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Ankle control is essential to safe over-ground navigation for humans. Middle- aged and older adults and patients with stroke whose ankle control is poor often lose their balance or fall. Transcranial direct current stimulation (tDCS) is an emerging non-invasive brain stimulation technology that has great potential to be applied to neurorehabilitation; however, the optimization of its applications still needs further studies. The aims of this project are to compare the effects of anodal tDCS (AtDCS) applied to the primary motor cortex (M1) contralateral to the moving leg (cM1), posterior parietal cortex (PPC) contralateral to the moving leg (cPPC), and cerebellar cortex (CBM) ipsilateral to the moving leg (iCBM) on motor learning, motor adaptation, and brain connectivity in healthy middle-aged and older adults and hemiparetic patients with chronic subcortical stroke.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| cM1 stimulation group | Experimental | cM1= primary motor cortex (M1) contralateral to the moving leg |
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| cPPC stimulation group | Experimental | cPPC= posterior parietal cortex (PPC) contralateral to the moving leg |
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| iCBM stimulation group | Experimental | iCBM= cerebellar cortex ipsilateral to the moving leg |
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| Sham group | Sham Comparator |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| cM1 transcranial direct current stimulation | Other | During the 5-day skill acquisition phase, all participants will undertake a 20-minute session of learning a sequential ankle tracking task with their non-dominant (for healthy adults) or affected (for patients with stroke) foot each day, using a custom-built ankle tracking system. The cM1 group will receive AtDCS stimulation at 2 mA during acquisition phase. |
| Measure | Description | Time Frame |
|---|---|---|
| Change of mean RMSE value of ankle tracking performances | Using a custom-built ankle tracking system | 1 week |
| Change of Brain MRI data acquisition | Structural images: T1- and T2 weighted imaging, fluid attenuation inversion recovery (FLAIR) images, and diffusion spectrum image (DSI) Functional image: Resting-state functional MRI (rs-fMRI) images using a T2* gradient echo, echo-planar sequence. | 1 week |
| Measure | Description | Time Frame |
|---|---|---|
| Fall histories | Fall Efficacy Scale (16~64 points, the higher score, the worsen outcome) | 1 week |
| Attention | language-free Color Trail Test- Part 1 |
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Inclusion Criteria: Part 1: healthy middle-aged and older adults
Exclusion Criteria: Part 1: healthy middle-aged and older adults
Inclusion Criteria: Part 2: patients with chronic subcortical stroke
Exclusion Criteria: Part 2: patients with chronic subcortical stroke The exclusion criteria will be the same as those listed for healthy participants described in Part 1 except for items (3) and (4). Item (3) will be changed to "(3a) symptoms or history of other neurological diseases, including epilepsy, history of abnormal EEG, meningitis, encephalitis, brain tumors, brain surgery, and sensory disorders, etc." and item (4) will be changed to "(4a) severe musculoskeletal problems of the non-hemiparetic limbs that would affect mobility functions".
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Pei-Fang Tang, PhD | Contact | +886 33668128 | pftang@ntu.edu.tw |
| Name | Affiliation | Role |
|---|---|---|
| Pei-Fang Tang, PhD | School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taiwan | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| School and Graduate Institute of Physical Therapy, National Taiwan University | Recruiting | Taipei | 100 | Taiwan |
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|
| cPPC transcranial direct current stimulation | Other | During the 5-day skill acquisition phase, all participants will undertake a 20-minute session of learning a sequential ankle tracking task with their non-dominant (for healthy adults) or affected (for patients with stroke) foot each day, using a custom-built ankle tracking system. The cPPC group will receive AtDCS stimulation at 2 mA during acquisition phase. |
|
| iCBM transcranial direct current stimulation | Other | During the 5-day skill acquisition phase, all participants will undertake a 20-minute session of learning a sequential ankle tracking task with their non-dominant (for healthy adults) or affected (for patients with stroke) foot each day, using a custom-built ankle tracking system. The iCBM group will receive AtDCS stimulation at 2 mA during acquisition phase. |
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| sham transcranial direct current stimulation | Other | For the Sham group, the montages of the paired electrode placements will be randomly selected from the other three pairs using blocks of size 3, so that the three types of montages will have equal opportunities to be used in the Sham group. The intensity will be set at 0 mA for the Sham group. There will be a 30-second ramp-up for the Sham group. Once the current reaches 2 mA in the ramp-up period, it will drop to 0 mA for the entire 20 minutes during learning for the Sham group. |
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| 1 week |
| Muscle strength of bilateral ankle dorsiflexors and plantarflexors | Measured with a hand-held dynamometer | 1 week |
| Mobility | "Timed "Up and Go" test, four square step test | 1 week |
| Single-task gait | Measured with the GAITRite | 1 week |
| Sensory and motor functions of patients with stroke | Fugl-Meyer Assessment | 1 week |
| Balance | One-leg stance | 1 week |
| ID | Term |
|---|---|
| D020521 | Stroke |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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