Tele-CE in Severe Stroke
Purpose
The goal of this clinical trial is to determine the effects of home-based cross-education on lower limb neuroplasticity in severe stroke. The main questions the investigators aim to answer are: - What are the effects of home-based cross-education on lower limb neuroplasticity? - What are the effects of home-based cross-education on lower limb function? - Is home-based cross-education feasible to administer and accepted by participants? Participants will take part in ten home-based, remotely supervised sessions, during which participants will either perform unilateral skill and strength training of the unaffected lower limb (Tele-Cross Education or Tele-CE) or cognitive training and unilateral movements of the unaffected lower limb (Tele-control). Each participant will experience measures of brain and spinal activity and motor function testing before and after both sessions (Tele-CE and Tele-control). Each participant will also be asked to fill out a feedback questionnaire to assess acceptability after intervention sessions (Tele-CE and Tele-control).
Condition
- Stroke
Eligibility
- Eligible Ages
- Between 18 Years and 80 Years
- Eligible Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- Single, monohemispheric stroke - Chronic stroke (> 6 months prior) - Severe stroke (Fugl-Meyer Lower Extremity motor scale score < 21 or 6 Minute Walk Test distance < 300m)
Exclusion Criteria
- Use of anti-spasticity medications - Existence of other neurological disorders - Have brainstem or cerebellar lesions. - Mini-Mental State Examiniation score of <21, to ensure participants have the cognitive capacity to consent and can understand instructions both in-person and during remote supervision. - Non-English-speaking individuals - Bone, joint or soft tissue injury - Uncontrolled medical conditions (such as uncontrolled hypertension, untreated cardiac disease, or untreated pulmonary disease) - Unable to see the tablet and zoom screen - Unable to move non-paretic ankle (< 5 degrees of ankle ROM) - Fugl-Meyer Lower Extremity sensory scale score < 6 TMS exclusion criteria - Previous adverse reaction to TMS - Skull abnormalities or fractures - Concussion within the prior 6 months - Unexplained, recurring headaches - Implanted cardiac pacemaker - Metal implants in the head or face - History of seizures or epilepsy - Use of medications that could alter cortical excitability or increase risk of seizure (e.g., antidepressants, antipsychotics, anxiolytics, anticonvulsants) - Current pregnancy PNS exclusion criteria - Skin hypersensitivity at any sites of stimulation, including the scalp, thoracolumbar spine, and peripheral limbs - History of contact dermatitis at any of the sites of stimulation - History of allodynia and/or hyperalgesia - Active skin infection - Skin lesions - Deep vein thrombosis - Any other skin or scalp condition that could be aggravated by stimulation - Implanted electronic, metallic, or highly conductive devices near site of stimulation that cannot be removed without permission from a health professional
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Primary Purpose
- Treatment
- Masking
- Double (Participant, Outcomes Assessor)
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Experimental Tele-Cross Education (Tele-CE) |
While seated, participants will begin with 15 minutes of game-based ankle skill training of the unaffected lower limb. Participants will perform skilled dorsiflexion and plantarflexion movements of the unaffected ankle to play simple and engaging games. Three game blocks will be played (5 mins/block) with 1-minute rest between blocks. Following this, participants will engage in unaffected leg strength training using a theraband targeting hip flexors, hip abductors, hip adductors, knee flexors, knee extensors, and ankle plantarflexors. Participants will perform 3 sets of 10 repetitions for each muscle group. |
|
|
Sham Comparator Tele-Control |
While seated, participants will begin with 15 minutes of cognitive training using games focusing on memory and executive function. Participants will play three cognitive games (5 minutes each with 1-min rest between blocks). Following this, participants will engage in unilateral leg movements of the unaffected hip flexors, hip abductors, hip adductors, knee flexors, knee extensors, and ankle plantarflexors. Participants will perform 3 sets of 10 repetitions of movements for each muscle group. |
|
Recruiting Locations
Chicago, Illinois 60612
More Details
- Status
- Recruiting
- Sponsor
- University of Illinois at Chicago