Identifying Personalized Brain States Predicting Residual Corticospinal Tract Output After Stroke

What this Trial Is About

Researchers are investigating how transcranial magnetic stimulation (TMS) might strengthen remaining brain pathways controlling hand movement in people who have had a stroke. This study focuses on delivering TMS during specific brain activity patterns that best activate these pathways, a method called brain state-dependent TMS. A machine learning framework previously developed in healthy adults will now be applied to stroke survivors to identify these patterns and explore how well the method relates to brain pathway health. Participants will attend two separate lab visits. On the first day, after consenting and screening, they undergo assessments of arm and hand motor function and disability. They will be tested for residual brain-to-muscle connections by applying single-pulse TMS to the stroke-affected brain areas and recording muscle responses. Those who show muscle twitches indicating these connections will continue in the study. On the second day, electrodes will be placed on the scalp and affected arm muscles, and TMS pulses will be delivered in multiple blocks while participants rest with eyes open. During their participation, subjects will complete clinical motor tests and have muscle activity recorded through electrodes. Researchers will measure the ability of a personalized brain activity classifier to detect strong versus weak brain pathway activation, alongside imaging overlap of stroke lesions and pathways. The study will last about two weeks from enrollment to completion, including safety monitoring and assessments. A total of 20 chronic stroke survivors will be enrolled to help understand this new TMS approach.

Identifying Personalized Brain States Predicting Residual Corticospinal Tract Output After Stroke