Stroke Clinical Trial
Official title:
Boosting the Therapeutic Benefits of Prism Adaptation by Combining it With tDCS
The present study aims to compare the relative therapeutic efficacy of prism adaptation
therapy combined with real versus sham tDCS. The investigators will test the hypothesis that
the magnitude and duration of neglect improvement will be increased when prism therapy is
combined with real tDCS compared to sham tDCS.
A second objective is to test whether individual differences in baseline clinical or brain
imaging measures can predict: 1) neglect severity or 2) inter-individual differences in
patients' therapeutic response.
A third goal is to use brain imaging to characterize the patterns of neural change induced by
the intervention to identify brain structures that mediate therapeutic response.
'Neglect' is a common neurological syndrome that affects approximately 50% of
right-hemisphere stroke patients. It is a complex multi-faceted syndrome, but its core
defining feature is that patients lose the capacity to voluntarily control attention in the
left half of space. Neglect has a significant debilitating effect on patients' functional
independence and everyday life and indicates a poor prognosis for long-term functional
recovery.
To date, there is no effective rehabilitation intervention available for routine clinical
use. One of the most promising experimental strategies for neglect rehabilitation is prism
adaptation, a form of motor training that induces short-lived improvements in a variety of
cognitive domains. However, its major limitation is that the benefits are transient. The
investigators aim to test the hypothesis that by combining prism therapy with transcranial
direct current stimulation (tDCS), this will boost learning/memory processes, resulting in
larger and longer-lasting therapeutic effects.
The investigators will conduct a randomized controlled clinical trial to test the efficacy of
multi-session prism therapy combined with real versus sham tDCS for the rehabilitation of
chronic post-stroke neglect. Baseline neuroimaging data will be used as predictor variables
to explain inter-individual variation in therapeutic response. Contrasts between pre- and
post-intervention imaging data will be performed to identify neural structures that mediate
therapeutic effects.
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