tDCS and Robotic Therapy in Stroke

University Hospital of Ferrara

Status and phase: Completed; Phase 2

Conditions: Stroke; Upper Extremity Impairments

Treatments: Device: real-tDCS + UE robot-assisted therapy; Device: sham-tDCS + UE robot-assisted therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT01828398

Stroke_tDCS

Details and patient eligibility

About

After stroke a limited motor recovery in the paretic upper limb accounts for a large proportion of the disabling sequelae. Only about 15% of those with initial complete upper limb paralysis after stroke recover functional use of their impaired arm in daily life.

The aim of this study is to test the effects of tDCS combined with upper extremity robot-assisted therapy on stroke survivors.

Enrollment: 40 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Males and females subjects. Age > 18 years.
• Diagnosis of first ischemic stroke
• Impairment of the upper limb
• Trunk control defined in the Trunk-Control Test (TCT), with a score > 50.

Exclusion criteria

• anyone who does not have adequate understanding of verbal or written information in Italian sufficient to complete any test
• Impaired cognitive functioning: score less than 24 on the Mini Mental Status Examination (MMSE)
• contraindications to single-pulse transcranial magnetic stimulation (TMS)(TMS will be used to measure cortical excitability): presence of a history of epilepsy, frequent headaches or neck pain, implantable devices (ventriculoperitoneal shunts, pacemakers, intrathecal pumps, intracranial metal implants)
• Contraindications to tDCS: intracranial metal implants that can be stimulated, incorrectly positioned or over-heated by the electric current
• Neurological or psychiatric pathology
• severe cardio-pulmonary, renal, hepatic diseases
• Pregnancy

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Triple Blind

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40 participants in 2 patient groups

sham-tDCS + UE robot-assisted therapy

Sham Comparator group

Description:

This group will receive the same robot-assisted therapy of the intervention group, in association of sham-tDCS. This consists in a 30 seconds stimulation, with the same instrumentation and electrodes placement. This method of sham stimulation was previously validated.

Treatment:

Device: sham-tDCS + UE robot-assisted therapy

real-tDCS + UE robot-assisted therapy

Experimental group

Description:

This group will receive continuous stimulation lasting 30 minutes during the session of robot-assisted therapy. The training session, which includes multiplanar, repetitive and target reaching movements, will be given 5 times a week for 2 weeks(REO Therapy System; Motorika, Medical LTD, Israel). Each session will last about 30 minutes. Transcranial direct current stimulation (tDCS) will be administered as follows. The anode will be placed on the primary motor cortex (M1) of the affected hemisphere and the cathode on the contralateral M1 area. The direct current is transmitted through a pair of sponge electrodes, with a surface of 35 cm2 (7x5), soaked in saline solution and, it is generated by a constant current stimulator, with rechargeable batteries (Brainstim, EMS, Italy). This continuous stimulation lasted 30 minutes, with an intensity of 1mA.

Treatment:

Device: real-tDCS + UE robot-assisted therapy