Wireless Nerve Stimulation Device To Enhance Recovery After Stroke
NCT ID: NCT04534556
Last Updated: 2024-07-26
Study Results
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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UNKNOWN
NA
30 participants
INTERVENTIONAL
2021-09-01
2025-01-31
Brief Summary
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
CROSSOVER
DEVICE_FEASIBILITY
TRIPLE
Study Groups
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Immediate Start Vagus Nerve Stimulation group
The Immediate Start VNS group will receive rehabilitation and active stimulation for 18 in-office sessions over the course of approximately six weeks during Phase 1. For Phase 2, all subjects will be provided with the option to participate in an open-label extension consisting of an additional 18 sessions of in-office rehabilitation with active VNS over the course of approximately six weeks. Additionally, participants may be provided with a system of rehabilitative devices to utilize at home.
Active Vagus Nerve Stimulation
Stimulation of the vagus nerve that is paired with upper limb rehabilitation. VNS stimulation as described in the current study consists of 0.5 second trains of 0.8 mA; 100 µsec biphasic pulses at 30 Hz. Stimulation trains are delivered only during rehabilitation.
Delayed Start Vagus Nerve Stimulation group
The Delayed Start VNS group will receive equivalent rehabilitation with placebo stimulation for 18 in-office sessions over the course of approximately six weeks during Phase 1. For Phase 2, all subjects will be provided with the option to participate in an open-label extension consisting of an additional 18 sessions of in-office rehabilitation with active VNS over the course of approximately six weeks. Additionally, participants may be provided with a system of rehabilitative devices to utilize at home.
Placebo Vagus Nerve Stimulation
During Phase 1 of the study, the placebo group will receive a minimal amount of stimulation that fails to sufficiently activate the nerve, unknown to the participant and therapists. All participants will receive active stimulation during the Phase 2 open-label portion of the study.
Interventions
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Active Vagus Nerve Stimulation
Stimulation of the vagus nerve that is paired with upper limb rehabilitation. VNS stimulation as described in the current study consists of 0.5 second trains of 0.8 mA; 100 µsec biphasic pulses at 30 Hz. Stimulation trains are delivered only during rehabilitation.
Placebo Vagus Nerve Stimulation
During Phase 1 of the study, the placebo group will receive a minimal amount of stimulation that fails to sufficiently activate the nerve, unknown to the participant and therapists. All participants will receive active stimulation during the Phase 2 open-label portion of the study.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Provision of signed and dated informed consent form
* Stated willingness to comply with all study procedures and availability for the duration of the study
* Adult, aged 22-79
* Ischemic or hemorrhagic stroke that occurred ≥ 12 months prior to enrollment
* UEFM score of 20 to 50
* Modified Rankin Score of 2, 3, or 4
* Right vocal cord has normal movement when assessed by laryngoscopy
* Women of reproductive potential must use contraceptive protection
* Meets all clinical criteria for the surgical VNS implantation as determined by the PI, surgeon, and anesthesiologist
Exclusion Criteria
* Deficits in language or attention that interfere with study participation
* Severe spasticity (Modified Ashworth ≥ 3)
* Medical or mental instability that would likely interfere with study protocol
* Receiving any therapy (medication or otherwise) that would interfere with VNS, such as drugs that perturb neurotransmitter action (anticholinergics, adrenergic blockers, etc.)
* Presence of any other implanted electrical stimulation device
* Prior injury to vagus nerve
* Lactating, pregnant, or plan to become pregnant
* Participation in another interventional clinical trial
* Clinical complications that hinder or contraindicate the surgical procedure
* Abusive use of alcohol and/or illegal substances use
* Participants with sickle cell, lupus, clotting disorders or active neoplastic disease.
* Participants with any any medical condition or other circumstances that might interfere with their ability to return for follow-up visits in the judgment of the Investigator.
* Any condition which, in the judgment of the Investigator, would preclude adequate evaluation of device's safety and performance.
