Plasticity of Grey and White Matter in Response to Motor Skill Training in Healthy Individuals and Those With Spinal Cord Injury

We aim to investigate the effect of motor skill training of the upper and lower limbs on the function and structure of the CNS as measured by neuroimaging parameters sensitive to changes in tissue volume and density and the properties of myelin.

Study Overview

• Status: Completed
• Conditions: Investigating Spinal Atrophy in Patients With Spinal Injury

Detailed Description

Functional recovery following human spinal cord injury (SCI) remains frustratingly limited and the majority of patients are left with severe impairments. While rehabilitative training has been shown to improve clinical outcome following SCI and has a major effect on patients' quality of life, the neuronal mechanisms underpinning neurological and functional recovery are not well understood.

Until recently, degenerative changes in components of the CNS remote to a SCI were thought to occur slowly (over years) and correlate with the degree of disability. Using longitudinal MRI protocols we have shown that these structural changes in fact occur early and progress both at the cord and brain level according to a specific spatial and temporal pattern (Freund et al 2013). It is thought that these trauma-induced structural changes progress retrogradely along central motor nerve fibres of the myelinated corticospinal tract (CST) and this is accompanied over time by shrinkage of corticospinal projecting neuronal bodies. Crucially, patients with less atrophy throughout the CST were those with better clinical recovery at twelve months. Despite this significant recovery advantage in some patients, all participants showed irreversible tissue loss, potentially hindering further recovery. Using the neuroimaging biomarkers established in the previous study cited above, we now aim to assess whether specific and intensive motor learning through tasks for the upper and lower limb might slow or reverse the atrophy seen in the sensorimotor system.

• Study Type: Observational
• Enrollment (Actual): 51

Contacts and Locations

Study Locations

• Switzerland
  • Zurich, Switzerland, 8008
    • Universitätsklinik Balgrist

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients with spinal injury

Description

Inclusion Criteria:

Patients:

• Injury to the spinal cord which leads to any neurological deficits
• able to provide Informed consent

Controls:

- able to provide informed consent

Exclusion Criteria:

• Pregnancy
• MRI incompatible
• Neurologic or physiatric disorders

Study Plan

How is the study designed?

Number of groups / cohorts

5

Cohorts and Interventions

Group / Cohort
SCI patients with upper limb impairment - Upper limb training
SCI patients with lower limb impairment - Lower limb training
Healthy controls - Upper limb training
Healthy controls - Lower limb training
Healthy controls - No intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
MRI parameters: tensor based morphometry, longitudinal relaxation rate, magnetisation transfer and diffusion index changes in the cervical and cranial corticospinal tract, basal ganglia, motor, premotor and parietal cortex.	MRI scans at weekly intervals (day 0, 7, 14, 28 and 84 after commencement of training)
Raw performance data in the upper and lower limb training task, recorded at each training session.	Training sessions 4x1hour per week for 4 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Overall activity levels as recorded by a worn accelerometer and clinical scoring tests repeated immediately following the first and final training scan sessions (Day 0 and 28) and the 84 day follow-up scan.	Training sessions 4x1hour per week for 4 weeks; clinical assessments at day 0, 28, 84
3D gait analysis will be performed on certain patients and control subjects at the first and final training scan sessions (Day 28) and the 84 day follow-up scan	3D gait analysis at day 0, 28, 84

Collaborators and Investigators

• Sponsor: University of Zurich
• Collaborators: Foundation Wings For Life

Study record dates

Study Major Dates

• Study Start: February 1, 2014
• Primary Completion (Actual): May 1, 2018
• Study Completion (Actual): May 1, 2018

Study Registration Dates

• First Submitted: May 23, 2014
• First Submitted That Met QC Criteria: May 23, 2014
• First Posted (Estimate): May 28, 2014

Study Record Updates

• Last Update Posted (Actual): July 11, 2018
• Last Update Submitted That Met QC Criteria: July 9, 2018
• Last Verified: July 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Wounds and Injuries; Back Injuries; Spinal Injuries
• Other Study ID Numbers: KEK-ZH-2013-0559/PB_2016-00624