Using Transcranial Direct Current Stimulation (tDCS) to Improve Post-Stroke Aphasia

• Sponsor: Georgetown University (Other)
• Overall Status: Completed
• CT.gov ID: NCT01709383
• Collaborator: Medstar Health Research Institute (Other)
• Enrollment: 38
• Locations: 2
• Arms: 2
• Duration (Months): 33
• Patients Per Site: 19
• Patients Per Site Per Month: 0.6

Study Details

Study Description

Brief Summary

This study tests whether weak electrical stimulation of the brain is effective in improving language or reading difficulties occurring after a brain injury or stroke.

Condition or Disease	Intervention/Treatment	Phase
Aphasia	Device: Transcranial Direct Current Stimulation; Device: Sham Stimulation	N/A

Detailed Description

This study tests whether aphasia or alexia, language and reading disorders occurring after traumatic brain injury or stroke, can be improved using transcranial direct current stimulation (tDCS). tDCS is a non-invasive technique that applies a small amount of direct electrical current to the brain in order to temporarily alter brain processing. Adults with aphasia/alexia resulting from stroke or traumatic brain injury will undergo baseline behavioral testing of various language and cognitive functions. Subjects who are willing to undergo MRI evaluation will also be scanned. They will then receive five days of either real or sham tDCS with standardized speech-language therapy, under a double-blind randomized placebo-controlled design. Behavioral assessments, and MRIs for those participating in the MRI portion of the study, will be performed again at multiple time points after completing tDCS to assess for changes in these measures.

Study Design

• Study Type: Interventional
• Actual Enrollment: 38 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
• Primary Purpose: Treatment
• Official Title: Can Enhancing Left Lateralization Using Transcranial Direct Current Stimulation Improve Recovery From Post-Stroke Aphasia?
• Study Start Date: Dec 1, 2012
• Actual Primary Completion Date: Jul 1, 2015
• Actual Study Completion Date: Sep 1, 2015

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Transcranial Direct Current Stimulation TDCS was applied bilaterally, with the anodal electrode on the left temple and cathodal electrode on the right. TDCS was applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period	Device: Transcranial Direct Current Stimulation; The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Sham Comparator: Sham Stimulation Sham tDCS was applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Device: Sham Stimulation; The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.

Outcome Measures

Primary Outcome Measures

1. Western Aphasia Battery - Revised: Naming and Word Finding Score [Change from baseline to one day after treatment]

   This is a composite measure of verbal expression skills including tests of naming, verbal fluency, sentence completion, and responsive naming (one-word answers to basic questions). It is a subtest within the Western Aphasia Battery. The minimum score is 0 and maximum is 10, with 10 being the best outcome, and subscores are summed to determine the total score.

Secondary Outcome Measures

1. Western Aphasia Battery - Revised: Spontaneous Speech, Repetition, Auditory Verbal Comprehension and Overall Aphasia Quotient [Change from baseline to 1 day after treatment]

   The above subtests will reflect the following: a composite measure of information content in conversational speech and picture description (scored from 0 (no speech produced or only meaningless utterances) to 10 (no signs of aphasia)); a measure of word and sentence repetition (scored from 0 (unable to repeat any part of a single word) to 100 (perfect repetition of all words and up to a 10 word sentence)); a composite measure of yes/no questions, auditory word recognition, and following sequential commands (composite subscore is from 1 to 10, with 10 being the best outcome); and an overall aphasia severity score (composite score, or Aphasia Quotient, comprised of all the above measures plus the naming and word finding score used as the primary outcome measure. Quotient scores range from 0 to 100, with 100 indicating no aphasia is present).

2. Philadelphia Naming Test (PNT) [1 day after treatment]

   A test of picture naming using more common items than other picture naming tests, which reduces relationships between performance and premorbid education and socioeconomic status. There are 60 items on the test. A score of 0 means no pictures were named correctly. A score of 60 means all pictures were named correctly.

