Spatial-Motor Stroke-Rehab Study

NCT ID: NCT06053320

Last Updated: 2025-10-16

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

65 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-04-11

Study Completion Date

2026-03-31

Brief Summary

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The purpose of this study is to understand how prism adaptation training with and without electrical stimulation changes visuospatial behavior, motor system neurophysiology, and walking dysfunction.

Detailed Description

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Spatial Neglect (SN) is defined as pathological asymmetric spatial behavior causing functional disability and occurs in greater than 50% of individuals with right hemisphere stroke. SN post-stroke is associated with increased fall risk, increased hospital length of stay, poorer rehabilitation outcomes, and severe long-term disability. Prism adaptation therapy (PAT) is an evidence-based treatment for SN after stroke, however, the effects of SN on gait are not well known. Neuromuscular electrical stimulation delivered via surface electrodes is a common therapeutic adjunct in stroke rehabilitation, including for SN and gait training. However, the additive therapeutic effects of combining electrical stimulation and PAT, as well as the effects of motor training on gait deficits associated with SN are poorly understood. Furthermore, although there is limited literature examining the effects of electrical stimulation on corticospinal tract output (CST), there is an inadequate understanding of the neural mechanisms of PAT and the combinatorial effects of PAT with electrical stimulation. To parse out the neural mechanisms of PAT and electrical stimulation on the visuospatial system, researchers will first examine the effects of PAT with or without electrical stimulation in neurologically unimpaired adults, researchers will then compare results to individuals with stroke with spatial neglect.

The primary objective is to study the effects of PAT on visuospatial behavior and motor cortical excitability in able-bodied individuals (young and older), and on spatial neglect, motor cortical neurophysiology, and walking function in individuals post-stroke.

The long-term goal of this project is to develop novel, effective, and personalized rehabilitation protocols targeting SN deficits and gait dysfunction to reduce disability in stroke survivors. The rationale of this project is to explore and generate data regarding future novel combinatorial motor-spatial retraining approaches that will enhance the rehabilitation approach of SN and gait performance in individuals post-stroke.

Conditions

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Spatial Neglect Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

After treatment, three weeks will be allowed for washout, then participants will receive the opposite (second) PAT condition with sham stim or electrical stimulation.
Primary Study Purpose

OTHER

Blinding Strategy

DOUBLE

Participants Caregivers
Both experiments include a sham condition: Sham electrical stimulation consisting of electrode placement with the stimulator turned off.

Study Groups

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Young Able-Bodied individuals

18-30 years old able-bodied individuals (healthy without any physical disability or neurological disorder).

Group Type ACTIVE_COMPARATOR

Prism adaptation therapy (PAT) + Electrical stimulation (E-stim)

Intervention Type DEVICE

PAT requires one to wear prism lenses while making arm-reaching movements toward visual targets. For treating left-sided neglect, a person wears the prism lenses that shift the visual field, including the images of the target and of one's own reaching arm, certain degrees to the right depending on the diopter of the lens (e.g., the 20-diopter lens shifts the visual field by 11.4 degrees). The visual system adapts over the repetitive practice of the arm reaching toward the target. The person eventually achieves success with a leftward movement reaching the actual target. Electrical stimulation (E-stim) involves parameters and settings commonly used in clinical practice as well as research for pain relief and other applications, commonly referred to as transcutaneous electrical nerve stimulation (TENS). TENS and E-stim are delivered using FDA-approved, commercially available portable clinical transcutaneous electrical stimulators (e.g. Empi TENS Unit).

Prism adaptation therapy (PAT) + Sham Stimulator

Intervention Type DEVICE

Participants in the PAT with sham stim condition group will receive sham electrical stimulation treatment (electrodes will be attached but the stimulator will not be turned on) to the left upper limb with the same placement of electrodes while undergoing PAT.

Old Able-Bodied individuals

45-90 years old able-bodied individuals (healthy without any physical disability or neurological disorder).

