Cortical Enhancement of Posture, Movement Planning, and Execution of Upright Reaching Following Stroke

NCT ID: NCT04308629

Last Updated: 2020-03-16

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 10 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-10-01
• Study Completion Date: 2017-10-30

Brief Summary

Stroke is the leading cause of disability and diminished quality of living that frequently includes impairments of postural control and upper extremity (UE) function. The interaction of posture and UE coupling in terms of movement planning, initiation, and execution is not well understood. StartReact responses triggered by a loud acoustic stimulus (LAS) during the planning and preparation of goal intended actions has been used to probe the state of brainstem neuronal excitability related to posture and movement sequencing. The purpose of this study is to examine posture and goal-directed movement planning and execution using startReact responses and to evaluate posture and UE movement sequence during reaching while standing in individuals with chronic hemiparesis and healthy controls. Secondly, the investigators will determine the modulatory role of the cortical premotor areas (PMAs) in startReact responses in healthy controls and in persons with stroke by using transcranial direct current stimulation (tDCS) to up- or down-regulate PMAs excitability.

Conditions

Stroke; Upper Extremity Paresis

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

tDCS over PMAs

One session of transcranial direct current stimulation (tDCS) over premotor areas (PMAs)

Group Type: EXPERIMENTAL

Transcranial direct current stimulation

Intervention Type: OTHER

tDCS over M1

One session of transcranial direct current stimulation (tDCS) over primary motor area (M1)

Group Type: ACTIVE_COMPARATOR

Transcranial direct current stimulation

Intervention Type: OTHER

Interventions

Transcranial direct current stimulation

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Unilateral cortical or white matter subcortical stroke
• Age 40 yrs and older
• ≥ 6 months post ischemic stroke or ≥ 12 months post hemorrhagic stroke
• Residual arm hemiparesis as indicated by Fugl-Meyer Upper Extremity score between 20-65
• Having the ability to perform reaching movements with the paretic arm in standing without an assistive device.

• Age-matched to the stroke subjects
• Without a history of stroke or any known neurological conditions
• Having the cognitive ability to follow two-step commands and give informed consent

Exclusion Criteria

• Stroke involving bilateral hemisphere, brainstem or cerebellum
• Any medical condition precluding participation in testing
• Other health conditions affecting balance and upper extremity movement function beyond the effects of stroke.

• Any medical condition precluding participation in testing
• Other health conditions affecting balance and upper extremity movement function beyond the effects of stroke.

Participants were also excluded if they did not meet the TMS safety criterion including having implantable medical devices, history of seizures, taking medications to reduce anxiety, sedatives, and seizure, and pregnancy.

• Minimum Eligible Age: 40 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

University of Maryland, Baltimore

OTHER

Sponsor Role: lead

Responsible Party

Sandy McCombe Waller

Principle Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

References

Yang CL, Gad A, Creath RA, Magder L, Rogers MW, Waller SM. Effects of transcranial direct current stimulation (tDCS) on posture, movement planning, and execution during standing voluntary reach following stroke. J Neuroeng Rehabil. 2021 Jan 7;18(1):5. doi: 10.1186/s12984-020-00799-8.

Reference Type: DERIVED

PMID: 33413441 (View on PubMed)

Other Identifiers

HP-00064894

Identifier Type: -

Identifier Source: org_study_id