Transcranial Direct Current Stimulation (tDCS)-Enhanced Stroke Recovery

Recruitment & Eligibility

Inclusion Criteria

ischemic stroke causing arm weakness within 5-15 days
no other neurological or psychiatric disease, who are able to perform study tasks

Exclusion Criteria

patients younger than 18 or older than 80 years
patients with more than one disabling stroke
Patients with bilateral motor impairment
Patients with poor motivational capacity, history of severe alcohol or drug abuse
Patients with severe language disturbances, particularly of receptive nature
Patients with serious cognitive deficits (defined as equivalent to a MMS score of 23 or less)
Patients with severe uncontrolled medical problems (e.g., seizures, progressive stroke syndromes, severe rheumatoid arthritis, active joint deformity of arthritic origin, active cancer or renal disease, end-stage pulmonary or cardiovascular disease, or a deteriorated condition due to age or others),
Patients with unstable thyroid disease
Patients with increased intracranial pressure
Patients with unstable cardiac arrhythmia
Patients with contraindication to TMS or tDCS stimulation (pacemaker, an implanted medication pump, a metal plate in the skull, or metal objects inside the eye or skull, patients who had a craniotomy, skin lesions at the site of stimulation)
Patients who are not available for follow-up at 3 and 12 months
Pregnancy
Patients with contraindication to MRI will not participate in MRI

Arm && Interventions

Group	Intervention	Description
tDCS and occupational therapy	tDCS	1 mA electric current will be delivered over the lesioned motor cortex for the first 20 minutes during the one hour physical therapy.
Sham and occupational therapy	Sham tDCS	Electric current will be ramped up and down over the lesioned motor cortex for the first seconds during the one hour physical therapy.

Primary Outcome Measures

Name	Time	Method
Upper Extremity Fugl-Meyer	1 year after stroke	Motor outcome measure for the upper extremity. Scores vary between 0-66, higher values mean better performance.

Secondary Outcome Measures

Name	Time	Method
Wolf Motor Function Test	3 months	The Wolf Motor Function Test (WMFT) is a quantitative index of upper extremity motor ability determined through the use of timed and functional tasks. The score represents the average speed the subject could perform of the timed motor tasks. The score is the average of the scores calculated from "how many times would a person have completed the task, had he or she been performing it continuously for 60 seconds". The score ranges from 0 to no theoretical maximum, with higher numbers meaning faster/ better performance. (See publication Dr. Hodics et al. 2012.)