Transcranial Direct Current Stimulation and Computer-based Training for the Traumatic Brain Injury Rehabilitation

NCT03382626 | Unknown

• 1 other identifier: 71391917000000068
• Study Type: interventional
• Target: 30
• Locations: 1 country
• Sites: 1

Brief Summary

Traumatic Brain Injury (TBI) is a serious public health problem due to its high mortality and morbidity rates, mainly affecting young adult males. Aggression to the prefrontal cortex, caused by an external physical force, responsible for anatomical injury and/or functional impairment, causes cognitive deficits with important consequences for the individual affected by the trauma and their caregivers. Therefore, rehabilitation is of utmost importance. The increase in pre-frontal cortical activation through training, activity-dependent stimulation and neuroplasticity, especially in the dorsolateral prefrontal cortex (DLPFC) is related to better performance in functional memory. In this context, Transcranial Direct Current Stimulation (tDCS), intended to drive neuroplastic changes in the brain, has been widely used to bring benefits to the cognitive function of individuals affected by various neurological conditions, including TBI by promoting neuroplasticity for critically involved cortical areas in the performance of tasks, culminating in cognitive benefits. In addition, studies have shown greater benefits when the technique is combined with cognitive training. Therefore, the objective of this parallel, randomized, double-blind, placebo-controlled clinical trial is to investigate the effect of tDCS applied on the dorsolateral prefrontal cortex and virtual reality cognitive training alone or in association with tDCS on cognitive function of individuals with severe chronic TBI.

Conditions

Traumatic Brain Injury

Keywords

Traumatic Brain Injury; Transcranial Direct Current Stimulation; Computer-assisted training; Cognitive training; Cognitive function; Executive function; Working memory; Attention

Outcome Measures

Primary Outcomes (5)

• Change from baseline working memory at 10 days of intervention (scale assessment)

  Will be performed throughWechsler Adult Intelligence Scale IV (Digit span, Letter-Number Sequencing and Arithmetic subtests). These subtests evaluates the working memory and attention. The Digit span involves a forward and a backward recitation condition. The maximum score is 30 points, where higher score indicates better the performance. Letter-Number sequencing involves a combination of numbers and letters that must be recited.The maximum scores is 21 points, where higher scores shows better performance. The Arithmetic subtest is formed by some calculations must be solved without the aid of paper and pen. The maximum score is 22 points in which higher scores indicates better performance. The score of each subtest will be considered separately for characterization of the working memory. In addition, The sum of the weighted individual scores in each subtest will be calculated for the Working Memory Index.

  We will apply these instruments at T0 (baseline time), T2 (at end of all sessions, i.e 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline working memory at 10 days of intervention (computer-based assessment)

  This assessment will occur through the Genius game, which will evaluate the performance in the unit of measure of execution time (i.e. seconds) of the task.

  We will apply these instruments at T0 (baseline time), T1 (one day after the first session), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline executive function at 10 days of intervention (scale assessment)

  This assessment will occur through the Trail Making Test A and B, which provides information on visual search, scanning, speed of processing, mental flexibility, and executive functions. It requires the subject to connect encircled numbers randomly arranged on a page (Part A) and encircled numbers and letters in alternating order (Part B). Scoring is expressed in time in seconds required for completion of each of the two parts of the test. Scoring is expressed in terms of the time in seconds required for completion of each of the two parts of the test, on which the shorter the time to complete the task the better the performance (i.e part A \< 180 s and part B \< 300 s).

  We will apply these instruments at T0 (baseline time), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline attention and executive function at 10 days of intervention (scale assessment)

  This assessment will occur through the Stroop Color and Word Test, which assesses the ease with which a person can maintain a goal in mind and suppress the habitual response in favor of a less familiar one (i.e selective attention and cognitive flexibility). Both the time to complete and the number of errors. In addition, the interference effect is determined by calculating the extra time required to name colors in the interference task in comparison to the time required to name colors in the control task.

  We will apply these instruments at T0 (baseline time), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline processing speed at 10 days of intervention (scale assessment)

  This assessment will occur through the Code Search subtest (WAIS), which as evaluates the processing speed to complete a card with number and symbols that must be related to a correct execution of the test. The score is formulated based on correct answers. The maximum score is 133 points. The higher scores are related to better performance.

  We will apply these instruments at T0 (baseline time), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

Secondary Outcomes (4)

• Change from baseline processing speed at 10 days of intervention (computer-based assessment)

  We will apply these instruments at T0 (baseline time), T1 (one day after the first session), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline reasoning and planning at 10 days of intervention (computer-based assessment)

  We will apply these instruments at T0 (baseline time), T1 (one day after the first session), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline quality of life at 10 days of intervention

  We will apply the QOLIBRI at T0 (baseline time), T2 (at end of all sessions, ie 10 days after the first session) and T3 (i.e after 1 month of follow-up time).

