Harnessing Neuroplasticity of Postural Sensorimotor Networks Using Non-Invasive Spinal Neuromodulation to Maximize Functional Recovery After Spinal Cord Injury
The Methodist Hospital Research Institute
60 participants
Dec 6, 2023
INTERVENTIONAL
Conditions
Summary
It has been demonstrated that the human lumbosacral spinal cord can be neuromodulated with epidural (ESS) and transcutaneous (TSS) spinal cord stimulation to enable recovery of standing and volitional control of the lower limbs after complete motor paralysis due to spinal cord injury (SCI). The work proposed herein will examine and identify distinct electrophysiological mechanisms underlying transcutaneous spinal stimulation (TSS) and epidural spinal stimulation (ESS) to define how these approaches determine the ability to maintain self-assisted standing after SCI.
Eligibility
Inclusion Criteria18
- All participants must be able to provide a provision of a signed and dated informed consent form.
- Stated willingness to comply with all study procedures and availability for the duration of the study.
- Male or female, aged 22-75 years old.
- Documentation from the participant's primary treating physician confirming a stable medical condition.
- Inability to maintain standing independently without external support due to SCI AIS A-C.
- Ability to tolerate at least 15 minutes in an upright (supported) position.
- Able to self-transfer from the wheelchair and demonstrate active range of motion of bilateral upper extremities in gravity dependent plane.
- Able to passively range bilateral lower extremities within normal mobility parameters including:
- greater than 90 degrees of hip flexion and 165 degrees of hip extension;
- greater than 90 degrees of knee flexion and reach neutral knee extension of 180 degrees;
- neutral ankle position reaching a minimum of 90 degrees of dorsiflexion.
- Participants should be on a stable intrathecal baclofen or oral anti-spasticity regimen/dose for the period of the study unless advised otherwise by their physician.
- to 30 years post spinal cord injury.
- Non-progressive spinal cord injury.
- Neurological level of injury below C4 and above T12 (excluding conus injury and/or indications of lower motor neuron injury).
- Eligible for fMRI per safety questionnaire.
- Women of childbearing potential must agree to the use of an effective means of avoiding pregnancy for the duration of the study.
- Able to commit to the full study.
Exclusion Criteria18
- Ability to maintain standing independently without external support.
- Currently involved in another rehabilitation training of the lower extremities.
- Active pressure sores, unhealed bone fractures, peripheral neuropathies, or painful musculoskeletal dysfunction (including but not limited to contractures in the upper and lower extremities).
- Any ongoing medical condition which would preclude participant from regular physical activity (including but not limited to: cardiopulmonary disease, uncontrollable autonomic dysreflexia or orthostatic hypotension, active urinary tract infections, pregnant or nursing).
- Intrathecal baclofen pump therapy for spasticity not compatible with 3T MRI.
- Must not have received Botox injections to primary lower extremity and trunk musculature within the past 3 months, resulting in absence of muscle tone and precluding response to electrical stimulation therapy.
- Current or history of neuromuscular conditions (including but not limited to: unhealed ligament of muscular tears in the upper or lower extremities, pain in weight bearing positions for upper and lower extremities).
- Clinically significant depression, psychiatric disorders, or ongoing drug abuse, including heavy alcohol use.
- Any reason the PI or treating physician may deem as harmful to the participant to enroll or continue in the study.
- Body Mass Index (BMI) over 30.
- Pregnancy.
- Use a ventilator or diaphragmatic pacer.
- Participants with the following conditions will be excluded from TMS, but may take part in the overall study:
- Personal or first-degree family history of seizures or epilepsy.
- Metal in the head, except mouth implants.
- History of suicide attempts.
- History of intracranial lesions, increased intracranial pressure, or stroke.
- Current use of tricyclic anti-depressants, selective serotonin reuptake inhibitors (SSRIs), serotonin nor-epinephrine reuptake inhibitors (SNRIs), buproprion (Wellbutrin), or tramadol.
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Interventions
Delivered using a constant-current stimulator
The device used for ESS, the CoverEdgeX 32 Surgical Lead system (Boston Scientific, USA), is a device approved by the FDA used in the treatment of severe pain and is approved for individuals to manage chronic pain when other treatments have not been effective. If you are in the ESS group, you will have surgery to have the stimulator placed and the stimulator will be removed at an office visit towards the end of the study.
Locations(1)
View Full Details on ClinicalTrials.gov
For the most up-to-date information, visit the official listing.
NCT06213012