3. Subjective Assessments Including: Communicative Effectiveness Index (CETI), Stroke and Aphasia Quality of Life Scale (SAQOL), and Stroke Aphasic Depression Questionnaire (SADQ) [3 weeks post-treatment]

   Questionnaires were given at baseline, 3 weeks and 3 months after treatment. The SADQ consists of 21 questions graded on a 0-3 scale with 3 indicating the highest depression symptoms and 0 indicating none. Therefore, means reported below are an average score between 0 and 3. The SAQOL includes 17 questions about functional physical limitations and 7 questions about functional communication limitations in daily life. Questions are rated on a 1-5 scale with a score of 1 indicating greater disability and 5 indicating none. Therefore, means reported below are an average score between 1 and 5. The CETI measures change in functional communication by asking caregivers to make a mark on a straight line with "as able as before the stroke" written on the right side of the line and "not at all as able" on the left. The 16 responses are then converted by measuring the location of the mark on the line. A score of 10 indicates "as able as before the stroke" and 0 indicates "not at all as able".

4. Cognitive-Linguistic Quick Test (CLQT) [Change from baseline to 1 day after treatment]

   The following subtests from the CLQT will be administered: Symbol Cancellation, Story Retelling, Generative Naming, Symbol Trails, Design Memory, Mazes,and Design Generation. These scores will be used to calculate composite scores for the cognitive domains of Attention, Executive Function (EF), and Visuospatial skills (VS). Some tests are weighted more than others in each composite score, by multiplying the score as follows and then adding the scores together: Attention = Symbol Cancellation (x9), Story Retelling (x2), Symbol Trails (x3), Mazes (x4), and Design Generation (x1); EF = sum of Symbol Trails, Generative Naming, Mazes, and Design Generation; VS = Symbol Cancellation (x2), Symbol Trails (x2), Design Memory (x4), Mazes (x3), Design Generation (x1). For all composite scores, a low number indicates greater deficit. For Attention, the highest score is 215 and lowest is 0. For EF, the highest score is 40 and lowest is 0. For VS, the highest score is 105 and lowest is 0

5. Reading Assessments [Change from baseline to 1 day after treatment]

   A set of reading tasks designed to assess oral reading of real words and non-words at the single word level. The list of real words consisted of 142 words. A score of 0 indicates no words were read correctly and a score of 142 indicates all words were read correctly. The non-word test included 30 non-words. A score of 0 indicates no non-words were read correctly and a score of 30 indicates that all non-words were read correctly.

6. Motricity Index [Change from baseline to 1 day after treatment]

   An assessment of upper extremity motor impairment, including: pinch grip, elbow flexion, and shoulder abduction. For pinch grip, which consisted of holding a small plastic cube between the thumb and index finger, scoring was as follows: 0=No movement, 11=Beginnings of prehension, 19=Grips cube but unable to hold against gravity, 22=Grips cube, held against gravity but not against weak pull, 26=Grips cube against pull but weaker than left side, 33=Normal pinch grip. For elbow flexion and shoulder abduction, scoring was as follows: 0=No movement, 9=Palpable contraction in muscle but no movement, 14=Movement seen but not full range/not against gravity, 19=Full range against gravity, not against resistance, 25=Movement against resistance but weaker than left side, 33=Normal power. Both the right and the left side were tested.

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Inclusion Criteria:

• Age 18 or older

• Aphasia due to left hemisphere stroke diagnosed by a physician or speech-language pathologist

Exclusion Criteria:

• Skull defect at or near the site of tDCS delivery

• History of a significant stroke or traumatic brain injury other than the event that caused the aphasia

• History of other brain conditions that could impact interpretation of results (such as multiple sclerosis, brain tumor, encephalitis, premorbid dementia)

• Presence of implanted electrical or metallic devices in the head or body (except titanium; e.g. cochlear implants, implanted shunts with metal parts, deep brain stimulators, pacemakers, defibrillators)

• Presence of ferrous metal in the head (e.g. shrapnel)

• History of psychiatric disease requiring hospitalization, electroconvulsive therapy, or ongoing medication use (other than common selective serotonin reuptake inhibitor antidepressants)

• Pregnancy

• Severe comprehension deficits

Additional Exclusion Criteria for the optional MRI portion of the study:

• Presence of metal in the body (except titanium)

• Claustrophobia

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	MedStar National Rehabilitation Hospital	Washington, D.C.	District of Columbia	United States	20010
2	Georgetown University	Washington, D.C.	District of Columbia	United States	20057

