Using Transcranial Direct Current Stimulation (tDCS) to Enhance the Benefit of Movement Training in Stoke Patients
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      This study will determine if electrical brain stimulation during movement practice can
      improve the ability of stroke patients to reach for objects more than movement practice
      alone.

      People between 18 and 85 years old who have had a stroke may be eligible for this study.
      Participants are randomly assigned to one of two study groups: movement training with active
      (tDCS) or movement training with sham (tDCS).

      Participants will undergo 1-hour movement training and (tDCS) sessions twice a day, 5 days a
      week, for 3 weeks. For these sessions, subjects will sit in front of a computer screen that
      shows a target (round dots) and a cursor (a line). Participants will be instructed to move
      the cursor to various targets on the computer screen as fast and as accurately as possible,
      controlling the position of the cursor by moving their arm, which will rest on a mechanical
      device.

      Participants will receive real or sham (tDCS) during the movement training sessions. For
      (tDCS), electrode sponges soaked in tap water are placed on the scalp and forehead. A small
      electrical current is passed between the electrodes. The stimulation lasts 20 minutes.

      Patients will have the following tests four times during the study - 1) before starting
      movement training 2) (tDCS) during the course of training and (tDCS), 3) after completing
      training and (tDCS), 4) and 3 months after completing training and (tDCS):

      Functional magnetic resonance imaging (fMRI)

      Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to take pictures of
      the brain. Functional MRI (fMRI) shows what parts of the brain are used when a task is
      performed. For the test, the subject lies on a table that can slide in and out of the
      scanner. A computer screen can be seen from inside the scanner. During the scan, subjects may
      be asked to do the study task or to lie still for up to 20 minutes at a time.

      Movement and function tests

        -  Measurement of arm stiffness

        -  Moving the arms actively and against resistance

        -  Picking up objects and moving them as quickly as possible

        -  Performing daily living tasks like buttoning, dressing and walking

        -  Performing tasks while wearing a glove that monitors the position of the arm

        -  Completing questionnaires on ability to perform daily activities or other movements and
           level of tiredness

      Transcranial magnetic stimulation (TMS)

      TMS uses a magnet to stimulate the brain in way that is different from (tDCS). This study
      us...
    

Detailed description: 
      Individuals who have suffered a stroke may benefit from the development of new rehabilitative
      interventions that can improve motor recovery after a stroke.

      Objective:

      The objective of this protocol is to test the hypothesis that active training on a complex
      upper extremity visuomotor task combined with anodal transcranial direct current stimulation
      (tDCS) used to activate the affected hemisphere improves functionality during reaching of the
      affected upper-extremity in comparison to training combined with sham tDCS in stroke
      patients.

      The Study population:

      The study population will include chronic (more than 3 months) stroke patients.

      Design:

      The study will follow a factorial design in which all subjects will undergo several sessions
      of complex visuomotor task training of the upper extremity. One half of the patients will
      undergo anodal transcranial direct current stimulation during the first 20 minutes of each
      training session, while the control subjects will have sham stimulation applied.

      Outcome Measures:

      The primary outcome measure for the study is accuracy during completion of a reaching task.
      The primary endpoint for the study will be the end of 3 weeks of training (15 days).
      Secondary endpoint measures include timing of reach, kinematic, and functional measures.
      These measures will be taken at the end of training and at a 3 month follow-up.
    

Intervention name(s): Visumotor Upper Extremity Training; Anodal/Sham tDCS
Intervention type(s): Other; Other
Intervention description(s): Control; Condition
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Double
Primary purpose: Treatment
Keywords: Direct Current Stimulation; Rehabilitation; Motor Learning; Stroke