Overall goal of this study is to determine if transcranial direct current stimulation (tDCS) plus conventional occupational therapy improves functional motor recovery in the affected arm-hand in patients after an acute ischemic stroke compared to sham tDCS plus conventional occupational therapy, and to obtain information to plan a large randomized controlled trial.
Patients Successive admissions to the stroke service of the Veterans Affairs Medical Center with ischemic strokes will participate in this study.
1. Unilateral, 1st acute stroke event within 4 weeks of admission to an in-patient rehabilitation facility
2. Ischemic stroke documented clinically and by neuroimaging.
3. Severe upper limb weakness (MRC grade of 2 or less at the shoulder joint)
4. Medically stable from a cardio-respiratory stand point so that they can participate in daily therapies.
5. Depressed patients will be included in the study (psychiatrist referral will be made if deemed necessary).
6. Aphasic alert patients will be included in the study provided they were able to follow simple directions by verbal or gestural cues and provided with a written informed consent.
7. Informed consent, from cognitively intact patients (admission Mini Mental Scale Examination [MMSE] greater than or equal to 21). When it is not possible for the patient to provide informed consent or patient is cognitively impaired with MMSE ≤ 20, proxy consent will be obtained from the next of kin (legal authorized representative) according to institutional IRB standards. Informed consent will be obtained by the admitting physicians.
1. Hemorrhagic strokes
2. Patient's with an episode post-stroke seizure or history of epilepsy.
3. Patients medically unstable, demented, or terminally ill (e.g., patients with stroke as a complication of a terminal cancer).
4. On medications such as botox for spasticity or other medications known to enhance motor recovery such as d-amphetamine,
5. Stroke patients with implanted pacemakers and defibrillators.
6. Refusal to provide informed consent
Trial Stopped: Slow accrual over 6 year period
- T DC stimulation Device
Other Names: Sham transcranial DC brain stimulator Intervention Desc: tDCS is a non-invasive, non-painful technique that modulates cortical excitability. tDCS can induce intracerebral current flow that is sufficiently large to achieve changes in cortical excitability. Thus, tDCS can be applied to humans non-invasively and painlessly to induce focal, lasting but reversible shifts of cortical excitability. ARM 1: Kind: Experimental Label: t DC stimulation Description: Sham transcranial direct current stimulation tDCS induces slight short-lasting tingling with onset of the stimulation. These sensations usually fade away in seconds. Sham interventions are essential to blind the subject and the assessor in order to obtain unbiased assessment of intervention effects ARM 2: Kind: Experimental Label: tDC stimulation Description: Actual DC stimulation
- TDCStimulation Device
Other Names: Experimental tDC stimulator Intervention Desc: 1 mA of tDCS will be delivered through surface electrodes (25-35 cm2) to the unaffected motor cortex for 30 min prior to a patient's scheduled OT. In the sham group patient will receive stimulation for 30 seconds only. ARM 1: Kind: Experimental Label: t DC stimulation Description: Sham transcranial direct current stimulation tDCS induces slight short-lasting tingling with onset of the stimulation. These sensations usually fade away in seconds. Sham interventions are essential to blind the subject and the assessor in order to obtain unbiased assessment of intervention effects ARM 2: Kind: Experimental Label: tDC stimulation Description: Actual DC stimulation
- Allocation: Randomized
- Masking: Double Blind (Subject, Caregiver, Outcomes Assessor)
- Purpose: Treatment
- Endpoint: Efficacy Study
- Intervention: Single Group Assignment
|Type||Measure||Time Frame||Safety Issue|
|Primary||total Functional Independence Measure (TFIM)||after 4-weeks of therapy||No|
|Secondary||Action Research Arm Test (ARAT)||after 4-weeks of therapy||No|