An interventional study of Fast intervention and Active Monitoring in Cerebrovascular Stroke, sponsored by University of Southern California. Completed at 1 site in United States. Open to participants aged 21 Years and older. Per ClinicalTrials.gov, last updated 2026-06-26.
Sponsored by University of Southern California · Not applicable, Interventional, and Treatment
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.
About 65% of stroke survivors experience long-term limitations in upper extremity (UE) functions. In particular, limitations in arm reaching movements are prominent and correlate strongly with patients' impairment levels. Because activities of daily living often involve the UEs, retraining reach and grasp skills is critical for return to a full quality-of-life. Yet, the training parameters required for effective rehabilitation of UE function are not known. Recent evidence suggests that high-speed movements during training are effective at improving arm movements in individuals with chronic stroke. Hence, fast movements generating large errors, would promote the restoration of the feedforward controllers and therefore improves arm movements and UE functions in individuals with chronic stroke. Because the cerebellum is involved in learning feedforward controllers from motor errors, the improvements would be proportional to the integrity of the cerebellar-cortical networks.
A double-blind quasi-randomized controlled study will be carried out in chronic post-stroke survivors. Participants will be assigned to either the speed-bias training group or a dose equivalent accuracy-bias training group (control) and will receive 4 days of training over a 1week period by a trained Occupational or physical therapist. Behavioral, EMG, and MRI data will be acquired within two weeks before, 3 days post, and one month after intervention.
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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
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
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.
This is an observation-only group. The training received in this group will be dose equivalent to the active group.
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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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.
Time frame: 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 Action Research Arm Test (ARAT)
The ARAT assesses specific changes in upper limb function among individuals who have sustained a stroke.The test consists of performing functional reaching tasks, with each sub-task scored on a scale from 0 to 3, where a score of 3 indicates the movement was performed normally. Scores range from 0 to 57, with higher scores indicating better performance. Positive changes reflect improvements in limb function.
Time frame: 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)
The UEFM is a test used to assess sensorimotor impairments in the upper extremity most affected by stroke. The test consists of performing specific upper extremity movements, with each sub-task scored on a scale from 0 to 2, where a score of 2 indicates normal performance. Scores range from 0 to 66, with higher scores indicating better performance. Positive changes reflect improvements in motor function.
Time frame: 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)
The Box and Block Test (BBT) measures unilateral gross manual dexterity. The test involves moving, one by one, as many blocks as possible from one compartment of a box to an adjacent, identical compartment within 60 seconds. Scores range from 0 to 150, with higher scores indicating better performance. Positive changes reflect improvements in upper limb function.
Time frame: 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)
The ARAT assesses specific changes in upper limb function among individuals who have sustained a stroke. The test consists of performing functional reaching tasks, with each sub-task scored on a scale from 0 to 3, where a score of 3 indicates the movement was performed normally. Scores range from 0 to 57, with higher scores indicating better performance. Positive changes reflect improvements in limb function.
Time frame: 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)
The UEFM is a test used to assess sensorimotor impairments in the upper extremity most affected by stroke. The test consists of performing specific upper extremity movements, with each sub-task scored on a scale from 0 to 2, where a score of 2 indicates normal performance. Scores range from 0 to 66, with higher scores indicating better performance. Positive changes reflect improvements in motor function.
Time frame: 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 Box and Block Test Score (BBT)
The Box and Block Test (BBT) measures unilateral gross manual dexterity.
Time frame: 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.
| Milestone | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Started | 22 | 22 |
| Completed | 21 | 21 |
| Not completed | 1 | 1 |
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.
| seconds | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Arm Reaching Movement Time. | -0.13 ± 0.001 | 0.07 ± 0.0004 |
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.
| number of peaks | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Movement Smoothness | -0.43 ± 0.008 | -0.1 ± 0.005 |
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.
| Fitts' slope (sec/index of difficulty) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Speed Accuracy Trade-off | -0.034 ± 0.014 | 0.033 ± 0.018 |
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.
| seconds | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Arm Reaching Movement Time. | -0.04 ± 0.004 | 0.016 ± 0.003 |
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.
| number of peaks | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Movement Smoothness | -0.27 ± 0.016 | -0.05 ± 0.01 |
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.
