Deep Brain Stimulation + Therapy for Stroke

Deep Brain Stimulation of the Motor Thalamus Combined With Speech and Swallowing Therapy to Improve Post-Stroke Motor Speech and Swallowing Production Impairments

The purpose of this study is to evaluate the safety and potential benefits of combining deep brain stimulation (DBS) with targeted speech and swallowing rehabilitation in individuals who have experienced a stroke and have moderate to severe difficulties with speech and/or swallowing. Speech difficulties may include apraxia, which affects the ability to plan and coordinate speech movements, and dysarthria, which affects the ability to produce clear speech. Participants may also have difficulty swallowing (dysphagia).

The primary objective of this feasibility study is to evaluate the safety of the SR-DBS system in individuals with post-stroke speech and swallowing difficulties. The secondary objective is to evaluate whether combining DBS with speech and swallowing rehabilitation improves motor speech and swallowing function and reduces related impairments. The study will compare outcomes following rehabilitation alone with outcomes following rehabilitation combined with DBS to determine whether the addition of DBS provides greater improvements in speech and swallowing function.

Study Overview

• Status: Not yet recruiting
• Conditions: Stroke; Dysphagia; Apraxia; Dysarthria; Hemiparesis After Stroke
• Intervention / Treatment: Device: Boston Scientific Vercise Deep Brain Stimulation (DBS) System; Other: Rehabilitation Training Protocol

Detailed Description

The study will be conducted in three sequential phases. Following baseline assessments, participants will complete a structured speech and swallowing therapy program in Phase 1 (Rehabilitation), consisting of 60-minute sessions 3 days per week for 6 weeks, with 45 minutes dedicated to speech therapy and 15 minutes to swallowing therapy. In Phase 2 (Rehabilitation + DBS), participants will undergo implantation of the Stroke Rehabilitation Deep Brain Stimulation (SR-DBS) System and complete the same 6-week therapy program, with DBS delivered during the therapy sessions. Each session will include 45 minutes of speech therapy and 15 minutes of swallowing therapy. In Phase 3, implanted participants will be followed for 6 months after the intervention, with monthly laboratory visits to assess the effects of DBS on speech and swallowing function.

• Study Type: Interventional
• Enrollment (Estimated): 15
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Cierra Clark, MS; Phone Number: 2404414216; Email: cic27@pitt.edu
• Study Contact Backup: Name: Amy Boos, MS; Phone Number: 412-648-4179; Email: amyy.boos@pitt.edu

Study Locations

• United States
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15213
      • University of Pittsburgh
      • Principal Investigator: Jorge Gonzalez-Martinez, MD, PhD
      • Contact: Cierra Clark, MS; Phone Number: 2404414216; Email: cic27@pitt.edu
      • Contact: Amy Boos, MS; Phone Number: 4126484179; Email: amy.boos@pitt.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 22 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Participants must have suffered an ischemic or hemorrhagic stroke causing motor speech and swallowing deficits as a result. For ischemic stroke, the event needs to have occurred more than 6 months before the time of enrollment, whereas, for hemorrhagic stroke, the event needs to have occurred more than 12 months before the time of enrollment. Prior strokes that did not cause motor speech or swallowing deficits are not exclusionary.
2. Participants must be between the ages of 22 and 75 years old.
3. English speaker.
4. Participants must have 30-84% intelligibility on the Speech Intelligibility Test (SIT), score ≤14 on the Communicative Participation Item Bank (CPIB) AND an instrumental swallowing assessment (VFSS or FEES) demonstrating Penetration-Aspiration-Scale (PAS) ≥ 2.

Exclusion Criteria:

1. Participants must not have any serious disease or disorder (e.g., neurological conditions other than stroke, cancer, severe cardiac or respiratory disease, renal failure, etc.) that could affect their ability to participate in this study.
2. Participants must not have a high risk of recurrent stroke as evident from their medical history or upon judgment of the study physician.
3. Participants must not have a score on the Short Blessed Test assessment scale of ≥10.
4. Female participants of child-bearing age must not be pregnant or breastfeeding during the study.
5. Participants that cannot suspend their antiplatelets and/or anticoagulant therapy including aspirin, clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta), warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa) for two weeks around the surgery will be excluded from participation.
6. Participants may not have any implanted medical device that is not MRI safe and must not have any active medical devices, including implanted stimulation devices, even if they are MRI safe.
7. Participants cannot have severe claustrophobia that can prevent them from executing the required MRI imaging sessions.
8. Participants must not be taking oral or systemic anti-spasticity or anti-epileptic medications or facial and/or neck anti-spasticity injections (e.g., cosmetic Botox, migraine treatment, or bruxism/TMJ treatment) for 3 months prior to enrollment in the study and for the duration of the study. Participants may continue anti-spasticity injections localized to the upper- and/or lower-limbs.
9. Participants with a T-score >63 on the 18-question Brief Symptoms Inventory (BSI-18) who have undergone discussions with and been deemed unsuitable by the Principal Investigator, and a study physician will be excluded from participation.
10. Participants with gross anatomical variances in MR imaging or cerebral vascular accidents involving motor thalamus and cerebellar areas.
11. Participants must not have any lesions in the lower motoneuron causing flaccid dysarthria and/or bulbar dysphagia.
12. Participants with deficits affecting language (i.e., pure aphasia) and not speech deficits.
13. Participants with diabetes mellitus whose recent Hemoglobin A1C value is 8.0% or greater.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Rehabilitation Alone, then Combined with Deep Brain Stimulation; Two Vercise™ Cartesia™ X Directional Leads (16-contact) - Model DB-2203 (P150031 - S065) will be surgically implanted bilaterally in the thalamus for the duration of Phases 2 and 3. The leads will be connected to a Vercise Genus R32 IPG (P150031 - S050), which will be surgically implanted in the chest and remain implanted for the duration of Phases 2 and 3. The IPG is rechargeable.

Device: Boston Scientific Vercise Deep Brain Stimulation (DBS) System; The Vercise Genus R32 IPG (P150031 - S050) is a rechargeable implantable pulse generator designed to deliver electrical stimulation to the thalamus via two surgically implanted Vercise™ Cartesia™ X Directional Leads (16-contact), Model DB-2203 (P150031 - S065). The system will be used for the duration of Phases 2 and 3.; Other: Rehabilitation Training Protocol; The speech and swallowing training protocol (Rehab) is designed to engage with tailored exercises for speech and swallowing. For speech, the training exercises will be executed following the "Be Clear" program, which has been extensively validated in participants with non-progressive dysarthria and apraxia and has been recently shown to be effective also when administered through telemedicine. For swallowing, the training exercises will be based on the Intensive Dysphagia Rehabilitation protocol, developed for adults with neurogenic dysphagia.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number and Severity of Adverse Events	Success Criteria: No serious adverse events related to the stimulation or intolerable adverse events reported.	From enrollment to the end of treatment at 49 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Absolute PAS Change - Phase 2	The investigators will measure the change in the Penetration Aspiration Scale (PAS) from post-implant to the end of Phase 2 with stimulation off. The PAS is an 8-point medical rating system used to describe how deep food, liquid, or saliva goes into a person's airway during a swallow. Scores range from 1 to 8, with lower scores indicating better swallowing function and higher scores indicating worse swallowing function. Success criteria: Mean change in PAS score across Phase 2 is greater than zero, indicating an additional therapeutic benefit of DBS beyond speech and swallowing training executed in Phase 1.	11 weeks
Absolute PAS Change - Baseline to Phase 2	The investigators will measure the change in the Penetration Aspiration Scale (PAS) from baseline to the end of Phase 2 with stimulation off. The PAS is an 8-point medical rating system used to describe how deep food, liquid, or saliva goes into a person's airway during a swallow. Scores range from 1 to 8, with lower scores indicating better swallowing function and higher scores indicating worse swallowing function. Success criteria: Mean change in PAS score across the study period is greater than zero.	19 weeks
Absolute Intelligibility - Phase 2	The investigators will measure the change in intelligibility from the Speech Intelligibility Test (SIT) from post-implant to the end of Phase 2 with stimulation off. The SIT is a clinical tool used to measure how clearly a person speaks and how well an unfamiliar listener can understand them. The SIT score ranges from 0% to 100%, with higher scores indicating better speech intelligibility and lower scores indicating worse speech intelligibility. It is calculated by counting the number of correct words, dividing that by the total number of words in the target stimulus, and multiplying that by 100 to calculate the percent-correct intelligibility score. Success criteria: Mean change in intelligibility across Phase 2 is greater than zero, indicating an additional therapeutic benefit of DBS beyond speech and swallowing training executed in Phase 1.	11 weeks
Absolute Intelligibility - Baseline to Phase 2	The investigators will measure the change in intelligibility from the Speech Intelligibility Test (SIT) from baseline to the end of Phase 2 with stimulation off. The SIT is a clinical tool used to measure how clearly a person speaks and how well an unfamiliar listener can understand them. The SIT score ranges from 0% to 100%, with higher scores indicating better speech intelligibility and lower scores indicating worse speech intelligibility. It is calculated by counting the number of correct words, dividing that by the total number of words in the target stimulus, and multiplying that by 100 to calculate the percent-correct intelligibility score. Success criteria: Mean increase in intelligibility across the study period is equal or greater than 15 percentage points, indicating the average improvement surpasses the minimal clinically meaningful threshold.	19 weeks
Modified Barium Swallow Impairment Profile Changes - Phase 2 to Phase 3	The investigators will measure changes in the Modified Barium Swallow Impairment Profile (MBSImP) scores with stimulation on and stimulation off during the same session. The MBSImP evaluates 17 distinct physiological components of swallowing, grouped into three main operational domains. Each component is rated on an ordinal impairment scale, with scores ranging from 0 (normal swallowing function) to 3 to 5 points depending on the specific physiological measure. Lower scores indicate less swallowing impairment and better swallowing function, while higher scores indicate greater swallowing impairment. Success criteria: 75% of participants will have significantly lower MBSImP scores with DBS ON compared to DBS OFF. This will confirm that DBS can immediately improve swallowing function.	31 weeks
Motor Speech Function - Frenchay Dysarthria Assessment	The investigators will measure changes in Frenchay Dysarthria Assessment-Second Edition (FDA-2) scores with stimulation on and stimulation off during the same session. The FDA-2 uses a 9-point rating scale, ranging from 1 (severe impairment) to 9 (normal function), with higher scores indicating better motor speech function. Participants will complete either of the motor speech function assessments depending on the nature of their motor speech impairments (i.e., dysarthria vs. apraxia) as identified by a speech-language pathologist prior to speech and swallowing training in Phase 1. Participants with both dysarthria and apraxia will complete both assessments. Success criteria: 75% of participants will have significantly improved scores on the FDA-2 (i.e., higher score) with DBS ON compared to DBS OFF. This will confirm that DBS can immediately improve motor speech function.	31 weeks
Motor Speech Function - Apraxia Battery for Adults	The investigators will measure changes in Apraxia Battery for Adults-Second Edition (ABA-2) scores with stimulation on and stimulation off during the same session. The ABA-2 assesses multiple aspects of motor speech and praxis, with subtest scores ranging from 0 to the maximum value specified for each subtest; higher or lower scores indicate better performance depending on the subtest. Participants will complete either of the motor speech function assessments depending on the nature of their motor speech impairments (i.e., dysarthria vs. apraxia) as identified by a speech-language pathologist prior to speech and swallowing training in Phase 1. Participants with both dysarthria and apraxia will complete both assessments. Success criteria: 75% of participants will have significantly improved scores on the ABA-2 (i.e., higher or lower score depending on the subsection) with DBS ON compared to DBS OFF. This will confirm that DBS can immediately improve motor speech function.	31 weeks

