Evaluation of the Observance and the Tolerance of a Motor Training Program

Evaluation of the Observance and the Tolerance of a Motor Training Program Combining With Repetitive tDCS Sessions on Walking Performance of Hemiplegic Stroke Patients at the Subacute Stage Post Stroke. ESTIMAH Study

Transcortical direct current stimulation (tDCS) is an emerging technique in the rehabilitation of hemiplegic patients after stroke.

This study aims to assess the observance and the tolerance of repeated tDCS stimulation over the primary motor cortex of the lower limb coupled to a motor training program, among hemiplegic patients at the sub-acute stage. This is a prospective, randomized, double-blind, study with two parallel groups of 15 subjects each. The study will analyze first, the patient's observance considered good if 75% of the patients completed the entire protocol duration and the tolerance through a questionnaire. The secondary end point will try to estimate, if possible, the effect size of the walking performance measured with the six-minute walk test and aerobic performance measured with VO2peak of this training program compared to the same program combine with placebo stimulations. These evaluations are performed before, during and after the rehabilitation program.

During the initial 20 min of each session, the patient received a 2 mA anodal tDCS over the lower limb ipsilesional motor area. The anodal electrode was positioned on the hotspot previously identified with TMS. The cathode was placed above the contralesional orbit. The pseudo stimulation reproduces during the first and the last 30 seconds of the stimulation, tingling feelings due to current flow experienced during tDCS. In this way there is no possibility for the patient to recognize the difference between the real and the placebo stimulation.

Inclusion Criteria:

• Having had a first ischemic stroke within 6 months, or have already had a stroke in the same lesion zone.
• No recurrence.
• Responsible of a right or left hemiplegia.
• Able to walk alone with or without technical assistance.
• Over a distance of at least 10 meters.
• Performance on the six-minute walk test less than 400 meters.
• Without neurological history other than stroke.

Exclusion Criteria:

• Patients who did not have brain MRI after their stroke
• Patients with complete lesion of the primary motor cortex (as identified on MRI).
• Patients with an addiction to alcohol or drugs.
• Patients with psychiatric disease, cognitive impairment disease, uncontrolled epilepsy, neoplastic disease, severe renal or pulmonary failure.
• Patients with cerebellar syndrome associated.
• Patients with clinical involvement of the brainstem (cranial nerve deficit).
• Patients who refused to sign the written consent.
• Patients who have an ongoing pregnancy.
• Patients under justice protection.
• Patients with contraindication to practice aerobic training after stress test.