| Fitts' slope (sec/index of difficulty) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Speed Accuracy Trade-off | -0.012 ± 0.01 | 0.014 ± 0.018 |
The ARAT assesses specific changes in upper limb function among individuals who have sustained a stroke.The test consists of performing functional reaching tasks, with each sub-task scored on a scale from 0 to 3, where a score of 3 indicates the movement was performed normally. Scores range from 0 to 57, with higher scores indicating better performance. Positive changes reflect improvements in limb function.
| Scores on a scale | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Action Research Arm Test (ARAT) | 2.3 ± 2 | 1.7 ± 1.1 |
The UEFM is a test used to assess sensorimotor impairments in the upper extremity most affected by stroke. The test consists of performing specific upper extremity movements, with each sub-task scored on a scale from 0 to 2, where a score of 2 indicates normal performance. Scores range from 0 to 66, with higher scores indicating better performance. Positive changes reflect improvements in motor function.
| Scores on a scale | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Upper Extremity Fugl-Meyer (UEFM) | 3.9 ± 1.8 | 2.6 ± 1.1 |
The Box and Block Test (BBT) measures unilateral gross manual dexterity. The test involves moving, one by one, as many blocks as possible from one compartment of a box to an adjacent, identical compartment within 60 seconds. Scores range from 0 to 150, with higher scores indicating better performance. Positive changes reflect improvements in upper limb function.
| Number of blocks | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Box and Block Test Score (BBT) | 2.7 ± 1.6 | 2.6 ± 0.9 |
The ARAT assesses specific changes in upper limb function among individuals who have sustained a stroke. The test consists of performing functional reaching tasks, with each sub-task scored on a scale from 0 to 3, where a score of 3 indicates the movement was performed normally. Scores range from 0 to 57, with higher scores indicating better performance. Positive changes reflect improvements in limb function.
| Scores on a scale | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Action Research Arm Test (ARAT) | 3.6 ± 2 | 4.6 ± 1.2 |
The UEFM is a test used to assess sensorimotor impairments in the upper extremity most affected by stroke. The test consists of performing specific upper extremity movements, with each sub-task scored on a scale from 0 to 2, where a score of 2 indicates normal performance. Scores range from 0 to 66, with higher scores indicating better performance. Positive changes reflect improvements in motor function.
| Scores on a scale | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Upper Extremity Fugl-Meyer (UEFM) | 4.6 ± 1.8 | 1.2 ± 1.1 |
The Box and Block Test (BBT) measures unilateral gross manual dexterity.
| Number of blocks | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| Change in Box and Block Test Score (BBT) | 2.2 ± 1.7 | 2.3 ± 1 |
Collected over 1 month. Non-serious events are listed at a 2% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Speed-biased Complex Motor Skill Training | 0/21 (0%) | 0/21 (0%) | 1/21 (4.8%) |
| Accuracy-biased Complex Motor Skill Training | 0/21 (0%) | 0/21 (0%) | 0/21 (0%) |
| Event | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training |
|---|---|---|
| nauseaGeneral disorders | 1/21 | 0/21 |
| Age, Categorical(Participants) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training | Total |
|---|---|---|---|
| <=18 years | 0 | 0 | 0 |
| Between 18 and 65 years | 15 | 11 | 26 |
| >=65 years | 6 | 10 | 16 |
| Sex: Female, Male(Participants) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training | Total |
|---|---|---|---|
| Female | 9 | 9 | 18 |
| Male | 12 | 12 | 24 |
| Ethnicity (NIH/OMB)(Participants) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training | Total |
|---|---|---|---|
| Hispanic or Latino | 8 | 8 | 16 |
| Not Hispanic or Latino | 13 | 13 | 26 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(participants) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training | Total |
|---|---|---|---|
| United States | 21 | 21 | 42 |
| Upper Extremity Fugl-Meyer (UEFM)(Scores on a scale) | Speed-biased Complex Motor Skill Training | Accuracy-biased Complex Motor Skill Training | Total |
|---|---|---|---|
| Mean | 42 ± 2.1 | 43 ± 1.6 | 42.9 ± 1.3 |
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