- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03945331
Transcutaneous and Epidural Spinal Stimulation for Enabling Motor Function in Humans With Motor Complete Paraplegia (TransEpi)
October 15, 2020 updated by: Kristin Zhao, PhD, Mayo Clinic
Characterization of Transcutaneous and Epidural Spinal Stimulation for Enabling Motor Function in Humans With Motor Complete Paraplegia
The purpose of this study is to compare transcutaneous electrical spinal stimulation (TESS) and epidural electrical stimulation (EES); in particular, the motor activity enabled by each method and the potential health benefits of each method.
Study Overview
Status
Terminated
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
2
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Minnesota
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Rochester, Minnesota, United States, 55905
- Mayo Clinic
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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
22 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria
- Spinal cord injury due to trauma located between the seventh cervical and tenth thoracic vertebrae
- American Spinal Injury Association grading scale of A or B (at least 4 each of A and B) below the level of SCI
- Intact spinal reflexes below the level of SCI
- At least 1-year post-SCI
- At least 22 years of age
- Willing to use medically acceptable methods of contraception, if female and of child-bearing potential
Exclusion Criteria
- Currently a prison inmate, or awaiting trial, related to criminal activity
- Pregnancy at the time of enrollment
- DEXA t score <-3.5 at spine and femur head
- History of chronic and/or treatment resistant urinary tract infection
- Unhealed decubitus ulcer
- Unhealed skeletal fracture
- Untreated clinical diagnosis of depression
- Presence of joint contractures or an Ashworth spasticity score of 4
- Active anti-spasticity medication regimen within 3 months prior to study enrollment
- Presence of transcranial magnetic stimulation-evoked potentials in leg muscles
- Non MRI-compatible implanted medical devices.
- Undergoing, or planning to undergo, diathermy treatment
- Active participation in another interventional clinical trial
- Presence of conditions or disorders which require MRI monitoring
- For EES cohort subjects, a history of coagulopathy or other significant cardiac or medical risk factors for surgery
- Current use of a ventilator
- Clinically diagnosed cardiopulmonary complications such as chronic obstructive pulmonary disease, cardiac failure, or heart arrhythmia that contraindicate changes in body position such as supine-to-sit-to-stand activities, prolonged standing, or stepping
- Mass > 113 kg (250 pounds)
- History of frequent hypotension characterized by light headedness, or loss of consciousness
- History of frequent hypertension characterized by headache, or bradycardia
- History of frequent, severe, autonomic dysreflexia
- Any illness or condition which, based on the research team's assessment, will compromise with the patient's ability to comply with the protocol, patient safety, or the validity of the data collected during this study.
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
- Primary Purpose: Device Feasibility
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: TESS
Transcutaneous Electrical Spinal Stimulation (TESS), used during all training sessions.
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DS8R Electrical Stimulator For Human Research
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Experimental: EES
TESS, used during the initial 6-month training period, followed by Epidural Electrical Stimulation (EES) during the final 6-month training period.
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DS8R Electrical Stimulator For Human Research
Spectra WaveWriter Epidural Spinal Cord Stimulator System with CoverEdge 32 Electrode Surgical Lead
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Kinematics
Time Frame: Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Change in measurements of joint angles using video-based, inertial measurement, and/or electromagnetic markers.
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Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Electromyography
Time Frame: Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Change in measurements of electrical activity at major muscle groups below the level of injury.
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Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Foot pressure
Time Frame: Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Change in measurements of foot pressure through shoe-insole pressure sensors.
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Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
|
Somatosensory evoked potentials
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Change in measurements of change in conduction in the peripheral nerves, cervical and lumbosacral spinal cord, deep brain structures, and sensory cortex, through surface electrodes.
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Baseline, Month 6, End of Month 7, Month 13
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Transcranial magnetic stimulation motor evoked potentials
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Change in measurements of stimulus intensity required to elicit muscle responses in muscle groups known to elicit optimal motor evoked potential responses, both above and below the level of injury.
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Baseline, Month 6, End of Month 7, Month 13
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Monosynaptic spinal reflex testing
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Change in measurements of stimulation intensity H and F wave thresholds and maximal responses through surface electrodes.
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Baseline, Month 6, End of Month 7, Month 13
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Trunk stability
Time Frame: Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Change in measurements of trunk stability using the modified functional reach test (mFRT).
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Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Injury severity: American Spinal Injury Association Impairment Scale (AIS)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Change in measurements of impairment of sensory and motor functions using the American Spinal Injury Association Impairment Scale (AIS).
Individuals are classified from A" (complete spinal cord injury) to "E" (normal function).
28 dermatomes and 10 key muscles are assessed bilaterally.
Results are summed to produce overall sensory and motor scores and are used in combination with evaluation of anal sensory and motor function as a basis for the determination of AIS classification.
