Music and Brain Stimulation for Upper Extremity Performance in Patients With Corticobasal Syndrome

NCT ID: NCT05073471

Last Updated: 2025-04-10

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

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-04-22

Study Completion Date

2026-06-30

Brief Summary

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This study is designed to investigate how musical patterns (e.g., patterned sensory enhancement, PSE) and non-invasive brain stimulation (e.g., transcranial direct current stimulation, tDCS) are effective to improve functional upper extremity performances in patients with corticobasal syndrome (CBS).

20 individuals with CBS will be randomly assigned to either PSE group (n= 10) or PSE+tDCS (n=10) group. Both interventions are 30 minutes long, twice a week for three weeks (a total of 6 sessions). Participants' self-reported and measurable outcomes including upper extremity function, kinematic quantities, quality of life, mood, cognitive level, and brain activity (e.g. electroencephalography, EEG) will be assessed in the baseline, pre- and post- each session, and follow-up phase.

This study seeks to assess the possibility that music-based intervention and non-invasive brain stimulation may improve outcomes in CBS patients for patients' non-invasive but cost-effective rehabilitation settings in the future.

Detailed Description

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Corticobasal syndrome (CBS) is a form of atypical Parkinsonian disorder that shares several features with Parkinson's disease (e.g., rigidity, tremor, and difficulties in balance and coordination). However, CBS additionally includes other motor and highly cortical features such as dyspraxia, dystonia, myoclonus, aphasia, sensory loss, and alien limb. Other features including abnormal eye movements, difficulties in objects recognition, and speech changes can also be revealed. The symptoms of CBS often appear in an asymmetric pattern that only shows on one side of the body. Imaging research has found that CBS is associated with brain atrophy in dorsal neocortical regions and basal ganglia. In particular, widespread frontoparietal cortex atrophy is exhibited in CBS. The frontoparietal network is known to orchestrate accurate, rapid, and goal-directed motor behaviors which are crucial performances in the daily life of humans.

Transcranial direct current stimulation (tDCS) is non-invasive neuromodulation that uses direct electrical currents to stimulate specific brain regions. This painless stimulation has been largely developed as a promising tool for depression, stroke, Parkinson's disease as well as other neuropsychological disorders. Specifically, tDCS over the frontoparietal area has enhanced processing speed and consolidation as well as upper extremity performances.

While tDCS has been applied to modulate a variety of cognitive and motor abilities, studies using tDCS in CBS patients are limited. To the best of the investigators' knowledge, two studies have been investigated on how tDCS modulation over the parietal cortex enhances the performance of an ideomotor apraxia test as well as action observation and representation in CBS. These studies provided potentials of using tDCS as a promising tool for linguistic and sensorimotor deficits in patients with CBS. Intriguingly, previous studies have suggested that tDCS combined with rehabilitative training can enhance motor outcomes. Furthermore, there is a need to better understand the mechanisms and effects of tDCS in real time in order to cater treatment protocols in a patient-specific manner. For this purpose, electroencephalography (EEG) has been proposed. EEG which measures brainwaves in milliseconds will be able to measure neurophysiological responses during tDCS modulation as well as rehabilitation intervention, such as music therapy.

Music has been extensively developed as a therapeutic medium to enhance and/or maintain functional skills based on scientific evidence in neurorehabilitation settings. In particular, the use of musical cueing to facilitate motor and cognitive performance has been widely studied. Patterned Sensory Enhancement (PSE) is one of the Neurologic Music Therapy (NMT) interventions to facilitate functional movement patterns and sequences by using tempo, meter, and rhythmic patterns. PSE translates movement patterns into musical patterns to provide spatial, temporal, and force cues. PSE has been employed to improve the functional motor abilities of individuals with stroke, cerebral palsy and Parkinson's disease.