Sponsors and Collaborators

• Georgetown University
• Medstar Health Research Institute

Investigators

• Principal Investigator: Peter Turkeltaub, M.D., Ph.D., Georgetown University and MedStar National Rehabilitation Hospital

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

• Responsible Party: Georgetown University
• ClinicalTrials.gov Identifier: NCT01709383
• Other Study ID Numbers: DDCF 2012062
• First Posted: Oct 18, 2012
• Last Update Posted: Jul 6, 2017
• Last Verified: Oct 1, 2016

• Individual Participant Data (IPD) Sharing Statement: Undecided
• Plan to Share IPD: Undecided
• Keywords provided by Georgetown University: Aphasia; Stroke; Transcranial Direct Current Stimulation; Neuroplasticity
• Additional relevant MeSH terms: Aphasia

Study Results

Participant Flow

Recruitment Details	Inclusionary criteria were as follows: over 18; aphasia due to left hemisphere stroke; no other significant brain damage, neurological, or psychiatric disease; no skull defects near electrode sites; no implanted devices or ferrous metal in the body; not pregnant; comprehension sufficient to perform study tasks
Pre-assignment Detail	Before randomization, potential subjects were tested on the Western Aphasia Battery -Revised (WAB-R) to determine a baseline score and to rule out severe comprehension deficits.

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Period Title: Overall Study
STARTED	24	14
Completed Treatment	24	14
Completed Follow-ups	23	14
Included in Analysis	22	13
COMPLETED	23	14
NOT COMPLETED	1	0

Baseline Characteristics

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation	Total
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Total of all reporting groups
Overall Participants	24	14	38
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	60.0 (10.8)	59.8 (8.7)	60.0 (10.0)
Sex: Female, Male (Count of Participants)
Female	8 33.3%	5 35.7%	13 34.2%
Male	16 66.7%	9 64.3%	25 65.8%
Region of Enrollment (participants) [Number]
United States	24 100%	14 100%	38 100%

Outcome Measures

1. Primary Outcome

Title	Western Aphasia Battery - Revised: Naming and Word Finding Score
Description	This is a composite measure of verbal expression skills including tests of naming, verbal fluency, sentence completion, and responsive naming (one-word answers to basic questions). It is a subtest within the Western Aphasia Battery. The minimum score is 0 and maximum is 10, with 10 being the best outcome, and subscores are summed to determine the total score.
Time Frame	Change from baseline to one day after treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	22	13
Mean (Standard Deviation) [scores on a scale]	.30 (.64)	.48 (.74)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Transcranial Direct Current Stimulation, Sham Stimulation
	Comments
	Type of Statistical Test	Superiority or Other
	Comments
Statistical Test of Hypothesis	p-Value	.57
	Comments
	Method	Mixed Models Analysis
	Comments

2. Secondary Outcome

Title	Western Aphasia Battery - Revised: Spontaneous Speech, Repetition, Auditory Verbal Comprehension and Overall Aphasia Quotient
Description	The above subtests will reflect the following: a composite measure of information content in conversational speech and picture description (scored from 0 (no speech produced or only meaningless utterances) to 10 (no signs of aphasia)); a measure of word and sentence repetition (scored from 0 (unable to repeat any part of a single word) to 100 (perfect repetition of all words and up to a 10 word sentence)); a composite measure of yes/no questions, auditory word recognition, and following sequential commands (composite subscore is from 1 to 10, with 10 being the best outcome); and an overall aphasia severity score (composite score, or Aphasia Quotient, comprised of all the above measures plus the naming and word finding score used as the primary outcome measure. Quotient scores range from 0 to 100, with 100 indicating no aphasia is present).
Time Frame	Change from baseline to 1 day after treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	23	14
Spontaneous Speech Baseline	7.6 (2.0)	7.1 (2.8)
Spontaneous Speech 1 day post-treatment	7.8 (2.4)	7.0 (2.9)
Repetition Baseline	5.5 (2.9)	6.2 (2.9)
Repetition 1 Day post-treatment	5.8 (2.8)	6.2 (3.1)
Auditory Verbal Comprehension Baseline	7.9 (1.3)	8.0 (1.9)
Auditory Verbal Comprehension 1 day post	8.1 (1.4)	7.8 (1.9)
Aphasia Quotient Baseline	66.2 (21.7)	61.9 (28.6)
Aphasia Quotient 1 Day post-treatment	66.2 (21.7)	65.1 (26.7)

