RecruitingEarly Phase 1NCT06989905

MEP Up-conditioning to Target Corticospinal Plasticity

Operant Conditioning of the Wrist Extensor Motor Evoked Potential to Target Corticospinal Plasticity and Upper Limb Motor Recovery After Cervical Spinal Cord Injury

Sponsor

Medical University of South Carolina

Enrollment

11 participants

Start Date

May 27, 2025

Study Type

INTERVENTIONAL

Conditions

Spinal Cord Injury Tetraplegia/Tetraparesis

Summary

Individuals with chronic cervical spinal cord injury will complete a 10-week training protocol where participants receive non-invasive brain stimulation and feedback on the size of the corresponding muscle response (wrist extensor). Investigators will assess the impact of the brain stimulation training on 1) the brain-to-spinal cord-to-muscle connection and 2) motor functions of the arm and hand. Also, brain and spine magnetic resonance imaging will be collected before and after the training. The imaging measurements will tell investigators about how spinal damage, brain function, and brain structure relate to motor presentation and the response to the training.

Eligibility

Min Age: 18 Years

Inclusion Criteria5

Adult (≥18 yrs old)
A history of injury to spinal cord at or above C6
\>6 months post SCI
Weak wrist extension at least unilaterally
Expectation that current medication will be maintained without change for at least 3 months. Stable use of anti-spasticity medication (e.g., baclofen, diazepam, tizanidine) is accepted.

Exclusion Criteria11

Motoneuron injury
Medically unstable condition
Cognitive impairment
A history of epileptic seizures
Metal implants in the cranium
Implanted biomedical device in or above the chest (e.g., a cardiac pacemaker, cochlear implant)
Extensive use of functional electrical stimulation to the arm on a daily basis
Pregnancy (due to changes in posture and potential medical instability)
Contraindications to MRI
No measurable MEP elicited in the ECR
Unable to produce any voluntary ECR EMG activity

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Interventions

BEHAVIORALUp-conditioning of the wrist extensor motor evoked potential

At the beginning of each session, EMG recording and nerve stimulating electrodes are placed over the arm. In all sessions, MEPs will be measured while the sitting subject provides a pre-set level of background muscle EMG with joint angles fixed. In 225 control trials of each baseline sessions and the first 20 trials of conditioning sessions the subject will receive no feedback as to MEP size (i.e., control MEPs). In 225 conditioning trials of each conditioning session, the subject will be encouraged to increase the target muscle MEP, and will receive immediate feedback as to whether MEP size was above a criterion (i.e., whether the trial was a success).