- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03635008
Anodal Transcranial Direct Current Stimulation Over the Contralesional Hemisphere on Motor Recovery in Subacute Stroke Patients
Effects of Anodal Transcranial Direct Current Stimulation Over the Contralesional Hemisphere on Motor Recovery in Subacute Stroke Patients With Severe Upper Extremity Hemiparesis: Study Protocol for a Randomized Controlled Trial
Upper limb recovery is not predicted by the initial severity of paralysis and the parameters reflecting the integrity of the corticospinal tract (e.g. motor evoked potential, fractional anisotropy in diffusion tensor imaging). Although the inhibition of the contralesional hemisphere is known to be beneficial for the upper limb recovery after stroke in previous studies, this is not proven in the severely paralyzed upper limb. And the studies using the noninvasive stimulation in subacute stroke is lack. In addition, the role of contralesional (unaffected) hemisphere is known to be playing the important role in severe stroke.
In this randomized, double-blind, sham-controlled studies, the patients with subacute stroke (<3 months after stroke onset), severe paralysis of the upper limb with poor prognosis (poor motor score and no response of motor evoked potential recorded in the extensor carpi radialis muscle) will be recruited. Interventional group will receive the 25 mins of anodal transcranial direct current stimulation (tDCS) over the contralesional premotor area plus 25 mins of robotic arm training per session for 10 sessions in 2 weeks. Control group will receive the same treatment except for sham tDCS instead of anodal tDCS over the contralesional premotor area. Functional outcome will be measured before and after the intervention (baseline, immediately after the intervention and 1 month after the intervention). Cortical activation pattern will be measured by the electroencephalography (EEG) at baseline and immediately after the intervention.
Study Overview
Status
Conditions
Intervention / Treatment
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Won-Seok Kim, MD, PhD
- Phone Number: +82317877735
- Email: wondol77@gmail.com
Study Contact Backup
- Name: Jihong Park, MD
- Email: wpeo00@gmail.com
Study Locations
-
-
Please Select
-
Seongnam-si, Please Select, Korea, Republic of, 13620
- Recruiting
- Seoul National University Bundang Hospital
-
Contact:
- Won-Seok Kim, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age: 18-85 years old
- Ischemic or Hemorrhagic stroke confirmed by the MRI or CT
- First-ever stroke
- < 3 months after stroke
- Unilateral upper limb weakness due to the stroke and meets the following all conditions: (1)Shoulder Abduction Finger Extension (SAFE) score (range 0-10) revealing the motor paralysis is below 8 (lower score mean worse function)), (2)Fugl Meyer Assessment score in the affected upper extremity is 25 or under 25. (3)No response in the motor evoked potential recorded on the affected extensor carpi radialis muscle,
Exclusion Criteria:
- recurrent stroke
- history of the other brain injury (e.g. traumatic brain injury)
- poor cognitive function (score of korean version of mini-mental state exam is 15 or below 15).
- Poor cooperation due to delirium or problems in the consciousness
- Uncontrolled or unstable medical conditions.
- Pregnant
- Scalp problems which interfere with the tDCS application
- Robotic arm training can not be applied due to the unstable sitting posture or head control, or arm pain.
- Metals in the head (e.g. clip, coil)
- Cardiac pacemaker or cochlear implants
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Anodal tDCS
This group will receive the 25 mins of the tDCS (Yrain, Korea) over the contralesional premotor area simultaneously with 25 mins of the robotic arm training using Armeo Power (Hocoma, Switzerland), per day. Additional 30 mins of occupational therapy focusing on the arm motor recovery will be provided per day. These interventions will be provided for 10 weekdays. Other conventional rehabilitation (e.g. gait training, speech therapy) will be permitted. Regard to the anodal tDCS, the anode will be placed over the contralesional premotor area (2.5 cm anterior to the C3 or C4 in 10-20 EEG system) and cathode will be placed over the contralateral supraorbital area. The stimulation intensity will be 2mA. |
Regard to the anodal tDCS, the anode will be placed over the contralesional premotor area (2.5 cm anterior to the C3 or C4 in 10-20 EEG system) and cathode will be placed over the contralateral supraorbital area.
