tDCS and CO-OP in Chronic Stroke
Condition: Chronic Stroke
MeSH terms: Stroke
Study type: Interventional
Phase: Phase 1

Summary: 
      This project seeks to evaluate the acceptability feasibility, practicality feasibility, and
      preliminary effect of combining transcranial direct current stimulation (tDCS) and
      metacognitive strategy training (MCST) in individuals with chronic stroke.
    

Detailed description: 
      Currently seven million people are living in the United States post stroke, making stroke the
      leading cause of long term disability. Almost half of the people living in the community
      following stroke have problems that challenge the activities that support their daily lives.
      This is in part due to the rehabilitation community's focus on short term stroke recovery and
      not on supporting survivors' need to actively manage their long-term disability and the
      environment around them so they can return to full participation in communities of their
      choice post-rehabilitation. The rehabilitation community is in need of evidence-based
      interventions for addressing post-stroke functional limitations. Metacognitive strategy
      training is a performance-based, problem-solving approach to task performance difficulties.
      Participants are taught to identify when to apply a cognitive strategy, how to apply it, and
      how to monitor and adapt usage of cognitive strategies within task performance. Metacognitive
      strategy training is recognized as a practice standard for addressing functional limitations
      post-stroke. Transcranial direct current stimulation is a method that has been used for over
      15 years to modulate the excitability of targeted brain regions. While it does not directly
      stimulate neurons, it results in changes to polarity of neuronal membranes and is thought to
      facilitate or inhibit neuroplasticity. Combination of these approaches may result in an
      interaction of effects and a greater effect on function in individuals post-stroke than
      either approach used alone.
    

Intervention name(s): tDCS and CO-OP Group
Intervention type(s): Combination Product
Intervention description(s): Transcranial direct current stimulation modulates the excitability of targeted brain regions, and is thought to facilitate or inhibit neuroplasticity. Participants will receive anodal tDCS (1.5 mA) to the dorsolateral prefrontal cortex (dlPFC) for 20 minutes at the beginning of each session. CO-OP focuses on learning of a global problem-solving strategy, Goal-Plan-Do-Check (GPDC), within the performance of participant-chosen goals. Use of a broadly applicable strategy and meaningful activity ensures the intervention is salient to the participant and increases likelihood of transfer. Uniquely, therapists applying CO-OP use guided discovery methods to support participants in analyzing their own performance of a given task and generating potential solutions for improving performance. Participants become equipped with these skills through repetitive application of the Goal-Plan-Do-Check process.The intervention focuses on learning GPDC with gradual withdrawal of guided discovery methods.
Other intervention name(s): Brain Stimulation and Metacognitive Strategy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Stroke; Metacognitive Strategy Training; Brain Stimulation; CO-OP; tDCS