Measurement of Pulse Wave Velocity in Spinal Cord Injury and Stroke Patients

January 6, 2006 updated by: National Taiwan University Hospital

According to the theory of wave transmission, the speed of wave transmission is dependent on the nature of the transmission medium, which is the vessel wall for pulse wave transmission. Then, the pulse wave velocity is related to the mechanical property of the vessel wall. The mechanical property of the vessel wall is determined by the texture of the vessel wall and the contraction status of the smooth muscle within the vessel wall. Because the texture of the vessel wall could not be changed in a short duration, the sympathetic nerve activity, which controls the contractibility of the smooth muscle, becomes the only determinant factor of pulse wave velocity. So, pulse wave velocity may reflect the status of sympathetic nerve activity. The purpose of this project is to use the pulse wave velocity to measure the sympathetic activity of stroke and spinal cord patients. The present project plans to measure the pulse wave simultaneously at four limbs by pressure receptors, and use the electrocardiogram as the reference to synchronize the recorded pulse wave at different vessels, using the corrected data to calculate the pulse wave velocity. With the pulse wave velocity of different vessels, we, the investigators at National Taiwan University Hospital, can understand the local sympathetic nerve activity in different diseases and different sites.

The first year, we will set up the equipment for measuring the pulse wave velocity, and then apply it to 20 healthy subjects to adjust the measurement error and ascertain the reproducibility of the machine. The second year, we will apply the measurement to 15 complete cervical cord injury individuals and 15 healthy subjects in different erected angles by a tilting table. This procedure will make us understand the response of sympathetic nerve activity to different postures in normal subjects and cervical cord injury patients. The third year, we will apply the measurement to 30 cerebrovascular accident patients to understand the change of sympathetic nerve activity after having a stroke. By comparing the clinical information, we hope to clear up the relationship between sympathetic nerve activity and pulse wave velocity.

Study Overview

Status

Unknown

Conditions

Detailed Description

There are many diseases related to the dysfunction of sympathetic nerve activities in rehabilitation medicine. Shoulder hand syndrome, a common complication after having a cerebrovascular accident, is believed to combine with hyper-exciting of the sympathetic nerve at the lesion side. Autonomic dysfunction in spinal cord injury patients comes from the vicious cycle of local stimulation of the sympathetic nerve and results in the elevated blood pressure. Myofascial pain syndrome has been reported to have abnormal sympathetic activities in the late stage. Considering the above facts, accurate evaluation of sympathetic nerve activities is an important issue in rehabilitation practice.

Measuring the skin temperature and the status of local sweating are the common methods in evaluating the sympathetic nerve activity. However, many external environment factors would interfere with the result, and the accuracy of the result is questionable. Sympathetic skin reflex is the traditional electrodiagnostic method in measuring the sympathetic nerve activity, but its application is limited by poor reproducibility. Microneurography can measure the sympathetic nerve activity along the distribution of peroneus and bronchial nerves by inserting the needles into the above nerves, but its application is limited because of the invasive nature of the test.

When the heart is contracted, it pumps the blood into the peripheral vessels and transits a pulse wave along the vessel walls. The propagation velocity of the pulse wave is different from that of the blood flow. According to the theory of wave transmission, the speed of wave transmission is dependent on the nature of the transmission medium, which is the vessel wall for pulse wave transmission. Then, the pulse wave velocity is related to the mechanical property of the vessel wall. The mechanical property of the vessel wall is determined by the texture of the vessel wall and the contraction status of the smooth muscle within the vessel wall. Because the texture of the vessel wall could not be changed in a short duration, the sympathetic nerve activity, which controls the contractibility of the smooth muscle, becomes the only determinant factor of pulse wave velocity. So, pulse wave velocity may reflect the status of sympathetic nerve activity.

There were limited reports regarding the pulse wave velocity measurement and lack of reports of clinical application. The present project plans to measure the pulse wave simultaneously at four limbs by pressure receptors, and use the electrocardiogram as the reference to synchronize the recorded pulse wave at different vessels, using the corrected data to calculate the pulse wave velocity. With the pulse wave velocity of different vessels, we can understand the local sympathetic nerve activity in different diseases and different sites.

The first year, we will set up the equipment for measuring the pulse wave velocity, and then apply it to 20 healthy subjects to adjust the measurement error and ascertain the reproducibility of the machine. The second year, we will apply the measurement to 15 complete cervical cord injury individuals and 15 healthy subjects in different erected angles by a tilting table. This procedure will make us understand the response of sympathetic nerve activity to different postures in normal subjects and cervical cord injury patients. The third year, we will apply the measurement to 30 cerebrovascular accident patients to understand the change of sympathetic nerve activity after having a stroke. By comparing the clinical information, we hope to clear up the relationship between sympathetic nerve activity and pulse wave velocity.

The study will use the self-designed pulse wave velocity (PWV) machine to measure the patients with cerebrovascular accident (CVA) and spinal cord injury (SCI). The CVA patients will be divided into two groups with or without shoulder pain. The skin temperature and range of motion will be recorded. We hypothesize that the patients with shoulder pain may have higher sympathetic activity and will have higher speed of PWV. Sixty patients will be included. For SCI patients, we will compare the PWV of the upper extremity and lower extremity. We hypothesize that the cervical cord injury patients will have lower sympathetic tone below the lesion, and have lower speed of PWV when compared to the upper extremity.

Through this study, we will confirm the hypothesis that the PWV is an accurate method to measure the sympathetic activity and understand the change of sympathetic activity in CVA and SCI patients.

Study Type

Observational

Enrollment

80

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Taiwan
      • Taipei, Taiwan
        • Recruiting
        • Wang Tyng-Guey
        • Contact:
        • Principal Investigator:
          • Wang Chung-Li

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Stroke patients with shoulder pain
  • Spinal cord injury patients with complete cervical lesion

Exclusion Criteria:

  • Peripheral vascular disease

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

National Taiwan University Hospital

Investigators

  • Study Director: Wang Tyng-Guey, MD, National Taiwan University, School of Medicine, National Taiwan University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

August 1, 2004

Study Completion

December 1, 2006

Study Registration Dates

First Submitted

September 12, 2005

First Submitted That Met QC Criteria

September 12, 2005

First Posted (Estimate)

September 15, 2005

Study Record Updates

Last Update Posted (Estimate)

January 9, 2006

Last Update Submitted That Met QC Criteria

January 6, 2006

Last Verified

December 1, 2004

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 9261701395

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Cerebrovascular Accident

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Angola

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

3
Subscribe