Effects of Dual-transcranial Direct Current Stimulation During Physical Therapy in Sub-acute Stroke

Study Overview
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Brief Summary
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The aim of the present study is to evaluate the possible effect of using dual-tDCS applied during conventional physical therapy on lower limb function in stroke patients.

Detailed Description
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Recently dual-tDCS applied before the conventional physical therapy show positive effect of lower limb performance. However to explore the time during which dual-tDCS can be combined with physical therapy to maximize motor performance is required. Results from the present study with be compared with our previous study that used dual-tDCS applied before physical therapy.

Official Title
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Effects of Dual-transcranial Direct Current Stimulation During Physical Therapy in Sub-acute Stroke

Conditions
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Stroke

Intervention / Treatment
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* Device: Transcranial direct current stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age range 18-75 years. First ever-ischemic lesion in the territory of middle cerebral artery or anterior cerebral artery. CT scan/MRI result is thus required. Sub acute phase of stroke (less than 6 months) Able to sit-to-stand and stand-to-sit independently Able to walk without physical assistance at least 6 m Free of any neurological antecedent, unstable medical conditions or condition that may increase the risk of stimulation such as epilepsy Exclusion Criteria: Pre-stroke disability Pregnant Be unable to understand the instruction No clear neurological antecedent history or psychiatric disorder Excessive pain in any joint of the paretic limb (numerical pain rating score > 7) Presence of intracranial metal implantation, cochlea implant, or cardiac pacemaker Subjects are participating in the other protocol or receiving alternative treatment such as acupuncture

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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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Active tDCS & PT<br>Dual transcranial direct current stimulation (tDCS) will be applied over the leg motor area (M1) during the first 20 mins of conventional physical therapy (about 1 hours). Anodal on affected hemisphere, Cathodal on unaffected hemisphere. Current intensity is fixed at 2 mA and current will flow continuously during 20. Physical therapist will give an intervention program exactly the same in all cases. The scope of intervention is administered to improve strength of weakened and postural lower limbs muscles such as trunk muscles, hip flexors/extensors/abductors, knee flexors/extensors. | Device: Transcranial direct current stimulation<br>* Dual Active/sham tDCS will be applied over the leg motor area (M1) during the first 20 mins of conventional physical therapy. Anodal on affected hemisphere, Cathodal on unaffected hemisphere. Each participant will complete two experiments (active/sham tDCS). The interval between two experiments is at least 2 weeks. The two experiments will be performed in random order for each subject.<br>|
| Active Comparator: Sham tDCS & PT<br>Dual transcranial direct current stimulation (tDCS) will be applied over the leg motor area (M1) during the first 20 mins (sham mode) of conventional physical therapy (about 1 hours). Anodal on affected hemisphere, Cathodal on unaffected hemisphere. Physical therapist will give an intervention program exactly the same in all cases. The scope of intervention is administered to improve strength of weakened and postural lower limbs muscles such as trunk muscles, hip flexors/extensors/abductors, knee flexors/extensors. | Device: Transcranial direct current stimulation<br>* Dual Active/sham tDCS will be applied over the leg motor area (M1) during the first 20 mins of conventional physical therapy. Anodal on affected hemisphere, Cathodal on unaffected hemisphere. Each participant will complete two experiments (active/sham tDCS). The interval between two experiments is at least 2 weeks. The two experiments will be performed in random order for each subject.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Five-Times-Sit-To-Stand test (FTSST) | sling. Subjects will be instructed as the following I want you to stand up and sit down 5 times as quickly as you can when I say 'Go'. Subjects must be fully standing between repetitions. Timing will begin at GO and ends when the patient's buttocks touch the seat after the fifth sit-to-stand. | 5 minutes | 
| Timed Up & Go test (TUG) | Subjects will sits on the chair and place their back against the chair. Timing will begin at GO, the subjects will be asked to walk 3m, turn, walk back, and sit down. The stopwatch stops when the patient's buttocks touch the seat. | 5 minutes |