• Change from baseline depression at 10 days of intervention

  We will apply the BDI at T0 (baseline time), T2 (at end of all sessions, ie 10 days after the first session) and and T3 (i.e after 1 month of follow-up time).

Other Outcomes (3)

• Adverse effects assessment

  We will apply the AEQ at end of each sessions of anodal tDCS (i.e one by day during 10 days)

• Sociodemographic and Neurological assessment

  We will apply this questionnaire only at T0 (baseline time)

• Mental state examination assessment

  We will apply this questionnaire only at T0 (baseline time)

Study Arms (2)

tDCS plus Computer-assisted training

ACTIVE COMPARATOR

Patients will receive 10 sessions of active anodal tDCS on the left prefrontal cortex dorsolateral (F3 area using International 10-20 system for electroencephalogram (EEG) electrode placement) plus Computer-assisted cognitive training (games to improve working memory, attention, and executive function).

Device: anodal tDCS; Device: Computer-assisted training

tDCS sham plus Computer-assisted training

SHAM COMPARATOR

Patients will receive 10 sessions of sham anodal tDCS on the left prefrontal cortex dorsolateral plus Computer-assisted cognitive training (games to improve working memory, attention and executive function).

Device: Computer-assisted training; Device: sham tDCS

Interventions

anodal tDCS DEVICE

Anodal tDCS will be applied on the left prefrontal cortex dorsolateral (F3 area using International 10-20 system for EEG electrode placement) with the following parameters: electrode size of 25-35 cm², 2mA, 0.057 mA/cm² and duration of 20 minutes. The cathode will be placed over the supra-orbital region.

tDCS plus Computer-assisted training

Computer-assisted training DEVICE

The computer-assisted cognitive training will consist of games with visual and auditory stimuli to improve working memory, attention, and executive function. The games will be Genius and Labyrinth games, reaction time and timing-coincident.

tDCS plus Computer-assisted training; tDCS sham plus Computer-assisted training

sham tDCS DEVICE

Sham tDCS will be applied with the same parameters and electrode placement of active anodal tDCS. However, the current flow will be interrupted by the device after few seconds.

tDCS sham plus Computer-assisted training

Eligibility Criteria

• Age: 18 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Chronic TBI (≥ 12 months)
• Severe TBI (Glasgow ≤ 8, loss of consciousness \> 24 hours, post-traumatic amnesia \> 1 week)
• Working memory, attention or executive deficit
• Score in Mini Mental State Examination according the cut-off point (i.e, 13 to illiterates individuals, 18 to low and medium schooling and 26 to high schooling).

You may not qualify if:

• Individuals unable to perform the activities proposed in the study protocol (e.g. physical deficits, lack of collaboration, aphasia, accuses, amaurosis)
• Mid or extensive cranial defects
• Titanium cranial prosthesis
• Extensive cranial prosthesis located on the dorsal prefrontal cortex
• Metallic devices implanted in the brain
• Psychotic disorders
• Recent history of alcoholism or use of drugs
• Neurological diseases (e.g Parkinson, Stroke, Alzheimer).

Sponsors & Collaborators

• University of Sao Paulo General Hospital: lead

Study Sites (1)

Ambulatório de Reabilitação Cognitiva do Hospital das Clínicas da Universidade de São Paulo

São Paulo, Brazil

RECRUITING

MeSH Terms

Conditions

Brain Injuries, Traumatic

Interventions

Transcranial Direct Current Stimulation

Condition Hierarchy (Ancestors)

Brain Injuries; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Craniocerebral Trauma; Trauma, Nervous System; Wounds and Injuries

Intervention Hierarchy (Ancestors)

Electric Stimulation Therapy; Therapeutics; Convulsive Therapy; Psychiatric Somatic Therapies; Behavioral Disciplines and Activities; Electroshock; Psychological Techniques

Central Study Contacts

Amanda Vitória L de Araújo, Master

CONTACT

11971212653; amandavitooria@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Doctor

Model Details: Prospective, double-blind, randomized, parallel, controlled study

Study Record Dates

• First Submitted: December 4, 2017
• First Posted: December 26, 2017
• Study Start: February 19, 2018
• Primary Completion: November 30, 2018
• Study Completion: October 1, 2019
• Last Updated: November 5, 2018

Record last verified: 2018-11

Locations

BR (1)