GRAViceptive NEGlect Treatment in Acute Stroke Using Targeted Cranial ELECTrotherapy
Graviceptive Neglect After Stroke: Clinical, Neuroanatomical and Physiological Effects of Focal Neuromodulation
University of Sao Paulo
28 participants
Jan 3, 2025
INTERVENTIONAL
Conditions
Summary
We aim to determine if targeted high-definition transcranial direct current stimulation (HD-tDCS) can safely correct errors in visual verticality perception in patients after stroke affecting either hemisphere.
Eligibility
Inclusion Criteria7
- Supratentorial ischemic stroke diagnosed by neuroimaging and clinical analysis;
- Clinically stable (stable vital signs for 24 hours; no chest pain in the last 24 hours; no significant arrhythmia; no evidence of deep vein thrombosis);
- Normal or corrected-to-normal vision;
- No previous experience with HD-tDCS;
- Ability to provide informed consent (patient or legal representative);
- Ability to comply with the intervention and assessment schedule of the protocol.
- Presence of visual verticality misperception.
Exclusion Criteria18
- Migraine;
- Pregnancy;
- Pacemakers;
- Seizures;
- Claustrophobia;
- Transient ischemic attack;
- Other neurological disorders;
- Psychiatric disorders;
- Sensitive scalp or prior brain surgery;
- Diagnosis of severe carotid atherosclerotic disease (stenosis ≥ 70%);
- Presence of metal implants, cardiac pacemakers, or claustrophobia;
- Diagnosis of COVID-19 or other infectious disease that requires isolation;
- Uncontrolled medical problems, such as terminal cancer or kidney disease.
- Left-handed or mixed-handed individuals as determined using the Edinburgh Handedness Inventory (Appendix 10);
- Peripheral vestibular deficits observed using neuro-otological screening tests when the participant's clinical condition allows (head shake test, head thrust test, Dix-Hallpike, and Pagnini-McClure);
- Prior musculoskeletal disorders affecting alignment and postural balance (e.g., moderate to severe scoliosis; torticollis);
- Cognitive dysfunction outside normal limits on the Mini-Mental State Examination (score below 23);
- Global or Wernicke's aphasia;
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Interventions
Active high-definition transcranial direct current stimulation (HD-tDCS) will be delivered by a low-intensity direct current stimulator (Soterix Medical) using a 3x1 ring configuration with a central cathode over the contralesional temporo-parietal junction. During the stimulation, participants will perform tasks to stimulate correct visual verticality perception. Six active HD-tDCS sessions of 2mA for 20 minutes HD-tDCS, 3 times daily for 2 days with session intervals greater than 3 hours.
Six sessions (3 times daily for 2 days) of 2mA sham HD-tDCS cathode center over the contralesional TPJ for 20min. Direct current (DC) will be generated by a low-intensity direct current stimulator (Soterix Medical) and then split into the 3 high-density Ag/AgCl sintered ring electrodes. The sham stimulation condition will consist of the same positioning of the electrodes as the active condition, with a ramp-up to 2mA over 30 seconds and a subsequent ramp-down of 30 seconds.
Locations(2)
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NCT06747676