A Closed Loop Neural Activity Triggered Stroke Rehabilitation Device

NCT ID: NCT02098265

Last Updated: 2025-05-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

288 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-06-30

Study Completion Date

2026-06-30

Brief Summary

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The purpose of this research is to determine if two non-invasive brain stimulation techniques, muscle stimulation of the arm and neuro-stimulation through the tongue, can increase the extent of stroke recovery.

Detailed Description

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The aim of this study is to determine if functional muscle stimulation, in addition to non-invasive neurostimulation through the tongue (TDU), directed by electroencephalogram (EEG) output, can increase the extent of stroke recovery on behavioral measures and induce brain plasticity as measured by functional magnetic resonance imaging (fMRI).

Adult stroke patients with upper extremity motor impairments (henceforth "experimental group"), healthy controls, and participants with risk factors for stroke, without upper extremity impairment (allowing them to serve as controls for patients with upper extremity impairments (henceforth "control group")), will be recruited in this study. Half of the participants in the experimental group will be randomly assigned to the EEG-BCI (brain-computer interface) training ("closed-loop") group and will receive training on the BCI task along with muscle and tongue stimulation. The other half of the participants in the experimental group receiving traditional rehab will not receive any kind of FES or tongue stimulation for the first 8-10 weeks of study period and then will start receiving BCI-FES-tongue stimulation rehab therapy.

All participants without UE impairment in Control group 1 will receive 4-6 (minimum 4, up to a maximum of 6) sessions of training on the BCI system and pre- and post MRI and 2 behavioral testing sessions.

Addition of a Control group 2 is consistent with the AHA grants - Twenty four ischemic stroke patients with moderate upper extremity (dominant right hand affected) impairment (score of 1 or 2 on the motor sub-component of the NIH stroke scale (NIHSS) and ARAT score 20-45); no upper extremity injury or conditions that limited use prior to the stroke; and pre-stroke independence with a Modified Rankin Score of 0 or 1), will be recruited in this arm. All participants in this group will receive MR sessions and behavioral testing similar to the Experimental group.

Addition of an Experimental group receiving EEG-BCI-bilateral FES intervention using the recoveriX system: recoveriX is a brain driven rehabilitation system for stroke patients that pairs mental activities with motor functions. Through the EEG-based recoveriX BCI system, the brain receives visual and tactile feedback in real-time, making rehabilitation more effective. A stroke patient imagines a hand movement while receiving visual feedback through a virtual avatar, and tactile feedback through electrical muscle stimulation paired to the patient's imagined movement, with the aim that these patients might regain the volitional ability to grasp following therapy. Unlike the current EEG-BCI-FES intervention that involves stimulation of only the impaired arm, with recoveriX, both arms are simultaneously stimulated during the course of the intervention.

Specific Aims

To determine if functional muscle stimulation of the arms, in addition to non-invasive neurostimulation through the tongue (TDU), directed by electroencephalogram (EEG) output, can increase the extent of stroke recovery as measured by behavioral measures and induce brain plasticity as measured by functional magnetic resonance imaging (fMRI).

Primary objective

* To examine the effect of EEG guided functional muscle stimulation on improvement in upper extremity function

Secondary objective

* To examine plasticity changes as measured by EEG/fMRI measures before and after EEG guided functional muscle stimulation.

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Experimental Group - Immediate BCI Therapy

EEG - BCI training (closed loop)

Group Type EXPERIMENTAL

Behavioral Assessments

Intervention Type BEHAVIORAL

These assessments will include measures of upper extremity motor assessments, standard stroke scales, and measures of activities of daily living.

Magnetic Resonance Imaging

Intervention Type OTHER

A functional magnetic resonance image will be collected.

EEG

Intervention Type OTHER

EEG electrodes will be attached to the participant's scalp using a standard, commercially available electrode cap. Proper electrode placement is made according to the international 10-20 system, ensuring complete electrode coverage over sensorimotor cortex.

BCI-FES

Intervention Type DEVICE

Experimental Group - Delayed BCI Therapy

Scanned and tested 4 times over a 10-week period before EEG-BCI training

Group Type EXPERIMENTAL

Behavioral Assessments

Intervention Type BEHAVIORAL

These assessments will include measures of upper extremity motor assessments, standard stroke scales, and measures of activities of daily living.

Magnetic Resonance Imaging

Intervention Type OTHER

A functional magnetic resonance image will be collected.

EEG

Intervention Type OTHER

EEG electrodes will be attached to the participant's scalp using a standard, commercially available electrode cap. Proper electrode placement is made according to the international 10-20 system, ensuring complete electrode coverage over sensorimotor cortex.

Delay

Intervention Type OTHER

10 week delay before intervention

BCI-FES

Intervention Type DEVICE

Experimental Group - RecoveriX

Recruited from participants who have completed the study intervention

Group Type EXPERIMENTAL

RecoveriX

Intervention Type OTHER

RecoveriX is a brain driven rehabilitation system for stroke patients that pairs mental activities with motor functions.

Control Group 1

48 stroke patients, 48 participants with risk factors for stroke, 48 healthy controls receiving 4-6 training sessions on the EEG-BCI, pre- and post- behavioral testing, and MRI

Group Type ACTIVE_COMPARATOR

Behavioral Assessments

Intervention Type BEHAVIORAL

These assessments will include measures of upper extremity motor assessments, standard stroke scales, and measures of activities of daily living.

Magnetic Resonance Imaging

Intervention Type OTHER

A functional magnetic resonance image will be collected.

EEG

Intervention Type OTHER

EEG electrodes will be attached to the participant's scalp using a standard, commercially available electrode cap. Proper electrode placement is made according to the international 10-20 system, ensuring complete electrode coverage over sensorimotor cortex.

BCI-FES

Intervention Type DEVICE

Control Group 2

24 Stroke Patients with UE impairment receiving standard FES only therapy

Group Type ACTIVE_COMPARATOR

Functional Electric Stimulation (FES)

Intervention Type DEVICE

FES uses low energy electrical pulses to artificially generate body movements in individuals with muscle paralysis. FES can be used to generate muscle contraction in otherwise paralyzed limbs to restore function.

Interventions

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Functional Electric Stimulation (FES)

FES uses low energy electrical pulses to artificially generate body movements in individuals with muscle paralysis. FES can be used to generate muscle contraction in otherwise paralyzed limbs to restore function.

Intervention Type DEVICE

Behavioral Assessments

These assessments will include measures of upper extremity motor assessments, standard stroke scales, and measures of activities of daily living.

Intervention Type BEHAVIORAL

Magnetic Resonance Imaging

A functional magnetic resonance image will be collected.

Intervention Type OTHER

EEG

EEG electrodes will be attached to the participant's scalp using a standard, commercially available electrode cap. Proper electrode placement is made according to the international 10-20 system, ensuring complete electrode coverage over sensorimotor cortex.

Intervention Type OTHER

RecoveriX

RecoveriX is a brain driven rehabilitation system for stroke patients that pairs mental activities with motor functions.

Intervention Type OTHER

Delay

10 week delay before intervention

Intervention Type OTHER

BCI-FES

Intervention Type DEVICE

Other Intervention Names

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Electroencephalography

Eligibility Criteria

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Inclusion Criteria

* Stroke patients with persistent upper extremity (UE) deficits


* Stroke patients without UE impairments
* Participants with risk factors for stroke
* healthy controls

* No known neurologic, psychiatric or developmental disability


* Stroke patients with persistent upper extremity (UE) deficits
* Moderate upper extremity (dominant right hand affected) impairment (score of 1 or 2 on the motor sub-component of the NIH stroke scale (NIHSS) and ARAT score 20-45)
* No upper extremity injury or conditions that limited use prior to the stroke
* Pre-stroke independence with a Modified Rankin Score of 0 or 1, for the standard FES only intervention.

Exclusion Criteria

* Allergic to electrode gel, surgical tape and metals
* Participants under treatment for infectious diseases or having apparent oral lesions or inflammation will be excluded from the study
* Women who are pregnant or may become pregnant during the course of the study will be excluded
* Participants with contraindications for MRI will be offered the opportunity to participate in the interventions study only (e.g. EEG-BCI-FES and behavioral testing)


* Contraindications for MRI
* Allergic to electrode gel, surgical tape, and metals.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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American Heart Association

OTHER

Sponsor Role collaborator

University of Wisconsin, Madison

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Vivek Prabhakaran, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Wisconsin, Madison

Locations

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University of Wisconsin

Madison, Wisconsin, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Radiology Studies

Role: CONTACT

608-282-8349

Facility Contacts

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Veena Nair, PhD

Role: primary

608-265-5269

References

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Young BM, Stamm JM, Song J, Remsik AB, Nair VA, Tyler ME, Edwards DF, Caldera K, Sattin JA, Williams JC, Prabhakaran V. Brain-Computer Interface Training after Stroke Affects Patterns of Brain-Behavior Relationships in Corticospinal Motor Fibers. Front Hum Neurosci. 2016 Sep 16;10:457. doi: 10.3389/fnhum.2016.00457. eCollection 2016.