Group Type ACTIVE_COMPARATOR

Prism adaptation therapy (PAT) + Electrical stimulation (E-stim)

Intervention Type DEVICE

PAT requires one to wear prism lenses while making arm-reaching movements toward visual targets. For treating left-sided neglect, a person wears the prism lenses that shift the visual field, including the images of the target and of one's own reaching arm, certain degrees to the right depending on the diopter of the lens (e.g., the 20-diopter lens shifts the visual field by 11.4 degrees). The visual system adapts over the repetitive practice of the arm reaching toward the target. The person eventually achieves success with a leftward movement reaching the actual target. Electrical stimulation (E-stim) involves parameters and settings commonly used in clinical practice as well as research for pain relief and other applications, commonly referred to as transcutaneous electrical nerve stimulation (TENS). TENS and E-stim are delivered using FDA-approved, commercially available portable clinical transcutaneous electrical stimulators (e.g. Empi TENS Unit).

Prism adaptation therapy (PAT) + Sham Stimulator

Intervention Type DEVICE

Participants in the PAT with sham stim condition group will receive sham electrical stimulation treatment (electrodes will be attached but the stimulator will not be turned on) to the left upper limb with the same placement of electrodes while undergoing PAT.

Stroke with Spatial Neglect (SN) individuals

40-90 years individuals with more than 3 months following right hemisphere stroke.

Group Type EXPERIMENTAL

Prism adaptation therapy (PAT) + Electrical stimulation (E-stim)

Intervention Type DEVICE

PAT requires one to wear prism lenses while making arm-reaching movements toward visual targets. For treating left-sided neglect, a person wears the prism lenses that shift the visual field, including the images of the target and of one's own reaching arm, certain degrees to the right depending on the diopter of the lens (e.g., the 20-diopter lens shifts the visual field by 11.4 degrees). The visual system adapts over the repetitive practice of the arm reaching toward the target. The person eventually achieves success with a leftward movement reaching the actual target. Electrical stimulation (E-stim) involves parameters and settings commonly used in clinical practice as well as research for pain relief and other applications, commonly referred to as transcutaneous electrical nerve stimulation (TENS). TENS and E-stim are delivered using FDA-approved, commercially available portable clinical transcutaneous electrical stimulators (e.g. Empi TENS Unit).

Prism adaptation therapy (PAT) + Sham Stimulator

Intervention Type DEVICE

Participants in the PAT with sham stim condition group will receive sham electrical stimulation treatment (electrodes will be attached but the stimulator will not be turned on) to the left upper limb with the same placement of electrodes while undergoing PAT.

Gait Training

Intervention Type OTHER

After PAT, participants will complete multiple 30-seconds to 4-minute bouts of walking on the treadmill or overground at speeds ranging from self-selected to fast speeds (faster than comfortable self-selected speed), with rest breaks between bouts.

Interventions

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Prism adaptation therapy (PAT) + Electrical stimulation (E-stim)

PAT requires one to wear prism lenses while making arm-reaching movements toward visual targets. For treating left-sided neglect, a person wears the prism lenses that shift the visual field, including the images of the target and of one's own reaching arm, certain degrees to the right depending on the diopter of the lens (e.g., the 20-diopter lens shifts the visual field by 11.4 degrees). The visual system adapts over the repetitive practice of the arm reaching toward the target. The person eventually achieves success with a leftward movement reaching the actual target. Electrical stimulation (E-stim) involves parameters and settings commonly used in clinical practice as well as research for pain relief and other applications, commonly referred to as transcutaneous electrical nerve stimulation (TENS). TENS and E-stim are delivered using FDA-approved, commercially available portable clinical transcutaneous electrical stimulators (e.g. Empi TENS Unit).

Intervention Type DEVICE

Prism adaptation therapy (PAT) + Sham Stimulator

Participants in the PAT with sham stim condition group will receive sham electrical stimulation treatment (electrodes will be attached but the stimulator will not be turned on) to the left upper limb with the same placement of electrodes while undergoing PAT.