The stimulation intensity will be 2mA.
For the sham tDCS the stimulation will be applied for just first 30 seconds.
|
Placebo Comparator: sham tDCS
This group will receive the 25 mins of the tDCS (Yrain, Korea) over the contralesional premotor area simultaneously with 25 mins of the robotic arm training using Armeo Power (Hocoma, Switzerland), per day. Additional 30 mins of occupational therapy focusing on the arm motor recovery will be provided per day. These interventions will be provided for 10 weekdays. Other conventional rehabilitation (e.g. gait training, speech therapy) will be permitted. Regard to the sham tDCS, the anode will be placed over the contralesional premotor area (2.5 cm anterior to the C3 or C4 in 10-20 EEG system) and cathode will be placed over the contralateral supraorbital area. The stimulation intensity will be started but the intensity will decrease and stop in 30 seconds. |
Regard to the anodal tDCS, the anode will be placed over the contralesional premotor area (2.5 cm anterior to the C3 or C4 in 10-20 EEG system) and cathode will be placed over the contralateral supraorbital area.
The stimulation intensity will be 2mA.
For the sham tDCS the stimulation will be applied for just first 30 seconds.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Fugl-Meyer Assessment (FMA) scores of the upper extremity
Time Frame: Change from Baseline FMA at 2 weeks
|
range: 0 (worst) -66 (best)
|
Change from Baseline FMA at 2 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Korean version of modified Barthel Index (K-MBI)
Time Frame: Change from baseline K-MBI at 2 weeks
|
range: 0 (worst) -100 (best)
|
Change from baseline K-MBI at 2 weeks
|
Korean version of modified Barthel Index (K-MBI)
Time Frame: Change from baseline K-MBI at 6 weeks
|
range: 0 (worst) -100 (best)
|
Change from baseline K-MBI at 6 weeks
|
Brunnstrom stage (B-stage) of arm
Time Frame: Change from baseline B-stage at 2 weeks
|
range: 1(worst) -6 (best)
|
Change from baseline B-stage at 2 weeks
|
Brunnstrom stage (B-stage) of arm
Time Frame: Change from baseline B-stage at 6 weeks
|
range: 1(worst) -6 (best)
|
Change from baseline B-stage at 6 weeks
|
Box and Block Test (BBT)
Time Frame: Change from baseline BBT at 2 weeks
|
maximum number of blocks from one compartment of a box to another of equal size, within 60 seconds, more numbers mean better function
|
Change from baseline BBT at 2 weeks
|
Box and Block Test (BBT)
Time Frame: Change from baseline BBT at 6 weeks
|
maximum number of blocks from one compartment of a box to another of equal size, within 60 seconds, more numbers mean better function
|
Change from baseline BBT at 6 weeks
|
Modified Ashworth Scale
Time Frame: 2 weeks after baseline
|
to measure the spasticity: 6 grades: 0 (no spasticity), 1, 1+, 2, 3, 4 (severe spasticity)
|
2 weeks after baseline
|
Modified Ashworth Scale
Time Frame: 6 weeks after baseline
|
to measure the spasticity: 6 grades: 0 (no spasticity), 1, 1+, 2, 3, 4 (severe spasticity)
|
6 weeks after baseline
|
Manual muscle power test
Time Frame: 2 weeks after baseline
|
3 proximal (shoulder abduction, elbow flexion, and extension) and 5 distal (flexion and extension of the hand and fingers, and thumb flexion) muscle groups, 6 grades ranges from 0 (flaccid) to 5 (strongest).