Collaborators and Investigators

• Sponsor: Pirondini, Elvira, PhD
• Investigators: Principal Investigator: Jorge Gonzalez-Martinez, MD, PhD, University of Pittsburgh

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2027
• Primary Completion (Estimated): July 1, 2030
• Study Completion (Estimated): July 1, 2030

Study Registration Dates

• First Submitted: September 16, 2026
• First Submitted That Met QC Criteria: September 23, 2026
• First Posted (Actual): September 30, 2026

Study Record Updates

• Last Update Posted (Actual): September 30, 2026
• Last Update Submitted That Met QC Criteria: September 23, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Keywords: deep brain stimulation
• Additional Relevant MeSH Terms: Neurologic Manifestations; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Digestive System Diseases; Gastrointestinal Diseases; Neurobehavioral Manifestations; Esophageal Diseases; Otorhinolaryngologic Diseases; Pharyngeal Diseases; Psychomotor Disorders; Communication Disorders; Language Disorders; Speech Disorders; Articulation Disorders; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Stroke; Deglutition Disorders; Apraxias; Dysarthria; Therapeutics; Surgical Procedures, Operative; Drug Therapy; Electric Stimulation Therapy; Drug Delivery Systems; Deep Brain Stimulation
• Other Study ID Numbers: STUDY26040015

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

All of the individual participant data collected during the trial, after deidentification, may be shared with other researchers for the purpose of data analysis and collaboration.

IPD Sharing Time Frame

Data will become available at the end of the trial upon publication of the first manuscript. Estimation is 2 years from enrollment of first participant.

IPD Sharing Access Criteria

Data must be directly requested to the PI and will be shared upon completion of necessary data sharing agreement to protect confidential patient information.

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes