Can we Train Patients With Chronic Stroke Out of Abnormal Hand Synergy?

Recruiting

Phase N/A Results N/A

Trial Description

This study plans to determine whether training with concurrent non-invasive brain stimulation can change abnormal flexion synergy in chronic stroke patients.

Detailed Description

The aim of the current study is to investigate whether non-invasive brain stimulation (intervention) applied during motor training in chronic stroke patients can change their abnormal flexion synergy. The investigators will study chronic stroke patients , who are defined as patients that sustained a stroke at least 6 months prior to our testing date.
Three functional aspects of each finger will be tested: maximal voluntary contraction (MVC), finger dexterity, and hand posture.
Prior to intervention, participants will have a baseline assessment including clinical tests, MVC, the individuation task, and the configuration task. Following the baseline assessment patients will receive intervention, training on the configuration task paired with concurrent transcranial Direct Current Stimulation (tDCS) for 5 consecutive days. On the sixth day and as a one week follow-up after, subjects will have a post-intervention assessment containing the same tests performed in baseline.
This design will allow us to determine speed and accuracy during the configuration task, the individuation index, and possible changes in abnormal flexion synergy.

Conditions

Interventions

  • Sham tDCS Device
    Intervention Desc: Sham Non-invasive brain stimulation to stimulate motor-associated areas in the brain
    ARM 1: Kind: Experimental
    Label: Sham tDCS & Configuration task
    Description: Sham-stimulation: Chronic stroke patients (i.e. great than 6 months) with ischemic stroke confirmed by CT or MRI, residual unilateral upper extremity weakness, able to give informed consent, and able to understand the tasks involved. Participants will receive sham SHAM tDCS stimulation during the training.
  • Real tDCS Device
    Intervention Desc: Anodal Non-invasive brain stimulation to stimulate motor-associated areas in the brain
    ARM 1: Kind: Experimental
    Label: Real tDCS & Configuration task
    Description: Real-stimulation: Chronic stroke patients (i.e. great than 6 months) with ischemic stroke confirmed by CT or MRI, residual unilateral upper extremity weakness, able to give informed consent, and able to understand the tasks involved. Participants will receive REAL anodal tDCS stimulation during the training.
  • Configuration task Behavioral
    Intervention Desc: Training the impaired hand on a configuration task
    ARM 1: Kind: Experimental
    Label: Real tDCS & Configuration task
    Description: Real-stimulation: Chronic stroke patients (i.e. great than 6 months) with ischemic stroke confirmed by CT or MRI, residual unilateral upper extremity weakness, able to give informed consent, and able to understand the tasks involved. Participants will receive REAL anodal tDCS stimulation during the training.
    ARM 2: Kind: Experimental
    Label: Sham tDCS & Configuration task
    Description: Sham-stimulation: Chronic stroke patients (i.e. great than 6 months) with ischemic stroke confirmed by CT or MRI, residual unilateral upper extremity weakness, able to give informed consent, and able to understand the tasks involved. Participants will receive sham SHAM tDCS stimulation during the training.

Outcomes

Type Measure Time Frame Safety Issue
Primary Individuation Index Change from Baseline Individuation Index at 2 weeks
Primary Action Research Arm Test (ARAT) Change from Baseline ARAT at 2 weeks
Primary Fugl-Meyer (Motor Function - Upper Extremity Subscale) Change from Baseline Impairment Index at 2 weeks
Primary Accuracy (Euclidian norm) Change from Baseline Accuracy at 2 weeks
Secondary Execution Time Change from Baseline Execution Time at 2 weeks
Secondary Semmes Weinstein Monofilament Examination (SWME) Change from Baseline SWME at 2 weeks
Secondary Modified Ashworth scale Change from Baseline Modified Ashworth Scale at 2 weeks

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