Combined Transcranial Direct Current Stimulation and Motor Imagery-based Robotic Arm Training for Stroke Rehabilitation
Stroke
About this trial
This is an interventional treatment trial for Stroke focused on measuring Stroke, Noninvasive brain stimulation, Brain-computer interface, Motor imagery, Rehabilitation
Eligibility Criteria
Inclusion Criteria:
- first ever haemorrhagic or ischaemic subcortical stroke more than 9 months prior to study enrollment
- upper extremity impairment of 11-45 on the Fugl-Meyer assessment scale
Exclusion Criteria:
- epilepsy
- neglect
- cognitive impairment
- other neurological or psychiatric diseases
- severe arm pain
- spasticity score >2 on the Modified Ashworth Scale in the shoulder or elbow
- contraindications to TMS or tDCS (cranial implants, ventricular shunts, pacemakers, intrathecal pumps)
- grip strength <10kg as measured by a dynamometer
- participation in other interventions or trials targeting stroke motor recovery.
Sites / Locations
- National University Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Sham Comparator
real-tDCS with MI-BCI
sham-tDCS with MI-BCI
10 sessions of the following: 20 minutes of tDCS prior to each session of motor training with the MI-BCI system. Direct current at an intensity of 1mA with anode placed over the M1 motor cortex of the affected hemisphere and the cathode placed over the unaffected M1. After initial calibration, MI-BCI training will involve motor imagery of reaching tasks using the clock game interface of the MIT-Manus robotic system to perform multi-directional reaching movements. Upon detection of the intention to move towards the target on BCI, the robotic arm will complete the reaching movement towards the target. Each training session will last for 40 minutes excluding set-up time.
10 sessions of sham tDCS with BCI motor training, each session of which will be conducted as follows: The same electrode placement and stimulation parameters will be employed for sham tDCS as for real tDCS. However, the current will be applied for 30 seconds only, to give subjects the sensation of the stimulation. This method of sham stimulation has also been validated (Gandiga et al., 2006). Current intensity will be increased and decreased gradually to decrease perception. MI-BCI training will be the same as the real-tDCS group and will similarly last for 40 minutes.