Epidural Electrical Stimulation for Stroke Patients - Improve Motor and Sensory Function and Alleviate Pain

Study Overview
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Brief Summary
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This study aims to verify whether epidural electrical stimulation (EES) of the cervical spinal cord can activate muscles of the upper limbs in people with hemiplegia following a stroke.

Detailed Description
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The purpose of this study is to verify whether epidural electrical stimulation (EES) of the cervical spinal cord can activate muscles of the arm and hand in people with hemiplegia following stroke. Participants will undergo a surgical procedure to implant a system that provides epidural electrical stimulation (EES) of the cervical spinal cord. After surgery, Participants will undergo a structured physical rehabilitation program and electrical stimulation. Researchers will quantify the motor potentials in the arm and hand muscles generated by EES of the cervical spinal cord, tune optimal stimulation parameters to induced arm and hand movement, and assess participant motor function of the upper limb with standard clinical tests and simple motor tasks.

Official Title
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Epidural Electrical Stimulation for Stroke Patients - Improve Motor and Sensory Function and Alleviate Pain

Conditions
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Stroke

Intervention / Treatment
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* Device: Epidural electrical stimulation (EES)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between 20 and 70 years of age First-ever clinical manifest stroke Right or left hemiparesis Scores higher than 7 and lower than 45 on the Fugl-Meyer scale. Expected will undergo spinal cord stimulation surgery. Able to comply with procedures and follow up. Stable medical condition without cardiopulmonary disease or dysautonomia that would contraindicate participation in upper extremity rehabilitation or testing activities. Exclusion Criteria: Pregnancy or breast feeding. Have Major depressive disorder. Had a mental illness within one year or been treated in the past. Have significant cognitive impairment (MMSE<24) or serious disease that could affect the ability to participate in study activities. Cardiovascular or musculoskeletal disease or injury that would prevent full participation in physical therapy intervention. Receiving anticoagulant, anti-spasticity or anti-epileptic medications prior to or throughout the duration of the study. Unable to read and/or comprehend the consent form. Have concerns about this trial and do not sign consent. Presence of joint contractures deemed by study clinician/investigator to be too severe to participate in study activities.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 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
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Epidural electrical stimulation (EES)<br>Subjects will be implanted with 16-electrode epidural array in the C6-T1 area of the spinal cord. After surgery, subjects will undergo a structured program of physical rehabilitation and electrical stimulation. | Device: Epidural electrical stimulation (EES)<br>* Subjects will undergo a surgical procedure to implant a system that provides epidural electrical stimulation (EES) of the cervical spinal cord. After surgery, subjects will undergo a structured physical rehabilitation program and electrical stimulation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in motor functioning and sensation as measured by the Fugl-Meyer Assessment (FMA) | The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index. It is main assesses motor functioning and sensation in patients with post-stroke hemiplegia. It is applied clinically and in research to determine disease severity, describe motor recovery, and plan and assess treatment. The upper extremity motor function score ranges from 0 to 66. | Time Frame: Baseline; at 1 - 4 - 7 - 13 - 19 - 25 months after the implantation | 
| Change dexterity of the upper limb as measured by the Action Research Arm Test (ARAT) | Use the Action Research Arm Test (ARAT) assessment to quantify functional hand and arm dexterity. The score ranges from 0 to 57, with a higher value indicating better function. | Time Frame: Baseline; at 1 - 4 - 7 - 13 - 19 - 25 months after the implantation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Quality of Life (QOL) as measured by the World Health Organization Quality of Life (WHOQOL-BREF) | The WHOQOL-BREF is a self-administered questionnaire comprising 26 questions on the individual's perceptions of their health and well-being over the previous two weeks. Responses to questions are on a 1-5 Likert scale where 1 represents disagree or not at all and 5 represents completely agree or extremely. , The higher the score, the better the quality of life | Baseline; at 1 - 4 - 7 - 13 - 19 - 25 months after implantation | 
| Change in spasticity as measured by the Modified Ashworth Scale (MAS) | Quantify spasticity scores using the Modified Ashworth Scale (MAS) for the shoulder, elbow, and wrist. The muscle tension is divided into 0-4 grades. The lower the score, the closer to normal. The higher the score, the more severe the spasticity. | Time Frame: Baseline; at 1 - 4 - 7 - 13 - 19 - 25 months after the implantation |