Transcranial Direct Current Stimulation for Improving Gait Training in Stroke

NCT ID: NCT01807637

Last Updated: 2018-12-11

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

6 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-03-01

Study Completion Date

2017-11-17

Brief Summary

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The purpose of this study is to determine if transcranial direct current stimulation (tDCS)applied over the lower extremity motor cortex in conjunction with assisted gait training is effective for improving gait in patients with chronic stroke.

Detailed Description

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Conditions

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Stroke Cerebral Vascular Accident

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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transcranial direct current stim

tDCS will be applied using a Soterix constant current stimulator with 5 x 5 cm (25cm2) carbon rubber electrodes (Covidien 664 REFX 2x2) applied to the scalp with 10-20 conductive paste. The anodal electrode will be placed over the lower extremity representation of primary motor cortex of the lesioned hemisphere \[established during TMS motor threshold testing (Baseline Testing) and the functional MRI assessment\]. The cathodal electrode will be placed over the contralateral motor cortex.

Group Type EXPERIMENTAL

transcranial direct current stim (tDCS)

Intervention Type DEVICE

During anodal tDCS, participants will receive 20 min at 2mA over motor cortex (with 30 seconds of ramp-up and ramp-down). During sham stimulation the stimulator is turned off.

sham tDCS

Sham stimulation will be performed by turning the stimulator off after the initial sensory experience (30 seconds).

Group Type PLACEBO_COMPARATOR

transcranial direct current stim (tDCS)

Intervention Type DEVICE

During anodal tDCS, participants will receive 20 min at 2mA over motor cortex (with 30 seconds of ramp-up and ramp-down). During sham stimulation the stimulator is turned off.

Interventions

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transcranial direct current stim (tDCS)

During anodal tDCS, participants will receive 20 min at 2mA over motor cortex (with 30 seconds of ramp-up and ramp-down). During sham stimulation the stimulator is turned off.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Stroke survivors \> 3 months from most recent unilateral, stroke based on clinically or experimentally obtained MRI brain scans and behavioral evidence of stroke (e.g., risk factors, hemiplegia, unilateral sensory impairment, or localized higher cortical dysfunction) by report or in the medical record.
* Age: \>21 years of age.
* Complete NIH Stroke Scale.
* Sufficient endurance, motor ability and balance to ambulate at least 10 meters continuously with moderate or less assistance.
* Demonstrate gait impairment during ambulation such that gait instability or inefficient gait patterns \[gait pattern manifesting "dragging" or "catching" of the affected toes during swing phase of gait, or use of compensatory strategies such as circumducting the affected limb, vaulting with the unaffected limb or hiking the affected hip to clear the toes\] are exhibited.
* Pass the Transcranial Magnetic Stimulation (TMS) Adult Safety Screen (TASS) except for items related specifically to stroke and the treatment for stroke.

Exclusion Criteria

* Edema, skin breakdown, absent sensation of the affected lower limb which interferes with the peroneal nerve stimulator.
* History of potentially fatal cardiac arrhythmias, such as ventricular tachycardia, supraventricular tachycardia, and rapid ventricular response atrial fibrillation with hemodynamic instability.
* Demand pacemakers or any other implanted electronic systems.
* Pregnant women, uncontrolled seizure disorder, Parkinson's Disease, Spinal cord injury, Traumatic brain injury with evidence of motor weakness, Multiple sclerosis.
* Documented episode in the medical record of a seizure occurring 1 month or more post stroke for which the patient received consultation or treatment for said seizures. Seizures occurring within the first month following a stroke are not exclusionary unless followed by another seizure.
* Fixed ankle plantar flexor contracture, peroneal nerve injury at the fibular head as the cause of foot-drop.
* History of dementia, severely impaired cognition, communication or comprehension deficits.
* Presence of severe or frequent headaches
* History of Botulinum toxin (Botox) injection to either of the lower extremities within the 3 month period preceding study entry.
* Have other medical conditions or are taking medications that compromise ambulation or balance.
* Failure to meet established screening criteria for TMS or tDCS (i.e., TASS)
* Principal Investigator's or Medical Monitor's discretion not to include a participant.


* Claustrophobia, or the inability to lie still in a confined space
* Major medical disorders (e.g., HIV, cancer)
* Medications which may affect image quality (e.g., water pills)
* Magnetic metallic implants (such as screws, pins, shrapnel remnants, aneurysm clips, artificial heart valves, inner ear (cochlear) implants, artificial joints, and vascular stents), as these may heat, pull, or twist in the strong magnetic field of the MRI scanner
* Non-removable dental implants, such as braces or permanent retainers, as these will distort the MRI images we collect (note: filings, crowns, and silver or gold teeth are OK)
* Permanent makeup or tattoos with metallic dyes
* A positive pregnancy test (for females), since the effect of strong magnetic fields on the developing fetus remains unknown and inconclusive. (We will conduct a pregnancy test for all female participants on the day of the MRI scan.)
* Psychotic disorders (e.g., schizophrenia)
* Any other condition that the investigator believes might put the participant at risk
Minimum Eligible Age

21 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Central Arkansas

OTHER

Sponsor Role collaborator

University of Arkansas

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Mark Mennemeier, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Arkansas

Locations

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University of Central Arkansas

Conway, Arkansas, United States

Site Status

University of Arkansas for Medical Sciences

Little Rock, Arkansas, United States

Site Status

Countries

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United States

References

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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. Cochrane Database Syst Rev. 2020 Nov 11;11(11):CD009645. doi: 10.1002/14651858.CD009645.pub4.

Reference Type DERIVED
PMID: 33175411 (View on PubMed)

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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138159

Identifier Type: OTHER

Identifier Source: secondary_id

138159

Identifier Type: -

Identifier Source: org_study_id