Despite the importance of developing non-invasive but cost-effective interventions for CBS, neuro-rehabilitative effects associated with tDCS/EEG and PSE in this population have been less investigated. Therefore, the present study will investigate the effectiveness of PSE and PSE +tDCS on upper extremity performances in individuals with CBS, and EEG will be used to measure neurophysiological responses during sessions. Non-invasive and patient-oriented interventions may have a broad impact on CBS by improving the quality of functional upper extremity performance.

Conditions

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Corticobasal Syndrome Upper Extremity Dysfunction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants will be randomly assigned to either PSE or PSE+tDCS group. Following baseline assessment, participants in both groups will receive 30 minutes long, twice a week for 3 weeks. Assessments will be conducted before and after each session. Follow-up assessment will be administrated one month after the last session (6th session).
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors
Participants will be randomly assigned to either PSE or PSE+tDCS group. There will be double blinding for tDCS sessions. The research assistant who administrates tDCS modulation will be blinded to whether participants are receiving active (right or left) or sham tDCS. The participants will also be blinded to whether they receive active (right or left) vs. sham tDCS.

Outcomes assessors will also be blinded whether the participant receives active (right or left) or sham tDCS modulation.

Study Groups

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PSE Only

Participants will exercise their hands, arms, shoulders, and torso with musical cues provided by neurologic music therapist. A simple gross/fine movements and emotional level will be assessed before and after each session. During the session, participants will be measured their brainwaves using electroencephalography (EEG) to understand their neurophysiological responses. Participant's motion will be also captured to acquire kinematic quantities.

Group Type EXPERIMENTAL

Patterned Sensory Enhancement (PSE)

Intervention Type BEHAVIORAL

Patterned Sensory Enhancement (PSE) is one of Neurologic Music Therapy (NMT) techniques. NMT is a research-guided clinical model that is driven by advances in neuroscience and the understanding of the perception, production, and performance of music and how music can influence and change non-musical brain and behavior function.

PSE is a technique that uses the rhythmic, melodic, harmonic, and dynamic-acoustical elements of music to provide temporal, spatial, and. force cues for movements which reflect functional movements of activities of daily.

PSE+tDCS

Participants in this group will proceed with the same procedure as PSE only group, but tDCS modulation will be additionally provided.

Group Type EXPERIMENTAL

Patterned Sensory Enhancement (PSE)

Intervention Type BEHAVIORAL

Patterned Sensory Enhancement (PSE) is one of Neurologic Music Therapy (NMT) techniques. NMT is a research-guided clinical model that is driven by advances in neuroscience and the understanding of the perception, production, and performance of music and how music can influence and change non-musical brain and behavior function.

PSE is a technique that uses the rhythmic, melodic, harmonic, and dynamic-acoustical elements of music to provide temporal, spatial, and. force cues for movements which reflect functional movements of activities of daily.

Transcranial Direct Current Stimulation (tDCS)

Intervention Type DEVICE

We will apply five small electrodes to participant's head. Once the electrodes are in place, a small electrical current will be passed between the electrodes. Participants will also get "sham" tDCS, which means they will not receive any real stimulation from the electrodes. Most individuals do not find the procedure uncomfortable, and there are no known long-term risks of tDCS. When the current goes through the electrodes, you may feel an itching or tingling sensation under the electrodes or see brief flashes of light, or you may not feel anything at all. If the sensation is unpleasant, participant can report to co-investigator immediately. If participant finds the procedures too uncomfortable, they may stop it at any time. A trained staff member will be present throughout the procedure.

Interventions

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Patterned Sensory Enhancement (PSE)

Patterned Sensory Enhancement (PSE) is one of Neurologic Music Therapy (NMT) techniques. NMT is a research-guided clinical model that is driven by advances in neuroscience and the understanding of the perception, production, and performance of music and how music can influence and change non-musical brain and behavior function.

PSE is a technique that uses the rhythmic, melodic, harmonic, and dynamic-acoustical elements of music to provide temporal, spatial, and. force cues for movements which reflect functional movements of activities of daily.

