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.
연구 개요
상태
상세 설명
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.
연구 유형
등록 (추정된)
단계
- 해당 없음
연락처 및 위치
연구 연락처
- 이름: Cierra Clark, MS
- 전화번호: 2404414216
- 이메일: cic27@pitt.edu
연구 연락처 백업
- 이름: Amy Boos, MS
- 전화번호: 412-648-4179
- 이메일: amyy.boos@pitt.edu
연구 장소
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, 미국, 15213
- University of Pittsburgh
-
수석 연구원:
- Jorge Gonzalez-Martinez, MD, PhD
-
연락하다:
- Cierra Clark, MS
- 전화번호: 2404414216
- 이메일: cic27@pitt.edu
-
연락하다:
- Amy Boos, MS
- 전화번호: 4126484179
- 이메일: amy.boos@pitt.edu
-
-
참여기준
자격 기준
공부할 수 있는 나이
건강한 자원 봉사자를 받아들입니다
연구 대상 성별
설명
Inclusion Criteria:
- 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.
- Participants must be between the ages of 22 and 75 years old.
- English speaker.
- 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:
- 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.
- Participants must not have a high risk of recurrent stroke as evident from their medical history or upon judgment of the study physician.
- Participants must not have a score on the Short Blessed Test assessment scale of ≥10.
- Female participants of child-bearing age must not be pregnant or breastfeeding during the study.
- 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.
- 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.
- Participants cannot have severe claustrophobia that can prevent them from executing the required MRI imaging sessions.
- 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.
- 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.
- Participants with gross anatomical variances in MR imaging or cerebral vascular accidents involving motor thalamus and cerebellar areas.
- Participants must not have any lesions in the lower motoneuron causing flaccid dysarthria and/or bulbar dysphagia.
- Participants with deficits affecting language (i.e., pure aphasia) and not speech deficits.
- Participants with diabetes mellitus whose recent Hemoglobin A1C value is 8.0% or greater.
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
- 주 목적: 치료
- 할당: 해당 없음
- 중재 모델: 단일 그룹 할당
- 마스킹: 없음(오픈 라벨)
무기와 개입
참가자 그룹 / 팔 |
개입 / 치료 |
|---|---|
|
실험적: 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. |
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. 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. |
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Number and Severity of Adverse Events
기간: From enrollment to the end of treatment at 49 weeks
|
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
|
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
Absolute PAS Change - Phase 2
기간: 11 weeks
|
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
기간: 19 weeks
|
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
기간: 11 weeks
|
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
기간: 19 weeks
|
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
기간: 31 weeks
|
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
기간: 31 weeks
|
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
기간: 31 weeks
|
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
|
공동 작업자 및 조사자
수사관
- 수석 연구원: Jorge Gonzalez-Martinez, MD, PhD, University of Pittsburgh
연구 기록 날짜
연구 주요 날짜
연구 시작 (추정된)
기본 완료 (추정된)
연구 완료 (추정된)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
키워드
추가 관련 MeSH 약관
기타 연구 ID 번호
- STUDY26040015
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
IPD 계획 설명
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 공유 기간
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 공유 액세스 기준
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 공유 지원 정보 유형
- 연구_프로토콜
- 수액
- ICF
- ANALYTIC_CODE
- CSR
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .