Improving Measurement and Treatment of Post-stroke Neglect

It is very common for stroke survivors to have difficulty attending to one side of their body
or space (neglect). Stroke survivors with neglect not only demonstrate impairments in
attention but they also experience motor impairment. These individuals also have an imbalance
in excitation in the brain. This study will examine the preliminary effects of non-invasive
brain stimulation (transcranial direct current stimulation, tDCS) combined with arm
rehabilitation training (repetitive task-specific practice, RTP) for individuals with neglect
following stroke. The investigators will examine the effects of the intervention on brain
excitability, upper extremity motor impairment, and attentional impairment. This study will
also examine assessment of neglect. There are many clinical assessments designed to assess
neglect; however, it is unknown whether items from some of the most commonly used assessments
are able to effectively measure neglect or whether items from these assessments can be
combined. Clinicians rely on clinical assessments to inform treatment and document patient
progress. Therefore, it is important that investigators more closely examine these existing
assessments.

Inclusion Criteria:

- Right ischemic or hemorrhagic subcortical stroke 3 months post stroke.

- Fugl-Meyer Upper Extremity (FMA-Upper Extremity) score between 20-56/60

- Inducible motor evoked potential (MEP) of the abductor pollicis brevis (APB) on the
paretic stimulation (TMS)

- Demonstrate the presence of unilateral neglect (Virtual Reality Lateralized Attention
Test score <18)

Exclusion Criteria:

- History of cortical hemorrhagic stroke

- Presence of any MRI, TMS, tDCS risk factors including:

- history of seizures

- history of brain tumor

- hardware in skull or spine (e.g. coils, clips)

- implantable medical device (e.g. pacemaker)

- metal in body (not compatible with MRI)

- pregnancy

- Severe spasticity (Modified Ashworth Scale score 3)

- Severe aphasia or cognitive impairment limiting participants' comprehension (National
Institutes of Health Stroke Scale Level of Consciousness Commands Item score 1 or Best
Language Item score 2)

- Unable to travel to UE Motor Function Laboratory at the Center for Rehabilitation
Research in Neurological Conditions (a collaborative, MOU approved, research center
Ralph H. Johnson VA Medical Center and the Medical University of South Carolina) for
the study