Intervention Type BEHAVIORAL

Transcranial Direct Current Stimulation (tDCS)

We will apply five small electrodes to participant's head. Once the electrodes are in place, a small electrical current will be passed between the electrodes. Participants will also get "sham" tDCS, which means they will not receive any real stimulation from the electrodes. Most individuals do not find the procedure uncomfortable, and there are no known long-term risks of tDCS. When the current goes through the electrodes, you may feel an itching or tingling sensation under the electrodes or see brief flashes of light, or you may not feel anything at all. If the sensation is unpleasant, participant can report to co-investigator immediately. If participant finds the procedures too uncomfortable, they may stop it at any time. A trained staff member will be present throughout the procedure.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients with CBS
* Age range 18-89
* Right-handed

Exclusion Criteria

* A history of migraines
* Have a scalp or skin condition (e.g., psoriasis or eczema)
* Have any metallic implants, including intracranial electrodes, surgical clips, shrapnel or a pacemaker
* Have had a head injury resulting in a loss of consciousness that has required further investigation
* Have diagnosed psychological or neurological disorders
* Have had a seizure
* Have had adverse effects to previous tDCS or other brain stimulation techniques (e.g., TMS)
* Pregnancy
* Inability or unwillingness to follow directions for study procedures
Minimum Eligible Age

18 Years

Maximum Eligible Age

89 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Johns Hopkins University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Alexander Pantelyat, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Neurology, Johns Hopkins School of Medicine

Locations

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Johns Hopkins School of Medicine

Baltimore, Maryland, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Alexander Pantelyat, MD

Role: CONTACT

4105023290

Kyurim Kang, PhD

Role: CONTACT

4106145671

Facility Contacts

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Alexander Pantelyat, MD

Role: primary

Kyurim Kang, PhD

Role: backup

References

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Armstrong MJ, Litvan I, Lang AE, Bak TH, Bhatia KP, Borroni B, Boxer AL, Dickson DW, Grossman M, Hallett M, Josephs KA, Kertesz A, Lee SE, Miller BL, Reich SG, Riley DE, Tolosa E, Troster AI, Vidailhet M, Weiner WJ. Criteria for the diagnosis of corticobasal degeneration. Neurology. 2013 Jan 29;80(5):496-503. doi: 10.1212/WNL.0b013e31827f0fd1.

Reference Type BACKGROUND
PMID: 23359374 (View on PubMed)

Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke. 2010 Jun;41(6):1229-36. doi: 10.1161/STROKEAHA.109.576785. Epub 2010 Apr 15.

Reference Type BACKGROUND
PMID: 20395612 (View on PubMed)

Benninger DH, Lomarev M, Lopez G, Wassermann EM, Li X, Considine E, Hallett M. Transcranial direct current stimulation for the treatment of Parkinson's disease. J Neurol Neurosurg Psychiatry. 2010 Oct;81(10):1105-11. doi: 10.1136/jnnp.2009.202556.

Reference Type BACKGROUND
PMID: 20870863 (View on PubMed)

Bianchi M, Cosseddu M, Cotelli M, Manenti R, Brambilla M, Rizzetti MC, Padovani A, Borroni B. Left parietal cortex transcranial direct current stimulation enhances gesture processing in corticobasal syndrome. Eur J Neurol. 2015 Sep;22(9):1317-22. doi: 10.1111/ene.12748. Epub 2015 Jun 13.

Reference Type BACKGROUND
PMID: 26073740 (View on PubMed)

Boelmans K, Bodammer NC, Suchorska B, Kaufmann J, Ebersbach G, Heinze HJ, Niehaus L. Diffusion tensor imaging of the corpus callosum differentiates corticobasal syndrome from Parkinson's disease. Parkinsonism Relat Disord. 2010 Sep;16(8):498-502. doi: 10.1016/j.parkreldis.2010.05.006. Epub 2010 Jun 22.

