RecruitingNot ApplicableNCT07504055

Non-invasive Spinal Cord Stimulation and Blood Pressure Regulation After Spinal Cord Injury

Effectiveness of Transcutaneous Spinal Cord Stimulation on Blood Pressure Regulation in Individuals With Chronic Spinal Cord Injury

Sponsor

University of Louisville

Enrollment

40 participants

Start Date

Apr 1, 2026

Study Type

INTERVENTIONAL

Conditions

Spinal Cord Injury Autonomic Dysreflexia Orthostatic Hypertension

Summary

The goal of this clinical trial is to learn if non-invasive spinal cord stimulation intervention improves blood pressure regulation in individuals with chronic spinal cord injury. The main questions it aims to answer are: * Can site specific spinal cord stimulation enhance blood pressure regulation? * Does this stimulation affect enzymes responsible for blood pressure regulation? Researchers will stimulate different sites of spinal cord and compare to see if site-specific stimulation provide blood pressure stability. Participants will have up to six pairs of self-adhesive conductive electrodes placed on the skin over the spinal cord (midline and/or just to the left and right of midline) as cathodes and up to six pairs of self-adhesive electrodes located symmetrically on the skin over the iliac crests, clavicles, shoulders, and/or abdominal muscles (left and right of the umbilicus) as anodes for stimulation of the spinal cord.

Eligibility

Min Age: 18 Years

Inclusion Criteria9

At least 18 years old,
Stable medical condition,
Non-progression SCI (no negative change in the neurological level and motor-completeness assess during screening when compared to the neurological status assessed at 6-month period after injury or at least 6 months prior to the screening),
Motor-complete SCI according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade "A," "B," or "C" above T1 spinal level according to the ASIA International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Neurological Level of Injury (NLI),
Sustained SCI at least 12 months prior to entering the study,
Evidence of symptomatic hypotension as determined by a total score >0 on the Orthostatic Hypotension Symptom Assessment (OSHA),
Normal renal function as defined by eGFR > 59 ml/min/1.73, creatinine value within the range of 0.6-1.2 mg/dl, and BUN values within the range of 7-18 mg/dl,
Competent to give informed consent for the research protocol,
Able to understand instructions.

Exclusion Criteria15

Major pulmonary or cardiovascular disease unrelated to SCI,
Ventilator dependence,
Painful musculoskeletal dysfunction that might interfere with testing or stimulation,
Unhealed fracture that might interfere with testing or stimulation,
Unhealed contracture that might interfere with testing or stimulation,
Unhealed pressure sore that might interfere with testing or stimulation,
Untreated clinically significant depression or psychiatric disorders,
Ongoing drug abuse,
Malignancy ,
Class III obesity (BMI >40) and at least one co-morbidity thereof: a) Type 2 diabetes as defined by ≥6.5% level on two separate glycated hemoglobin (A1C) tests, b) hypertension as defined by consistent blood pressure readings of ≥140/90 mmHg or taking medication for blood pressure,
Acute or chronic obstructive deep vein thrombosis,
Secondary hypotension unrelated to SCI (anemia, hypervolemia, endocrine and neurological diseases),
Major esophageal/gastrointestinal problem,
Currently pregnant (females of childbearing potential only),
Other major medical illness contraindicated for testing or stimulation.

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Interventions

DEVICESpinal Cord Transcutaneous Stimulation

Spinal Cord Transcutaneous Stimulation (scTS) will be administered using the Biostim/Neostim (Cosyma Inc., Denver CO) device. Up to six pairs of self-adhesive conductive electrodes will be placed on the skin over the spinal cord (midline and/or just to the left and right of midline) as cathodes and up to six pairs of self-adhesive electrodes located symmetrically on the skin over the iliac crests, clavicles, shoulders, and/or abdominal muscles (left and right of the umbilicus) as anodes. During scTS mapping sessions, stimulation will be provided to assess the impact on functional outcomes and to refine stimulation parameters for training (e.g., blood pressure modulation, respiratory function) targeted for each arm. Using multi-variant combinations of electrode locations and different electrical configurations, the stimulation will be delivered at a level specific to each arm with frequency of up to 100 Hz, with incrementally increased intensity up to 200 mA.