Please select the eligibility criteria that correspond to the clinical trial below.
Title: Late LTP-like Plasticity Effects of tDCS in Subacute Stroke Patients
Brief Summary: Rationale: About 80% of stroke patients suffer motor impairments, but current therapies have limited effects on motor recovery. Therefore, investigating new potential therapeutic approaches is crucial. Transcranial Direct Current Stimulation (tDCS) is a form of non-invasive electrical stimulation where a weak current is applied through electrodes over the scalp. This stimulation is known to (1) induce changes in neuronal excitability -which can last up to one day with late LTP-like plasticity protocols in a polarity and site-specific manner, and (2) facilitate motor learning and stroke recovery. So far, several pilot studies have reported beneficial results from tDCS in both subacute and chronic stroke patients, but it's still unclear how tDCS should be repeated over multiple days to optimally enhance recovery and training effects. Using a late LTP-like plasticity protocol could increase effectiveness of standard clinical care rehabilitation sessions and thus enhance the effects of rehabilitation. Therefore, the investigators want to investigate how late LTP-like plasticity tDCS affects rehabilitation in subacute stroke patients. The outcome of this study can provide important guidelines on effective motor therapy during stroke rehabilitation.

Objective: Identify the effect of late LTP-like plasticity on motor rehabilitation during the subacute phase after stroke.

Study design: Double-blinded, randomized between-subjects trials. Study population: Subacute stroke patients. Main study parameters/endpoints: The primary outcome measure is the upper limb motor function during the subacute phase after stroke.


Options:
A: Inclusion Criteria:

* stroke with at least slight deficit in superior or inferior limb

Exclusion Criteria:

* epilepsy
* contraindication to tDCS and/or to fMRI
* presence of metal in the head
* inability to understand/complete behavioural tasks
* chronic intake of alcohol or recreative drugs
* major health condition
* presence of pacemaker
* pregnancy
B: Inclusion Criteria:

* ischemic stroke causing arm weakness within 5-15 days
* no other neurological or psychiatric disease, who are able to perform study tasks

Exclusion Criteria:

* patients younger than 18 or older than 80 years
* patients with more than one disabling stroke
* Patients with bilateral motor impairment
* Patients with poor motivational capacity, history of severe alcohol or drug abuse
* Patients with severe language disturbances, particularly of receptive nature
* Patients with serious cognitive deficits (defined as equivalent to a MMS score of 23 or less)
* Patients with severe uncontrolled medical problems (e.g., seizures, progressive stroke syndromes, severe rheumatoid arthritis, active joint deformity of arthritic origin, active cancer or renal disease, end-stage pulmonary or cardiovascular disease, or a deteriorated condition due to age or others),
* Patients with unstable thyroid disease
* Patients with increased intracranial pressure
* Patients with unstable cardiac arrhythmia
* Patients with contraindication to TMS or tDCS stimulation (pacemaker, an implanted medication pump, a metal plate in the skull, or metal objects inside the eye or skull, patients who had a craniotomy, skin lesions at the site of stimulation)
* Patients who are not available for follow-up at 3 and 12 months
* Pregnancy
* Patients with contraindication to MRI will not participate in MRI
C: Inclusion Criteria:

* Subacute stroke (within 1-4 weeks post stroke)
* Acute hemiparesis (Fugl-Meyer Stage \< IV) with single thromboembolic non-hemorrhagic infarction documented by a neurologist
* Aged 18-79

Exclusion Criteria:

* Absence of voluntary movement (Fugl-Meyer Stage \< III)
* Head injury or the presence of intracranial metal or intracranial lesions
* History of cranial irradiation
* History of epilepsy
* Presence of a pacemaker
* Taking anticonvulsant or neuroleptic medication
* Substance abuse
* Inability to understand instructions
D: Inclusion Criteria:

age ≥18 years; first-ever ischemic stroke; chronic phase of recovery (\>6 months); ability to walk 6- meter supported or unsupported; ability to stand at least unsupported for 40-seconds with eyes closed; only ischemic stroke involving middle cerebral artery (MCA) territory confirmed by CT or MRI.

Exclusion Criteria:

Use of any neuro- or psycho-active medications that alters balance; any other neurological conditions or sensory disorders affecting postural control; such as brain tumor, or substance abuse; orthopedic diseases; ongoing/recent (within 3 months) balance rehabilitation.

Answer: C