Ignite Creation Date:
2024-05-05 @ 5:17 PM
Last Modification Date:
2024-10-26 @ 9:30 AM
Study NCT ID:
NCT00426465
Status:
COMPLETED
Last Update Posted:
2019-12-17
First Post:
2007-01-23
Brief Title:
Spaced Versus Massed Skill Learning
Sponsor:
National Institute of Neurological Disorders and Stroke NINDS
Organization:
National Institutes of Health Clinical Center CC
Study Overview
Official Title:
Neural Substrates of Lasting Motor Skill Learning by Spacing Effect
Status:
COMPLETED
Status Verified Date:
2013-12-16
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This study will explore the optimum training schedule for stroke patients to learn motor skills It will see if motor training is more effective when training sessions are distributed over time spaced training or when the sessions are scheduled close together massed training The results of this study may help researchers devise the best training schedule for patients to derive the maximum benefit from rehabilitation therapy
Healthy normal volunteers and people who have had a stroke may be eligible for this study Patients must be 3 months post-stroke All participants must be right-handed and between 18 and 80 years of age
Participants practice a pinch motor task and receive transcranial magnetic stimulation TMS Hand muscle activity is measured using surface electromyography EMG Pinch training involves training the participant to pinch as strongly as possible using a device that records the force 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 For surface EMG electrodes small metal disks are filled with a conductive gel and taped to the skin over the muscle
Following one practice session of pinch task training and TMS participants have four training sessions which are scheduled 24 hours 2 weeks 1 month and 3 months after the practice session
For the 4- to 5-hour practice session subjects do the following
Perform a single session of pinch motor task for familiarization
Undergo TMS to measure brain activity
Practice five 6-minute blocks of pinch motor task with rest periods between sessions and perform a calculation task addition and subtraction tasks during each rest period
Receive TMS over 15 minutes Some sessions may have sham TMS
Read books and magazines during a 45-minute rest period
Perform a single block of the pinch motor task
Undergo TMS to measure brain activity
Complete a questionnaire that measures attention fatigue and mood
For the remaining four sessions participants perform one practice block and TMS Each session lasts about 2 hours
Healthy normal volunteers and people who have had a stroke may be eligible for this study Patients must be 3 months post-stroke All participants must be right-handed and between 18 and 80 years of age
Participants practice a pinch motor task and receive transcranial magnetic stimulation TMS Hand muscle activity is measured using surface electromyography EMG Pinch training involves training the participant to pinch as strongly as possible using a device that records the force 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 For surface EMG electrodes small metal disks are filled with a conductive gel and taped to the skin over the muscle
Following one practice session of pinch task training and TMS participants have four training sessions which are scheduled 24 hours 2 weeks 1 month and 3 months after the practice session
For the 4- to 5-hour practice session subjects do the following
Perform a single session of pinch motor task for familiarization
Undergo TMS to measure brain activity
Practice five 6-minute blocks of pinch motor task with rest periods between sessions and perform a calculation task addition and subtraction tasks during each rest period
Receive TMS over 15 minutes Some sessions may have sham TMS
Read books and magazines during a 45-minute rest period
Perform a single block of the pinch motor task
Undergo TMS to measure brain activity
Complete a questionnaire that measures attention fatigue and mood
For the remaining four sessions participants perform one practice block and TMS Each session lasts about 2 hours
Detailed Description:
In cognitive psychology practice is most effective when training sessions are distributed over time spaced rather than when they are close to each other massed This phenomenon thought to engage long-term potentiation-like mechanisms in animal models and described as spacing effect has not been investigated in the motor domain It is not known if spaced motor training elicits longer lasting learning effects than massed motor training
Objective and Study Population
The purpose of this investigation is to assess the relevance of the spacing effect in motor skill learning in healthy volunteers and in patients with chronic stroke
Design
Experiment 1 Determination of long term learning in healthy volunteers with spaced and massed practice
The first hypothesis is that spaced practice will enhance long-lasting learning of a motor task defined as performance improvements measured 1 and 3 months post training to a larger extent than massed practice in separate groups of healthy volunteers Healthy volunteers will practice a well-characterized pinch force task following spaced or massed schedules in a factorial design n26 If this hypothesis is proven correct we will proceed as suggested by PIRC to Experiments 2 and 3 to gain information on the mechanisms underlying the superior training strategy in healthy volunteers Exp 2 and to determine if this training strategy is also superior to massed practice in stroke patients Exp 3 an issue of crucial importance in neurorehabilitation
Experiment 2 Study of mechanisms underlying superior effects of spaced over massed practice in healthy volunteers rTMS
Previous work demonstrated the involvement of the primary motor cortex M1 in consolidation of motor learning and the importance of top-down attentional control by the prefrontal cortex It is possible that an enhanced recruitment of these two regions mediates the superior performance levels reached with spaced training Here we plan to study the effects of inhibitory 1 Hz TMS applied to M1 and PFC on performance improvements with spaced training We hypothesize that the superiority of spaced practice relative to massed practice will be cancelled by down regulation of activity in M1 and PFC but not by sham or posterior parietal cortex PPC stimulation n104
Experiment 3 Determination of long term learning in stroke patients with spaced and massed practice
We hypothesize that motor learning in chronic stroke patients will improve to a larger extent with spaced than with massed practice n42
This study is expected to delineate the role of the spacing effect on human motor learning and identify two of the possible neural cortical substrates in healthy volunteers and its possible beneficial effects on motor learning after stroke
