None listed
Conditions
Brief summary
Spasticity affects more than half of stroke survivors and can severely impact on functional independence, quality of life and caregiver burden.Recently non-invasive brain stimulation (NIBS) has been proposed as an alternative approach to promote the recovery of motor impairments after stroke. This type of intervention aims to alter brain excitability and may have potential as a therapeutic intervention to enhance neuroplasticity after stroke. There may be benefits in combining this novel intervention with standard therapies. Therefore in this study we will assess the effect of NIBS on upper limb spasticity in individuals with stroke concurrently treated with botulinum toxin. We anticipate that this study will guide us to develop a novel intervention program to improve spasticity in stroke survivors and in turn motor control and upper limb function.
Interventions
The intervention will consist of theta-burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS). TBS will be delivered at a low intensity (80% of active motor threshold of the target muscle) with a 90 mm wing diameter, figure of 8 flat coil connected to a Magstim Rapid 2 stimulator (MagStim Co., Whitland, Dyfed, Wales). The paradigm consists of 10 bursts of triplets of pulses (50 Hz) applied at 5 Hz every 10 seconds, a total of 600 pulses. The stimulation will not ta
The intervention will consist of theta-burst stimulation (TBS), a form of repetitive transcranial magnetic stimulation (TMS). TBS will be delivered at a low intensity (80% of active motor threshold of the target muscle) with a 90 mm wing diameter, figure of 8 flat coil connected to a Magstim Rapid 2 stimulator (MagStim Co., Whitland, Dyfed, Wales). The paradigm consists of 10 bursts of triplets of pulses (50 Hz) applied at 5 Hz every 10 seconds, a total of 600 pulses. The stimulation will not take longer than a total of 3 minutes. Participants will receive TBS to the ipsilesional hemisphere four times a week for two weeks.
Sponsors
Flinders University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
History of stroke at least 12 months before the recruitment into the study Spasticity of moderate severity (Modified Ashworth Score = 3) in at least one upper limb No contraindications to TMS or TBS No other neurological or musculoskeletal disorders affecting the cervical spine. Concurrent treatment with botulinum toxin
Exclusion criteria
Patients with cognitive deficits and patients unable to reliably follow instructions Patients with unstable cardiac dysrhythmias, pacemakers etc Patients with history of seizure(s) or family history of seizures in first degree relatives Patients who have undergone brain surgery or had brain trauma Patients with history of intracranial hypertension Patients using tranquilizers or medications that can alter the seizure threshold unless they are able to cease the medications at least two weeks period to the stimulation Patients with intracranial metallic, magnetic pieces, with pacemakers or any other device Any other coexisting neurological or musculoskeletal condition that can result in contracture, spasticity or hypertonia
Outcome results
None listed