A Randomized Controlled Trial of Anodal Transcranial Direct Current Stimulation and Transcutaneous Electrical Nerve Stimulation for Improving Lower Limb Function in Stroke Patients
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 92
- 试验地点
- 2
- 主要终点
- Paretic ankle dorsiflexor strength
研究概览
简要总结
This study aims to evaluate the effectiveness of transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) in augmenting the efficacy of the lower limb task-oriented training in people with stroke. It is hypothesize that lower limb motor function can be best improved by combining anodal tDCS with TENS, when compared with sham-tDCS with TENS, anodal tDCS with placebo-TENS, or control training at improving ankle muscle strength, motor control of lower limbs, walking performance, functional mobility and community integration in people with stroke.
详细描述
The application of transcutaneous electrical nerve stimulation (TENS) over a paretic lower limb could augment the effects of task-oriented exercise therapy on lower limb motor function in people with stroke, possibly through increased excitability of sensorimotor cortex.
In transcranial direct current stimulation (tDCS), a weak electrical current is applied through electrodes placed on the scalp to modulate cortical excitability and neural activity in targeted brain regions. Anodal tDCS, specifically, involves positioning the positively charged electrode over the targeted cortical area, which facilitates neuronal depolarization and increases cortical excitability in the underlying brain tissue. The enhanced neural excitability induced by anodal tDCS could promote neuroplasticity and optimize motor learning processes, potentially through the modulation of N-methyl-D-aspartic acid (NMDA) receptor -dependent mechanisms and alterations in GABAergic activity, leading to improved motor function and rehabilitation outcomes in various neurological conditions.
The next question concerns whether anodal tDCS could be combined with TENS and whether their synergetic effects could maximise the motor output of paretic limbs in people with stroke.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 50 Years 至 85 Years(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •are between 50 and 85 years of age;
- •have had a single stroke more than 6 months and less than 15 years;
- •have at least 5 degrees of active ankle dorsiflexion in the antigravity position;
- •are able to walk 10 m independently, with or without a walking aid;
- •are able to score 6 or higher out of 10 on the abbreviated mental test;
- •have no skin allergies (e.g. redness or itchiness after application of the electrical stimulation pads) to electrical stimulation or electrodes;
- •are able to follow instructions and give informed consent.
排除标准
- •have any additional medical, cardiovascular or orthopedic conditions that would hinder their treatment or assessment;
- •have a cardiac pacemaker;
- •have aphasia or cognitive difficulties that may interfere with their comprehension of instructions;
- •have had one or more epileptic seizures within the year prior to the date of inclusion in the study;
- •have an intracerebral metal clip;
- •have a major somatosensory deficit
- •have any contraindication to tDCS;
- •are currently involved in drug studies or other clinical trials.
研究组 & 干预措施
Anodal tDCS+Bi-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Transcranial direct current stimulation (tDCS) (Device)
Anodal tDCS+Bi-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Bilateral Transcutaneous electrical nerve stimulation (Bi-TENS) (Device)
Anodal tDCS+Bi-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Lower-limb task-oriented training (Behavioral)
Sham-tDCS+Bi-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Sham transcranial direct current stimulation (Sham-tDCS) (Device)
Sham-tDCS+Bi-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Bilateral Transcutaneous electrical nerve stimulation (Bi-TENS) (Device)
Sham-tDCS+Bi-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Lower-limb task-oriented training (Behavioral)
Anodal tDCS+placebo-TENS
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
Control training
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Sham transcranial direct current stimulation (Sham-tDCS) (Device)
Control training
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Placebo transcutaneous electrical nerve stimulation (Placebo-TENS) (Device)
Control training
All subjects will receive eighteen 60-minute sessions of intervention, 3 sessions per week for 6 weeks.
干预措施: Lower-limb task-oriented training (Behavioral)
结局指标
主要结局
Paretic ankle dorsiflexor strength
时间窗: Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks)
The paretic ankle dorsiflexor strength (in kilograms) is measured with a Nicholas hand-held dynamometer (model 01,160, Lafayette Instrument Company, Lafayette, IN) in supine lying position. The muscle strength will be measured twice. The average strength of the 2 trials will be recorded. A higher value indicated a better paretic ankle dorsiflexor strength.
Fugl-Meyer Assessment of Lower Extremity (FMA-LE)
时间窗: Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks)
FMA-LE is used to evaluate the lower extremity motor control, including reflexes, voluntary control of isolated movement and coordination. The scale score ranging from 0 to 34, with 17 items and ordinal scoring from 0 to 2. A higher score indicates a better lower extremity motor control.
Paretic ankle plantarflexor strength
时间窗: Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks)
The paretic ankle plantarflexor strength (in kilograms) is measured with a Nicholas hand-held dynamometer (model 01,160, Lafayette Instrument Company, Lafayette, IN) in supine lying position. The muscle strength will be measured twice. The average strength of the 2 trials will be recorded. A higher value indicated a better paretic ankle dorsiflexor strength.
次要结局
- 10-Meter Walk Test (10MWT)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Timed 'Up and Go' test (TUG)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Lower-extremity motor co-ordination test(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Gait Parameters (via GAITRite)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Berg Balance Scale (BBS)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Limits of Stability (LOS) Test(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Sensory Organization Test (SOT)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Cantonese version of Community Integration Measures (CIM-C)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- Foot & Ankle Disability Index Score (FADI)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
- EQ-5D Visual Analogue Scale (EQ-5D VAS)(Baseline (0 week), Mid-intervention (3 weeks), Post-intervention (6 weeks), 1-month follow-up (10 weeks))
研究者
Shamay Ng
Prof
The Hong Kong Polytechnic University
