Cerebrovascular Accident, Plegia, Stroke
Conditions
Keywords
Stroke, Cerebrovascular Accident, Plegia, Upper Extremity, rTMS, tDCS
Brief summary
The procedure involves: (1) assisted hand movement by a mechanical device, (2) mechanical vibration applied to the surface of the forearm, and (3) stimulation of the brain with either transcranial magnetic stimulation (TMS) or transcortical direct current stimulation (DCS). These 3 components of the procedure are carried out simultaneously. Each subject will be evaluated pre- and post-treatment with several clinical tests of functional movement. The hypotheses of this project are that the AMES+rTMS and AMES+tDCS procedures are safe and will enable most of the stroke patients to recover finger extension.
Detailed description
This protocol is designed to investigate the safety and efficacy of a procedure for treating chronic (\>1 year post) stroke patients who still cannot move the hand affected by the stroke. The treatment involves: (1) assisted hand movement by a mechanical device, (2) mechanical vibration applied to the surface of the forearm, and (3) stimulation of the brain with either transcranial magnetic stimulation (TMS) or transcortical direct current stimulation (DCS). Subjects receiving TMS during treatment are expected to respond more fully (i.e., increased volitional EMG) in the treated hand compared to those receiving DCS.
Interventions
DEVICEAMES + brain stimulation
Stroke survivors with plegia of affected upper extremity receive either AMES + rTMS or AMES + tDCS.
Sponsors
National Institute of Neurological Disorders and Stroke (NINDS)
AMES Technology
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Stroke occurring ≥12 months before enrollment * Hemispheric stroke (ischemic or hemorrhagic), cortical or subcortical * Residual upper-extremity weakness without the ability to activate volitionally extensor digitorum (no volitional EMG in the long finger extensor muscle)independently * Age 18-75 years old
Exclusion criteria
* Significant upper-extremity proprioceptive deficit (\<70% correct detection of the direction of passive finger movement, with eyes closed) * Cortical stroke involving the primary motor cortex * Epilepsy not controlled by medication * Botox injections 5 months before or during enrollment; use of intrathecal Baclofen * Residual pain in the tested arm * Significant neglect involving the affected limb (NIHSS 2 on the extinction and attention items) * Exercise intolerant * Uncontrolled hypertension or angina * Cognitive or behavioral inability to follow instructions * Current abuse of alcohol or drugs * Terminal illness with anticipated survival of \<12 months * Severe apraxia; inability to understand oral directions in English; or inability to communicate adequately with study personnel * Circumference of arm incompatible with the AMES device (checked by placing the limb in the device) * Contractures, decreased range of motion, or skin condition preventing tolerance of the AMES muscle vibrators * Spinal cord injury, arthritis, or fractures of affected limbs resulting in loss of range of motion * In the tested arm, peripheral nerve injury or neuropathy resulting in significant motor or sensory loss * Pathological neurological/physical condition other than stroke that impairs the function of the impaired arm or that produces pain in the impaired arm * Implanted device (e.g., cardiac pacemaker, Baclofen pump) the operation of which might be adversely affected by the brain stimulation * Previous vascular surgery on the blood vessels of the brain or heart or heart valve surgery * Female and pregnant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum volitional EMG in the extensor digitorum and the finger flexors | Following each treatment with the AMES device | EMG intensity will be measured during maximal efforts at hand opening and closing at the end of each treatment session. The averages of 3 attempted openings and 3 closings will be determined and recorded. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Chedoke-McMaster Stroke Assessment | Before the first treatment session, and again after the last treatment session. | A validated assessment tool for evaluating the severity of physical impairment in adult stroke survivors. |
Countries
United States
Outcome results
None listed