Please select the eligibility criteria that correspond to the clinical trial below.
Title: Potentiation of the Effects of Prismatic Adaptation by Transcranial Direct Current Stimulation (tDCS) : Evaluation of Functional Interest in Negligence Rehabilitation
Brief Summary: Following stroke, over 50% of patients keep severe neurological deficiency whose unilateral neglect, mostly following a right hemispheric lesion. The prismatic adaptation involves to pointing movements toward visual targets wearing prismatic glasses. These prismatic glasses induce a shift to the right visual field for improving symptoms in short term.

Transcranial direct stimulation (tDCS) has been evaluated for different types of deficiency resulting from stroke with encouraging results. The hypothesis of the study is to evaluate the usefulness of brain stimulation as an adjunctive intervention to optimize and increase the rehabilitation of unilateral neglect to long-term.

Thus, the main objective is to evaluate the effectiveness of standard treatment with prismatic adaptation with anodal tDCS or sham tDCS.


Options:
A: Inclusion Criteria:

All subjects must be between the ages of 18-90 and must not be pregnant.

Additional Entry criteria for Stroke subject enrollment:

1. First-time clinical ischemic or hemorrhagic cerebrovascular accident - evidenced by a radiological (or physician's) report;
2. Weakness, defined as score of less than 55 (out of 66) on arm motor Fugl-Meyer (FM) scale
3. Stroke onset \>6 months prior to study enrollment.

Exclusion Criteria:

1. Significant pre-stroke disability;
2. Major depression, as defined by Hamilton Depression (HAM-D) scale grater then or equal 17 if needed (history of depression before the stroke);
3. Any substantial decrease in alertness, language reception, or attention that might interfere with understanding instructions for motor testing;
4. Excessive pain in any joint of the paretic extremity (not applicable to severe stroke subjects);
5. Contraindications to single pulse Transcranial Magnetic Stimulation (TMS) (TMS will be used to measure cortical excitability) such as metal head implants

   * history of seizures
   * unexplained loss of consciousness
   * metal in the head
   * frequent or severe headaches or neck pain
   * implanted brain medical devices.
6. Contraindications to tDCS

   * metal in the head
   * implanted brain medical devices
7. Advanced liver, kidney, cardiac, or pulmonary disease;
8. A terminal medical diagnosis consistent with survival \< 1 year;
9. Coexistent major neurological or psychiatric disease as to decrease number of confounders;
10. A history of significant alcohol or drug abuse in the prior 6 months;
11. Use of carbamazepine and amitriptyline;
12. Subjects may not be actively enrolled in a separate intervention study targeting stroke recovery and
13. Subjects may not have already received constraint induced motor therapy and/or tDCS treatment for stroke;
14. History of epilepsy before stroke (or episodes of seizures within the last six months).
15. Subjects with global aphasia and deficits of comprehension
16. Pregnancy
B: Inclusion Criteria:

1. Ischemic stroke affecting the right hemisphere, confirmed by CT or MRI.
2. Persistent neglect for one month after ictus (confirmed by BIT).
3. Prestroke functional independence (modified Rankin Scale score 0-2).
4. Between 18-90 years of age

Exclusion Criteria:

1. Patients younger than 18.
2. Patients who do not understand verbal or written English (ie.need of translaters)
3. bilateral infarcts (Confirmed by CT, MRI)
4. Dementia (MOCA, Score \<26).
5. Neurological Disease (eg. Parkinson's Disease, epilepsy, MS)
6. Significant morbidity (eg cancer, severe cardiac failure) likely to affect participation.
7. Alcohol excess (more than 50/40 units a week for men/women respectively).
8. Patients who fall under the exclusion criteria for TDCS which includes patients suffering from a stroke related seizure :

History of epilepsy, medications or psychoactive drugs that can lower seizure threshold \[imipramine, amitriptyline, doxepine, nortriptyline, maprotiline, chlorpromazine, clozapine, foscarnet, ganciclovir, ritonavir, amphetamines, cocaine, (MDMA, ecstasy), phencyclidine (PCP, angel dust), ketamine, gammahydroxybutyrate (GHB), alcohol, theophylline\]. Withdrawal from alcohol, barbiturates, benzodiazepines, meprobamate, chloral hydrate. Patients who are pregnant or have suffered from a stroke-related seizure.
C: Inclusion Criteria:

* Ischaemic acute stroke
* Informed consent

Exclusion Criteria:

* 25 ≤ National Institute of Health Stroke Scale ≤ 32
* Rankim ≥ 5
* Mini Mental State Examination ≤ 24
* tDCS criteria: use of modulators of the Central Nervous System drugs; patients with implanted metallic or electronic devices; pacemaker; seizures; pregnancy;any other condition that might limit or interfere in the sensorimotor system CIMT criteria: inability to actively execute the movements of wrist flexion, metacarpophalangeal and interphalangeal active extension of 10º and wrist extension of 20º
D: Inclusion Criteria:

* Right-handed
* All subjects must be between the ages of 18-80
* Patient with unilateral negligence consecutive to a right hemispheric stroke
* Hospitalized in the Department of Physical Medicine and Rehabilitation (day or week) or external monitoring
* Ischemic or hemorrhagic stroke with right hemispheric topography - evidenced by a radiological report
* Diagnosis of negligence evidenced by Behavioural Inattention Test (BIT) : score ≤ 129
* Stroke \>1 month prior to study enrollment

Exclusion Criteria:

* Degenerative neurological complaint
* Uncontrolled epilepsy
* Temporo-spatial disorientation
* Language disorders or psychiatric disorders preventing understanding instructions
* History of prior stroke, multiple stroke
* Medical condition not stabilized
* Pregnancy
* Implanted material (pacemaker, defibrillator, cochlear implant, surgical clips, metal object)
* Intra-cranial material
* Unweaned alcoholism

Answer: D