Enhancing the Response to Rehabilitation After Stroke Using Repetitive Transcranial Magnetic Stimulation (rTMS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00850408
Recruitment Status : Terminated
First Posted : February 25, 2009
Last Update Posted : April 24, 2013
Canadian Institutes of Health Research (CIHR)
Information provided by (Responsible Party):
Lisa Koski, McGill University Health Center

February 24, 2009
February 25, 2009
April 24, 2013
June 2008
March 2011   (Final data collection date for primary outcome measure)
The Box and Blocks Test of Manual Dexterity [ Time Frame: Post-intervention and 1 month later ]
Same as current
Complete list of historical versions of study NCT00850408 on Archive Site
Cortical excitability of the motor system [ Time Frame: Post-intervention and one month later ]
Same as current
Not Provided
Not Provided
Enhancing the Response to Rehabilitation After Stroke Using Repetitive Transcranial Magnetic Stimulation (rTMS)
Enhancing the Response to Rehabilitative Interventions After Stroke Using Transcranial Magnetic Stimulation

Weakness of the arm and hand results in long-term disability for many persons who suffer a stroke. After the initial recovery phase, only limited gains are achieved by retraining the weak limb to perform daily tasks. However, new treatment strategies such as repetitive transcranial magnetic stimulation (rTMS) show promise for enhancing motor recovery after stroke. rTMS is a noninvasive technique for modifying brain activity that aims to improve motor function by correcting abnormal patterns that occur after stroke. We believe that giving rTMS right before a therapy session will prepare the brain so that the patient is better able to participate in and benefit from training of the hand and arm. The goal of this study is to test how well this new strategy works to improve recovery in people who have mild to moderate weakness of the arm and hand after stroke.

Participants will receive magnetic stimulation of the movement area of the brain just prior to arm and hand training for a series of eight sessions. We will evaluate changes in hand and arm function after the intervention and one month later to see if the changes are maintained. We will also test whether some groups of people benefit more than others from the intervention. If improvements in hand and arm function are observed after the intervention, we will test it more rigourously in a future clinical trial in which participants are randomly assigned to different treatment conditions. This research will show whether brain stimulation can be used to improve the effectiveness of rehabilitation care.

Not Provided
Phase 2
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Procedure: Repetitive Transcranial Magnetic Stimulation
For real rTMS,1200 pulses will be delivered at a frequency of 1Hz, with an intensity equal to the 115% of the motor threshold as established at baseline. For Sham rTMS, procedures will be identical to those used for real rTMS with the exception that a placebo coil will be used, which provides acoustic and sensory stimulation like the real coil but does not stimulate neural tissue. 20-minute Real and Sham stimulation sessions will be administered bi-weekly for a period of 4 weeks
  • Experimental: Real rTMS
    Real rTMS - subjects receiving real repetitive TMS - 1Hz over unaffected hemisphere
    Intervention: Procedure: Repetitive Transcranial Magnetic Stimulation
  • Sham Comparator: Sham rTMS
    Sham rTMS
    Intervention: Procedure: Repetitive Transcranial Magnetic Stimulation
Higgins J, Koski L, Xie H. Combining rTMS and Task-Oriented Training in the Rehabilitation of the Arm after Stroke: A Pilot Randomized Controlled Trial. Stroke Res Treat. 2013;2013:539146. doi: 10.1155/2013/539146. Epub 2013 Dec 3.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
March 2011
March 2011   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • first clinical stroke involving the middle cerebral artery confirmed by CT or MRI scan during acute care at the MUHC, or second stroke involving the same hemisphere when there were no clinical residual effects from the first stroke;
  • cortical or subcortical stroke resulting in hemiparesis;
  • at least 3 months post-stroke;
  • discharged from standard rehabilitation;
  • able to provide informed consent, to follow instructions and participate in therapy, as evidenced by Mini Mental State Exam score > 14;
  • able to understand instructions in English or French.

Exclusion Criteria:

  • minimal or no residual upper extremity motor impairment;
  • severe upper extremity motor impairment as indicated by inability to produce any voluntary contraction of intrinsic hand muscles; severe cognitive impairment in language or attention sufficient to impair communication during the consenting or intervention procedures (score < 14 on the Mini Mental Status Exam);
  • other central nervous system disorder or peripheral neuropathy of the upper extremity;
  • pain, spasticity, or other complications that would prevent participation in the intervention;
  • history of seizure confirmed by interview and medical chart review;
  • comorbidity such as Parkinson's disease, osteoarthritis, or cancer, precluding full participation in the assessments and in the experimental intervention;
  • other conditions that increase the risk of side effects due to rTMS procedures: metal in cranium, intracardiac line, increased intracranial pressure, pregnancy, cardiac pacemaker, medication pump, tricyclic antidepressants, neuroleptics, history of seizure in the immediate family
Sexes Eligible for Study: All
19 Years and older   (Adult, Senior)
Contact information is only displayed when the study is recruiting subjects
CHIR MOP 84354
CHIR MOP 84354 ( Other Identifier: CHIR )
Not Provided
Not Provided
Lisa Koski, McGill University Health Center
McGill University Health Center
Canadian Institutes of Health Research (CIHR)
Principal Investigator: Lisa M Koski, PhD McGill University
McGill University Health Center
April 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP