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Combining tDCS and Neurorehabilitation to Treat Age-related Deficits of Mobility and Cognition: UPfront Walking Study

Primary Purpose

Mobility Limitation, Cognitive Impairment

Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Neurorehabilitation of Standard Walking
Neurorehabilitation of Complex Walking
Transcranial Direct Current Stimulation (tDCS) dosage A
Transcranial Direct Current Stimulation (tDCS) dosage B
Sponsored by
University of Florida
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Mobility Limitation

Eligibility Criteria

65 Years - 110 Years (Older Adult)All SexesAccepts Healthy Volunteers

Inclusion criteria

  • preferred 10m walking speed < 1.0 m/s
  • 40th-80th percentile rank (age and education corrected score) on NIH toolbox executive assessments: Card Sort Test and Flanker test
  • willingness to be randomized to either intervention and to participate in all aspects of study assessment and intervention

Exclusion criteria

  • contraindications to non-invasive brain stimulation and/or MRI including metal in the head, pacemaker, known abnormal cranial fissures/holes.
  • difficulty communicating with study personnel
  • uncontrolled hypertension at rest (systolic > 180 mmHg and/or diastolic > 100 mmHg)
  • low vision that cannot be corrected by wearing glasses. Low visual will be operationally defined as visual acuity less than 20/70 on a standard eye chart, or difficulty performing complex walking tasks due to visual conditions affecting accurate navigation around and over obstacles (self-reported or observed by examiner).
  • illiterate, due to the likelihood of difficulties performing some of the cognitive tasks
  • non-English speaking, due to the likelihood of difficulties following instructions during therapy and during assessments
  • use of medications that are know to modify tDCS effectiveness including those with anticholinergic, GABAergic, or glutamatergic properties, or sodium channel blockers
  • clinical judgment of investigative team

Sites / Locations

  • HealthStreet
  • UF Institute on Aging
  • University of Florida

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Active Comparator

Arm Label

Standard walking with tDCS dosage A

Complex walking with tDCS dosage A

Complex walking with tDCS dosage B

Arm Description

Neurorehabilitation of Standard Walking and Transcranial Direct Current Stimulation (tDCS) dosage A

Neurorehabilitation of Complex Walking and Transcranial Direct Current Stimulation (tDCS) dosage A

Neurorehabilitation of Complex Walking and Transcranial Direct Current Stimulation (tDCS) dosage B

Outcomes

Primary Outcome Measures

Mobility: Figure-of-eight walking test (Figure-8 Walk Test)
Time to complete a walking course at usual pace. The course is 15 feet in length and arranged as a Figure-8 pattern.

Secondary Outcome Measures

Cognitive Composite executive score on NIH EXAMINER battery (EXAMINER)
A battery of assessments that tests 7 domains of executive function separately and as a composite score.
Adherence to interventions
number of sessions attended
Retention of participants
number of participants completing rehabilitation and post-therapy assessment
Adverse events in each study arm
Number of unexpected and/or serious adverse events
Changes in prefrontal/executive activity during performance of the Figure-8 Walk Test
Assesses the change in demand for executive control resources during walking.
Changes in prefrontal/executive activity during performance EXAMINER test to probe mechanisms of response
Assesses the change in demand for executive control resources cognitive/executive tasks.

Full Information

First Posted
April 7, 2017
Last Updated
May 10, 2021
Sponsor
University of Florida
Collaborators
National Institute on Aging (NIA)
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1. Study Identification

Unique Protocol Identification Number
NCT03122236
Brief Title
Combining tDCS and Neurorehabilitation to Treat Age-related Deficits of Mobility and Cognition: UPfront Walking Study
Official Title
Combining tDCS and Neurorehabilitation to Treat Age-related Deficits of Mobility and Cognition: UPfront Walking Study
Study Type
Interventional