Intervention Type DEVICE

Gait Training

After PAT, participants will complete multiple 30-seconds to 4-minute bouts of walking on the treadmill or overground at speeds ranging from self-selected to fast speeds (faster than comfortable self-selected speed), with rest breaks between bouts.

Intervention Type OTHER

Other Intervention Names

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PAT + E-stim Sham Stim Gait Training After PAT

Eligibility Criteria

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Inclusion Criteria

Young Adults Able Bodied (YAB) Individuals

* 18-30 years
* Able-Bodied (healthy without any physical disability or neurological disorder)

Older Adults Able-Bodied Individuals (OAB)

* 45-90 years
* Able-Bodied (healthy without any physical disability or neurological disorder)

Individuals with right hemisphere stroke (40-90 years)

* \>3 months following stroke.
* Presence of Aiming SN
* Ability to walk \>10m with or without assistive devices.
* Unilateral left-sided hemiparesis with gross arm strength of ≤ grade 4/5 on the Medical Research Council Scale
* Ability to follow 3-stage commands and provide informed consent.

Exclusion Criteria

Young Adults Able Bodied (YAB) Individuals and Older Adults Able-Bodied Individuals (OAB)

* History or evidence of orthopedic or physical disability
* History or evidence of neurological pathology
* Pregnancy (female)
* Uncontrolled hypertension
* Cardiac pacemaker or other implanted electronic system
* Presence of skin conditions preventing electrical stimulation setup
* Impaired sensation in the left upper limb.
* Bruises or cuts at the stimulation electrode placement site
* Concurrent enrollment in rehabilitation or another investigational study.
* History or evidence of orthopedic or physical disability interfering with study procedures
* History or evidence of neurological pathology or disorder
* Severe uncontrolled medical problems (e.g., hypertension, cardiovascular disease, rheumatoid arthritis, active cancer or renal disease, epilepsy) that may interfere with study procedures
* Contraindications to TMS such as metal implants, medications that can increase cortical excitability, unexplained dizziness in the past 6 months

Individuals with right hemisphere stroke (40-90 years)

* History of multiple strokes or brainstem strokes
* Cerebellar disorders
* Impaired sensation in the left upper limb.
* History of other neurological disorders
* Uncontrolled hypertension
* Cardiac pacemaker or other implanted electronic system
* Pregnancy (female)
* Presence of skin condition
* Bruises at the electrode placement site
* Concurrent enrollment in rehabilitation or another investigational study
* Severe uncontrolled medical problems (e.g., hypertension, cardiovascular disease, rheumatoid arthritis, active cancer or renal disease, epilepsy) or other medical conditions that can interfere with study procedures
* Contraindications to TMS such as metal implants in the brain, medications that will increase cortical excitability, etc.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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National Institute of Neurological Disorders and Stroke (NINDS)

NIH

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role lead

Responsible Party

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Trisha Kesar

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Trisha Kesar, PT, PhD

Role: PRINCIPAL_INVESTIGATOR

Emory University

Fisayo Aloba, PT, DPT

Role: PRINCIPAL_INVESTIGATOR

Emory University

Locations

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Emory Rehabilitation Hospital

Atlanta, Georgia, United States

Site Status RECRUITING

Emory University Hospital (EUH)

Atlanta, Georgia, United States

Site Status RECRUITING

Executive Park

Atlanta, Georgia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Fisayo Aloba, PT, DPT

Role: CONTACT

404-712-5803

Facility Contacts

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Fisayo Aloba, PT, DPT

Role: primary

Fisayo Aloba, PT, DPT

Role: primary

Fisayo Aloba, PT, DPT

Role: primary

Other Identifiers

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1F31NS131020-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY00005012

Identifier Type: -

Identifier Source: org_study_id

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