3. Secondary Outcome

Title	Philadelphia Naming Test (PNT)
Description	A test of picture naming using more common items than other picture naming tests, which reduces relationships between performance and premorbid education and socioeconomic status. There are 60 items on the test. A score of 0 means no pictures were named correctly. A score of 60 means all pictures were named correctly.
Time Frame	1 day after treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	TDCS was applied bilaterally, with the anodal electrode on the left temple and cathodal electrode on the right. TDCS was applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham tDCS was applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period. Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	23	14
PNT Score Baseline	31.3 (17.8)	32.1 (23.5)
PNT Score 1 Day Post-treatment	34.1 (21.1)	34.9 (3.1)

Statistical Analysis 1

Statistical Analysis Overview	Comparison Group Selection	Transcranial Direct Current Stimulation, Sham Stimulation
	Comments
	Type of Statistical Test	Superiority or Other
	Comments
Statistical Test of Hypothesis	p-Value	.64
	Comments
	Method	Mixed Models Analysis
	Comments

4. Secondary Outcome

Title	Subjective Assessments Including: Communicative Effectiveness Index (CETI), Stroke and Aphasia Quality of Life Scale (SAQOL), and Stroke Aphasic Depression Questionnaire (SADQ)
Description	Questionnaires were given at baseline, 3 weeks and 3 months after treatment. The SADQ consists of 21 questions graded on a 0-3 scale with 3 indicating the highest depression symptoms and 0 indicating none. Therefore, means reported below are an average score between 0 and 3. The SAQOL includes 17 questions about functional physical limitations and 7 questions about functional communication limitations in daily life. Questions are rated on a 1-5 scale with a score of 1 indicating greater disability and 5 indicating none. Therefore, means reported below are an average score between 1 and 5. The CETI measures change in functional communication by asking caregivers to make a mark on a straight line with "as able as before the stroke" written on the right side of the line and "not at all as able" on the left. The 16 responses are then converted by measuring the location of the mark on the line. A score of 10 indicates "as able as before the stroke" and 0 indicates "not at all as able".
Time Frame	3 weeks post-treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	18	10
SADQ Baseline	1.2 (.2)	1.58 (.4)
SADQ 3 weeks post-treatment	1.0 (.3)	1.3 (.4)
SAQOL Baseline	2.7 (.7)	2.6 (.7)
SAQOL 3 weeks post-treatment	2.9 (.8)	2.7 (.9)
CETI Baseline	5.7 (1.7)	6.8 (1.9)
CETI 3 weeks post-treatment	6.6 (2.0)	6.4 (1.9)

5. Secondary Outcome

Title	Cognitive-Linguistic Quick Test (CLQT)
Description	The following subtests from the CLQT will be administered: Symbol Cancellation, Story Retelling, Generative Naming, Symbol Trails, Design Memory, Mazes,and Design Generation. These scores will be used to calculate composite scores for the cognitive domains of Attention, Executive Function (EF), and Visuospatial skills (VS). Some tests are weighted more than others in each composite score, by multiplying the score as follows and then adding the scores together: Attention = Symbol Cancellation (x9), Story Retelling (x2), Symbol Trails (x3), Mazes (x4), and Design Generation (x1); EF = sum of Symbol Trails, Generative Naming, Mazes, and Design Generation; VS = Symbol Cancellation (x2), Symbol Trails (x2), Design Memory (x4), Mazes (x3), Design Generation (x1). For all composite scores, a low number indicates greater deficit. For Attention, the highest score is 215 and lowest is 0. For EF, the highest score is 40 and lowest is 0. For VS, the highest score is 105 and lowest is 0
Time Frame	Change from baseline to 1 day after treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	23	14
Attention Composite Score Baseline	150.0 (46.4)	175.5 (33.1)
Attention Composite Score 1 day post-treatment	155.9 (50.3)	184.9 (21.2)
Executive Function Composite Score Baseline	21.9 (6.5)	23.7 (5.8)
Executive Function Composite Score 1 Day Post	23.1 (7.6)	25.3 (5.6)
Visuospatial Function Composite Score Baseline	78.6 (17.6)	86.7 (12.9)
Visuospatial Function Composite Score 1 Day Post	80.7 (20.4)	91.4 (12.6)