2. Study Status

Record Verification Date
May 2021
Overall Recruitment Status
Completed
Study Start Date
June 1, 2017 (Actual)
Primary Completion Date
May 31, 2020 (Actual)
Study Completion Date
March 6, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Florida
Collaborators
National Institute on Aging (NIA)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Loss of mobility and cognitive ability are serious conditions that threaten the independence of older adults. The objective of this study is to initiate a line of research to develop a novel therapeutic intervention to enhance both mobility and cognition via neuroplasticity of frontal/executive circuits.
Detailed Description
Frontal lobe dysfunction has been implicated as a factor contributing to gait deficits in some individuals with Alzheimer's disease, frontotemporal dementia and vascular dementia. There is a critical gap in knowledge about what therapeutic strategies are effective for maintaining or reinstating function in this critical brain region in order to preserve physical and cognitive health in older adults. The goal of our research is to develop a novel therapeutic intervention to enhance both mobility and cognition via neuroplasticity of frontal/executive control circuits. The Investigator will engage neuroplasticity of frontal circuits in two ways. The first is through neurorehabilitation with "complex walking tasks" (CWTs), such as obstacle crossing, obstacle avoidance and walking on non-uniform surfaces. CWTs are a potent behavioral approach for engaging prefrontal circuits. Furthermore, CWTs are crucial to successful ambulation in the home and community settings and therefore provide an ecologically valid therapeutic approach. The second approach that the Investigator will use to engage neuroplasticity of frontal circuits is anodal transcranial direct current stimulation (tDCS). Anodal tDCS is a safe, non-invasive neuromodulation technique. It has previously been shown to induce excitatory effects on brain tissue and, in single-session assessments, to improve performance during complex walking tasks. tDCS has also been shown to be an effective adjuvant for enhancing the effects of cognitive training. The objective of this study is to calculate effect size, establish variance of response and demonstrate feasibility of the experimental interventions in order to plan for a full scale clinical trial. Participants will include thirty older adults who demonstrate evidence of frontal/executive impairment. Participants will be randomized to one of three groups: 1) standard walking neurorehabilitation with sham tDCS ('standard/sham' group), 2) complex walking neurorehabilitation with sham tDCS ('complex/sham' group), or 3) complex walking neurorehabilitation with active anodal tDCS ('complex/active' group). Functional near infrared spectroscopy (fNIRS) will be used to explore intervention-induced changes in prefrontal cortical activity. Assessments will be conducted at baseline, post-treatment and 3-month follow up. The Investigator propose the following specific aims: Specific Aim 1: Determine preliminary efficacy for recovery of mobility and cognitive function. Specific Aim 2: Demonstrate feasibility/safety of tDCS as an adjuvant to rehabilitation. Specific Aim 3: Explore the relationship between prefrontal activity and behavioral outcomes The data collected here will provide the information needed to justify and plan a future full scale clinical trial to assess the relative efficacy and underlying mechanisms of each intervention approach.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Mobility Limitation, Cognitive Impairment