* Recent history of syncope
* Recent history of dysphagia
* Current or anticipated requirement for diathermy
* Uncontrolled hypertension
* Diagnosed with Cerebral amyloid angiopathy
22 Years
79 Years
ALL
No
Sponsors
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The University of Texas at Dallas
OTHER
University of Texas Southwestern Medical Center
OTHER
National Institute of Neurological Disorders and Stroke (NINDS)
NIH
Baylor Research Institute
OTHER
Responsible Party
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Principal Investigators
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Michael Kilgard, PhD
Role: PRINCIPAL_INVESTIGATOR
University of Texas at Dallas
Robert Rennaker, PhD
Role: PRINCIPAL_INVESTIGATOR
University of Texas at Dallas
Seth Hays, PhD
Role: STUDY_DIRECTOR
University of Texas at Dallas
Jane Wigginton, MD
Role: PRINCIPAL_INVESTIGATOR
University of Texas Southwestern Medical Center
Rita Hamilton, DO
Role: PRINCIPAL_INVESTIGATOR
Baylor Scott & White Institute for Rehabilitation
Michael Foreman, MD, FACS
Role: STUDY_DIRECTOR
Baylor Health Care System
Richard Naftalis, MD, FAANS, FACS
Role: STUDY_DIRECTOR
Baylor Health Care System
Mark Powers, PhD
Role: STUDY_DIRECTOR
Baylor Health Care System
Ann Marie Warren, PhD
Role: STUDY_DIRECTOR
Baylor Health Care System
Locations
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Baylor Scott & White Institute for Rehabilitation
Dallas, Texas, United States
Countries
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Central Contacts
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Facility Contacts
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References
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Engineer ND, Kimberley TJ, Prudente CN, Dawson J, Tarver WB, Hays SA. Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke. Front Neurosci. 2019 Mar 29;13:280. doi: 10.3389/fnins.2019.00280. eCollection 2019.
Khodaparast N, Hays SA, Sloan AM, Hulsey DR, Ruiz A, Pantoja M, Rennaker RL 2nd, Kilgard MP. Vagus nerve stimulation during rehabilitative training improves forelimb strength following ischemic stroke. Neurobiol Dis. 2013 Dec;60:80-8. doi: 10.1016/j.nbd.2013.08.002. Epub 2013 Aug 15.
Khodaparast N, Hays SA, Sloan AM, Fayyaz T, Hulsey DR, Rennaker RL 2nd, Kilgard MP. Vagus nerve stimulation delivered during motor rehabilitation improves recovery in a rat model of stroke. Neurorehabil Neural Repair. 2014 Sep;28(7):698-706. doi: 10.1177/1545968314521006. Epub 2014 Feb 18.
Hays SA, Khodaparast N, Ruiz A, Sloan AM, Hulsey DR, Rennaker RL 2nd, Kilgard MP. The timing and amount of vagus nerve stimulation during rehabilitative training affect poststroke recovery of forelimb strength. Neuroreport. 2014 Jun 18;25(9):676-82. doi: 10.1097/WNR.0000000000000154.
Hays SA, Khodaparast N, Hulsey DR, Ruiz A, Sloan AM, Rennaker RL 2nd, Kilgard MP. Vagus nerve stimulation during rehabilitative training improves functional recovery after intracerebral hemorrhage. Stroke. 2014 Oct;45(10):3097-100. doi: 10.1161/STROKEAHA.114.006654. Epub 2014 Aug 21.
Hays SA, Ruiz A, Bethea T, Khodaparast N, Carmel JB, Rennaker RL 2nd, Kilgard MP. Vagus nerve stimulation during rehabilitative training enhances recovery of forelimb function after ischemic stroke in aged rats. Neurobiol Aging. 2016 Jul;43:111-8. doi: 10.1016/j.neurobiolaging.2016.03.030. Epub 2016 Apr 7.
Khodaparast N, Kilgard MP, Casavant R, Ruiz A, Qureshi I, Ganzer PD, Rennaker RL 2nd, Hays SA. Vagus Nerve Stimulation During Rehabilitative Training Improves Forelimb Recovery After Chronic Ischemic Stroke in Rats. Neurorehabil Neural Repair. 2016 Aug;30(7):676-84. doi: 10.1177/1545968315616494. Epub 2015 Nov 4.
Pruitt DT, Schmid AN, Kim LJ, Abe CM, Trieu JL, Choua C, Hays SA, Kilgard MP, Rennaker RL. Vagus Nerve Stimulation Delivered with Motor Training Enhances Recovery of Function after Traumatic Brain Injury. J Neurotrauma. 2016 May 1;33(9):871-9. doi: 10.1089/neu.2015.3972. Epub 2015 Aug 5.
Ganzer PD, Darrow MJ, Meyers EC, Solorzano BR, Ruiz AD, Robertson NM, Adcock KS, James JT, Jeong HS, Becker AM, Goldberg MP, Pruitt DT, Hays SA, Kilgard MP, Rennaker RL 2nd. Closed-loop neuromodulation restores network connectivity and motor control after spinal cord injury. Elife. 2018 Mar 13;7:e32058. doi: 10.7554/eLife.32058.