Reference Type BACKGROUND
PMID: 20573537 (View on PubMed)

Boeve BF. The multiple phenotypes of corticobasal syndrome and corticobasal degeneration: implications for further study. J Mol Neurosci. 2011 Nov;45(3):350-3. doi: 10.1007/s12031-011-9624-1. Epub 2011 Aug 19.

Reference Type BACKGROUND
PMID: 21853287 (View on PubMed)

Broeder S, Nackaerts E, Heremans E, Vervoort G, Meesen R, Verheyden G, Nieuwboer A. Transcranial direct current stimulation in Parkinson's disease: Neurophysiological mechanisms and behavioral effects. Neurosci Biobehav Rev. 2015 Oct;57:105-17. doi: 10.1016/j.neubiorev.2015.08.010. Epub 2015 Aug 20.

Reference Type BACKGROUND
PMID: 26297812 (View on PubMed)

Dedoncker J, Brunoni AR, Baeken C, Vanderhasselt MA. A Systematic Review and Meta-Analysis of the Effects of Transcranial Direct Current Stimulation (tDCS) Over the Dorsolateral Prefrontal Cortex in Healthy and Neuropsychiatric Samples: Influence of Stimulation Parameters. Brain Stimul. 2016 Jul-Aug;9(4):501-17. doi: 10.1016/j.brs.2016.04.006. Epub 2016 Apr 12.

Reference Type BACKGROUND
PMID: 27160468 (View on PubMed)

Dutt S, Binney RJ, Heuer HW, Luong P, Attygalle S, Bhatt P, Marx GA, Elofson J, Tartaglia MC, Litvan I, McGinnis SM, Dickerson BC, Kornak J, Waltzman D, Voltarelli L, Schuff N, Rabinovici GD, Kramer JH, Jack CR Jr, Miller BL, Rosen HJ, Boxer AL; AL-108-231 investigators. Progression of brain atrophy in PSP and CBS over 6 months and 1 year. Neurology. 2016 Nov 8;87(19):2016-2025. doi: 10.1212/WNL.0000000000003305. Epub 2016 Oct 14.

Reference Type BACKGROUND
PMID: 27742814 (View on PubMed)

Kang S, Shin JH, Kim IY, Lee J, Lee JY, Jeong E. Patterns of enhancement in paretic shoulder kinematics after stroke with musical cueing. Sci Rep. 2020 Oct 22;10(1):18109. doi: 10.1038/s41598-020-75143-0.

Reference Type BACKGROUND
PMID: 33093633 (View on PubMed)

Loo CK, Alonzo A, Martin D, Mitchell PB, Galvez V, Sachdev P. Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial. Br J Psychiatry. 2012 Jan;200(1):52-9. doi: 10.1192/bjp.bp.111.097634.

Reference Type BACKGROUND
PMID: 22215866 (View on PubMed)

Manenti R, Bianchi M, Cosseddu M, Brambilla M, Rizzetti C, Padovani A, Borroni B, Cotelli M. Anodal transcranial direct current stimulation of parietal cortex enhances action naming in Corticobasal Syndrome. Front Aging Neurosci. 2015 Apr 14;7:49. doi: 10.3389/fnagi.2015.00049. eCollection 2015.

Reference Type BACKGROUND
PMID: 25926792 (View on PubMed)

Marek S, Dosenbach NUF. The frontoparietal network: function, electrophysiology, and importance of individual precision mapping. Dialogues Clin Neurosci. 2018 Jun;20(2):133-140. doi: 10.31887/DCNS.2018.20.2/smarek.

Reference Type BACKGROUND
PMID: 30250390 (View on PubMed)

McClintock SM, Martin DM, Lisanby SH, Alonzo A, McDonald WM, Aaronson ST, Husain MM, O'Reardon JP, Weickert CS, Mohan A, Loo CK. Neurocognitive effects of transcranial direct current stimulation (tDCS) in unipolar and bipolar depression: Findings from an international randomized controlled trial. Depress Anxiety. 2020 Mar;37(3):261-272. doi: 10.1002/da.22988. Epub 2020 Jan 16.

