Telerehabilitation and Biomarkers of Recovery After Stroke in Brazil (TR-BR-1)

June 9, 2026 updated by: Taiza G. S. Edwards, PhD, University of Sao Paulo

Telerehabilitation and Biomarkers of Functional Recovery After Stroke in Brazil: TR-BR-1 Clinical Trial

The purpose of this research study is to provide preliminary evidence of whether telerehabilitation targeting arm movement, when added to usual care, improves arm function and reduces global disability after stroke, compared to usual care alone in Brazil. Evaluate the safety and feasibility of telerehabilitation in the Brazilian context. Explore the clinical, neuroimaging, neurophysiological, and economic factors that influence telerehabilitation efficacy in functional recovery following stroke.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This is a two-arm phase II randomized controlled trial with blinded outcome assessment. A total of 20 post-stroke participants will be randomized to either telerehabilitation added to usual care (TR+UC) or usual care alone (UC). The primary outcome measure is the Action Research Arm Test (ARAT), which assesses upper extremity motor function. Secondary measures will include feasibility and intervention-related outcomes.

Study participation will span approximately 4 months and includes 6 in-person assessment visits. At these visits, participants will complete a battery of assessments, including upper extremity motor function tests, resting-state functional electroencephalography (EEG), and a single magnetic resonance imaging (MRI) scan of the brain. Participants assigned to the TR+UC group will receive structured arm motor training consisting of 36 sessions of prescribed exercises, interactive games, and stroke education delivered over 6 weeks at a frequency of 6 days per week, with each session lasting approximately 70 minutes. TR+UC participants will continue all usual care concurrently. Participants in the UC group will continue all therapies recommended by their medical team without participating in telerehabilitation.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
20

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Phase 2

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Taiza G. S. Edwards, PhD
  • Phone Number: +5516-36021202
  • Email: trbr1@usp.br

Study Contact Backup

  • Name: Antonio Carlos Santos, MD, PhD
  • Phone Number: +551636022964

Study Locations

  • Brazil
    • São Paulo
      • Ribeirão Preto, São Paulo, Brazil, 14049900
        • Ribeirão Preto Medical School, University of São Paulo
        • Contact:
          • Taiza G. S. Edwards, PhD
          • Phone Number: +5516-36021202
          • Email: trbr1@usp.br
        • Contact:
          • Antonio Carlos dos Santos, MD, PhD
        • Principal Investigator:
          • Taiza G. S. Edwards, PhD
        • Sub-Investigator:
          • Antonio Carlos dos Santos, MD, PhD

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  1. Age 18-80 years at the time of randomization.
  2. The index stroke was radiologically verified, due to ischemia, and had time of onset 120±30 days prior to randomization.
  3. The stroke caused upper extremity deficits as defined by Action Research.
  4. Arm Test score 18-44 (out of 57) at Baseline Visit.
  5. Box & Block Test score with affected arm is ≥1 block in 60 seconds at Baseline Visit.
  6. Able to successfully perform all 3 rehabilitation exercise test examples (simple commands) at Baseline Visit.
  7. Informed consent and behavioral contract signed by the subject (i.e., no surrogate consent).

Exclusion Criteria:

