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Acquired Brain InjuryNCT05637957

Feasibility of tDCS as an Adjunct to Outpatient Physiotherapy in Children With ABI

A study testing active transcranial direct current stimulation in people with Acquired Brain Injury and Stroke, run by Holland Bloorview Kids Rehabilitation Hospital at 1 site in Canada.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This study will evaluate the feasibility of transcranial direct current stimulation (tDCS) as an adjunct to an outpatient motor skills-based physiotherapy intervention for children and youth with acquired brain injury. Read more about this study

Who is it for?
Ages 5 to 18 years
What is being tested?
active transcranial direct current stimulation
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
10 participants
Where
1 siteCanada
Study dates
1 Jun 2022to 31 Dec 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 5 to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Stroke or moderate to severe traumatic brain injury, diagnosed with imaging (e.g., MRI, CT scan);
  • 5-18 years of age inclusive (at time of study enrolment);
  • In the outpatient stage of rehabilitiation
  • Followed by a physician through ABI medical follow-up clinic at Holland Bloorview OR previously admitted to the inpatient ABI program at Holland Bloorview;
  • Medically stable, as determined by their ABI physician;
  • Walks a minimum of 10m with or without assistance;
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  • Stands independently for 10s;
  • Balances for less than 20s on most affected leg;
  • Hemiplegia, identified by decreased selective motor control at one ankle compared to the other (i.e., decreased ability to isolate ankle plantar flexion and dorsiflexion on the more affected ankle);
  • Available to attend twice weekly appointments for five weeks, as well as a two-hour baseline and post-treatment assessment;
  • Tolerates 2 hours of physiotherapy assessment (with short breaks as needed);
  • Tolerates 45 minutes of physiotherapy treatment;
  • Capable of participating in standardized physiotherapy assessment, from a cognitive and behavioural perspective; and
  • Can communicate discomfort either verbally or non-verbally
  • Follows directions provided in English
  • Parent/legal guardian can read and speak English

Who cannot join

  • Admitted to acute care or inpatient rehabilitation hospital
  • Seizure(s) in the last 6 months;
  • Planned medication changes during study (i.e., any medication that affects their ability to participate in therapy from a physical, cognitive, emotional standpoint);
  • Botox injections in the last 3 months;
  • Brain tumour;
  • Metal implants or fragments in the head;
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  • Cranial bone flap removed;
  • Stitches/staples on the head;
  • Wounds or unhealed incisions at electrode placement sites;
  • Cochlear implant;
  • Implanted neurostimulator (e.g., vagal nerve stimulator, deep brain stimulator);
  • Cardiac pacemaker;
  • Battery-powered medication infusion device (e.g., baclofen or insulin pump);
  • Pregnancy;
  • Diagnosed with another neuromotor disorder(s) affecting gross motor function (e.g., cerebral palsy, spinal cord injury, etc.…);
  • Onset of ABI before the age of two years;
  • Neurodegenerative diagnosis;
  • Lower extremity weight bearing activity restrictions secondary to injuries (e.g., fracture, ligamentous injury) as present at time of study enrollment;
  • Non-orthopaedic activity restrictions that limit gross motor activity (e.g., splenic laceration with orders not to run or jump); or
  • Enrolment in another treatment-based research study during the current study

Trial locations and contacts

1 site in 1 country.

Canada1 site, 1 recruiting
  • Holland Bloorview Kids Rehabilitation Hospital

    Toronto, Ontario, M4G1R8

    Trina Mitchell, tmitchell@hollandbloorview.ca

    Recruiting

Other trials in Canada

About this study

Official title: The Feasibility of Transcranial Direct Current Stimulation as an Adjunct to Outpatient Physiotherapy in Children With Acquired Brain Injury

This study will evaluate the feasibility of transcranial direct current stimulation (tDCS) as an adjunct to an outpatient motor skills-based physiotherapy intervention for children and youth with acquired brain injury. Up to 10 children (age 5-18 years) with childhood onset stroke or traumatic brain injury will be randomly allocated to receive active or sham anodal tDCS immediately prior to the physiotherapy session. These sessions will occur twice weekly for a total of 10 sessions. Assessment of gross motor outcome measures will occur immediately before and after the combined tDCS and physiotherapy treatment protocol. The preliminary treatment effect between the two treatment groups will be compared and other feasibility indicators will be evaluated.

