- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01644929
Rehabilitation Combined With Bihemispherictranscranial Direct Current Stimulation in Subacute Ischemic Stroke (RECOMBINE)
Rehabilitation Combined With Bihemispherictranscranial Direct Current Stimulation in Subacute Ischemic Stroke to Increase Upper Limb Motor Recovery, a Randomised, Controlled, Double-blind Study
Rehabilitation after stroke improves motor functions by promoting plastic changes however, after completing standard rehabilitation, 50-60% of patients still exhibit some degree of motor impairment and require at least partial assistance in activities of day living. Therefore, the exploration of other approaches to promote recovery is compulsory. Non invasive brain stimulation and motor rehabilitation are thought to share similar mechanisms in inducing neuroplastic changes in the human cortex and an emerging field of research is focusing on the possibility of coupling both therapies in order to achieve an additive effect and improve outcome.
We hypothesize that coupling bihemispheric transcranial direct current stimulation (tDCS) with simultaneous physical/occupational therapy in the subacute phase of ischemic stroke patients may improve upper limb motor recovery in humans.
This is a randomized, controlled, double blind, cross-over, multicentre, clinical trial. Thirty-six ischemic stroke patients in the subacute phase will be recruited in three centers of neurorehabilitation in Switzerland. After stratification based on the Fugl-Meyer Assessment Upper Extremity according to the severity of the deficit, the patient will be randomized to receive besides standardized physical/occupational treatment according to the Impairment-Oriented Training, tDCS of themotor cortex (1.5 mA, 30 minutes) (group 1: 12 patients) or sham stimulation (without current) (group 2: 12 patients). After three weeks of treatment group 1 and 2 will cross-over and will be treated for other three weeks. Group 3 (12 patients) will receive routine physical/occupational treatment and sham tDCS for six weeks. Assessment will be performed before starting tDCS, at week 3, 6 and at 6 months. Outcome measures are the Fugl-Meyer Assessment Upper Extremity, the extended Barthel Index, the Ashworth scale, the Test of Upper Limb Apraxia (only baseline, week 6, month6), the grip strength evaluated by the Jamar Hydraulic Hand dynamometer. At baseline at week 6 and at month 6 depression will be assessed by the Hamilton depression Rating Scale.
Study Overview
Status
Conditions
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Carlo Cereda, MD
- Phone Number: +41 91 811 66 91
- Email: Carlo.Cereda@eoc.ch
Study Contact Backup
- Name: Paolo Rossi, MD
- Phone Number: +41 091 786 86 86
- Email: paolo.rossi@clinica-hildebrand.ch
Study Locations
-
-
-
Bern, Switzerland, 3010
- Withdrawn
- Universitätsspital Bern, Inselspital, Neuropsychologische Rehabilitation
-
Brissago, Switzerland, 6614
- Recruiting
- Clinica Hildebrand, Centro di riabilitazione Brissago
-
Contact:
- Paolo Rossi, MD
- Phone Number: +41 91 786 86 86
- Email: p.rossi@clinica-hildebrand.ch
-
Principal Investigator:
- Paolo Rossi, MD
-
Zihlschlacht, Switzerland, 8588
- Terminated
- HELIOS Klinik Zihlschlacht AG, Neurologisches Rehabilitationszentrum
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Ischemic lesions in the territory of middle cerebral artery subcortical or subcortical/cortical confirmed neuroimaging
- Inclusion must be in the sub-acute phase defined as within 2-4 weeks after stroke
- Persistent hemiparesis, indicated by a score of 1-3 on the motor arm item of the NIH Stroke Scale (NIHSS) (Brott et al. 1989) but wrist and finger movement is not required
- No UE injury or conditions that limited use prior to the stroke.
- The patient is >18 years old.