  1. A major, active, coexistent neurological, psychiatric, or medical disease that reduces the likelihood that a subject will be able to comply with all study procedures.
  2. Unable or unwilling to perform study procedures/therapy, or expectation of noncompliance with study procedures/therapy, or expectation that subject cannot participate in all study visits.
  3. A diagnosis (apart from the index stroke) that substantially affects paretic arm function.
  4. Severe depression, defined as Geriatric Depression Scale Score >10/15 at Baseline Visit.
  5. Significant cognitive impairment, defined as Montreal Cognitive Assessment [a lower score can be permitted at the discretion of the PI].
  6. Deficits in communication that interfere with reasonable study participation.
  7. Severe UE spasticity, defined as presence of contracture or modified Ashworth Scale score=4 in either biceps or pectoralis.
  8. Modified Rankin Scale score >2 prior to the index stroke.
  9. A new symptomatic stroke has occurred since the index stroke, or a separate stroke occurred within 30 days prior to the index stroke.
  10. Lacking visual acuity, with or without corrective lens, of 20/50 or better in at least one eye.
  11. Life expectancy < 9 months
  12. Pregnancy; women of child-bearing potential must have a negative pregnancy test.
  13. Botulinum toxin to the paretic arm: received in the prior 3 months or expected by the 1-Month Visit.
  14. Concurrent enrollment in another therapy-based investigational study where the duration of the investigational therapy's activity is likely to occur during the subject's participation in the study.
  15. Subject lacks sufficient Portuguese to comply with study procedures and TR instructions.
  16. Contraindication to MRI.
  17. Contraindication to TMS.
  18. Box and Block Test score of ≥30 blocks with the unaffected arm within 60 seconds at Baseline Visit;
  19. Spatial neglect interfering with reasonable participation in the study;
  20. On isolation precautions, e.g., due to active COVID-19.
  21. Expectation that participant will not have a single domicile address during the 6 weeks of therapy.
  22. Distance from the participant's home to the study site greater than 120 km [this can be waived at the discretion of the PI].

22. Availability of a 2 m² space for a table and chair setup.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Other: Usual Care
Participants in the usual care group will receive no TR, but will continue with the recommendations made by their care team.
Other: Usual Care
Usual care rehabilitation refers to the recommendations made by their care team.
Active Comparator: Telerehabilitation + Usual Care
In addition to the usual care, patients will receive 36 telerehabilitation sessions targeting arm motor function in addition to their usual care. TR consists of 70 minutes/day of activities targeting arm function, 6 days/week for 6 weeks. Half of these sessions are supervised by a licensed therapist, and the other half are done independently.
Other: Usual Care
Usual care rehabilitation refers to the recommendations made by their care team.
Device: Telerehabilitation
Participants will receive 36 telerehabilitation sessions targeting arm motor function in addition to their usual care. TR consists of 70 minutes/day of activities targeting arm function, 6 days/week for 6 weeks. Half of these sessions are supervised by a licensed therapist, and the other half are done independently.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Change in Action Research Arm Test (ARAT) Score from baseline to the early post-intervention.
Time Frame: From baseline to early (within 7 days) post-intervention
Change in Action Research Arm Test (ARAT) Score from baseline to the early post-intervention. The ARAT scale measures arm function using a scale that runs from 0 to 57 points, with higher numbers reflecting better arm function.
From baseline to early (within 7 days) post-intervention
Study feasibility in the Brazilian context - recruitment.
Time Frame: Through recruitment completion - an average of 15 months
Proportion of eligible participants who agree to take part in the study.
Through recruitment completion - an average of 15 months
Study feasibility in the Brazilian context - adherence.
Time Frame: Through study completion (specifically end of therapy) - an average of 17 months
Proportion of participants who complete TR therapy with sessions of 40 minutes or longer.
Through study completion (specifically end of therapy) - an average of 17 months
Study feasibility in the Brazilian context - retention.
Time Frame: Through study completion (specifically end of follow-up) - an average of 18 months
Proportion of dropouts during the study participation period.
Through study completion (specifically end of follow-up) - an average of 18 months

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Change in Action Research Arm Test (ARAT) Score from baseline to 1 month post-intervention.
Time Frame: From baseline to 1 month post-intervention
Change in Action Research Arm Test (ARAT) Score from baseline to 1 month post-intervention. The ARAT scale measures arm function using a scale that runs from 0 to 57 points, with higher numbers reflecting better arm function.
From baseline to 1 month post-intervention
Treatment-related adverse events reported by the participants.
Time Frame: From the start of TR to early (within 7 days) post-intervention
Number and severity of adverse events related to the telerehabilitation intervention reported by the participants.
From the start of TR to early (within 7 days) post-intervention