Read the detailed description

Objectives: The purpose of this study is to evaluate the feasibility of tDCS as a pre-treatment adjunct to outpatient physiotherapy (our outpatient 'physio+tDCS' protocol) for children with stroke or TBI. The primary objective is to evaluate the feasibility of an outpatient twice weekly 'physio+tDCS' protocol given over five weeks, as measured by participant eligibility, recruitment, tolerance, retention, and adherence to treatment protocol (e.g., session frequency and completion timelines). The secondary objective is to explore the preliminary effect of physio+tDCS on gross motor function in children with childhood onset stroke and TBI, as measured by individualized goal achievement and standardized gross motor outcome measures.

Randomization and Blinding: Once enrolled in the study, an independent research assistant (RA) will randomly assign each child to the "sham" or "active" tDCS treatment group using a computer randomization web-based program. Only the RAs involved in the study will be aware of each participant's treatment group assignment. The participants and the assessing/treating PTs will be blinded to the participant's treatment group.

Intervention:

tDCS Treatment- Depending on treatment group allocation, participants will receive 20 minutes of active tDCS or sham tDCS (provided by a trained RA) immediately prior to two physiotherapy sessions each week for a total of 10 sessions. Children and PTs will be blinded to their tDCS/sham allocation. Two electrodes (5x7cm) in size will be used such that the anodal electrode will be attached to the C3/4 position on the scalp, to target the lower extremity region of the primary motor cortex most affected by their brain injury, and the cathodal electrode will be attached to the contralateral supraorbital (Fp1/Fp2) area of the forehead. Each tDCS treatment will consist of up to 2.0 mA of stimulation, adjusting for the child's age, head size, and tolerance as required. Participant symptoms and safety will be tracked before, during, and after each tDCS session. Adverse events reported via a REB-approved standard process to an independent in-house safety monitoring committee. Physiotherapy Intervention- The physiotherapy treatment paired with the tDCS consists of the typical motor skills-based physiotherapy children receive brain injury program at Holland Bloorview. Each 45-minute physiotherapy session promotes motor learning by focusing on functional tasks related to the child's personalized motor goals. Therapists individualize the program by adapting the tasks, instructions, feedback, and the level of challenge based on the child's needs.

Outcomes Feasibility- Feasibility of study implementation and tDCS will be evaluated by tracking process, resource, and treatment indicators. A priori feasibility targets are as follows: 30% of children indentified by the child's clinical physiotherapist or nurse will be eligible for the study, 70% of eligible children will be recruited; 80% of the tDCS sessions started will last the entire 20-minute duration, 75% of treatment sessions will be completed, and 90% of reassessments will occur in the 14 days following the final treatment session. Adherence to the study protocol will be tracked by the number of tDCS and physiotherapy sessions scheduled per week and the number actually completed. Reasons for cancelled sessions or decreased number of sessions booked will be documented. Because tDCS should optimally occur in the half hour prior to physiotherapy, the start time and duration of stimulation will be documented, as well as the start time and duration of each physiotherapy session, on tracking sheets that will be completed by the RA/therapist conducting each tDCS/physiotherapy session.

Gross Motor- Baseline assessments will be conducted by a blinded independent PT assessor in the two weeks prior to beginning the study treatment protocol. The reassessment will be conducted by the same blinded PT assessor up to two weeks after their last study intervention session. A priori targets for the co-primary gross motor outcomes are as follows: The active tDCS group should have at least 3 mean points of change more than the sham group on the Gross Motor Function Measure (GMFM) and at least 2.0 mean points of change more than the sham group on the Canadian Occupational Performance Measure (COPM).

Being tested
active transcranial direct current stimulation, sham transcranial direct current stimulation
Keywords
transcranial direct current stimulation, physiotherapy, pediatric, motor learning
Medical subject headings
Brain Injuries, Stroke, Brain Injuries, Traumatic, Paresis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • active transcranial direct current stimulationDevice

    Device: 20 minutes of up to 2.0 mA active anodal tDCS (anode positioned at C3/4, cathode positioned at Fp1/2 as per 10-20 electrode placement guidelines) Behavioral: Physiotherapy motor skills based physiotherapy intervention (representative of typical goal-focused intervention in the clinical ABI program at Holland Bloorview), 45 minutes in duration

  • sham transcranial direct current stimulationDevice

    Device: 1 minute of 1.0 mA anodal tDCS (anode positioned at C3/4, cathode positioned at Fp1/2 as per 10-20 electrode placement guidelines) and 19 minutes with unit turned off and electrodes remaining in place Behavioral: Physiotherapy motor skills based physiotherapy intervention (representative of typical goal-focused intervention in the clinical ABI program at Holland Bloorview), 45 minutes in duration

