Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomised Trial of Non-Invasive Brain Stimulation (NIBS) in Stroke Survivors
Brief Summary: After a stroke affecting the right side of the brain, many patients are affected by "spatial neglect": the damage to the brain causes them to ignore the left side of their surroundings. At its most extreme they may be unaware that they have a left side, or believe that it is moving normally when it is in fact paralysed. In milder cases, people may be unable to recognise touch on the left side if their right side is also being touched, or objects in their left visual field if something is visible to their right. Neglect alters peoples' quality of life profoundly, often renders them more dependent on others to undertake basic activities of daily living, and makes effective rehabilitation much more difficult.

The limited success of current treatment approaches indicates gaps in understanding of the underlying mechanisms of neglect and its recovery. Recent data suggest that the problems in responding to the left side are a result of an imbalance of activity in those parts of the brain responsible for deciding which side to pay attention to. It might therefore be possible to help people with neglect by "rebalancing" the brain either by increasing activity in the damaged side, or alternatively by reducing activity in the undamaged side. In this pilot study, the investigators will test whether they can help by doing the second of these things.

The investigators propose to conduct a pilot clinical trial to explore whether using electric currents to temporarily modify the activity of specific areas of the intact side of the brain, influences recovery from neglect, when used either alone, or in combination with a training method that has previously appeared promising as a treatment. Brain activity will be modified using a technique called "transcranial direct current stimulation (tDCS)", in which small electric currents are applied to the scalp with a wire covered in damp cotton pads. This will be done over the specific parts of the brain that are responsible for focusing attention to one side.

The investigators will compare the clinical outcomes of four interventions (1: behavioural, 2: tDCS, 3: a combination of both and 4: control).

The investigators hope that these studies will advance their understanding of what treatments may help people with neglect, and how they might work.


Options:
A: Inclusion Criteria:

* first ever stroke as defined by the WHO (world health organisation) criteria
* assessed and included within 8 weeks after stroke onset
* unilateral motor impairment in the upper limb (ARAT \<52/56)
* unilateral somatosensory impairment in the upper limb (SSD \<0.00)
* minimally 18 years old
* substantially cooperation to perform the assessments and therapy
* written informed consent

Exclusion Criteria:

* musculoskeletal and/or other neurological disorders such as previous stroke, head injuries, multiple sclerosis of Parkinson's disease
* a subdural hematoma, tumor, encephalitis or trauma that lead to similar symptoms as a stroke
* severe communication deficits
* severe cognitive deficits
* the presence of contra-indications for proceeding an MRI scan such as defibrillator, pacemaker or metal prosthesis ( as defined in the MRI checklist of Radiology UZ Leuven)
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:

* ischemic or hemorrhagic stroke, confirmed by medical diagnoses compatible with a unilateral right lesion involvement (i.e. left hemiplegic), exhibited left visual field inattention or unilateral neglect by obtaining a total score of star cancellation subtest in the conventional battery of the Behavioural Inattention Test ≤ 51 (out of 54);
* stroke with onset of neurological condition ≤ 6 months previously;
* have normal or corrected-to-normal visual acuity better than 20/60 (6/18) in the better eye;
* with hemiplegic upper extremity functional levels 3-7 as rated by Functional Test for the Hemiplegic Upper Extremity and is able to move against gravity;
* ability to understand and follow simple verbal instructions, with Mini-mental State Examination ≥ 21;
* ability to participate in a therapy session lasting at least 30 minutes;
* consent to participant in the study

Exclusion Criteria:

* prior neurological or psychiatric disorders;
* severe spasticity (Modified Ashworth Scale \>3) over paretic arm;
* history of recent Botox injection or acupuncture to the paretic arm within the past three months;
* participation in another clinical study elsewhere apart from the study site during recruitment
D: Inclusion Criteria:

* Unilateral right brain stroke
* Functionally independent before stroke
* Presence of spatial neglect (moderate to severe, will be confirmed during the screening session)
* Ability to follow instructions and understand verbal or written English
* Currently living with a family member who will be enrolled into the study as well

Exclusion Criteria:

* History of progressive neurological disorder
* History of a significant psychiatric disorder
* Living outside of 50-mile radius of Kessler Foundation (West Orange, NJ)

Answer: B