Chronic Stroke, Stroke, Ischemic
Conditions
Keywords
Chronic ischemic stroke, Transcutaneous spinal cord stimulation, Activity based rehabilitation
Brief summary
The recovery from a stroke is often incomplete. It is the leading cause of acquired permanent disability in the adult population. Persistent functional loss of the hand and arm contributes significantly to disability. However, the current standard of care to treat hand and arm movements are inadequate. There is an urgent need for innovative and effective therapies for recovery of the upper limb after stroke. Growing evidence shows that electrical spinal cord stimulation, combined with activity-dependent rehabilitation, enables voluntary movement of paralyzed muscles in some neurologic disorders, such as spinal cord injury. The investigators hypothesize that spinal networks that lost control after stroke can be activated by non-invasive electrical stimulation of the spinal cord to improve functional recovery. The aims of the study are: 1. to determine the improvements in hand and arm function that result from the combined application of non-invasive spinal stimulation and activity-based rehabilitation. Surface electrodes placed over the skin of the neck will be used for non-invasive electrical stimulation of the spinal cord. Functional task practice will be used for activity-dependent rehabilitation, 2. to evaluate long-lasting benefits to hand and arm function that persist beyond the period of spinal stimulation.
Interventions
DEVICENon-invasive Electrical Spinal Cord Stimulation
Electrical stimulation of the spinal cord using surface electrodes
Exercise therapy targeting paralyzed hand and arm
Sponsors
University of Washington
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Prospective, randomized, two-arm cross-over study: All participants will receive one of the two treatment arms one after the other. The order of the treatments will be randomized.
Eligibility
Sex/Gender
ALL
Age
21 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Radiologically documented single ischemic stroke resulted in hemiplegia/hemiparesis * At least six months post-stroke * Upper Extremity Fugl-Meyer Assessment score moderate or moderate-mild (29-53 inclusive out of 66) at the screening visit * Medically and neurologically stable, as determined by medical history and documented physical examination * For women of childbearing potential, a negative over-the-counter pregnancy test at study entry and willingness to practice adequate contraception during the study * Ability to attend sessions three times per week * Adequate social support to participate in all intervention and baseline, follow-up assessment sessions throughout eight months. * Ability to read, comprehend and speak English
Exclusion criteria
* Hemorrhagic stroke * History of multiple strokes * Active implanted stimulator (e.g., pacemaker, vagus nerve stimulator, cochlear implant, etc.) or baclofen pump * Aphasia or any other deficit in communication that interferes with reasonable study participation * Moderate to severe cognitive impairment * Presence of neglect (inability to perceive or awareness of, or loss of attention to the weaker half of the body) * Severe spasticity in the upper limb * Taking baclofen more than 30 mg/day * Change in baclofen dose within four weeks before enrollment * Receiving benzodiazepines, dantrolene, tizanidine, anticoagulant, or antiepileptic medication * Botulinum toxin injection to the upper limb muscles within six months before enrollment * Severe joint contractures in the affected hand and arm * History of spontaneous seizure that had occurred one month or longer after the stroke
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline - Fugl-Meyer assessment of the upper limb | Measurements at baseline and repeated measurements once every two weeks throughout the study, an average of 8 months. | The clinician-administered a stroke-specific, performance-based impairment scale. It assesses movement function, sensation, joint range of motion, and pain. The score ranges from 0 to 66. Higher scores indicate better outcomes. |
| Change from baseline - Pinch and grip force | Measurements at baseline and repeated measurements once every two weeks throughout the study, an average of 8 months. | Measurement of hand strengths using a dynamometry. |
| Change from baseline - Modified Ashworth Scale | Measurements at baseline and repeated measurements once every two weeks throughout the study, an average of 8 months. | Clinician-administered test for resistance of a joint to passive movement. This scale grades muscle tone/spasticity. The score ranges from 0 to 4. Higher scores indicate worse outcomes. |
| Change from baseline - Wolf Motor Function Test | Measurements at baseline and repeated measurements once every two weeks throughout the study, an average of 8 months. | Quantifies upper limb motor ability through timed and functional tasks. The score range is 0-75; higher scores denote better function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline - Short Form-36 | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | A self-report health survey questionnaire. The score range from 0 to 100. The higher the score, the better the outcome. |
| Change from baseline - Patients Global Impression of Change | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | A self-report measure that reflects the participant's belief about the efficacy of treatment: the participant chooses the level of improvement and their functional status between much worse, worse, no change, improved and much improved, compared to the baseline. |
| Change from baseline - Action Research Arm Test | Measurements at baseline and repeated measurements once every two weeks throughout the study, an average of 8 months. | Clinician-administered observational measure to assess upper extremity performance, such as coordination, dexterity, and functioning, in stroke recovery. |
| Change from baseline - Somatosensory evoked potentials test | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | Electrophysiologic evaluation of sensory pathways between the brain and the limb. |
| Change from baseline - Spinally evoked motor potentials test | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | Electrophysiologic evaluation of motor pathways between the central nervous system and the muscles. |
| Change from baseline - H-reflex test | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | Electrophysiologic evaluation of the reflex response triggered on the motor nerves when sensory fibers in the peripheral nerve are stimulated. |
| Change from baseline - Box and Blocks Test | Measurements at baseline and repeated measurements once every two weeks throughout the study, an average of 8 months. | Participants move, one by one, the maximum number of blocks from one compartment of a box to another of equal size within 60 seconds. Measures gross manual dexterity. |
| Change from baseline - Revised Nottingham Sensory Assessment | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | A standardized scale for assessing sensory impairment in stroke patients. Tactile sensation, proprioception, stereognosis, and two-point discrimination are evaluated. |
| Change from baseline - Stroke Impact Scale | Repeated measurements once at baseline, once at the end of each treatment arm and through study completion, an average of 8 months. | A self-report questionnaire that evaluates disability and health-related quality of life after stroke. The questionnaire consists of 8 domains: strength, memory and thinking, emotion, communication, activities of daily living, mobility, hand function, and participation/role function. The score ranges from 0 to 100. Higher scores indicate better outcomes. |
Countries
United States
Contacts
Primary ContactFatma Inanici
Outcome results
None listed