Study groups in NCT05637957
Study groupRoleWhat they receive
Physiotherapy + Active tDCSExperimental20 minutes of active anodal tDCS immediately prior to physiotherapy intervention, twice a week for total of 10 sessions.
Receives: Device: active transcranial direct current stimulation
Physiotherapy + Sham tDCSActive comparator20 minutes of sham anodal tDCS immediately prior to physiotherapy intervention, twice a week for total of 10 sessions.
Receives: Device: sham transcranial direct current stimulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Gross Motor Function Measure (GMFM-88)

    A standardized physiotherapy assessment (validated for children with ABI) that assesses gross motor function in five dimensions (A- lying \& rolling, B- sitting, C- crawling \& kneeling, D- standing, walking, E-running \& jumping). Each of the 88 items is scored from 0-3.

    Measured: Change from baseline to reassessment (4-6 weeks)

  2. Canadian Occupational Performance Measure (COPM)

    The Canadian Occupational Performance Measure is a standardized outcome measure that allows children and families to set goals and evaluate their performance and satisfaction with each goal on a scale of 1 to 10, where higher ratings mean increased performance and satisfaction. In this study, the goals will be participation-based goals related to gross motor activities.

    Measured: Change from baseline to reassessment (4-6 weeks)

  3. Eligibility Rate

    The proportion of eligible participants compared to the number of children identified by brain injury clinicians using preliminary screening checklist.

    Measured: Duration of study (approximately 2 years)

  4. Enrollment Rate

    The proportion of eligible participants who enrollment in the study.

    Measured: Duration of study (approximately 2 years)

  5. Adherence Rate

    Proportion of participants who completed 10 treatment sessions

    Measured: Duration of study (approximately 2 years)

  6. Transcranial direct current stimulation tolerance

    The proportion of tDCS sessions that were started lasting the entire treatment session

    Measured: Duration of study (approximately 2 years)

Secondary outcomes (4)
  1. Acquired Brain Injury Challenge Assessment (ABI-CA)

    An 18-item standardized assessment of high level gross motor skills in children and youth with ABI. Each item assesses the child's ability to perform a skill and is scored on a 5-point scale according to time and quality of movement (where '5' indicates normal quality of movement and/or completion within a minimum amount of time while '0' indicates they were unable to complete the item within a maximum period of time and did not meet the criteria for quality).

    Measured: Change from baseline to reassessment (4-6 weeks)

  2. 10m Fast Walk Test

    Timed walk test over 10m with the participant walking as fast as possible.

    Measured: Change from baseline to reassessment (4-6 weeks)

  3. Goal Attainment Scaling

    Participant-specific mobility, balance, and/or gross motor goals created by the treating physiotherapist to target specific activities they will work on in physiotherapy. The child's baseline ability is scored as a '-2'. The physiotherapist sets individualized targets for the child where '-1' indicates they are performing somewhat less than expected, '0' indicates they are performing at the expected level for a given time frame, '+1' indicates they have done somewhat better than expected, and '+2' indicates they have done much better than expected. When the goal is set, the physiotherapist sets '0' (the expected level) based on the timing of the reassessment and what they think the child is clinically capable of accomplishing in that time period.

    Measured: Change from baseline to reassessment (4-6 weeks)

  4. Pediatric Evaluation of Disability Inventory (Mobility and Self-Care domains)

    Parent-reported computerized questionnaire evaluating their child's function ability. Each item is rated on 4-point scale where '0' indicates the child is unable to do and '4' indicates the activity is easy to do. A higher score indicates higher levels of independence with mobility and self-care.

    Measured: Change from baseline to reassessment (4-6 weeks)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Dec 2022
  2. Study start1 Jun 2022
  3. Primary completion31 Dec 2024 (estimated)
  4. Study completion31 Dec 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel group randomized feasibility trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
10 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05637957
Sponsor's protocol ID
504
Status last verified
Nov 2022
First submitted
25 Nov 2022
Last updated
6 Dec 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: At this time data will not be shared with other researchers

Questions about this trial

What is this clinical trial studying?

A study testing active transcranial direct current stimulation in people with Acquired Brain Injury and Stroke, run by Holland Bloorview Kids Rehabilitation Hospital at 1 site in Canada.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 16 inclusion and 20 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Trina Mitchell, PhD (416-425-6220 ext. 3965, tmitchell@hollandbloorview.ca), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Gross Motor Function Measure (GMFM-88) (time frame: Change from baseline to reassessment (4-6 weeks)). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Dec 2022.

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