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CompletedNCT03185234RAdiCSUpdated May 20, 2022

Rehabilitating (Stroke-induced) Apraxia With Direct Current Stimulation

An interventional study of anodal tDCS and sham tDCS in Stroke and Apraxia, sponsored by University of Cologne. Completed at 2 sites in Germany. Open to participants aged 18 Years to 90 Years. Per ClinicalTrials.gov, last updated 2022-05-20.

Sponsored by University of Cologne · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
117
Allocation
Randomized
Ages
18 Years to 90 Years
Sex
All
01

Study summary

The objective of the clinical trial is to investigate whether weak transcranial direct current stimulation (tDCS) can ameliorate the motor cognitive deficit apraxia during stroke rehabilitation. Stroke patients with apraxia will either receive a real stimulation or a sham stimulation (placebo) for 10 minutes at a time on 5 consecutive days during their in-patient stay in a rehabilitation center. Additionally, motor tasks are performed before and after the stimulation. The effect of the weak current stimulation on motor function is assessed 3-4 days after the last stimulation and 3 months after enrollment.

Read the detailed description

Despite the high incidence of the motor cognitive deficit apraxia after left-hemispheric stroke, evidence-based therapies do not exist. This randomized controlled clinical trial (RCT) investigates whether anodal transcranial direct current stimulation (tDCS) as an add-on therapy during neuro-rehabilitation can ameliorate apraxic deficits in patients with left hemisphere stroke. Therefore, anodal tDCS is applied over the parietal cortex of the left, lesioned hemisphere with an intensity of 2 mA for 10 minutes at a time on 5 consecutive days in combination with motor tasks before and after the stimulation. The effect of the stimulation is compared to a sham stimulation. Moreover, application of a pre-programmed study mode ensures a double-blind study design (patient and investigator). The performance in the apraxia test KAS (Cologne Apraxia Screening) 3-4 days after the last stimulation, compared to baseline, serves as primary endpoint of the study. Secondary endpoints are evaluated using various apraxia tests, motor tests and neuropsychological tests 3-4 days after the last stimulation and 3 months after enrollment.

02

Conditions studied

  • Stroke
  • Apraxia

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Keywords

  • tDCS
03

Who can participate

Ages eligible
18 Years to 90 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • left hemispheric ischemic stroke in the subacute/ chronic phase (>10 days and \<180 days post-stroke)
  • clinical confirmation of apraxia by KAS (Cologne Apraxia Screening), Cut-off ≤ 76/ 80 points;
  • age 18 - 90 years;
  • written Informed Consent

Exclusion criteria

Exclusion Criteria:

  • pregnancy, breastfeeding and women without exclusion of pregnancy
  • patients with clinical manifestation of a stroke prior to the index-stroke
  • malignant disease with affection of central nervous system
  • life expectancy \<12 months
  • current addiction to alcohol or drugs or other addictive disease (exception: nicotine)
  • current clinically manifest psychiatric disorders, such as schizophrenia or severe depressive episode
  • epileptic seizure within the past two years
  • continuous medication during the intervention phase with benzodiazepine, antipsychotics of high potential and anti-epileptic drugs taken for prophylaxis of epileptic seizures
  • enrollment in other studies with brain stimulation in the time period after the index stroke
  • heart pacemaker
  • electrodes for deep brain stimulation or other metal implants in the head (expected are dental fillings and inlays)
  • craniectomy or trepanation
  • vulnerable skin lesions at electrode positions
  • poor motivation/ cooperation
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
117 participants (actual)

Study arms

  • Active comparator
    Real tDCS

    Anodal tDCS at an intensity of 2 mA is applied for 10 minutes at a time on 5 consecutive days. The anodal electrode is placed over the left parietal cortex (P3 in 10/20 EEG) of the lesioned hemisphere, the cathodal electrode is located supraorbital on the right side. Motor tasks are performed before and after the stimulation.

    Device: anodal tDCS

  • Sham comparator
    Sham tDCS

    Sham stimulation is applied for 10 minutes at a time on 5 consecutive days. One electrode is placed over the left parietal cortex (P3 in 10/20 EEG) of the lesioned hemisphere and a second electrode supraorbital on the right side. Motor tasks are performed before and after the stimulation.

    Device: sham tDCS

Interventions

  • Deviceanodal tDCS

    2 mA, 10 min, 5 sessions

    Also known as: neuroConn DCS, model no. 008

  • Devicesham tDCS

    sham stimulation, 10 min, 5 sessions

    Also known as: neuroConn DCS, model no. 008

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What researchers measure

Primary outcomes

  1. KAS (Cologne Apraxia Screening)

    Degree of apraxia

    Time frame: 3-4 days after stimulation

Secondary outcomes

  1. KAS (Cologne Apraxia Screening)

    Degree of apraxia

    Time frame: 3 months after enrollment

  2. Goldenberg Imitation

    Degree of apraxia

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  3. de Renzi Imitation

    Degree of apraxia

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  4. de Renzi actual tool use

    Degree of apraxia

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  5. Action Research Arm Test (ARAT)

    Motor function

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  6. Jebsen Taylor Hand Function Test (JTHFT)

    Motor function

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  7. Gripforce (Vigorimeter)

    Motor function

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  8. Strength of hands (MRC)

    Motor function

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  9. National Institute of Health Stroke Scale (NIHSS)

    Impairment by stroke

    Time frame: enrollment

  10. modified Ranking Scale (mRS)

    Impairment by stroke

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

  11. Aphasia Check List (ACL-K)

    Aphasia

    Time frame: 3-4 days after stimulation, and 3 months after enrollment

06

Study locations

2 sites
  • Rehabilitationszentrum Godeshöhe e.V.
    Bonn, NRW 53177, Germany
  • MediClin Fachklinik Rhein/Ruhr für Neurologie
    Essen, NRW 45219, Germany
07

References and documents

Publications

  • Kleineberg NN, Richter MK, Becker I, Weiss PH, Fink GR. Verum versus sham tDCS in the treatment of stroke-induced apraxia: study protocol of the randomized controlled trial RAdiCS -"Rehabilitating (stroke-induced) Apraxia with direct Current Stimulation". Neurol Res Pract. 2020 Mar 4;2:7. doi: 10.1186/s42466-020-0052-y. eCollection 2020. PubMed 33324913 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03185234
Lead sponsor
University of Cologne
Responsible party
Gereon R. Fink (Univ.-Prof. Dr. med., University of Cologne) — Principal investigator
First posted
Jun 14, 2017
Start date
Jun 23, 2017
Primary completion
Jul 13, 2021
Completion
Nov 9, 2021
Last update
May 20, 2022

Study contacts

Gereon R. Fink, Univ-Prof.
principal investigator · University Hospital Cologne

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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