Establishing a Prognostic Model for Stroke Recovery

NCT ID: NCT05332652

Last Updated: 2024-08-16

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

68 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-09-01

Study Completion Date

2026-07-16

Brief Summary

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This main aim of the study is to investigate the changes in neurophysiological features after stroke, and its association with upper limb motor recovery, so as to establish a prognostic model for upper limb motor recovery after stroke. The investigators hypothesize that a combination of neurophysiological features measured by transcranial magnetic stimulation (TMS), high density electroencephalography (HD-EEG), functional magnetic resonance imaging (fMRI) and Diffusion Tensor Imaging (DTI) might be used as biomarkers to predict upper limb motor outcomes after stroke. The investigators also hypothesize that non-invasive brain stimulation strategies such as tDCS will more effectively improve motor outcomes as an adjunct to therapy, if tailored according to patient's predicted pattern of neural reorganization.

Detailed Description

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This study comprises 2 parts. Study 1 is a longitudinal cohort study to characterize the neurophysiological changes with upper limb motor recovery in stroke patients with moderate to severe upper limb motor function impairment, and its correlation with motor function recovery.

120 stroke subjects within 3 weeks post-stroke will be recruited from National University Hospital (NUH), Alexandra Hospital (AH), and Tan Tock Seng Hospital (TTSH). We will follow changes in cortical activity over time using Transcranial Magnetic Stimulation (TMS), MRI and EEG measures and correlate these with clinical outcome measures at the same time points, to study the interaction between neural excitability and functional outcome.

10 healthy subjects will be needed as control group to compare outcomes obtained from MRI scans.

Outcome measures of brain corticospinal excitability, clinical measures on upper limb motor function and cognitive tests, will be performed 4 times- within 4 weeks, at 3 months, 6 months and 1 year after stroke onset, except for MRI which will not be performed at 1 year after stroke onset.

Subjects from Study 1 whose ARAT (Action Research Arm test) score is \< = 42 at 3 months post-stroke will proceed to Study 2. ARAT score \< = 42 indicates limited functional capacity and below. The aim of Study 2 is to investigate the efficacy and the neurophysiological effects of 2 types of tDCS protocols in facilitating upper limb motor recovery in patients with significant limitations in upper limb function.

There are a total of 4 groups in Study 2. Subjects who are agreeable for transcranial direct current stimulation (tDCS) will be randomized into 3 groups with 17 subjects in each group, by stratified randomization using Microsoft Excel, according to the lesion location (cortical vs. subcortical), and type of stroke (haemorrhagic vs. ischemic). Subjects who refuse tDCS will be enrolled in the control group without receiving any tDCS stimulation.

* Group 1 will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb;
* Group 2 to receive 1mA anodal tDCS to the contralesional premotor cortex;
* Group 3 to receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1.
* Group 4: Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.

Cathode for all 3 tDCS groups will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. Subjects in Study 2 will continue with the 6-month and 1 year assessment, as in Study 1.

Conditions

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Stroke, Acute

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Subjects from Study 1 whose ARAT score is \< = 42 at 3 months post-stroke will proceed to Study 2. Subjects who are agreeable for transcranial direct current stimulation (tDCS) will be randomized into 3 groups with 17 subjects in each group, by stratified randomization, according to the lesion location (cortical vs. subcortical), and type of stroke (haemorrhagic vs. ischemic). Subjects who refuse tDCS will be enrolled in the control group without receiving any tDCS stimulation.

* Group 1 will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb;
* Group 2 to receive 1mA anodal tDCS to the contralesional premotor cortex;
* Group 3 to receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1.
* Group 4: Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Participants
Participant in Group 1-3 will be blinded to the stimulation protocol that they will be receiving.

Study Groups

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Anodal tDCS stimulation to the ipsilesional M1

Participant will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb.

Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training.

Group Type EXPERIMENTAL

trancranial magnetic stimulation

Intervention Type DEVICE

A trained research staff or physician will perform tDCS to the subject. Direct current will be delivered by a battery-operated, constant current stimulator, through 2 rubber electrodes embedded in a pair of saline-soaked sponge bag. Stimulation intensity will be ramped up to 1 mA over 30 seconds and maintain at 1 mA for 20 minutes, and then ramped down to 0 mA over 30 seconds.

Anodal tDCS to the contralesional premotor cortex

Participant will receive 1mA anodal tDCS to the contralesional premotor cortex. Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training.

Group Type EXPERIMENTAL

trancranial magnetic stimulation

Intervention Type DEVICE

A trained research staff or physician will perform tDCS to the subject. Direct current will be delivered by a battery-operated, constant current stimulator, through 2 rubber electrodes embedded in a pair of saline-soaked sponge bag. Stimulation intensity will be ramped up to 1 mA over 30 seconds and maintain at 1 mA for 20 minutes, and then ramped down to 0 mA over 30 seconds.

Sham tDCS

Participant will receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1.

Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training.

Group Type SHAM_COMPARATOR

trancranial magnetic stimulation

Intervention Type DEVICE

A trained research staff or physician will perform tDCS to the subject. Direct current will be delivered by a battery-operated, constant current stimulator, through 2 rubber electrodes embedded in a pair of saline-soaked sponge bag. Stimulation intensity will be ramped up to 1 mA over 30 seconds and maintain at 1 mA for 20 minutes, and then ramped down to 0 mA over 30 seconds.

Control group

Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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trancranial magnetic stimulation

A trained research staff or physician will perform tDCS to the subject. Direct current will be delivered by a battery-operated, constant current stimulator, through 2 rubber electrodes embedded in a pair of saline-soaked sponge bag. Stimulation intensity will be ramped up to 1 mA over 30 seconds and maintain at 1 mA for 20 minutes, and then ramped down to 0 mA over 30 seconds.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. 21-80 years old;
2. First ever stroke less than 6 weeks;
3. Moderate to severe upper limb impairment with Manual Muscle Testing (MMT) score on shoulder abduction plus finger extension (SAFE) \<5 within the first week post-stroke.

1. Age 21-80 years old;
2. No known medical history.

Exclusion Criteria

1. Pregnancy;
2. Any metal implants inside the body that are contraindications of MRI scan;
3. cardiac pacemakers;
4. History of epilepsy;
5. Sensorimotor disturbance due to other causes other than stroke;
6. Claustrophobia;
7. Uncontrolled medical conditions including hypertension, diabetes mellitus and unstable angina;
8. Major depression and a history of psychotic disorders;
9. Terminal diagnosis with life expectancy \<=1 year.

1. Pregnancy;
2. Any metal implants inside the body that are contraindications of MRI scan;
3. cardiac pacemakers;
4. Claustrophobia.
Minimum Eligible Age

21 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Alexandra Hospital

OTHER

Sponsor Role collaborator

National University of Singapore

OTHER

Sponsor Role collaborator

Nanyang Technological University

OTHER

Sponsor Role collaborator

National University Hospital, Singapore

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Effie Chew, MBBS

Role: PRINCIPAL_INVESTIGATOR

National University Hospital, Singapore

Locations

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Alexandra Hospital

Singapore, , Singapore

Site Status RECRUITING

National University Hospital

Singapore, , Singapore

Site Status RECRUITING

Countries

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Singapore

Central Contacts

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Effie Chew, MBBS

Role: CONTACT

Ning Tang, PhD

Role: CONTACT

Facility Contacts

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Effie Chew, MBBS

Role: primary

Effie Chew, MBBS

Role: primary

Other Identifiers

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2019/00932

Identifier Type: -

Identifier Source: org_study_id

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