Cortical Enhancement of Posture, Movement Planning, and Execution of Upright Reaching Following Stroke

NCT04308629 | Completed DMC

• 1 other identifier: HP-00064894
• Study Type: interventional
• Target: 10
• Locations: 0 countries
• Sites: N/A

Brief Summary

Stroke is the leading cause of disability and diminished quality of living that frequently includes impairments of postural control and upper extremity (UE) function. The interaction of posture and UE coupling in terms of movement planning, initiation, and execution is not well understood. StartReact responses triggered by a loud acoustic stimulus (LAS) during the planning and preparation of goal intended actions has been used to probe the state of brainstem neuronal excitability related to posture and movement sequencing. The purpose of this study is to examine posture and goal-directed movement planning and execution using startReact responses and to evaluate posture and UE movement sequence during reaching while standing in individuals with chronic hemiparesis and healthy controls. Secondly, the investigators will determine the modulatory role of the cortical premotor areas (PMAs) in startReact responses in healthy controls and in persons with stroke by using transcranial direct current stimulation (tDCS) to up- or down-regulate PMAs excitability.

Conditions

Stroke; Upper Extremity Paresis

Keywords

StartReact response; transcranial direct current stimulation; Postural control

Outcome Measures

Primary Outcomes (2)

• Change in startReact response

  The incidence of StartReact response following an loud acoustic stimulus

  Immediately after the intervention (one session tDCS)

• Change in the lag between anticipatory postural adjustments and reach onset

  The temporal lag between anticipatory postural adjustments (APA) onset and reach onset (unit: seconds)

  Immediately after the intervention (one session tDCS)

Secondary Outcomes (6)

• Change in the reach onset (unit: seconds)

  Immediately after the intervention (one session tDCS)

• Change in the APA onset (unit: seconds)

  Immediately after the intervention (one session tDCS)

• Change in the amount of trunk flexion (unit: radians)

  Immediately after the intervention(one session tDCS)

• Change in the amount of trunk rotation (unit: radians)

  Immediately after the intervention (one session tDCS)

• Change in the amount of pelvic rotation (unit: radians)

  Immediately after the intervention (one session tDCS)

Study Arms (2)

tDCS over PMAs

EXPERIMENTAL

One session of transcranial direct current stimulation (tDCS) over premotor areas (PMAs)

Other: Transcranial direct current stimulation

tDCS over M1

ACTIVE COMPARATOR

One session of transcranial direct current stimulation (tDCS) over primary motor area (M1)

Other: Transcranial direct current stimulation

Interventions

Transcranial direct current stimulation OTHER

tDCS over M1; tDCS over PMAs

Eligibility Criteria

• Age: 40 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Unilateral cortical or white matter subcortical stroke
• Age 40 yrs and older
• ≥ 6 months post ischemic stroke or ≥ 12 months post hemorrhagic stroke
• Residual arm hemiparesis as indicated by Fugl-Meyer Upper Extremity score between 20-65
• Having the ability to perform reaching movements with the paretic arm in standing without an assistive device.

You may not qualify if:

• Stroke involving bilateral hemisphere, brainstem or cerebellum
• Any medical condition precluding participation in testing
• Other health conditions affecting balance and upper extremity movement function beyond the effects of stroke.
• Age-matched to the stroke subjects
• Without a history of stroke or any known neurological conditions
• Having the cognitive ability to follow two-step commands and give informed consent
• Any medical condition precluding participation in testing
• Other health conditions affecting balance and upper extremity movement function beyond the effects of stroke.
• Participants were also excluded if they did not meet the TMS safety criterion including having implantable medical devices, history of seizures, taking medications to reduce anxiety, sedatives, and seizure, and pregnancy.

Sponsors & Collaborators

• University of Maryland, Baltimore: lead

Related Publications (1)

• Yang CL, Gad A, Creath RA, Magder L, Rogers MW, Waller SM. Effects of transcranial direct current stimulation (tDCS) on posture, movement planning, and execution during standing voluntary reach following stroke. J Neuroeng Rehabil. 2021 Jan 7;18(1):5. doi: 10.1186/s12984-020-00799-8.

  PMID: 33413441 DERIVED

MeSH Terms

Conditions

Stroke; Paresis

Interventions

Transcranial Direct Current Stimulation

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

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

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principle Investigator

Study Record Dates

• First Submitted: March 3, 2020
• First Posted: March 16, 2020
• Study Start: October 1, 2016
• Primary Completion: October 30, 2017
• Study Completion: October 30, 2017
• Last Updated: March 16, 2020

Record last verified: 2020-02