Stroke Clinical Trial
Official title:
Optimizing Transcranial Direct Current Stimulation for Motor Recovery From Severe Post-stroke Hemiparesis
This study will compare the effectiveness of different polarities of transcranial direct current stimulation paired with intensive motor training in recovery of upper extremity function in individuals with severe post-stroke hemiparesis. The hypothesis is that more severely impaired individuals will derive greater benefit from anodal stimulation of the ipsilesional hemisphere or cathodal stimulation of the contralesional hemisphere than dual stimulation (anodal applied to the ipsilesional hemisphere and cathodal applied to the contralesional hemisphere.)
This study has 2 aims: 1) determine which transcranial direct current stimulation (tDCS)
electrode configuration is most effective in combination with motor training to promote
motor recovery from severe post-stroke hemiparesis; and 2) begin to clarify the extent to
which baseline transcranial magnetic stimulation (TMS) measures predict response to tDCS, as
well as the effects of tDCS paired with motor training on TMS measures of motor cortical
organization.
To accomplish these aims, the investigators will recruit 36 human subjects with severe
post-stroke hemiparesis and assign each subject to 1 of 4 tDCS conditions (anodal excitatory
ipsilesional; cathodal inhibitory contralesional; a combination of anodal excitatory
ipsilesional during cathodal inhibitory contralesional; or sham). Each subject will undergo
a 20-minute stimulation session once a day for 10 days over a 2-week period. Each session
will be followed by 3 hours of intensive, task-oriented upper extremity motor training.
Outcome measures for this study include TMS motor cortical maps and standardized tests of
motor performance. The investigators hypothesize that all groups will show improvement in
all measures; however, both the anodal excitatory ipsilesional group and the cathodal
inhibitory contralesional group will show significantly greater improvement compared with
the other 2 groups. The investigators will also find evidence clarifying whether the
presence or absence of motor-evoked potentials (MEPs) has predictive value regarding which
tDCS configuration would be most effective for a particular subject.
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