tDCS During Contralaterally Controlled FES for Upper Extremity Hemiplegia
After a stroke, it is very common to lose the ability to open the affected hand. Occupational and physical rehabilitation therapy (OT and PT) combined with non-invasive brain stimulation may help a person recover hand movement. The purpose of this study is to compare 3 non-invasive brain stimulation protocols combined with therapy to see if they result in different amounts of recovery of hand movement after a stroke.
• Age ≥ 21 and ≤ 90
• ≥ 6 and ≤ 24 months since first clinical hemorrhagic or nonhemorrhagic stroke
• Able to follow 3-stage command
• Able to remember 2 of 3 items after 30 minutes
• Full volitional elbow extension/flexion and hand opening/closing of unaffected limb
• Adequate active movement of shoulder and elbow to position the paretic hand in the workspace for table-top task practice
• Patient must be able to sit unassisted in an armless straight-back chair for the duration of the screening portion of the eligibility assessment
• Medically stable
• ≥ 10° finger and wrist extension
⁃ Skin intact on hemiparetic arm, hand and scalp
⁃ Muscle contraction can be elicited with Transcranial Magnetic Stimulation
⁃ Unilateral upper limb hemiparesis with finger extensor strength of ≤ grade 4/5 on the Medical Research Council (MRC) scale
⁃ Score of ≥1/14 and ≤ 11/14 on the hand section of the upper extremity Fugl-Meyer Assessment
⁃ While relaxed, surface NMES of finger extensors and thumb extensors and/or abductors produces a functional degree of hand opening without pain.