Reference Type RESULT
PMID: 27695404 (View on PubMed)

Young BM, Nigogosyan Z, Walton LM, Remsik A, Song J, Nair VA, Tyler ME, Edwards DF, Caldera K, Sattin JA, Williams JC, Prabhakaran V. Dose-response relationships using brain-computer interface technology impact stroke rehabilitation. Front Hum Neurosci. 2015 Jun 23;9:361. doi: 10.3389/fnhum.2015.00361. eCollection 2015.

Reference Type RESULT
PMID: 26157378 (View on PubMed)

Song J, Nair VA, Young BM, Walton LM, Nigogosyan Z, Remsik A, Tyler ME, Farrar-Edwards D, Caldera KE, Sattin JA, Williams JC, Prabhakaran V. DTI measures track and predict motor function outcomes in stroke rehabilitation utilizing BCI technology. Front Hum Neurosci. 2015 Apr 27;9:195. doi: 10.3389/fnhum.2015.00195. eCollection 2015.

Reference Type RESULT
PMID: 25964753 (View on PubMed)

Song J, Young BM, Nigogosyan Z, Walton LM, Nair VA, Grogan SW, Tyler ME, Farrar-Edwards D, Caldera KE, Sattin JA, Williams JC, Prabhakaran V. Characterizing relationships of DTI, fMRI, and motor recovery in stroke rehabilitation utilizing brain-computer interface technology. Front Neuroeng. 2014 Jul 29;7:31. doi: 10.3389/fneng.2014.00031. eCollection 2014.

Reference Type RESULT
PMID: 25120466 (View on PubMed)

Young BM, Nigogosyan Z, Nair VA, Walton LM, Song J, Tyler ME, Edwards DF, Caldera K, Sattin JA, Williams JC, Prabhakaran V. Case report: post-stroke interventional BCI rehabilitation in an individual with preexisting sensorineural disability. Front Neuroeng. 2014 Jun 24;7:18. doi: 10.3389/fneng.2014.00018. eCollection 2014.

Reference Type RESULT
PMID: 25009491 (View on PubMed)

Remsik AB, Williams L Jr, Gjini K, Dodd K, Thoma J, Jacobson T, Walczak M, McMillan M, Rajan S, Young BM, Nigogosyan Z, Advani H, Mohanty R, Tellapragada N, Allen J, Mazrooyisebdani M, Walton LM, van Kan PLE, Kang TJ, Sattin JA, Nair VA, Edwards DF, Williams JC, Prabhakaran V. Ipsilesional Mu Rhythm Desynchronization and Changes in Motor Behavior Following Post Stroke BCI Intervention for Motor Rehabilitation. Front Neurosci. 2019 Mar 6;13:53. doi: 10.3389/fnins.2019.00053. eCollection 2019.

Reference Type DERIVED
PMID: 30899211 (View on PubMed)

Remsik AB, Dodd K, Williams L Jr, Thoma J, Jacobson T, Allen JD, Advani H, Mohanty R, McMillan M, Rajan S, Walczak M, Young BM, Nigogosyan Z, Rivera CA, Mazrooyisebdani M, Tellapragada N, Walton LM, Gjini K, van Kan PLE, Kang TJ, Sattin JA, Nair VA, Edwards DF, Williams JC, Prabhakaran V. Behavioral Outcomes Following Brain-Computer Interface Intervention for Upper Extremity Rehabilitation in Stroke: A Randomized Controlled Trial. Front Neurosci. 2018 Nov 8;12:752. doi: 10.3389/fnins.2018.00752. eCollection 2018.

Reference Type DERIVED
PMID: 30467461 (View on PubMed)

Related Links

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025476/

Publication resulting from this work.

https://www.ncbi.nlm.nih.gov/pubmed/26157378

Publication resulting from this work.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410488/

Publication resulting from this work.

https://www.ncbi.nlm.nih.gov/pubmed/25120466

Publication resulting from this work.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067954/

Publication resulting from this work.

Other Identifiers

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A539300

Identifier Type: OTHER

Identifier Source: secondary_id

SMPH/RADIOLOGY

Identifier Type: OTHER

Identifier Source: secondary_id

15GRNT25780033

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

Protocol Version 2/1/22

Identifier Type: OTHER

Identifier Source: secondary_id

2015-0469

Identifier Type: -

Identifier Source: org_study_id

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