t-RNS After Hand Recovery in Chronic Stroke

NCT ID: NCT05489146

Last Updated: 2022-12-28

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

14 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-01-15

Study Completion Date

2020-03-15

Brief Summary

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Upper extremity (UE) paresis or weakness is one of the most frequent impairments after stroke. Despite intense rehabilitation, motor and functional recovery of patients with severe hand impairments is poor. Hence, there is a need for more effective treatments to enhance motor function in patients with severe hand impairments after stroke. Adaptive functional electrical stimulation (FES) appears to be a promising treatment and has the potential to facilitate active movement in individuals with severe impairments post-stroke. In addition, transcranial random noise stimulation (trns) is a widely studied, non-invasive and safe method to enhance the corticomotor excitability in individuals with chronic stroke. However, the effect of combining trns and adaptive FES in patients with severe hand impairments has not been investigated. Therefore, the purpose of this study is to investigate whether combining trns with FES will enhance hand function in individuals with chronic stroke than FES alone. The investigators predict that combining trns with FES will significantly enhance hand function than FES alone.

Detailed Description

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The primary purpose of this study was to investigate whether combining transcranial random noise stimulation with functional electrical stimulation-facilitated task practice will enhance hand function in individuals with severe paresis post-stroke than functional electrical stimulation alone.

The study is an experimental randomized study comparing the effects of transcranial random noise stimulation with functional electrical stimulation to functional electrical stimulation alone on recovery of function in the more-affected hand in individuals with chronic stroke.

Participants were randomized to receive transcranial random noise stimulation and functional electrical stimulation-facilitated task practice or sham-transcranial random noise stimulation and functional electrical stimulation-facilitated task practice.

Participants received 18 treatment sessions over 6 weeks (3 times/week for 6 weeks).

Conditions

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Stroke

Keywords

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stroke hand brain stimulation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors
The participant, outcome assessor, investigator, and therapist providing the intervention were blinded.

Study Groups

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tRNS and FES facilitated task practice

In this arm, participants received real transcranial random noise stimulation with FES facilitated task practice

Group Type ACTIVE_COMPARATOR

transcranial random noise stimulation and functional electrical stimulation facilitated task practice

Intervention Type DEVICE

Participants were randomized to one of the two intervention groups \[transcranial current stimulation (tRNS) and functional electrical stimulation (FES) or FES with sham tRNS\] before pre-intervention testing. After randomization, participants underwent pre-intervention testing, followed by intervention 3 times per week for 6 weeks. Each intervention session lasted for 1 hour, where tRNS or sham-tRNS were delivered concurrently with the FES-facilitated task practice. tRNS or sham-tRNS was delivered for the first 30 minutes. Both tRNS and sham tRNS were delivered by the Starstim system. FES was delivered using the Neuromove system. All participants were treated by a licensed occupational therapist, who was trained on a manualized protocol.

sham tRNS and FES facilitated task practice

In this arm, participants received sham transcranial random noise stimulation with FES facilitated task practice

Group Type SHAM_COMPARATOR

transcranial random noise stimulation and functional electrical stimulation facilitated task practice

Intervention Type DEVICE

Participants were randomized to one of the two intervention groups \[transcranial current stimulation (tRNS) and functional electrical stimulation (FES) or FES with sham tRNS\] before pre-intervention testing. After randomization, participants underwent pre-intervention testing, followed by intervention 3 times per week for 6 weeks. Each intervention session lasted for 1 hour, where tRNS or sham-tRNS were delivered concurrently with the FES-facilitated task practice. tRNS or sham-tRNS was delivered for the first 30 minutes. Both tRNS and sham tRNS were delivered by the Starstim system. FES was delivered using the Neuromove system. All participants were treated by a licensed occupational therapist, who was trained on a manualized protocol.

Interventions

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transcranial random noise stimulation and functional electrical stimulation facilitated task practice

Participants were randomized to one of the two intervention groups \[transcranial current stimulation (tRNS) and functional electrical stimulation (FES) or FES with sham tRNS\] before pre-intervention testing. After randomization, participants underwent pre-intervention testing, followed by intervention 3 times per week for 6 weeks. Each intervention session lasted for 1 hour, where tRNS or sham-tRNS were delivered concurrently with the FES-facilitated task practice. tRNS or sham-tRNS was delivered for the first 30 minutes. Both tRNS and sham tRNS were delivered by the Starstim system. FES was delivered using the Neuromove system. All participants were treated by a licensed occupational therapist, who was trained on a manualized protocol.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Age 18 or older
* Episode (1 or more than one) of stroke at least 6 months prior
* Able to follow 3-step commands to rule out severe aphasia
* Unilateral hemiparesis
* Able to speak english
* No active drug or alcohol abuse, schizophrenia, other neurological or medical conditions that would confound results, or refractory depression
* Able to actively flex and extend the more-affected shoulder and elbow at least 30°.
* Able to elicit motor evoked potential in the flexor carpii radialis and extensor carpii radialis muscles of the affected hand.

Exclusion Criteria

* Spasticity greater than equal to 2 on the Modified Ashworth Scale in shoulder, elbow, wrist and finger joints of the more-affected upper extremity
* Scores \> 3 on the Amount scale of Motor Activity Log indicating good use of the more-affected hand
* Has ataxia determined via finger-to-nose testing section of the Fugl Meyer Upper Extremity assessment
* Has proprioceptive sensory deficits determined via a score of 2 on the position sense section (section H) of the Fugl Meyer Upper Extremity assessment proprioception
* Excessive pain \> equal to 4 on Visual Analog Scale in the more-affected upper extremity
* Skin lesions on the more-affected upper extremity and scalp
* Individuals with implanted devices that may be affected by electrical stimulation
* Participating in concurrent therapy
* Individuals with seizures
* History of seizures, schizophrenia, Bipolar disorder (type I or II) \[Answer yes to questions 16 and items of the (hypo) maniac module of MINI\], current moderate, severe depression (Scores of \>10 on PHQ-9) and other neurological or medical conditions that could confound results.
* Individuals with refractory depression, which are defined as individuals with severe depressive disorder that are resistant to antidepressants (Scores of \>10 on PHQ-9).
* Current treatment with antipsychotics or benzodiazepines.
* Current treatment with bupropion, which may induce seizure.
* Scores \< 24 on Mini Mental Status Examination
* Pregnant women
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Zynex Medical, Inc.

INDUSTRY

Sponsor Role collaborator

Neuroelectrics Corporation

INDUSTRY

Sponsor Role collaborator

Amit Sethi

OTHER

Sponsor Role lead

Responsible Party

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Amit Sethi

Associate Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Amit Sethi, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

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Neuromotor Recovery and Rehabilitation Lab

Pittsburgh, Pennsylvania, United States

Site Status

Countries

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United States

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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PRO13090080

Identifier Type: -

Identifier Source: org_study_id