Targeted Noninvasive Brain Stimulation to Improve Hand Dexterity in Stroke Patients

Study Overview
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Brief Summary
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This study will investigate the use of High-definition Transcranial Direct Current Stimulation (HD-tDCS) in the functional improvement of hand dexterity while performing music-assisted hand exercises.

Detailed Description
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Stroke is a serious medical and health problem in the US, and most of the stroke patients suffer from upper-limb motor deficits including weakened hand dexterity. As upper-limb motor functions are crucial for most of the daily living activities, there is a need for effective intervention. The current therapeutic approaches involve intensive physical therapy training involving repetitive tasks which causes fatigue and lack of engagement in the patients. To address this issue, the investigators will investigate the combined use of individually targeted noninvasive brain stimulation (T-NIBS) using High-definition Transcranial Direct Current Stimulation (HD-tDCS) and music-assisted hand exercises using MusicGlove to modulate the neuroplasticity in the desired manner to observe functional changes in hand dexterity.

Official Title
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Targeted Noninvasive Brain Stimulation (T-NIBS) for Improving Hand Dexterity in Stroke Patients

Conditions
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Stroke

Intervention / Treatment
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* Device: High-definition Transcranial Direct Current Stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged between 18-75 years Clinically diagnosed with hemiparetic stroke (weakness on one side - either left or right side of the body) Have had a stroke for more than 6 months Have weakness in moving the fingers of the affected hand Able to understand and perform the instructions that are part of the tDCS-MusicGlove testing and intervention. Willing and able to participate in and travel to Kessler Foundation for the screening session, MRI session, and tDCS-MusicGlove sessions. Able to sit and be active for 1.5 hours during the session without cardiac, respiratory and/or pain disturbances as assessed during the screening visit. Able to provide informed consent. Medically stable and not planning for a major change in medications for at least 4 weeks Exclusion Criteria: Unable to move the hand because of muscle stiffness (scoring 3 or more on the Ashworth scale) Have lost the sensation of hand movement Have a history of alcohol abuse and/or illicit drug use Have a history of smoking within the past 5 years Have a problem with the eyesight that would make it difficult to notice the changing instructions on a computer screen Currently enrolled in another research study that might affect this research study A history of epilepsy (including family members who are diagnosed with epilepsy) An active history of migraine or chronic headache A history of mental illness (e.g. schizophrenia, anxiety, depression, and PTSD) Past or current history of treated ringing in the ears known as tinnitus or severe hearing problems Have a tattoo with metal-based ink in the head or neck. Have severe skin damage on the scalp Afraid of confined spaces (claustrophobic) Have metallic implants, including intracranial electrodes, surgical clips, shrapnel or a pacemaker. Currently taking medications that increase the risk of seizures Pregnant

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Stroke<br>People suffering from upper-limb motor dysfunction due to stroke | Device: High-definition Transcranial Direct Current Stimulation<br>* Stimulation sessions will be conducted on 2 different visits separated by 2-week gap. In a crossover design, Anodal HD-tDCS will be delivered either in Active/Sham mode (during the first visit) and Sham/Active during the second visit in a 4x1 ring configuration (center electrode being Anode and the surrounding 4 electrodes being cathodes) over the affected motor area.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the Nine-Hole Peg Test (NHPT) scores | NHPT is a secondary outcome measure of finger dexterity that can be used in stroke patients with upper extremity motor deficits. It is considered to be a reliable measure of hand dexterity and recommended for inclusion in NIH toolbox Assessment of Neurological and Behavioral Function. NHPT requires participants to repeatedly place nine pegs into nine holes, one at a time, as quickly as possible and then remove them from the holes. The total time needed to complete the task is then recorded. | baseline (at day 1), during testing visits (day 2 and day 3)- all within 2 weeks from the screening and consenting | 
| Changes in the Dexterity and Speed Test (DAST) scores | DAST is exclusively developed for MusicGlove performance assessment and it is designed to evaluate how fast and accurately do the subjects respond to the sequence of music notes that continuously sped up. | baseline (at day 1), during testing visits (day 2 and day 3)- all within 2 weeks from the screening and consenting | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the Cortical Excitability using Motor Evoked Potentials (MEP) | MEP outcome measures have become the norm in brain stimulation studies. We hypothesize that the MEP amplitude and latency before- and after-intervention would reveal more information about the neuroplasticity changes during motor recovery. The motor evoked potential (MEP) will be provided by twenty unconditioned stimuli (120% RMT). | baseline (at day 1), during testing visits (day 2 and day 3) - all within 2 weeks from the screening and consenting | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stroke, HD-tDCS, musicglove, Upper-limb rehab