Sensory scores are rated 0 (sensation absent) to 2 (normal), bilaterally for each of 28 dermatomes.
Muscle function is rated 0 (total paralysis) to 5 (active movement, full range of motion against significant resistance) for each myotome.
Upper Extremity Motor Subscores and Lower Extremity Motor Subscores are each scored from 0 to 50; the ASIA Motor Score is scored from 0 to 100.
The presence of anal sensation and voluntary anal contraction are assessed as a yes/no.
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Baseline, Month 6, End of Month 7, Month 13
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Bowel function
Time Frame: Baseline, Month 6, Month 13
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Change in measurements of bowel function utilizing anorectal manometry.
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Baseline, Month 6, Month 13
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Bladder function
Time Frame: Baseline, Month 6, Month 13
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Change in measurements of bladder function utilizing a urodynamic test consisting of a filling phase and a voiding phase cystometrogram along with perineal patch muscle electromyography.
|
Baseline, Month 6, Month 13
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Spasticity
Time Frame: Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Change in measurements of spasticity using the Modified Ashworth Scale (MAS), an assessment which measures resistance during passive soft-tissue stretching of bilateral hip flexors, extensors, adductors, and abductors, knee extensors and flexors, and ankle plantarflexors and dorsiflexors.
Scoring is scaled from 0 (no increase in muscle tone) to 4 (affected part[s] rigid in flexion or extension), with higher scores indicating more spasticity.
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Baseline, Month 3, Month 6, End of Month 7, Month 10, Month 13
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Bone mineral density
Time Frame: Baseline, Month 6, Month 13
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Measurement by dual-energy x-ray absorptiometry (DXA) of change in bone mineral content and bone density.
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Baseline, Month 6, Month 13
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Body composition - body fat mass
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement by dual-energy x-ray absorptiometry (DXA) of change in regional and total body fat mass.
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Baseline, Month 6, End of Month 7, Month 13
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Body composition - lean mass
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement by dual-energy x-ray absorptiometry (DXA) of change in regional and total lean mass.
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Baseline, Month 6, End of Month 7, Month 13
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Body composition - android and gynoid fat percentage
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement by dual-energy x-ray absorptiometry (DXA) of change in regional and total android and gynoid fat percentage.
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Baseline, Month 6, End of Month 7, Month 13
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Body composition - android and gynoid fat ratio
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement by dual-energy x-ray absorptiometry (DXA) of change in regional and total android to gynoid fat ratio.
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Baseline, Month 6, End of Month 7, Month 13
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Body composition - bone mass
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement by dual-energy x-ray absorptiometry (DXA) of change in regional and total bone mass.
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Baseline, Month 6, End of Month 7, Month 13
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Knee cartilage health
Time Frame: Baseline, Month 6; Month 13 for TESS cohort only
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Assessment of change in knee cartilage breakdown using the modified Outerbridge classification or the International Cartilage Repair Society classification, utilizing magnetic resonance imaging (MRI).
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Baseline, Month 6; Month 13 for TESS cohort only
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Metabolics - CBC
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of changes in complete blood count with differential.
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Baseline, Month 6, End of Month 7, Month 13
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Metabolics - glucose
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in fasting glucose value.
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Baseline, Month 6, End of Month 7, Month 13
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Metabolics - total cholesterol
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in total cholesterol value.
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Baseline, Month 6, End of Month 7, Month 13
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Metabolics - HDL cholesterol
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in HDL cholesterol value.
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Baseline, Month 6, End of Month 7, Month 13
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Metabolics - calculated LDL cholesterol
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in calculated LDL cholesterol value.
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Baseline, Month 6, End of Month 7, Month 13
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Metabolics - triglycerides
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in triglycerides value.
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Baseline, Month 6, End of Month 7, Month 13
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Metabolics - non-HDL cholesterol
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in non-HDL cholesterol value.
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Baseline, Month 6, End of Month 7, Month 13
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Spinal structural integrity
Time Frame: Baseline
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Assessment of structural integrity via computerized tomography (CT).
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Baseline
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Injury severity and potential for spared tissue
Time Frame: Baseline
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Evaluation of severity and possibility of discomplete injury despite complete loss of motor function via MRI.
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Baseline
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Stimulator array location and migration (EES cohort only)
Time Frame: End of Month 7, Month 13
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Evaluation of current array location via CT.
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End of Month 7, Month 13
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Patient-reported bowel function (1)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in bowel function using the Neurogenic Bowel Dysfunction Score.
Answers to qualitative questions are rated from 0 to 5, with a higher number indicating more problematic symptoms, and totaled for a score which categorizes severity of neurogenic bowel symptoms.
