Functional Interest of Non Invasive Brain Stimulation During Physiotherapy at a Subacute Phase Post Stroke (Anodal Protocol): ReSTIM

Study Overview
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Brief Summary
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Previous research that utilises single sessions of transcranial direct current stimulation (tDCS) have demonstrated functional improvements. However these improvements are usually short-lived, lasting less than one hour before the patient's performance returns to baseline. In these studies, tDCS is typically applied with the goal of adaptively enhancing functional activation of pathologically under-active tissue or suppressing pathologically over-active tissue. Interestingly, a small body of evidence is now emerging to indicate that tDCS can improve learning/memory functions in healthy controls. The goal of this study is to test if the application of tDCS could enhance learning and/or memory for physiotherapy rehabilitation, which may in turn lead to correspondingly greater motor improvement. Patients at a subacute stage (1 to 6 month post stroke) will attend for 10 consecutive daily sessions of tDCS. This research has important implications; previous studies suggest that such an approach has the potential to facilitate physical rehabilitation post-stroke and establish tDCS as a clinically viable rehabilitative tool. Recovery of motor skills may take many months to acquire and therefore strategies that have the potential to enhance acquisition of skill are of practical and scientific interest.

Official Title
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Functional Interest of Non Invasive Brain Stimulation During Physiotherapy at a Subacute Phase Post Stroke (Anodal Protocol).

Conditions
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Stroke

Intervention / Treatment
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* Device: anodal tDCS (device) Eldith DC-Stimulator
* Device: Sham tDCS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All subjects must be between the ages of 18-90 and must not be pregnant. Patients volunteer to participate in the study, with a written informed consent signed Affiliation to a national health insurance program First-time clinical ischemic or hemorrhagic cerebrovascular accident - evidenced by a radiological (or physician's) report Contralesional motor deficit Lesion sparing primary motor cortex Stroke onset >1 month and <6 months prior to study enrollment Exclusion Criteria: Coexistent major neurological or psychiatric disease as to decrease number of confounders History of epilepsy before stroke (or episodes of seizures within the last six months) Any substantial decrease in alertness, language reception, or attention that might interfere with understanding instructions for motor testing Subjects with global aphasia and deficits of comprehension Excessive pain in any joint of the paretic extremity (VAS>4) Contraindications to Tdcs : metal in the head, implanted brain medical devices Coexistent major neurological or psychiatric disease as to decrease number of confounders A history of significant alcohol or drug abuse in the prior 6 months Anyone who is currently taking or who has taken anti-malarial treatment in the last 72 hours Subjects may not have already received constraint induced motor therapy and/or tDCS treatment for stroke Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 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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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Sham tDCS and motor training: sham comparator<br>Participants will receive sham tDCS over the primary motor cortex of the ipsilesional hemisphere during 20 minutes of motor training (10 consecutive sessions Monday-Friday during two weeks). Intervention: placebo tDCS Other: Motor Training | Device: Sham tDCS<br>* Participants will receive sham tDCS over the primary motor cortex of the ipsilesional hemisphere during 20 minutes of motor training (10 consecutive sessions Monday-Friday during two weeks).<br>|
| Experimental: Anodal tDCS and motor training: experimental<br>Participants will receive anodal tDCS over the primary motor cortex of the ipsilesional hemisphere. The following parameters will be used: stimulation intensity of 1mA during 20 minutes of motor training (10 consecutive sessions Monday-Friday during two weeks). Interventions: Device: anodal tDCS Other: motor Training during physiotherapy | Device: anodal tDCS (device) Eldith DC-Stimulator<br>* tDCS applied to the motor cortex every day of two consecutive weeks (10 sessions) at 1 mA during 20 minutes. Conductive rubber covered by sponges soaked in saline will be used, held in place by a band. The current will be gradually increased over 100 seconds.<br>* Other names: Eldith DC-Stimulator (CE certified);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fugl Meyer Assessment (Upper extremity) of motor recovery following stroke | Main primary outcome is change in score between the baseline session score and day 32. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional independence scale (MIF) | We are looking for a change in scores between the baseline session score, and those collected during each follow-up session. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 
| Motor Activity Log (MAL) | We are looking for a change in scores between the baseline session score, and those collected during each follow-up session. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 
| Jebsen Taylor Hand function test (JTT) | We are looking for a change in scores between the baseline session score, and those collected during each follow-up session. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 
| Box and block test (BBT) | We are looking for a change in scores between the baseline session score, and those collected during each follow-up session. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 
| Modified Ashworth Scale | We are looking for a change in scores between the baseline session score, and those collected during each follow-up session. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 
| Testing motor MRC | We are looking for a change in scores between the baseline session score, and those collected during each follow-up session. | assessed at one baseline session (day 4), and then again immediately following the last day of the intervention (day 18), 2 weeks (day 32), 1 month, 3 months and 6 months later. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke, transcranial direct current stimulation (tDCS), motor function