Stroke is the second cause of death worldwide and represented the first cause of death in Brazil between 2006 and 2010. Most patients survive, and there is a need to develop cost-effective rehabilitation strategies to decrease the burden of disability from stroke. This study addresses this important issue, by combining two different interventions in the early phase post-stroke: robotic therapy associated or not with transcranial direct current stimulation (tDCS), as adjuvant interventions to conventional physical therapy, for motor upper limb rehabilitation.
Our main goal is to confirm the safety of robotic therapy associated with active tDCS and conventional therapy, compared to robotic therapy associated with sham tDCS and to conventional therapy, and to conventional therapy alone, for upper limb rehabilitation in an early phase (3-9 weeks) after stroke. Patients will be randomized to receive one of these three treatments, 3 times per week, for 6 weeks. Data about eventual adverse effect will be collected in each session of treatment. The working hypothesis is that robotic therapy associated with active tDCS and conventional therapy will be as safe as robotic therapy associated with conventional therapy, and as conventional therapy alone. We will aso preliminarily evaluate the efficacy of robotic therapy associated with active tDCS and conventional therapy, compared to robotic therapy associated with sham tDCS and to conventional therapy alone, in improvement of upper limb motor impairment. Our secondary goals are: 1) To evaluate safety and upper limb motor impairments in patients submitted to each of the three interventions, 6 months after end of treatment; 2) To compare effects of the abovementioned interventions on disability, spasticity and quality of life, in patients at an early stage after stroke, immediately after treatment and 6 months later. The working hypothesis is that the association of robotic therapy, tDCS and conventional therapy will lead to better outcomes than robotic therapy and conventional therapy, or conventional therapy alone. Patients will be assessed before the first session and after the last session of treatment, as well as 6 months after the last session of treatment.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Robotic therapy (MIT - Manus, Interactive Motion Technologies) will be administered for 40 minutes to the paretic upper limb.
Active tDCS will be applied with the cathode positioned over the ipsilesional primary motor cortex and the anode over the contralateral supraorbital region for 20 minutes (1mA).
In sham tDCS, no current will be delivered through the tDCS device.
Hospital das Clínicas
São Paulo, São Paulo, Brazil
Change in Upper Extremity Fugl Meyer Assessment
Change in Motor function subscale was assessed. Scores range from 0 to 66. Lower scores indicate greater severity.
Time frame: 6 weeks from baseline
Percentage of Sessions With Adverse Events
Time frame: Post treatment (6 weeks from baseline).
Change in Modified Rankin Scale
Scores range from 0 to 6. Higher scores indicate greater severity.
Time frame: 6 weeks from baseline
Change in National Institutes of Health Stroke Scale
Scores range from 0 to 42. Higher scores indicate greater severity.
Time frame: 6 weeks from baseline
Change in Stroke Impact Scale
Scores in each domain of the Stroke Impact Scale range from 0 to 100, with higher scores indicating a better quality of life. The change was calculated as the value at the later time point minus the value at the earlier time point; so that, positive numbers represent increases and negative numbers represent decreases.
Time frame: 6 weeks from baseline
Number of Participants Who Presented Score on Modified Ashworth Scale >2
Scores range from 0 to 4, with 5 choices. A score of 1 indicates no resistance, and 4 indicates rigidity.
Time frame: 6 weeks
Change in Motor Activity Log
Each domain contains taks scored on 0 to 5 ordinal scale. Lower scores indicate greater severity.
Time frame: 6 weeks from baseline
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Masking
TRIPLE
Enrollment
9
Physical therapy will be administered for 40 minutes.
Occupational therapy will be administered for 40 minutes.
Upper Extremity Fugl Meyer Assessment
Motor function subscale was assessed. Scores range from 0 to 66. Lower scores indicate greater severity.
Time frame: 6 months follow-up
Number of Participants With Adverse Events
Time frame: 6 months follow-up
Change in Fatigue Severity Scale
Fatigue Severity Scale is a 9 -item questionnaire. Each item scores on a 7-point scale. The total score range from 9 to 63 points. Higher scores indicate greater fatigue.
Time frame: 6 weeks from baseline
Change in Pittsburgh Sleep Quality Index
The global Pittsburgh Sleep Quality Index score is calculated by totaling the seven component scores, providing an overall score ranging from 0 to 21. Lower scores denote a healthier sleep quality.
Time frame: 6 weeks from baseline