Non-invasive Brain Stimulation for People With Stroke

Early Phase 1

Completed

• Conditions: Stroke
• Interventions: Device: Robot therapy and transcranial direct current stimulation

• Registration Number: NCT01405378
• Lead Sponsor: University of Southampton

Brief Summary

Every five minutes someone in the UK has a stroke. It is the main cause of long-term disability among adults in the UK despite a fall in age-specific stroke incidence, with a growing number of survivors remaining dependent for activities of daily living. While most people with stroke regain walking ability, upper limb problems with no voluntary arm and hand activity, affecting a third of people after stroke, has a poor prognosis. Transcranial direct current stimulation (tDCS) is a non-invasive procedure used to polarise brain regions through the application of weak direct currents and has the potential to develop into a useful aid to treatment strategies in neurorehabilitation. Recent literature into the application of tDCS in people with arm and hand impairments after stroke has shown promising results on upper limb function measures like the Jebsen-Taylor hand function test. Furthermore, a recent pilot study evaluated a six-week training programme combining tDCS with robot-assisted hand training and reported significant improvements in upper limb function. However, the robot in the latter study focused on single-plane distal movements only and long-term effects of the tDCS were not assessed. Recent robotic developments included robots with three rotational degrees-of-freedom for the upper limb, but the effectiveness of this type of robot combined with tDCS in early stroke settings is unknown. Ethical Approval was sought from NHS NRES Committee South Central- Southampton B (Ref: 11/SC/0345) to conduct this study.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2011-07-21
• Study First Submitted QC: 2011-07-28
• Study First Posted: 2011-07-29
• Study Start: 2011-10
• Primary Completion: 2014-01
• Study Completion: 2014-02
• Status Verified: 2016-06
• Last Update Submitted: 2016-06-22
• Last Update Posted: 2016-06-23

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 23

Inclusion Criteria

1. Have a confirmed clinical diagnosis of a haemorrhagic or an ischaemic stroke confirmed clinically or by CT, PET or MRI Scan
2. Experienced a single (first) stroke or multiple strokes
3. In the acute, sub-acute or chronic phase of their recovery (the first three to seven days are referred to as the acute phase. The first two weeks to six months are defined as the sub-acute phase, and the chronic phase begins after three or six months (Teismann et al. 2011, Duncan et al. 2003a)
4. Have had a subcortical or cortical stroke
5. Be over the age of 18 years
6. Have any level of upper limb impairment

Exclusion Criteria

1. A history of epilepsy (TMS studies) due to the fact that TMS could cause an epileptic fit
2. Impaired gross cognitive function; score of less than 24 of the Mini-Mental State Examination (Folstein et al. 1975)
3. Any metal implants in the head including cochlear implants
4. Any another neurological condition apart from stroke
5. Are currently participants in another intervention study using TMS/tDCS

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Robot Therapy and Real Transcranial Direct Current Stimulation	Robot therapy and transcranial direct current stimulation	This group will involve carrying out robot therapy and real transcranial Direct Current Stimulation (tDCS).
Robot Therapy and sham tDCS	Robot therapy and transcranial direct current stimulation	Participants will be randomised to group 2 whereby they will carry out the same robot therapy programme however, receiving sham stimulation.

Primary Outcome Measures

Name	Time	Method
Report change in upper limb function from baseline to 8 weeks and 3 months after treatment	Will be used, exactly before commencing training programme (day 1), at the end of the 8 week training programme and at 3 months follow-up	Measures sensorimotor function of the upper limb (Sanford et al. 1993; Fugl-Meyer et al. 1975)

Secondary Outcome Measures

Name	Time	Method
Report change in cortical excitability from baseline to 8 weeks and 3 months after treatment	Will be used, exactly before commencing training programme (day 1), at the end of the 8 week training programme and at 3 months follow-up	Corticospinal excitability will be measured by the administration of focal TMS using a figure-of-eight coil to the M1 area of the affected hemisphere. The 'hot spot' will be established by using neuronavigation equipment called Brain Sight (Rogue Research Inc.). The amplitude of the MEPs and recruitment curve of the anterior deltoid (proximal muscle) and extensor digitorum communis (distal muscle) will be subsequently recorded using electromyography.

Trial Locations

Locations (1)

Faculty of Health Sciences, University of Southampton; 🇬🇧 Southampton, United Kingdom