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
Participants will take part in a 6-week, 18-session neurorehabilitation led by qualified and trained study personnel. Participants will be randomized to one of three groups: 1) standard walking neurorehabilitation with sham tDCS ('standard/sham' group), 2) complex walking neurorehabilitation with sham tDCS ('complex/sham' group), or 3) complex walking neurorehabilitation with active anodal tDCS ('complex/active' group). Training logs will be maintained to gauge the content and intensity of training.
Masking
ParticipantInvestigator
Masking Description
To control for intensity, participants will maintain a rating of perceived exertion of 4 (moderate to strong) on the Borg Category/Ratio Scale during walking. Exertion will be adjusted by modifying walking speed and/or by modifying the rest time between walking bouts.
Allocation
Non-Randomized
Enrollment
22 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Standard walking with tDCS dosage A
Arm Type
Active Comparator
Arm Description
Neurorehabilitation of Standard Walking and Transcranial Direct Current Stimulation (tDCS) dosage A
Arm Title
Complex walking with tDCS dosage A
Arm Type
Active Comparator
Arm Description
Neurorehabilitation of Complex Walking and Transcranial Direct Current Stimulation (tDCS) dosage A
Arm Title
Complex walking with tDCS dosage B
Arm Type
Active Comparator
Arm Description
Neurorehabilitation of Complex Walking and Transcranial Direct Current Stimulation (tDCS) dosage B
Intervention Type
Behavioral
Intervention Name(s)
Neurorehabilitation of Standard Walking
Intervention Description
Neurorehabilitation is a behavioral therapeutic approach for enhancing the neural control of task performance by: Restoration of function, specificity of training, Sensory input to the nervous system, Intensity, Repetition and Progression of training. Neurorehabilitation of standard walking will focus on the use of typical steady state walking.
Intervention Type
Behavioral
Intervention Name(s)
Neurorehabilitation of Complex Walking
Intervention Description
Neurorehabilitation is a behavioral therapeutic approach for enhancing the neural control of task performance by: Restoration of function, specificity of training, Sensory input to the nervous system, Intensity, Repetition and Progression of training. Neurorehabilitation of complex walking will focus on the use of walking tasks that require increased attention and executive functions. The following walking tasks will be used: over obstacles, navigating around obstacles, changing speeds, on soft surfaces (exercise mat), in dim lighting, while conversing with the therapist, up/down ramps and climbing/descending stairs.
Intervention Type
Device
Intervention Name(s)
Transcranial Direct Current Stimulation (tDCS) dosage A
Other Intervention Name(s)
Soterix Direct Current Stimulator
Intervention Description
tDCS will be used to induce positive neuromodulation of frontal/executive circuits to make them more amenable to the "activity-dependent neuroplasticity" that is known to occur with behavioral neurorehabilitation. Specifically, tDCS may facilitate the efficacy of our walking neurorehabilitation intervention by strengthening the synaptic connections within the recruited circuits.
Intervention Type
Device
Intervention Name(s)
Transcranial Direct Current Stimulation (tDCS) dosage B
Other Intervention Name(s)
Soterix Direct Current Stimulator
Intervention Description
tDCS will be used to induce positive neuromodulation of frontal/executive circuits to make them more amenable to the "activity-dependent neuroplasticity" that is known to occur with behavioral neurorehabilitation. Specifically, tDCS may facilitate the efficacy of our walking neurorehabilitation intervention by strengthening the synaptic connections within the recruited circuits.
Primary Outcome Measure Information:
Title
Mobility: Figure-of-eight walking test (Figure-8 Walk Test)
Description
Time to complete a walking course at usual pace. The course is 15 feet in length and arranged as a Figure-8 pattern.
Time Frame
Baseline to 6 weeks
Secondary Outcome Measure Information:
Title
Cognitive Composite executive score on NIH EXAMINER battery (EXAMINER)
Description
A battery of assessments that tests 7 domains of executive function separately and as a composite score.
Time Frame
Baseline to 6 weeks
Title
Adherence to interventions
Description
number of sessions attended
Time Frame
Baseline to 6 weeks
Title
Retention of participants
Description
number of participants completing rehabilitation and post-therapy assessment
Time Frame
Baseline to 6 weeks
Title
Adverse events in each study arm
Description
Number of unexpected and/or serious adverse events
Time Frame
3 month
Title
Changes in prefrontal/executive activity during performance of the Figure-8 Walk Test
Description
Assesses the change in demand for executive control resources during walking.
Time Frame
Baseline to 6 weeks
Title
Changes in prefrontal/executive activity during performance EXAMINER test to probe mechanisms of response
Description
Assesses the change in demand for executive control resources cognitive/executive tasks.
Time Frame
Baseline to 6 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
65 Years
Maximum Age & Unit of Time
110 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion criteria preferred 10m walking speed < 1.0 m/s 40th-80th percentile rank (age and education corrected score) on NIH toolbox executive assessments: Card Sort Test and Flanker test willingness to be randomized to either intervention and to participate in all aspects of study assessment and intervention Exclusion criteria contraindications to non-invasive brain stimulation and/or MRI including metal in the head, pacemaker, known abnormal cranial fissures/holes. difficulty communicating with study personnel uncontrolled hypertension at rest (systolic > 180 mmHg and/or diastolic > 100 mmHg) low vision that cannot be corrected by wearing glasses. Low visual will be operationally defined as visual acuity less than 20/70 on a standard eye chart, or difficulty performing complex walking tasks due to visual conditions affecting accurate navigation around and over obstacles (self-reported or observed by examiner). illiterate, due to the likelihood of difficulties performing some of the cognitive tasks non-English speaking, due to the likelihood of difficulties following instructions during therapy and during assessments use of medications that are know to modify tDCS effectiveness including those with anticholinergic, GABAergic, or glutamatergic properties, or sodium channel blockers clinical judgment of investigative team
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
David Clark, ScD
Organizational Affiliation
University of Florida
Official's Role
Principal Investigator
Facility Information:
Facility Name
HealthStreet
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32608
Country
United States
Facility Name
UF Institute on Aging
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32611
Country
United States
Facility Name
University of Florida
City
Gainesville
State/Province
Florida
ZIP/Postal Code
32611
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Citations:
PubMed Identifier
35410769
Citation
Chatterjee SA, Seidler RD, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ, Clark DJ. Effects of Prefrontal Transcranial Direct Current Stimulation on Retention of Performance Gains on an Obstacle Negotiation Task in Older Adults. Neuromodulation. 2023 Jun;26(4):829-839. doi: 10.1016/j.neurom.2022.02.231. Epub 2022 Apr 8.
Results Reference
derived

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Combining tDCS and Neurorehabilitation to Treat Age-related Deficits of Mobility and Cognition: UPfront Walking Study

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