Active clinical trials for "Stroke"

The purpose of the study is to determine the safety and possible effectiveness of brain transplants of CD34+ stem cells obtained from umbilical cord blood (UCB) to treat stroke.

Although the negative impact of sleep apnea on the clinical course of acute ischemic stroke (AIS) is well known, data regarding non-invasive ventilation in acute patients are scarce. Several studies showed its tolerability, safety and signals-of-efficacy, yet no controlled randomized sequential phase studies currently exist that aim to establish the efficacy of early non-invasive ventilation in AIS patients. The main hypothesis for this study is that early non-invasive ventilation with automated bilevel positive airway pressure (auto-BPAP) positively affects short-term clinical outcomes in AIS patients. This is a multicenter, prospective, randomized, controlled, third rater-blinded, parallel-group trial. Patients with AIS with proximal arterial obstruction and clinically suspected sleep apnea will be randomized to standard or standard stroke care plus auto-BPAP. Auto-BPAP will be initiated within 24 hours from stroke onset and performed for a maximum of 48 hours during diurnal and nocturnal sleep. Patients will undergo cardiorespiratory polygraphy between day 3 and 5 to assess sleep apnea. The primary endpoint is any early neurological improvement on the NIHSS at 72 hours from randomization. Safety, tolerability, short-term and 3 months functional outcomes are assessed as secondary endpoints by un-blinded and blinded observers respectively. This study will provide data to power a subsequent phase III study.

Transient ischemic attack (TIA) or minor ischemic stroke has a high risk of early recurrent stroke. As the golden standard, aspirin effect modestly on acute ischemic stroke, and slightly increase the risk of intracerebral hemorrhage. Recently, rivaroxaban, a new oral anticoagulant, is proved to be as effective as traditional anticoagulants, while carrying significantly less risk of intracranial hemorrhage. The TRACE trial is a randomized, double-blind, multicenter, controlled clinical trial in China. The investigators will assess the hypothesis that a 30-days rivaroxaban regimen is superior to aspirin alone for the treatment of high-risk patients with acute nondisabling cerebrovascular event.

This is a 12-week, randomized, placebo controlled study to determine if donepezil (Aricept) treatment during rehabilitation after stroke improves functional recovery.

The objective is to establish the effect of sour taste and cold temperature on the pharyngeal swallowing transit time after ischemic hemisphere stroke.

The purpose of the current study is to evaluate relative efficacy of (1)modified constraint-induced movement therapy (mCIMT) combined with eye patching, (2)mCIMT, and (3) traditional rehabilitation on motor, attentional, and activities of daily living functions in stroke patients with unilateral neglect (UN). UN represents a failure to respond or orient to stimuli presented contralateral to a brain lesion. Constraint-induced movement therapy is made up of a family of treatment that involve repeatedly practicing use of the affected limb and constraining use of the unaffected arm in the clinic and at home. mCIMT is an intervention based on modifications to conventional CIMT by distributing practice sessions to a longer period of time. mCIMT attempts to supplement the inadequacy of the current rehabilitation programs and to fit better into rehabilitation schedules. This technique has been suggested to be especially relevant for treatment of patients with UN.Half-field eye patching involves occlusion of the hemifield of both eyes (in the case of left UN, the right hemifields of both eyes). Patching the ipsilateral hemifield is believed to increase activation of the involved hemisphere, resulting in increased attention to the contralateral neglected side. Despite the promising relevance of mCIMT for rehabilitation of patients with hemiplegia, it remains unclear whether mCIMT is effective for alleviating UN. A further issue that warrants investigation is the combined effects of mCIMT and eye patching. Both approaches involve the use of controlled sensory input that may lead to increased activation of the lesioned hemisphere. Integration of both approaches may be more efficacious than mCIMT without direct intervention for UN. This project is proposed to study the combined effects of both approaches. It is hypothesized that combining both approaches will be more effective than mCIMT, which is hypothesized to be superior to traditional rehabilitation involving the same amount of therapy time. To test the hypotheses, 60 patients with unilateral stroke and UN will be recruited and randomly assigned to one of the three treatment groups (i.e., mCIMT and eye patching, mCIMT, and traditional rehabilitation). Testing for UN will include the use of the line bisection test, cancellation tasks, and examination for extinction to double simultaneous stimulations. The outcome measures will include traditional motor function tests, kinematic analysis, a circle discrimination test, and daily life functional measures. Each eligible participant will be tested before and immediately after the assigned intervention and at three months and six months after the treatment. Each type of treatment will be three-week long. Multivariate analysis of covariance will be used to analyze the obtained data in order to test for the relative effects of the three treatments. Each participant will be tested for motivation for participating in treatment sessions using the Pittsburgh Rehabilitation Participation Scale. It is hypothesized that patients with higher participation will improve more than those with lower participation. The uniqueness of this proposed project pertains to (1)modification of the CIMT protocol in a more feasible way; (2)concurrent use of mCIMT and eye patching for treating UN post stroke; and (3)use of kinematic analysis for detecting precise changes in motor behavior post intervention. Kinematic analysis is relevant for identifying trajectory control deficits that may accompany clinically "recovered" UN. Findings of this investigation will improve assessment and treatment for UN that is devastating to functional recovery from stroke.