Reference Type BACKGROUND
PMID: 31944487 (View on PubMed)

Meron D, Hedger N, Garner M, Baldwin DS. Transcranial direct current stimulation (tDCS) in the treatment of depression: Systematic review and meta-analysis of efficacy and tolerability. Neurosci Biobehav Rev. 2015 Oct;57:46-62. doi: 10.1016/j.neubiorev.2015.07.012. Epub 2015 Jul 29.

Reference Type BACKGROUND
PMID: 26232699 (View on PubMed)

Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000 Sep 15;527 Pt 3(Pt 3):633-9. doi: 10.1111/j.1469-7793.2000.t01-1-00633.x.

Reference Type BACKGROUND
PMID: 10990547 (View on PubMed)

Patel R, Ashcroft J, Patel A, Ashrafian H, Woods AJ, Singh H, Darzi A, Leff DR. The Impact of Transcranial Direct Current Stimulation on Upper-Limb Motor Performance in Healthy Adults: A Systematic Review and Meta-Analysis. Front Neurosci. 2019 Nov 15;13:1213. doi: 10.3389/fnins.2019.01213. eCollection 2019.

Reference Type BACKGROUND
PMID: 31803003 (View on PubMed)

Plewnia C, Schroeder PA, Kunze R, Faehling F, Wolkenstein L. Keep calm and carry on: improved frustration tolerance and processing speed by transcranial direct current stimulation (tDCS). PLoS One. 2015 Apr 2;10(4):e0122578. doi: 10.1371/journal.pone.0122578. eCollection 2015.

Reference Type BACKGROUND
PMID: 25837520 (View on PubMed)

Thaut MH, Kenyon GP, Hurt CP, McIntosh GC, Hoemberg V. Kinematic optimization of spatiotemporal patterns in paretic arm training with stroke patients. Neuropsychologia. 2002;40(7):1073-81. doi: 10.1016/s0028-3932(01)00141-5.

Reference Type BACKGROUND
PMID: 11900758 (View on PubMed)

Wang TH, Peng YC, Chen YL, Lu TW, Liao HF, Tang PF, Shieh JY. A home-based program using patterned sensory enhancement improves resistance exercise effects for children with cerebral palsy: a randomized controlled trial. Neurorehabil Neural Repair. 2013 Oct;27(8):684-94. doi: 10.1177/1545968313491001. Epub 2013 Jun 10.

Reference Type BACKGROUND
PMID: 23757295 (View on PubMed)

Whitall J, McCombe Waller S, Silver KH, Macko RF. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000 Oct;31(10):2390-5. doi: 10.1161/01.str.31.10.2390.

Reference Type BACKGROUND
PMID: 11022069 (View on PubMed)

van Wijck F, Knox D, Dodds C, Cassidy G, Alexander G, MacDonald R. Making music after stroke: using musical activities to enhance arm function. Ann N Y Acad Sci. 2012 Apr;1252:305-11. doi: 10.1111/j.1749-6632.2011.06403.x.

Reference Type BACKGROUND
PMID: 22524372 (View on PubMed)

Yoo GE, Kim SJ. Rhythmic Auditory Cueing in Motor Rehabilitation for Stroke Patients: Systematic Review and Meta-Analysis. J Music Ther. 2016 Summer;53(2):149-77. doi: 10.1093/jmt/thw003. Epub 2016 Apr 15.

Reference Type BACKGROUND
PMID: 27084833 (View on PubMed)

Thaut, M., & Hoemberg, V. (2014). Handbook of neurologic music therapy. Oxford University Press (UK).

Reference Type BACKGROUND

Other Identifiers

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IRB00303400

Identifier Type: -

Identifier Source: org_study_id

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