Non-invasive Brain Stimulation (NIBS) and Dual-task Walking After Stroke

Texas Woman's University15 enrolled

Overview

The study aims to identify neural locus critical for dual-task walking (walking and talking) in individuals with stroke. To achieve this aim, the investigators apply repetitive transcranial magnetic stimulation (rTMS) to different parts of the brain and evaluate the effects of brain stimulation on dual-task walking speed.

This study will enroll 12 individuals with a stroke at least 6 months ago. Participants will be tested across 3 sessions and each session will be approximately 1 week apart from each other. During testing, participants will be asked to walk under two conditions: single- and dual-task conditions. Under the single-task condition, participants walk on a instrumented mat such that their gait performance will be captured. Under the dual-task condition, participants walk on the mat while performing a counting backward task. The walking assessment is followed by a 12 minute non-invasive brain stimulation using high frequency rTMS. Another walking assessment will be conducted right after the brain stimulation session. High frequency rTMS will be applied to different neural loci, namely primary motor cortex (M1), supplementary motor area (SMA), and dorsolateral prefrontal cortex (DLPFC). The walking speed under two different conditions will be compared before and after brain stimulation to different neural loci.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Stroke

Interventions

high frequency rTMSDEVICE

Participants receive 16 minutes (5Hz, 24 10-second trains with a inter-train interval of 30s) of high frequency rTMS applied to either primary motor cortex (M1), supplementary motor area (SMA) and dorsolateral prefrontal cortex (DLPFC) at different sessions. Walking performance is evaluated before and after the brain stimulation.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age above 18 years 2. Diagnosis of Left hemispheric stroke at least 6 months ago 3. First time stroke OR complete gait recovery from prior stroke 4. Able to walk independently for at least 10 meters with or without walking aids 5. Have at least minimal movements (\> 5 degree of motion) at the affected ankle 6. Score \> 26 on Mini Mental State Exam (MMSE) 7. Ability to participate in the informed consent process Exclusion Criteria: 1. Diagnosis of other neurological conditions, such as Parkinson Disease, Alzheimer, Spinal Cord Injury, Multiple Sclerosis 2. Other comorbidities which could interfere with gait (i.e. amputation, severe osteoarthritis) 3. Unstable clinical conditions 4. Non-ambulatory prior to onset of stroke 5. History of significant head trauma 6. Electrical, magnetic, or mechanical implantation: cardiac pacemakers or intracerebral vascular clip 7. Metal implantation in the oral cavity, head/neck area and lower extremity 8. Pregnancy 9. History of seizures or unexplained loss of consciousness 10. Immediate family member with epilepsy 11. Use of seizure threshold lowering medicine 12. Current abuse of alcohol or drugs 13. Anticipated inability to complete the study 14. History of psychiatric illness requiring medication control

Locations (1)

Texas Woman's University

Dallas, Texas, United States

Outcomes

Primary Outcomes

Change in Gait Speed

gait speed in m/s will be captured using GaitRite gait assessment walkway

Time frame: before and 10 minutes after the non-invasive brain stimulation

Secondary Outcomes

Change in Step Lengths

Step lengths in centimeter (cm) will be captured using GaitRite gait assessment walkway

Time frame: before and 10 minutes after the non-invasive brain stimulation

Change in Single Support Times

Single support times (in % of gait cycle) will be captured using GaitRite gait assessment walkway

Time frame: before and 10 minutes after the non-invasive brain stimulation

Change in Counting Task Performance

number of correct responses in counting backward task

Time frame: before and 10 minutes after the non-invasive brain stimulation

Data from ClinicalTrials.gov

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