The investigators are looking for individuals who have suffered a stroke to participate in an experiment examining the use of robotics in rehabilitation. They are trying to develop a robotic environment for hands after having had a stroke. Participants will interact with up to two small robots and a visual display. The experiment involves minimal risk and may involve testing sessions over multiple weeks. Subjects must be at least 1 year post-stroke and have difficulty picking up small objects. For more information, contact: Bambi Brewer, CMU Ph.D. Student, 412-241-9423 or bambi@andrew.cmu.edu.

To assess whether patients with diabetes have less clinical improvement during inpatient rehabilitation than those without diabetes and whether hyperglycaemia during rehabilitation is an adverse prognostic indicator.

This study will gain information on methods of control of a prosthetic arm in stroke patients or traumatic brain inury patients through a technique called "brain-computer interface" (BCI). BCI allows for direct communication between man and machine. Brain cells communicate by producing electrical impulses that help to create such things as thoughts, memory, consciousness and emotions. In BCI, brain waves are recorded by an electroencephalogram (EEG) through electrodes (small wires) attached to the scalp. The electrodes measure the electrical signals of the brain. These signals are sent to the computer, which translates them into device control commands as messages that reflect a person's intention. This type of brain activity comes from the sensorimotor areas of the brain and can be controlled through voluntarily training to control the hand prosthesis through the BCI. Healthy normal volunteers and people who have had a stroke or traumatic brain injury more than 12 months ago and have paralysis in the right or left arm, hand or leg and who are between 18 and 80 years of age may be eligible for this study. Candidates are screened with a clinical and neurological examination and magnetic resonance imaging (MRI) of the brain. MRI uses a magnetic field and radio waves to obtain images of the brain. The scanner is a metal cylinder surrounded by a strong magnetic field. During the procedure, the subject lies in the scanner for about 45 minutes, wearing ear plugs to muffle loud knocking sounds that occur with the scanning. Participants undergo the following procedures: Sessions 1-2: Participants are connected to an EEG machine and familiarized with the hand orthosis (training device used in the study) and the tasks required for the study. Sessions 3-4: Participants receive baseline transcranial magnetic stimulation (TMS) and fMRI. For TMS, a wire coil is held on the scalp. A brief electrical current is passed through the coil, creating a magnetic pulse that stimulates the brain. The subject may feel a pulling sensation on the skin under the coil and there may be twitching in muscles of the face, arm or leg. The subject may be asked to tense certain muscles slightly or perform other simple actions. The effect of TMS on the muscles is detected with small metal disk electrodes taped to the skin of the arms. fMRI is like a standard MRI (see above), except it is done while the patient performs tasks to learn about brain activity involved in those tasks. Sessions 5-8: Participants are asked to repetitively move their hand (patients' paralyzed hand; healthy volunteers' normal hand), tongue and leg in response to three sound tones. After ten trials, they are asked to imagine the same movements 50 to 100 times while the EEG machine is recording brain activity. Sessions 9-14: Participants are trained in controlling the hand orthosis. The subject's hand is attached to the orthosis and asked to imagine that they are performing finger or hand movements. This continues until there is an 80-90 percent success rate in achieving hand movement. Sessions 15-16: Participants repeat TMS and fMRI for comparison before and after training with the hand orthosis. Sessions 17-28: Participants receive additional training with the hand orthosis device (as in sessions 5-8), focusing only on the hand and not other parts of the body. Sessions 29-30: Participants undergo repeat TMS and fMRI to compare with the effect following additional training with the hand orthosis. Sessions 31-32: Optional makeup sessions if needed because of scheduling problems. Participants are evaluated in the clinic after 3 months to see if they have benefited from the study.

The principal purpose of the study is to determine the efficacy and safety of Levetiracetam versus Carbamazepine, intended as the number of patients free from crisis during the whole period of treatment, in patients affected by post stroke late onset crisis.