Effects of Combined Spinal Direct Current Stimulation on Upper Limb Recovery in Acquired Brain Injury
Effects of Combined Spinal Direct Current Stimulation on Upper Limb Recovery in Acquired Brain Injury (ABI)
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Acquired brain injury (ABI) is the leading cause of neurological disability in the United States and accounts for the poor physical health and the social dysfunction evident in survivors. Hemiparesis due to acquired brain injury is the primary cause of disability and arm paresis is perceived as the primary cause of disability by individuals who have suffered ABI because of the limitations it creates in performing activities of daily living (ADL). Rehabilitation of the impaired limb is essential for improving motor function after ABI, yet only 31% of ABI survivors receive outpatient rehabilitation. Therefore, effective therapy for upper-limb paresis must be addressed. Approximately 80% of all ABI survivors suffer from upper limb paresis and only 18% of these individuals gain full motor recovery with conventional treatments in the year following ABI.
The study will use cross-over, randomized, sham controlled, double-blinded design. Participants with subacute or chronic ABI will each be assigned to receive active anodal spinal stimulation, active cathodal spinal stimulation, and sham spinal stimulation for the same duration, and the order that each participant will receive anodal, cathodal, and sham stimulation will be randomized. In all the experiments participants will receive robotic assisted training for duration of 1.5 hours. The first 20 minutes of training will be coupled with spinal stimulation. Treatment will be administered at an intensity of 5 sessions per week for 2 weeks.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Nuray Yozbatiran, PhD
- Phone Number: 713-797-5282
- Email: Nuray.Yozbatiran@uth.tmc.edu
Study Contact Backup
- Name: Vanessa Bernal, BS
- Phone Number: 713-797-7636
- Email: Vanessa.Bernal@uth.tmc.edu
Study Locations
-
-
Texas
-
Houston, Texas, United States, 77030
- The Institute for Rehabilitation and Research (TIRR) at Memorial Hermann
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Providing written informed consent prior to any study related procedures;
- Age above 18;
- Diagnosis of acquired brain injury at least for 6 month
- No neuropsychiatric comorbidities
- Not being involved in any specific exercise program (e.g., neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES)) within the previous 3 months;
- No planned alteration in upper-extremity therapy or medication for muscle tone during the course of the study;
- Eligibility for standard upper-extremity rehabilitation at the time of enrollment (i.e., absence medical comorbidities that would prevent standard rehabilitation);
- No condition (e.g., severe arthritis, extreme shoulder pain) that would interfere with valid administration of the measures or with interpreting motor testing;
No contraindications to tsDCS:
- metal in the head between stimulation area
- metal in the spine between stimulation area
- implanted brain medical devices
- No pregnancy;
- No contraindications for Transcranial Magnetic Stimulation (TMS) and magnetic resonance imaging (MRI) based on TMS and MRI screening forms
Exclusion Criteria:
- Uncontrolled epilepsy;
- Any joint contracture or severe spasticity in the affected upper extremity, as measured by a Modified Ashworth Score > than 3 out of 4;
- History of substance abuse;
- Subject who cannot provide self-transportation to the study location
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Triple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: tsDCS-Anodal & robotic arm training (RAT), then tsDCS-Cathodal & RAT, then tsDCS-Sham & RAT
anodal tsDCS over cervical spine, 2.5mA for 20 minutes
|
2.5mA anodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA cathodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA sham tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
70 minutes of robotic-assisted training (RAT) of arm and hand functions will follow each of the tsDCS sessions, five days a week, for two weeks.
Robotic-assisted training will be provided by using the MAHI Exo-II device.
|
|
Experimental: tsDCS-Anodal & robotic arm training (RAT), then tsDCS-Sham & RAT, then tsDCS-Cathodal & RAT
cathodal tsDCS over cervical spine, 2.5mA for 20 minutes
|
2.5mA anodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA cathodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA sham tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
70 minutes of robotic-assisted training (RAT) of arm and hand functions will follow each of the tsDCS sessions, five days a week, for two weeks.
Robotic-assisted training will be provided by using the MAHI Exo-II device.
|
|
Experimental: tsDCS-Cathodal & robotic arm training (RAT), then tsDCS-Anodal & RAT, then tsDCS-Sham & RAT
sham tsDCS over cervical spine, 2.5mA for 20 minutes
|
2.5mA anodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA cathodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA sham tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
70 minutes of robotic-assisted training (RAT) of arm and hand functions will follow each of the tsDCS sessions, five days a week, for two weeks.