- The patient has subscribed the informed consent
Exclusion Criteria:
- History of epilepsy, brain tumor, major head trauma, learning disorder, severe cognitive impairment, drug or alcohol abuse, major psychiatric illness
- Use of medications that may lower seizure threshold (e.g., metronidazole, fluoroquinolones)
- Severe pain in the affected upper limb (>=8 on the shoulder item of the "joint pain during passive motion" of the Fugl-Meyer Assessment Upper Extremity)
- Further stroke or other significant medical complication during the study
- Evidence of severe leucoencephalopathy (grade IV according to the Fazeka's scale)
- Important aphasia that would impair the understanding and performance of the assessment scales
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 1 tDCS-Sham
tDC stimulation for 3 weeks, then cross-over to sham stimulation
|
Anodal tDCS of the ipsilesional motor cortex and cathodal tDCS of contralesional motor cortex (1.5 mA, 30 minutes) for 15 days during three weeks, then sham stimulation for 30 seconds on 15 days during 3 weeks
|
Experimental: 2 Sham-tDCS
Sham stimulation for 3 weeks, then cross over to tDCS stimulation
|
Sham stimulation for 30 seconds on 15 days during 3 weeks, then anodal tDCS of the ipsilesional motor cortex and cathodal tDCS of contralesional motor cortex (1.5 mA, 30 minutes) for 15 days during three weeks
|
Sham Comparator: 3 Sham-Sham
Treatment for 6 weeks daily with sham stimulation
|
Sham stimulation for 30 seconds on 15 days during 6 weeks
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fugl-Meyer Assessment Upper Extremity
Time Frame: 6 weeks
|
Investigator administered questionnaire
|
6 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fugl-Meyer Assessment Upper Extremity
Time Frame: 3 weeks
|
Investigator administered questionnaire
|
3 weeks
|
Fugl-Meyer Assessment Upper Extremity
Time Frame: 6 months
|
Investigator administered questionnaire
|
6 months
|
Barthel Index
Time Frame: 3 weeks
|
Investigator administered questionnaire
|
3 weeks
|
Barthel Index
Time Frame: 6 weeks
|
Investigator administered questionnaire
|
6 weeks
|
Barthel Index
Time Frame: 6 months
|
Investigator administered questionnaire
|
6 months
|
Ashworth scale
Time Frame: 3 weeks
|
Investigator administered questionnaire
|
3 weeks
|
Ashworth scale
Time Frame: 6 weeks
|
Investigator administered questionnaire
|
6 weeks
|
Ashworth scale
Time Frame: 6 months
|
Investigator administered questionnaire
|
6 months
|
Test of Upper Limb Apraxia (TULIA)
Time Frame: 6 weeks
|
investigator administered questionnaire
|
6 weeks
|
Test of Upper Limb Apraxia (TULIA)
Time Frame: 6 months
|
investigator administered questionnaire
|
6 months
|
Grip strength
Time Frame: 3 weeks
|
Jamar Hydraulic Hand dynamometer
|
3 weeks
|
Grip strength
Time Frame: 6 weeks
|
Jamar Hydraulic Hand dynamometer
|
6 weeks
|
Grip strength
Time Frame: 6 months
|
Jamar Hydraulic Hand dynamometer
|
6 months
|
Hamilton depression Rating scale
Time Frame: 6 weeks
|
Patient administered questionnaire
|
6 weeks
|
Hamilton depression Rating scale
Time Frame: 6 months
|
Patient administered questionnaire
|
6 months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Carlo Cereda, MD, Ospedale Regionale di Lugano - Civico
Publications and helpful links
General Publications
- Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. Cochrane Database Syst Rev. 2020 Nov 11;11(11):CD009645. doi: 10.1002/14651858.CD009645.pub4.
- Lindenberg R, Renga V, Zhu LL, Nair D, Schlaug G. Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology. 2010 Dec 14;75(24):2176-84. doi: 10.1212/WNL.0b013e318202013a. Epub 2010 Nov 10.
Study record dates
Study Major Dates
Study Start
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- EOC.NSI.11.02
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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