Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: Study protocol for a randomized controlled trial

Mindy F. Levin, Melanie C. Baniña, Silvi Frenkel-Toledo, Sigal Berman, Nachum Soroker, John M. Solomon, Dario G. Liebermann

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved ("active control zone") after identification of a "spasticity zone". Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. Methods: This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two followup assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbowflexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. Discussion: This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries.

Original languageEnglish
Article number6
JournalTrials
Volume19
Issue number1
DOIs
Publication statusPublished - 01-01-2018

Fingerprint

Muscle Spasticity
Paresis
Upper Extremity
Randomized Controlled Trials
Elbow
Stroke
Single-Blind Method
Rehabilitation Centers
Aptitude
Hand Strength
Israel
Random Allocation
Biomechanical Phenomena
Canada
India
Rehabilitation
Transcranial Direct Current Stimulation
Learning
Costs and Cost Analysis
Brain

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Pharmacology (medical)

Cite this

Levin, Mindy F. ; Baniña, Melanie C. ; Frenkel-Toledo, Silvi ; Berman, Sigal ; Soroker, Nachum ; Solomon, John M. ; Liebermann, Dario G. / Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis : Study protocol for a randomized controlled trial. In: Trials. 2018 ; Vol. 19, No. 1.
@article{9fea8f127e9d418bb1766e8ccdbf19ce,
title = "Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: Study protocol for a randomized controlled trial",
abstract = "Background: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved ({"}active control zone{"}) after identification of a {"}spasticity zone{"}. Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. Methods: This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two followup assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbowflexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. Discussion: This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries.",
author = "Levin, {Mindy F.} and Bani{\~n}a, {Melanie C.} and Silvi Frenkel-Toledo and Sigal Berman and Nachum Soroker and Solomon, {John M.} and Liebermann, {Dario G.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1186/s13063-017-2377-6",
language = "English",
volume = "19",
journal = "Trials",
issn = "1745-6215",
publisher = "BioMed Central",
number = "1",

}

Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis : Study protocol for a randomized controlled trial. / Levin, Mindy F.; Baniña, Melanie C.; Frenkel-Toledo, Silvi; Berman, Sigal; Soroker, Nachum; Solomon, John M.; Liebermann, Dario G.

In: Trials, Vol. 19, No. 1, 6, 01.01.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis

T2 - Study protocol for a randomized controlled trial

AU - Levin, Mindy F.

AU - Baniña, Melanie C.

AU - Frenkel-Toledo, Silvi

AU - Berman, Sigal

AU - Soroker, Nachum

AU - Solomon, John M.

AU - Liebermann, Dario G.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved ("active control zone") after identification of a "spasticity zone". Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. Methods: This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two followup assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbowflexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. Discussion: This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries.

AB - Background: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved ("active control zone") after identification of a "spasticity zone". Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. Methods: This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two followup assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbowflexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. Discussion: This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries.

UR - http://www.scopus.com/inward/record.url?scp=85042515450&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042515450&partnerID=8YFLogxK

U2 - 10.1186/s13063-017-2377-6

DO - 10.1186/s13063-017-2377-6

M3 - Article

AN - SCOPUS:85042515450

VL - 19

JO - Trials

JF - Trials

SN - 1745-6215

IS - 1

M1 - 6

ER -