Research

The Timea Hodics Lab is currently conducting three clinical trials. We are seeking to improve the motor function of patients who have arm weakness as a result of a stroke. We are recruiting acute stroke and chronic stroke patients to participate.

The following videos show task performance of a subject who volunteered for the Transcranial Direct Current Stimulation (tDCS) trial for acute stroke patients. In the "before" video, the subject performs the task a few days after the stroke (between five and fifteen days). The "after" video shows the subject performing the same task two weeks later after receiving ten tDCS or sham treatments during standarized physical therapy.

Turning Key in a Lock

Stacking Checkers

Picking up a Pencil

Folding a Towel

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Transcranial Direct Cortical Stimulation (tDCS) for Acute Stroke Patients--Enhanced Stroke Recovery and Cortical Reorganization

Primary purpose: To test the hypothesis that transcranial Direct Current Stimulation or tDCS, applied in combination with standard rehabilitative training (RT), will enhance motor recovery in stroke patients relative to placebo and RT three months after admission.

Secondary purpose: To evaluate if functional recovery is associated with changes in cortical excitability in the ipsilesional primary motor cortex (M1) and dorsal pre-motor cortex.

Design: Randomized, double-blind, controlled clinical trial.

Patient Involvement: Eligible patients with weakness in an arm and/or hand who are within 15 days of their stroke will be randomized either in rehabilitative training (RT), tDCS or in RT placebo stimulation for one hour daily, Monday through Friday for 10 weekdays. tDCS will be applied for first 20 minutes of simultaneous rehabilitative therapy. A subgroup of patients will undergo functional MRI (fMRI) and transcranial magnetic stimulation (TMS) testing. Healthy volunteers and chronic stroke patients will not participate in the interventional component of the study. They will only participate in testing the experimental paradigm for TMS and fMRI.

Primary Outcome: Improvement in the Fugl-Meyer motor scale at 3 months

Contact: Bhim Upreti, M.D., Research Assistant, bhim.upreti@utsouthwestern.edu  

Transcranial Direct Current Stimulation (tDCS) in Chronic Stroke Recovery - Pilot

Purpose: Collect pilot information for a subsequent larger clinical trial for the best type of transcranial direct current stimulation (tDCS) in cortical and subcortical strokes and to help evaluate expected effect size in this subsequent larger study.

Design: Randomized and counterbalanced order, cross-over, double-blind controlled clinical trial.

Patient Involvement: The first exploratory phase involves chronic stroke patients (stroke more than 3 months ago) to undergo 4 different types of tDCS stimulation including sham stimulation, concurrently with 1 & ½ hours of physical therapy on each therapy day. In the second phase of the experiment, we will perform only the promising stimulation paradigms plus sham from the first part of the experiment simultaneously with 1 & ½ hours of physical therapy in a random, counterbalanced order. The patient time commitment in the second phase is 12 weeks where subjects will have 4 x 2 week-long treatment sessions (10 weekdays) with 1 week inter-treatment “rest period”.

Primary Outcome
First phase: Improvement in upper extremity maximum force, reaction time, motor function test at the end of each session.
Second phase: Improvement in motor scale at the end of each intervention and at 1 week follow-up.

Contact: Arun Alex, M.D., Research Assistant, arun.alex@utsouthwestern.edu

Neurostimulation in Rehabilitation

Purpose:  To explore the optimal parameters for effective transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS) and peripheral nerve stimulations (PNS) on motor cortical function.

Design: Randomized order counterbalanced cross-over, double-blind controlled clinical trial.

Potential Subjects: Healthy volunteers and patients who had a stroke more than three months prior to enrollment.

Patient Involvement: All the stimulation parameters will be performed in a random counterbalanced order spaced by at least a day. Up to 20 sessions will be performed, each lasting up to four hours. We will test motor function and perform a functional MRI before and after the stimulation protocols.

Primary Outcome: Optimized stimulation parameters and pilot data for future hypothesis-driven protocols.

Contact: Arun Alex, M.D., Research Assistant, arun.alex@utsouthwestern.edu          

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