Priming With tDCS: Expanding the Window of Recovery in Chronic Stroke
Upper Extremity Paresis
About this trial
This is an interventional treatment trial for Upper Extremity Paresis focused on measuring stroke, upper extremity, intervention, transcranial direct current stimulation, actigraph, fMRI
Eligibility Criteria
Inclusion Criteria:
- > 18-75 years of age;
- diagnosis of ≥ 1 stroke > 6 months before participation;
- in good health;
- classified with moderate impairment based on the UE Fugl Meyer Assessment (FMA; score of 19-47
- safe for the MRI environment;
- able to elevate and hold the paretic arm for 2 seconds at 90 degs shoulder elevation, 160-180O elbow extension and neutral forearm supination;
- ≥ 20 degrees gravity minimized wrist extension while holding a cylindrical object on a tabletop.
Exclusion Criteria:
- bone or joint limitations that restrict paretic arm motion;
- history of skull fractures or burr hole(s);
- resting heart rate and resting blood pressure outside the range of 40-100 beats/min and 90/60 to 170/90 mm Hg respectively;
- chest pain or shortness of breath at rest;
- history epilepsy or seizures;
- Botox injections to the paretic arm within 4 months of participation.
Sites / Locations
- University of the Sciences
Arms of the Study
Arm 1
Arm 2
Experimental
Sham Comparator
Experimental
Control
Transcranial Direct Current Stimulation.1) Scalp measurements of the scalp will be taken using the 10-20 EEG measurement system to determine anode and cathode placement. 2) One 1x1 Bicarbon electrode with wires attached will be placed in the center of each 5 cm x 7 cm sponge electrode dampened with 8 ml of saline. 3) One sponge electrode will be placed over the ipsilesional PMd (F3) and the other sponge electrode over the contralesional supraorbital region(Fp2). 4) Each sponge electrode will be secured under the plastic EZ strap 5) The current from the Actividose II will be turned up to 2 MA. The current will ramp up/down in 15 seconds. We will observe for adverse effects and hit the pause button, then turn the machine off, if a participant does not tolerate the stimulation. Individuals in this arm will have the stimulation stay in current until the full dose is delivered. Each participant will then engage in the UE TRT as outlined below.
Individuals in this arm will have the stimulation cycled off after 2-3 minutes. All will be part of the Circuit-Based, UE Task Related Training. Each participant will engage in the training program for 1.5 hours; rotating through 5 stations at about 15 minute intervals, participating in standing as tolerated, but stations can be adapted to sitting. The goal is for each participant perform > 225 movements with the affected arm per session, at the highest functional level. Rest breaks given as needed. Examples of stations are: Reach-to-grasp tasks to objects of various weight, texture and dimension at different distances and table heights. Practice opening simulated locks and containers. Shoulder wheel involving grasping plastic plates with varied grip patterns and sliding them up and over the wheel from the unaffected to the affected side encouraging shoulder abduction, external rotation and supination. Bimanual/unimanual ball toss: catching, releasing.