Experiment 4 Determination of whether original findings with the spacing effect in explicit motor learning generalized to implicitprocedural motor learning
The ability to generalize to implicit motor learning is important because implicit learning also known as procedural learning which is defined as learning which occurs without awareness and without intention underlies the development of automaticity which characterizes all well-learned motor skills Reber 1993 Squire 2004 Hence for the purposes of stroke rehabilitation it is important to determine if and how the spacing effect occurs for implicit procedural learning which underlies the development of automaticity that characterizes all well-learned motor skills In addition using explicit motor sequencing tasks it is difficult to determine if the spacing effect helps general motor skill or sequence-specific skill In other words performance benefits from the spacing effect can derive from improvements in the visuomotor transformation required to push the keys on the board independently of the presence or absence of sequence or from motor sequencing improvements Both of these issues can be addressed using the serial reaction time task or SRTT a well-studied implicit motor sequence learning task which is described in more detail in this protocol Nissen and Bullemer 1984
We hypothesize that the spacing effect occurs in a sequence-specific manner for implicit motor sequence learning We hypothesize that an SMA-based motor network underlies the superiority of the spacing effect for implicit motor sequence learning We will show this by using 1Hz TMS to create virtual lesions and establish a cause-effect link between the SMA or M1 but not CZ or sham and superior motor skill with Spaced over Massed training n80
Outcome Measures
The primary outcome measure will be improvement in pinch force Secondary outcome measurements will be measures of motor cortical excitability including motor evoked potential amplitudes intracortical inhibition and facilitation
For proceduralimplicit motor sequence learning the primary outcome measure will be an improvement in skill as seen by a difference in reaction time between sequenced and randomly ordered trials
Objective and Study Population
The purpose of this investigation is to assess the relevance of the spacing effect in motor skill learning in healthy volunteers and in patients with chronic stroke
Design
Experiment 1 Determination of long term learning in healthy volunteers with spaced and massed practice
The first hypothesis is that spaced practice will enhance long-lasting learning of a motor task defined as performance improvements measured 1 and 3 months post training to a larger extent than massed practice in separate groups of healthy volunteers Healthy volunteers will practice a well-characterized pinch force task following spaced or massed schedules in a factorial design n26 If this hypothesis is proven correct we will proceed as suggested by PIRC to Experiments 2 and 3 to gain information on the mechanisms underlying the superior training strategy in healthy volunteers Exp 2 and to determine if this training strategy is also superior to massed practice in stroke patients Exp 3 an issue of crucial importance in neurorehabilitation
Experiment 2 Study of mechanisms underlying superior effects of spaced over massed practice in healthy volunteers rTMS
Previous work demonstrated the involvement of the primary motor cortex M1 in consolidation of motor learning and the importance of top-down attentional control by the prefrontal cortex It is possible that an enhanced recruitment of these two regions mediates the superior performance levels reached with spaced training Here we plan to study the effects of inhibitory 1 Hz TMS applied to M1 and PFC on performance improvements with spaced training We hypothesize that the superiority of spaced practice relative to massed practice will be cancelled by down regulation of activity in M1 and PFC but not by sham or posterior parietal cortex PPC stimulation n104
Experiment 3 Determination of long term learning in stroke patients with spaced and massed practice
We hypothesize that motor learning in chronic stroke patients will improve to a larger extent with spaced than with massed practice n42
This study is expected to delineate the role of the spacing effect on human motor learning and identify two of the possible neural cortical substrates in healthy volunteers and its possible beneficial effects on motor learning after stroke
Experiment 4 Determination of whether original findings with the spacing effect in explicit motor learning generalized to implicitprocedural motor learning
The ability to generalize to implicit motor learning is important because implicit learning also known as procedural learning which is defined as learning which occurs without awareness and without intention underlies the development of automaticity which characterizes all well-learned motor skills Reber 1993 Squire 2004 Hence for the purposes of stroke rehabilitation it is important to determine if and how the spacing effect occurs for implicit procedural learning which underlies the development of automaticity that characterizes all well-learned motor skills In addition using explicit motor sequencing tasks it is difficult to determine if the spacing effect helps general motor skill or sequence-specific skill In other words performance benefits from the spacing effect can derive from improvements in the visuomotor transformation required to push the keys on the board independently of the presence or absence of sequence or from motor sequencing improvements Both of these issues can be addressed using the serial reaction time task or SRTT a well-studied implicit motor sequence learning task which is described in more detail in this protocol Nissen and Bullemer 1984
We hypothesize that the spacing effect occurs in a sequence-specific manner for implicit motor sequence learning We hypothesize that an SMA-based motor network underlies the superiority of the spacing effect for implicit motor sequence learning We will show this by using 1Hz TMS to create virtual lesions and establish a cause-effect link between the SMA or M1 but not CZ or sham and superior motor skill with Spaced over Massed training n80
Outcome Measures
The primary outcome measure will be improvement in pinch force Secondary outcome measurements will be measures of motor cortical excitability including motor evoked potential amplitudes intracortical inhibition and facilitation
For proceduralimplicit motor sequence learning the primary outcome measure will be an improvement in skill as seen by a difference in reaction time between sequenced and randomly ordered trials
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| 07-N-0072 | None | None | None |