Meyers EC, Solorzano BR, James J, Ganzer PD, Lai ES, Rennaker RL 2nd, Kilgard MP, Hays SA. Vagus Nerve Stimulation Enhances Stable Plasticity and Generalization of Stroke Recovery. Stroke. 2018 Mar;49(3):710-717. doi: 10.1161/STROKEAHA.117.019202. Epub 2018 Jan 25.
Engineer ND, Riley JR, Seale JD, Vrana WA, Shetake JA, Sudanagunta SP, Borland MS, Kilgard MP. Reversing pathological neural activity using targeted plasticity. Nature. 2011 Feb 3;470(7332):101-4. doi: 10.1038/nature09656. Epub 2011 Jan 12.
Kimberley TJ, Pierce D, Prudente CN, Francisco GE, Yozbatiran N, Smith P, Tarver B, Engineer ND, Alexander Dickie D, Kline DK, Wigginton JG, Cramer SC, Dawson J. Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke. Stroke. 2018 Nov;49(11):2789-2792. doi: 10.1161/STROKEAHA.118.022279.
Dawson J, Pierce D, Dixit A, Kimberley TJ, Robertson M, Tarver B, Hilmi O, McLean J, Forbes K, Kilgard MP, Rennaker RL, Cramer SC, Walters M, Engineer N. Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke. Stroke. 2016 Jan;47(1):143-50. doi: 10.1161/STROKEAHA.115.010477. Epub 2015 Dec 8.
Kilgard MP, Rennaker RL, Alexander J, Dawson J. Vagus nerve stimulation paired with tactile training improved sensory function in a chronic stroke patient. NeuroRehabilitation. 2018;42(2):159-165. doi: 10.3233/NRE-172273.
Darrow MJ, Mian TM, Torres M, Haider Z, Danaphongse T, Rennaker RL Jr, Kilgard MP, Hays SA. Restoration of Somatosensory Function by Pairing Vagus Nerve Stimulation with Tactile Rehabilitation. Ann Neurol. 2020 Feb;87(2):194-205. doi: 10.1002/ana.25664. Epub 2020 Jan 7.
Meyers EC, Kasliwal N, Solorzano BR, Lai E, Bendale G, Berry A, Ganzer PD, Romero-Ortega M, Rennaker RL 2nd, Kilgard MP, Hays SA. Enhancing plasticity in central networks improves motor and sensory recovery after nerve damage. Nat Commun. 2019 Dec 19;10(1):5782. doi: 10.1038/s41467-019-13695-0.
Darrow MJ, Torres M, Sosa MJ, Danaphongse TT, Haider Z, Rennaker RL, Kilgard MP, Hays SA. Vagus Nerve Stimulation Paired With Rehabilitative Training Enhances Motor Recovery After Bilateral Spinal Cord Injury to Cervical Forelimb Motor Pools. Neurorehabil Neural Repair. 2020 Mar;34(3):200-209. doi: 10.1177/1545968319895480. Epub 2020 Jan 22.
Heck C, Helmers SL, DeGiorgio CM. Vagus nerve stimulation therapy, epilepsy, and device parameters: scientific basis and recommendations for use. Neurology. 2002 Sep 24;59(6 Suppl 4):S31-7. doi: 10.1212/wnl.59.6_suppl_4.s31.
Agnew WF, McCreery DB, Yuen TG, Bullara LA. Histologic and physiologic evaluation of electrically stimulated peripheral nerve: considerations for the selection of parameters. Ann Biomed Eng. 1989;17(1):39-60. doi: 10.1007/BF02364272.
Hays SA, Adehunoluwa EA, Epperson JD, Malley KM, Porter A, Gallaway HL, Swank C, Carrera AJ, Stevens C, Gillespie J, Arnold D, Kian S, Bynum ZS, Meyers EC, Bleker N, Naftalis RC, Foreman ML, Hamilton R, Rennaker RL, Kilgard MP, Wigginton JG. Closed-Loop Vagus Nerve Stimulation Delivered With a Miniaturized System Produces Lasting Recovery in Individuals With Chronic Stroke. Stroke. 2025 Oct 7. doi: 10.1161/STROKEAHA.125.052937. Online ahead of print.
Other Identifiers
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020-392
Identifier Type: -
Identifier Source: org_study_id
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