|
2 weeks after baseline
|
Manual muscle power test
Time Frame: 6 weeks after baseline
|
3 proximal (shoulder abduction, elbow flexion, and extension) and 5 distal (flexion and extension of the hand and fingers, and thumb flexion) muscle groups, 6 grades ranges from 0 (flaccid) to 5 (strongest).
|
6 weeks after baseline
|
Laterality Index
Time Frame: 2 weeks after baseline
|
Ratio of the cortical activation between the contra- and ipsilesional motor area recorded by the electroencephalography
|
2 weeks after baseline
|
Laterality Index
Time Frame: 6 weeks after baseline
|
Ratio of the cortical activation between the contra- and ipsilesional motor area recorded by the electroencephalography
|
6 weeks after baseline
|
Fugl-Meyer Assessment (FMA) scores of the upper extremity
Time Frame: Change from Baseline FMA at 6 weeks
|
range: 0 (worst) -66 (best)
|
Change from Baseline FMA at 6 weeks
|
Collaborators and Investigators
Investigators
- Principal Investigator: Won-Seok Kim, MD, PhD, Seoul National University Bundang Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- B-1805/468-002
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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.
Clinical Trials on Stroke
-
University Hospital, GhentRecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Stroke HemorrhagicBelgium
-
Moleac Pte Ltd.RecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, CryptogenicSingapore, Philippines
-
Moleac Pte Ltd.Not yet recruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke, Cardiovascular | Strokes Thrombotic | Stroke, Embolic | Stroke, Cryptogenic
-
IRCCS San Camillo, Venezia, ItalyRecruitingStroke | Stroke, Ischemic | Stroke Sequelae | Stroke HemorrhagicItaly
-
Vanderbilt University Medical CenterPatient-Centered Outcomes Research Institute; University of Alabama at BirminghamEnrolling by invitationStroke | Stroke, Ischemic | Stroke, Acute | Stroke Sequelae | Engagement, Patient | Stroke HemorrhagicUnited States
-
University of MinnesotaAmerican Occupational Therapy FoundationRecruitingStroke | Stroke Sequelae | Stroke Hemorrhagic | Stroke IschemicUnited States
-
University of British ColumbiaCanadian Institutes of Health Research (CIHR); Michael Smith Foundation for...RecruitingStroke | Stroke, Ischemic | Stroke Hemorrhagic | Chronic StrokeCanada
-
University of CincinnatiMedical University of South Carolina; University of California, Los Angeles; University...RecruitingStroke | Stroke, Ischemic | Stroke, Acute | Stroke HemorrhagicUnited States
-
Turkish Stroke Research and Clinical Trials NetworkElectroCore INC; Turkish Neurological SocietyCompletedStroke | Stroke, Ischemic | Stroke, Acute | Stroke, HemorrhagicTurkey
-
University of LiegeCompletedStroke, Acute | Stroke Hemorrhagic | Stroke, ComplicationBelgium
Clinical Trials on tDCS
-
Hôpital le VinatierCompletedSchizophrenia | Auditory HallucinationsFrance, Tunisia
-
Universidad de AlmeriaSecretaría General de Universidades, Investigación y Tecnología, Junta de...Enrolling by invitationSubstance-Related DisordersSpain
-
Nachum Soroker, MDUnknown
-
Bambino Gesù Hospital and Research InstituteCompleted
-
Northeastern UniversityMassachusetts General Hospital; National Institute on Aging (NIA)Unknown
-
University of North Carolina, Chapel HillNational Institute of Mental Health (NIMH)CompletedMotor Activity | Motor NeuroplasticityUnited States
-
Charite University, Berlin, GermanyCompletedMigraine With Aura | CADASIL | Cerebral Microangiopathy | ICA StenosisGermany
-
Universidade Federal de PernambucoCompleted
-
University of California, Los AngelesNational Institute of Mental Health (NIMH)Completed
-
Thorsten RudroffTerminatedMultiple Sclerosis | Neuropathic PainUnited States