sit in a padded chair with their head inside of a helmet. The helmet will not cover their eyes or face. Participants will perform a series of typing tasks on a keyboard. They will have short breaks between each round. Their head movements will be tracked, and their eye and finger movements will be videotaped.
The goal of this study will be to examine the implementation and preliminary efficacy of a teacher taught gross motor skill-based physical activity (PA) intervention on cognitive variables in low low socio-economic (SES) preschoolers. The movement and cognition intervention will be implemented for 4 days per week for 6 months. Primary outcome variables will be processed evaluation data. Secondary outcome variables will be changes in children's cognitive function (executive functions and memory), gross motor skills, and PA levels at baseline, 3- and 6-month.
The intervention in this study, Let's Move, is a motor intervention for infants at risk for cerebral palsy. We will test the feasibility and acceptability of the intervention as well as preliminary effectiveness.
Background: Memory consolidation is the process by which memories become stable, long-term representations in the brain. Consolidation of a motor skill is dependent upon sleep. Some research shows that daytime naps improve people s motor performance and memory retention. Researchers want to find out how daytime naps may contribute to learning and support consolidation of motor skill memories. Objective: To learn the role of memory replay during wakeful rest and sleep (naps) in retaining a newly learned skill. Eligibility: English-speaking adults ages 18 and older with chronic stroke, or healthy, right-handed, English-speaking adults ages 18-35 and 50-80 Design: Participants will be screened with: * medical history * neurological history * medicine review * medical exam * neurological exam. Participants will have a magnetic resonance imaging (MRI) scan of the brain. For this, they will lie down in a scanner. The scanner makes loud noises, so they will wear earplugs. They will fill out an MRI screening form before each MRI. Participants will also have magnetoencephalography (MEG). MEG maps brain activity. It does this by recording the magnetic fields produced by naturally occurring electrical currents in the brain. For MEG, participants will lie down in the MEG room. Their eye movements may be recorded by a video camera. Participants will have behavior testing. They will practice typing random keys. Then they will repeatedly type a custom sequence that they see on a computer screen. Then they will take a 2-hour nap. Then they will type the same sequence again. Participants will have no more than 4 visits at the NIH over 3 months. Visits will last 2-4 hours each.