Robotic-assisted training will be provided by using the MAHI Exo-II device.
|
|
Experimental: tsDCS-Cathodal & robotic arm training (RAT), then tsDCS-Sham & RAT, then tsDCS-Anodal & RAT
|
2.5mA anodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA cathodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA sham tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
70 minutes of robotic-assisted training (RAT) of arm and hand functions will follow each of the tsDCS sessions, five days a week, for two weeks.
Robotic-assisted training will be provided by using the MAHI Exo-II device.
|
|
Experimental: tsDCS-Sham & robotic arm training (RAT), then tsDCS-Anodal & RAT, then tsDCS- Cathodal & RAT
|
2.5mA anodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA cathodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA sham tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
70 minutes of robotic-assisted training (RAT) of arm and hand functions will follow each of the tsDCS sessions, five days a week, for two weeks.
Robotic-assisted training will be provided by using the MAHI Exo-II device.
|
|
Experimental: tsDCS-Sham & robotic arm training (RAT), then tsDCS-Cathodal & RAT, then tsDCS-Anodal & RAT
|
2.5mA anodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA cathodal tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
2.5mA sham tsDCS over cervical spine for 20 minutes, five days a week, for two weeks.
tsDCS electrodes will be placed over cervical spine and shoulder.
Other Names:
70 minutes of robotic-assisted training (RAT) of arm and hand functions will follow each of the tsDCS sessions, five days a week, for two weeks.
Robotic-assisted training will be provided by using the MAHI Exo-II device.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Fugl-Meyer Arm (FMA) Motor Score
Time Frame: baseline
|
FMA is a stroke-specific, performance based impairment index.
It quantitatively measures impairment based on Twitchell and Brunnstrom's concept of sequential stages of motor return in hemiplegic stroke patients.
It uses an ordinal scale for scoring of 33 items for the upper limb component of the F-M scale (0:can not perform; 1:can perform partially; 2:can perform fully).
Total range is 0-66, 0 being poor and 66 normal.
|
baseline
|
|
Fugl-Meyer Arm (FMA) Motor Score
Time Frame: 2 weeks
|
FMA is a stroke-specific, performance based impairment index.
It quantitatively measures impairment based on Twitchell and Brunnstrom's concept of sequential stages of motor return in hemiplegic stroke patients.
It uses an ordinal scale for scoring of 33 items for the upper limb component of the F-M scale (0:can not perform; 1:can perform partially; 2:can perform fully).
Total range is 0-66, 0 being poor and 66 normal.
|
2 weeks
|
|
Fugl-Meyer Arm (FMA) Motor Score
Time Frame: 1 month
|
FMA is a stroke-specific, performance based impairment index.
It quantitatively measures impairment based on Twitchell and Brunnstrom's concept of sequential stages of motor return in hemiplegic stroke patients.
It uses an ordinal scale for scoring of 33 items for the upper limb component of the F-M scale (0:can not perform; 1:can perform partially; 2:can perform fully).
Total range is 0-66, 0 being poor and 66 normal.
|
1 month
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Jebsen Taylor Hand Function Test (JTHFT)
Time Frame: Baseline
|
The JTHFT is a motor performance test and assesses the time needed to perform 7 everyday activities (for example, flipping cards and feeding).
Score is reported as items completed per second.
|
Baseline
|
|
Action Research Arm Test (ARAT)
Time Frame: Baseline
|
The ARAT is used to assess subject's ability to manipulate-lift-release objects horizontally and vertically, which differs in size, weight and shape.
The test consists of 19 items divided into 4 sub-tests (grasp, grip, pinch, gross arm movement) and each item is rated on a 4-point scale.
The possible total score ranges between 0-57.
Higher scores indicate better performance.
|
Baseline
|
|
Motor Activity Log (MAL)
Time Frame: Baseline
|
The MAL ranges from 0 to 5, with a higher score indicating greater ability to use the affected arm.
|
Baseline
|
|
Pinch Strength
Time Frame: Baseline
|
A pinch gauge will be used to measure maximum pinch force.
|
Baseline
|
|
Quantitative Movement Measurement
Time Frame: Change from baseline at 2 weeks and at 1 month
|
Robotic movement data will be used to quantitatively measure changes in movement smoothness
|
Change from baseline at 2 weeks and at 1 month
|
|
Number of Participants With Adverse Effects Related to tsDCS
Time Frame: Baseline
|
Safety will be measured by questioning and observing participants at each treatment session.
Adverse effects, such as skin redness etc. will be recorded.
|
Baseline
|
|
Jebsen Taylor Hand Function Test (JTHFT)
Time Frame: 2 weeks
|
The JTHFT is a motor performance test and assesses the time needed to perform 7 everyday activities (for example, flipping cards and feeding).
