Assessment of Neurorehabilitation in Spinal Cord Injury Using Neuroimage Tools.

Assessment of Functional Neurorehabilitation in Spinal Cord Injury Using Fmri and Other Neuroimage Tools.

The sensorimotor cortex may play a role in the functional recovery after Spinal Cord Injury (SCI) through efference generated in the absence of the afference. OBJECTIVE: The purpose of this study was to evaluate the potential reorganization in the sensorimotor cortex in SCI patients after Body Weight Supported Treadmill Training (BWSTT) associated with conventional motor rehabilitation. METHOD: Seven SCI patients with ASIA C and D participated in this study. They were submitted to a motor-task functional magnetic resonance imaging study (fMRI) before and after the rehabilitation treatment.

Study Overview

• Status: Completed
• Conditions: Injuries, Spinal Cord
• Intervention / Treatment: Other: rehabilitation treatment

Detailed Description

Motor Rehabilitation The rehabilitation program consisted of five hours per day of the treatment, five times a week for two months (40 sessions). The treatment protocol included kinesiotherapy (passive and active mobilizations, muscle lengthening), BWSTT, bicycle, manual therapy (with and without assistance of a mechanical device) and daily life activities training. The duration of each event was approximately one hour.

The initial time of the treatment on the BWSTT was 20 minutes, and the modification of the time depended on the endurance and capability of each patient. Training charge began at 40% body weight supported and at treadmill speeds of at least 1.5 km per hour. The treadmill speed was increased progressively to 2.5 km per hour, and the level of weight supported was adjusted within sessions to achieve knee extension. Table 1 shows the initial and final training parameters for each patient.

To assess functional ability, each patient was assigned a Walking Index for Spinal Cord Injury (WISCI II) (Ditunno and Ditunno 2001) (Table 1), Manual Muscle Testing and Functional Independence Measure (FIM) before and after the treatment period (Table 2).

fMRI Protocol The patients were scanned using a 3T Siemens TIM TRIO system before and after the rehabilitation treatment protocol. The fMRI protocol consisted of a two motor-task fMRI series with the following technical parameters: TE=29 ms; TR=2000 ms, number of slices=36, matrix=128x128, FOV=240 mm, slice thickness= 3 mm; and FA=90º. The patients were given instructions for the motor task they were to perform prior to each scan. The patients were positioned with comfortable pads below the knee to allow the active movement of the ankle. During the functional imaging, each motor activation period was signalled with a short instruction to the subject through the headphones.

The motor task for the fMRI exploration of the foot was the ankle plantar flexion and toe flexion. The block design began with a 20 second rest period, followed by 30 second periods of movement of the right foot, 30 seconds of the left foot movement and 10 seconds of rest. This cycle was repeated three times. The movement performance was controlled visually by two examiners to monitor any movement or apparent change during the rest periods of the non-moving limbs. The patients were oriented to perform the motor task through a voluntary movement. Approximately 15 repetitions were made in each period.

Finally, a T1-weighted structural image of the whole brain was acquired to a perfect localization of activation areas. Acquisition parameters of the structural image were TE= 2.98 ms; TR= 2300 ms; T1= 900 ms; matrix= 256x256; FA= 9º; and T voxel=1x1x1 m3.

• Study Type: Interventional
• Enrollment (Actual): 7
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 80 years (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients with ASIA C or D (Table 1) and the ability to cooperate with instructions of the motor task required. The motor task was to perform ankle plantar flexion, toe flexion and fingers and thumbs movement of both sides; they also had to be able to fulfill the general conditions necessary for an MRI exploration.

Exclusion Criteria:

• Patients with uncontrollable spasticity-induced body movements.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Body Weight Supported Treadmill Training; The rehabilitation program consisted of five hours per day of the treatment, five times a week for two months (40 sessions). The treatment protocol included kinesiotherapy (passive and active mobilizations, muscle lengthening), BWSTT, bicycle, manual therapy (with and without assistance of a mechanical device) and daily life activities training. The duration of each event was approximately one hour. The initial time of the treatment on the BWSTT was 20 minutes, and the modification of the time depended on the endurance and capability of each patient. Training charge began at 40% body weight supported and at treadmill speeds of at least 1.5 km per hour. The treadmill speed was increased progressively to 2.5 km per hour, and the level of weight supported was adjusted within sessions to achieve knee extension.

Other: rehabilitation treatment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Changes in blood oxygen level (BOLD) signal after motor rehabilitation, evaluated by functional magnetic resonance imaging study (fMRI)	The blood oxygen level (BOLD) signal in the sensorimotor area, before and after motor rehabilitation, was evaluated by functional magnetic resonance imaging study (fMRI). The signals were obtained through the motor task of the foot: ankle plantar flexion and toe flexion. The block design began with a 20 second rest period, followed by 30 second periods of movement of the right foot, 30 seconds of the left foot movement and 10 seconds of rest. This cycle was repeated three times.	2 hour

Collaborators and Investigators

• Sponsor: Universidade do Vale do Paraíba

Publications and helpful links

General Publications

• Lucareli PR, Lima MO, Lima FP, de Almeida JG, Brech GC, D'Andrea Greve JM. Gait analysis following treadmill training with body weight support versus conventional physical therapy: a prospective randomized controlled single blind study. Spinal Cord. 2011 Sep;49(9):1001-7. doi: 10.1038/sc.2011.37. Epub 2011 May 3.
• Winchester P, McColl R, Querry R, Foreman N, Mosby J, Tansey K, Williamson J. Changes in supraspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury. Neurorehabil Neural Repair. 2005 Dec;19(4):313-24. doi: 10.1177/1545968305281515.

Study record dates

Study Major Dates

• Study Start (Actual): February 2, 2007
• Primary Completion (Actual): September 2, 2007
• Study Completion (Actual): November 15, 2007

Study Registration Dates

• First Submitted: March 29, 2019
• First Submitted That Met QC Criteria: April 11, 2019
• First Posted (Actual): April 16, 2019

Study Record Updates

• Last Update Posted (Actual): April 16, 2019
• Last Update Submitted That Met QC Criteria: April 11, 2019
• Last Verified: February 1, 2007

More Information

Terms related to this study

• Keywords: Robotic; Spinal Cord Injury; Functional magnetic resonance imaging; Motor rehabilitation; Sensorimotor reorganization
• Additional Relevant MeSH Terms: Central Nervous System Diseases; Nervous System Diseases; Trauma, Nervous System; Spinal Cord Diseases; Back Injuries; Wounds and Injuries; Spinal Cord Injuries; Spinal Injuries
• Other Study ID Numbers: 2007/3639

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No