Other Outcome Measures

Other Outcome Measures

For clinical trials, a planned measurement described in the protocol that is used to determine the effect of an intervention/treatment on participants. For observational studies, a measurement or observation that is used to describe patterns of diseases or traits, or associations with exposures, risk factors, or treatment. Types of outcome measures include primary outcome measure and secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
White matter integrity assessed using diffusion tensor imaging (DTI) magnetic resonance imaging (MRI).
Time Frame: Baseline
Cortical spinal tract integrity - lesion load (predictive factor).
Baseline
Interhemispheric connectivity of motor cortices assessed using resting-state functional magnetic resonance imaging (rs-fMRI).
Time Frame: Baseline
rs-fMRI interhemispheric functional connectivity in the primary motor cortex (predictive factor).
Baseline
Motor cortex mapping and motor representation assessed using neuronavigated transcranial magnetic stimulation (nTMS).
Time Frame: Baseline
nTMS motor mapping (predictive factor).
Baseline
Interhemispheric connectivity of motor cortices assessed using resting-state functional electroencephalography (rsEEG).
Time Frame: Baseline
rsEEG interhemispheric functional connectivity in the primary motor cortex (predictive factor).
Baseline
Change in upper-extremity Fugl-Meyer assessment (UE-FM) from baseline to the early post-intervention.
Time Frame: From baseline to early (within 7 days) post-intervention
Change in UE-FM. UE-FM is a scale that measures upper limb motor function using a scale that runs from 0 to 66 points, with higher scores reflecting better upper extremity motor function.
From baseline to early (within 7 days) post-intervention
Change in Modified Rankin Scale (mRS) from Baseline to the early post-intervention.
Time Frame: From baseline to early (within 7 days) post-intervention
Change in mRS. The mRS scale measures global function using a scale that runs from 0 to 6 points, with lower numbers reflecting better global function.
From baseline to early (within 7 days) post-intervention
Change in interhemispheric connectivity of motor cortices assessed using resting-state functional electroencephalography (rsEEG).
Time Frame: From baseline to early (within 7 days) post-intervention
Change in rsEEG interhemispheric functional connectivity in the primary motor cortex.
From baseline to early (within 7 days) post-intervention
Change in interhemispheric connectivity of motor cortices assessed using resting-state functional electroencephalography (rsEEG).
Time Frame: From baseline to 1-month post-intervention
Change in rsEEG interhemispheric functional connectivity in the primary motor cortex.
From baseline to 1-month post-intervention
Change in motor cortex mapping and motor representation assessed using neuronavigated transcranial magnetic stimulation (nTMS) from baseline to early post-intervention.
Time Frame: From baseline to early (within 7 days) post-intervention
nTMS motor mapping (predictive factor).
From baseline to early (within 7 days) post-intervention
Change in motor cortex mapping and motor representation assessed using neuronavigated transcranial magnetic stimulation (nTMS) from baseline to 1 month post-intervention.
Time Frame: From baseline to 1 month post-intervention
nTMS motor mapping (predictive factor).
From baseline to 1 month post-intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Sao Paulo

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
University of California, Los Angeles
Thomas Jefferson University
Ribeirão Preto Medical School, University of São Paulo
Clinical Hospital, Ribeirão Preto Medical School, University of São Paulo
Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Taiza G. S. Edwards, PhD, Ribeirão Preto Medical School, University of São Paulo

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
June 12, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 15, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
February 29, 2028

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 24, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 9, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
June 12, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
June 12, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
June 9, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
June 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 90571225.4.0000.5440
  • 2025/10298-4 (Other Grant/Funding Number: São Paulo Research Foundation (FAPESP))

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Non-PHI data will be shared with appropriate parties after the study is completed and published.

IPD Sharing Time Frame

Anytime after July, 2028.

IPD Sharing Access Criteria

Appropriate parties with appropriate intention for use of the data, starting 07/01/2028, with access to PHI-free data.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP
  • ANALYTIC_CODE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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