6. Secondary Outcome

Title	Reading Assessments
Description	A set of reading tasks designed to assess oral reading of real words and non-words at the single word level. The list of real words consisted of 142 words. A score of 0 indicates no words were read correctly and a score of 142 indicates all words were read correctly. The non-word test included 30 non-words. A score of 0 indicates no non-words were read correctly and a score of 30 indicates that all non-words were read correctly.
Time Frame	Change from baseline to 1 day after treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	23	14
Reading Real Words Baseline	89.1 (51.2)	85.1 (61.7)
Reading Real Words 1 Day Post-treatment	89.7 (50.5)	87.3 (59.2)
Reading Non-words Baseline	6.1 (6.3)	8.9 (8.8)
Reading Non-words 1 Day Post-treatment	6.3 (7.4)	8.5 (8.0)

7. Secondary Outcome

Title	Motricity Index
Description	An assessment of upper extremity motor impairment, including: pinch grip, elbow flexion, and shoulder abduction. For pinch grip, which consisted of holding a small plastic cube between the thumb and index finger, scoring was as follows: 0=No movement, 11=Beginnings of prehension, 19=Grips cube but unable to hold against gravity, 22=Grips cube, held against gravity but not against weak pull, 26=Grips cube against pull but weaker than left side, 33=Normal pinch grip. For elbow flexion and shoulder abduction, scoring was as follows: 0=No movement, 9=Palpable contraction in muscle but no movement, 14=Movement seen but not full range/not against gravity, 19=Full range against gravity, not against resistance, 25=Movement against resistance but weaker than left side, 33=Normal power. Both the right and the left side were tested.
Time Frame	Change from baseline to 1 day after treatment

Outcome Measure Data

Analysis Population Description

People with aphasia due to left hemisphere stroke

Arm/Group Title	Transcranial Direct Current Stimulation	Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.	Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
Measure Participants	23	14
Pinch Grip Left Baseline	33 (0)	33 (0)
Pinch Grip Left 1 Day Post-treatment	33 (0)	33 (0)
Elbow Flexion Left Baseline	33 (0)	33 (0)
Elbow Flexion Left 1 Day Post-treatment	33 (0)	33 (0)
Shoulder Abduction Left Baseline	32.6 (1.7)	33 (0)
Shoulder Abduction Left 1 Day Post-treatment	33 (0)	33 (0)
Pinch Grip Right Baseline	25.9 (10.2)	19.1 (15.9)
Pinch Grip Right 1 Day Post-treatment	25.9 (10.3)	18.4 (16.6)
Elbow Flexion Right Baseline	22.4 (12.2)	19.0 (14.9)
Elbow Flexion Right 1 Day Post-treatment	24.0 (11.7)	19.0 (14.9)
Shoulder Abduction Right Baseline	22.9 (11.7)	17.0 (15.0)
Shoulder Abduction Right 1 Day Post-treatment	21.7 (12.7)	17.4 (14.9)

Adverse Events

Arm/Group Title	Transcranial Direct Current Stimulation		Sham Stimulation
Arm/Group Description	Transcranial Direct Current Stimulation: The tDCS treatments will be applied bilaterally, with the anodal electrode placed on the left temple and the cathodal electrode placed on the right temple. The tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.		Sham Stimulation: The sham tDCS will be applied at the beginning of 60-minute speech-language treatment sessions for five days across a one-week period.
All Cause Mortality
	Transcranial Direct Current Stimulation		Sham Stimulation
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	/ (NaN)		/ (NaN)
Serious Adverse Events
	Transcranial Direct Current Stimulation		Sham Stimulation
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/24 (0%)		0/14 (0%)
Other (Not Including Serious) Adverse Events
	Transcranial Direct Current Stimulation		Sham Stimulation
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/24 (0%)		0/14 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.