Non-invasive Brain Stimulation for People With Stroke

Stroke Clinical Trial

Official title:

Combining Transcranial Direct Current Stimulation (tDCS) With Robot Therapy for the Impaired Upper Limb in Stroke Rehabilitation.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01405378
• Other study ID #: Wessex Innovative Grant P09
• Status: Completed
• Phase: Phase 0
• First received: July 21, 2011
• Last updated: June 22, 2016
• Start date: October 2011
• Est. completion date: February 2014

Study information

• Verified date: June 2016
• Source: University of Southampton
• Contact: n/a
• Is FDA regulated: No
• Health authority: United Kingdom: National Health Service
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 23
• Est. completion date: February 2014
• Est. primary completion date: January 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years to 80 Years

Eligibility

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

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Stroke

Intervention

Device:
• Robot therapy and transcranial direct current stimulation
Administration of Robot Therapy: Therapy will be administered by making use of the Armeo Robot. Sessions will involve high-intensity, repetitive, task-oriented movements directed by video screens. Administration of tDCS: Anodal tDCS will be administered using a CE marked transcranial Direct Current Stimulator (Newronika Italy). Direct current will be transferred by a saline-soaked pair of surface sponge electrodes (35 cm2).

Locations

Country	Name	City	State
United Kingdom	Faculty of Health Sciences, University of Southampton	Southampton

Sponsors (2)

Lead Sponsor	Collaborator
University of Southampton	University College, London

Country where clinical trial is conducted

United Kingdom, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Report change in upper limb function from baseline to 8 weeks and 3 months after treatment	Measures sensorimotor function of the upper limb (Sanford et al. 1993; Fugl-Meyer et al. 1975)	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	No
Secondary	Report change in cortical excitability from baseline to 8 weeks and 3 months after treatment	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.	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	No