Brain Stimulation-aided Stroke Rehabilitation: Neural Mechanisms of Recovery
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 21 - Any |
| Updated: | 3/10/2019 |
| Start Date: | July 2011 |
| End Date: | December 2019 |
The purpose of this study is to investigate whether benefits of training the affected hand in
patients with stroke can be improved by combining training with a painless, noninvasive
technique called Transcranial Direct Current Stimulation (TDCS). TDCS will be applied over
the part of the brain responsible for movements of the affected hand. Also, the investigators
will study the changes in the brain that favor recovery of hand function following
combination of training and tDCS.
patients with stroke can be improved by combining training with a painless, noninvasive
technique called Transcranial Direct Current Stimulation (TDCS). TDCS will be applied over
the part of the brain responsible for movements of the affected hand. Also, the investigators
will study the changes in the brain that favor recovery of hand function following
combination of training and tDCS.
The overall goal of this study is to develop a novel rehabilitative method, in chronic
stroke, which minimizes residual deficits by maximally utilizing the potential for cortical
plasticity.
Despite extensive rehabilitation, approximately 60-80% of patients with stroke experience
residual dysfunction of the upper limb. Deficits are believed to linger due to
neurophysiologic imbalance between the ipsilesional (stroke-affected) and contralesional
(intact) motor cortices. Specifically, the ipsilesional motor cortex loses its normal
inhibitory control over the contralesional areas, which, in return, intensify their
inhibitory influence upon the former. Constraint-Induced Movement Therapy (CIMT) represents a
family of techniques that alleviates residual deficits by rectifying these neurophysiologic
imbalances. By reinforcing use of the paretic upper limb in daily life during restraint of
the non-paretic limb, CIMT initiates use-dependent neuroplastic reorganization implicating
the ipsilesional motor areas, which demonstrate return-of-activity and regain territory in
the surviving regions, mitigating the exaggerated inhibitory influence exerted by the
contralesional areas.
Despite promising evidence, however, clinical utility of CIMT is limited due to its
labor-intensive protocols and inadequate gains. Our objective is to address gaps in existing
clinical rehabilitative research. The investigators propose to 1) combine CIMT with targeted
stimulation of the ipsilesional motor cortices, 2) Use a novel, noninvasive method of
stimulation, called transcranial direct current stimulation (tDCS), 3) Use multimodal imaging
to determine comprehensive mechanisms of recovery in patients. Our central hypotheses are 1)
ipsilesional motor cortices would be an ideal site for delivering stimulation during CIMT, 2)
tDCS will be easy, safe and inexpensive to apply and will target multiple maps concurrently
during rehabilitation as demonstrated in our elemental research. 3) structural and functional
imaging methods will demonstrate complementary cortical, corticospinal and cortico-muscular
markers of recovery.
stroke, which minimizes residual deficits by maximally utilizing the potential for cortical
plasticity.
Despite extensive rehabilitation, approximately 60-80% of patients with stroke experience
residual dysfunction of the upper limb. Deficits are believed to linger due to
neurophysiologic imbalance between the ipsilesional (stroke-affected) and contralesional
(intact) motor cortices. Specifically, the ipsilesional motor cortex loses its normal
inhibitory control over the contralesional areas, which, in return, intensify their
inhibitory influence upon the former. Constraint-Induced Movement Therapy (CIMT) represents a
family of techniques that alleviates residual deficits by rectifying these neurophysiologic
imbalances. By reinforcing use of the paretic upper limb in daily life during restraint of
the non-paretic limb, CIMT initiates use-dependent neuroplastic reorganization implicating
the ipsilesional motor areas, which demonstrate return-of-activity and regain territory in
the surviving regions, mitigating the exaggerated inhibitory influence exerted by the
contralesional areas.
Despite promising evidence, however, clinical utility of CIMT is limited due to its
labor-intensive protocols and inadequate gains. Our objective is to address gaps in existing
clinical rehabilitative research. The investigators propose to 1) combine CIMT with targeted
stimulation of the ipsilesional motor cortices, 2) Use a novel, noninvasive method of
stimulation, called transcranial direct current stimulation (tDCS), 3) Use multimodal imaging
to determine comprehensive mechanisms of recovery in patients. Our central hypotheses are 1)
ipsilesional motor cortices would be an ideal site for delivering stimulation during CIMT, 2)
tDCS will be easy, safe and inexpensive to apply and will target multiple maps concurrently
during rehabilitation as demonstrated in our elemental research. 3) structural and functional
imaging methods will demonstrate complementary cortical, corticospinal and cortico-muscular
markers of recovery.
Inclusion Criteria:
- Diagnosed with stroke that occurred at least 6 months ago
Exclusion Criteria:
- Pregnant
- Ongoing use of Central Nervous System activating medications
- Presence of an electrically, magnetically or mechanically activated implant, including
cardiac pacemaker, cochlear implant
- Metal in the head
- A history of medication-resistant epilepsy in the family
- Past history of seizures or unexplained spells of loss of consciousness
We found this trial at
1
site
9500 Euclid Avenue
Cleveland, Ohio 44106
Cleveland, Ohio 44106
216.444.2200
Principal Investigator: Ela B Plow, PhD PT
Phone: 216-445-6728
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