Score is reported as items completed per second.
|
2 weeks
|
|
Jebsen Taylor Hand Function Test (JTHFT)
Time Frame: 1 month
|
The JTHFT is a motor performance test and assesses the time needed to perform 7 everyday activities (for example, flipping cards and feeding).
Score is reported as items completed per second.
|
1 month
|
|
Action Research Arm Test (ARAT)
Time Frame: 2 weeks
|
The ARAT is used to assess subject's ability to manipulate-lift-release objects horizontally and vertically, which differs in size, weight and shape.
The test consists of 19 items divided into 4 sub-tests (grasp, grip, pinch, gross arm movement) and each item is rated on a 4-point scale.
The possible total score ranges between 0-57.
Higher scores indicate better performance.
|
2 weeks
|
|
Action Research Arm Test (ARAT)
Time Frame: 1 month
|
The ARAT is used to assess subject's ability to manipulate-lift-release objects horizontally and vertically, which differs in size, weight and shape.
The test consists of 19 items divided into 4 sub-tests (grasp, grip, pinch, gross arm movement) and each item is rated on a 4-point scale.
The possible total score ranges between 0-57.
Higher scores indicate better performance.
|
1 month
|
|
Motor Activity Log (MAL)
Time Frame: 2 weeks
|
The MAL ranges from 0 to 5, with a higher score indicating greater ability to use the affected arm.
|
2 weeks
|
|
Motor Activity Log (MAL)
Time Frame: 1 month
|
The MAL ranges from 0 to 5, with a higher score indicating greater ability to use the affected arm.
|
1 month
|
|
Number of Participants With Adverse Effects Related to tsDCS
Time Frame: 2 weeks
|
Safety will be measured by questioning and observing participants at each treatment session.
Adverse effects, such as skin redness etc. will be recorded.
|
2 weeks
|
|
Number of Participants With Adverse Effects Related to tsDCS
Time Frame: 1 month
|
Safety will be measured by questioning and observing participants at each treatment session.
Adverse effects, such as skin redness etc. will be recorded.
|
1 month
|
|
Pinch Strength
Time Frame: 2 weeks
|
A pinch gauge will be used to measure maximum pinch force.
|
2 weeks
|
|
Pinch Strength
Time Frame: 1 month
|
A pinch gauge will be used to measure maximum pinch force.
|
1 month
|
|
Grip Strength
Time Frame: baseline
|
A grip dynamometer will be used to measure maximum gross grasp force.
|
baseline
|
|
Grip Strength
Time Frame: 2 weeks
|
A grip dynamometer will be used to measure maximum gross grasp force.
|
2 weeks
|
|
Grip Strength
Time Frame: 1 month
|
A grip dynamometer will be used to measure maximum gross grasp force.
|
1 month
|
|
Spasticity as Assessed by the Modified Ashworth Scale (MAS)
Time Frame: baseline
|
This test measures spasticity in patients with lesions of the Central Nervous System by testing resistance to passive movement about a joint with varying degrees of velocity.
Scores range from 0-4, with 0 indicating normal muscle tone and 4 indicating very high spasticity.
The investigators will measure spasticity in the trained upper limb.
|
baseline
|
|
Spasticity as Assessed by the Modified Ashworth Scale (MAS)
Time Frame: 2 weeks
|
This test measures spasticity in patients with lesions of the Central Nervous System by testing resistance to passive movement about a joint with varying degrees of velocity.
Scores range from 0-4, with 0 indicating normal muscle tone and 4 indicating very high spasticity.
The investigators will measure spasticity in the trained upper limb.
|
2 weeks
|
|
Spasticity as Assessed by the Modified Ashworth Scale (MAS)
Time Frame: 1 month
|
This test measures spasticity in patients with lesions of the Central Nervous System by testing resistance to passive movement about a joint with varying degrees of velocity.
Scores range from 0-4, with 0 indicating normal muscle tone and 4 indicating very high spasticity.
The investigators will measure spasticity in the trained upper limb.
|
1 month
|
|
Spinal Reflexes
Time Frame: Change from baseline at 2 weeks and at 1 month
|
Change from baseline at 2 weeks and at 1 month
|
|
|
Change in Strength of Selective Muscle Groups
Time Frame: Change from baseline at 2 weeks and at 1 month
|
Change from baseline at 2 weeks and at 1 month
|
|
|
Neurophysiologic Testing for Spinal Conductivity (SSEP)
Time Frame: Change from baseline at 2 weeks and at 1 month
|
Change from baseline at 2 weeks and at 1 month
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Gerard Francisco, MD, The University of Texas Health Science Center, Houston
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- HSC-MS-16-0237
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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