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Baseline, Month 6, End of Month 7, Month 13
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Patient-reported bowel function (2)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in bowel function using the International Spinal Cord Injury Bowel Function Basic Data Set (v2.0).
Answers to qualitative questions are rated from 0 to 13, with a higher number indicating more problematic symptoms, and totaled for a score which categorizes neurogenic bowel dysfunction.
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Baseline, Month 6, End of Month 7, Month 13
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Patient-reported bladder function (1)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in bladder function using the Neurogenic Bladder Symptom Score.
Answers to qualitative questions are rated from 0 to 5, with a higher number indicating more problematic symptoms, and totaled for a score which categorizes severity of neurogenic bladder symptoms.
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Baseline, Month 6, End of Month 7, Month 13
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Patient-reported bladder function (2)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Assessment of change in bowel function using the International Spinal Cord Injury Urodynamic Basic Data Set.
Data from various urodynamic variables are aggregated into a single-page format for an abstract overview of bladder dysfunction.
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Baseline, Month 6, End of Month 7, Month 13
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Male patient-reported sexual function (1)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Assessment of change in sexual function using the International Spinal Cord Injury Male Sexual Function Basic Data Set (v2.0).
Data from various male sexual function variables are aggregated into a single-page format for an abstract overview of male sexual dysfunction.
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Baseline, Month 6, End of Month 7, Month 13
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Male patient-reported sexual function (2)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in erectile dysfunction using the Sexual Health Inventory for Men (SHIM).
Answers to qualitative questions are rated from 0 to 5, with a higher number indicating better erectile function, and totaled for a score which categorizes severity of erectile dysfunction.
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Baseline, Month 6, End of Month 7, Month 13
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Male patient-reported sexual function (3)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in erectile dysfunction using the International Index for Erectile Function (IIEF).
Answers to qualitative questions are rated from 0 to 5, with a higher number indicating better erectile function, and totaled for a score which categorizes severity of erectile dysfunction.
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Baseline, Month 6, End of Month 7, Month 13
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Female patient-reported sexual function (1)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Assessment of change in sexual function using the International Spinal Cord Injury Female Sexual and Reproductive Function Basic Data Set (v2.0).
Data from various female sexual and reproductive function variables are aggregated into a single-page format for an abstract overview of female sexual and reproductive dysfunction.
|
Baseline, Month 6, End of Month 7, Month 13
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Female patient-reported sexual function (2)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurement of change in sexual function using the Female Sexual Function Index (FSFI).
Answers to qualitative questions are rated from 0 to 5, with a higher number indicating better sexual function, and totaled for a score which categorizes severity of sexual dysfunction.
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Baseline, Month 6, End of Month 7, Month 13
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Patient-reported quality of life (1): Spinal Cord Injury Secondary Conditions Scale (SCI-SCS)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
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Measurements of change to quality of life as measured by the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS).
Answers to qualitative questions regarding patient activities, independence, and overall quality of life are rated from 0 to 3, with a higher number indicating more significant or chronic problems, and totaled for a score which categorizes patient quality of life.
|
Baseline, Month 6, End of Month 7, Month 13
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Patient-reported quality of life (2): World Health Organization Quality of Life Questionnaire (WHOQOL-BREF)
Time Frame: Baseline, Month 6, End of Month 7, Month 13
|
Measurement of change to quality of life as measured by the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF).
Answers to qualitative questions regarding patient activities, independence, and overall quality of life are rated from 1 to 5, with a higher number indicating a higher concurrence or frequency related to the item in question, and totaled for a score which categorizes patient quality of life.
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Baseline, Month 6, End of Month 7, Month 13
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Volitional movement (1)
Time Frame: 1 year
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Measurement of change in volitional movement through recordings of training time in minutes.
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1 year
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Volitional movement (2)
Time Frame: 1 year
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Measurement of change in volitional movement through recordings body weight support measured as a percentage of total body weight supported.
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1 year
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Volitional movement (3)
Time Frame: 1 year
|
Measurement of change in volitional movement through recordings of speed in miles per hour.
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1 year
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Volitional movement (4)
Time Frame: 1 year
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Measurement of changes in volitional movement through recordings of assistive devices used.
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1 year
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Volitional movement (5)
Time Frame: 1 year, for TESS cohort only
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Measurement of changes in volitional movement through recordings of stimulator electrode location.
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1 year, for TESS cohort only
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Volitional movement (6)
Time Frame: 1 year
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Measurement of changes in volitional movement through recordings of stimulator intensity, measured in milliamps per volt.
|
1 year
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Volitional movement (7)
Time Frame: 1 year
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Measurements of changes in volitional movement through recordings of stimulator frequency measured in Hertz.
|
1 year
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Volitional movement (8)
Time Frame: 1 year
|
Measurement of changes in volitional movement through recordings of pulse width, measured in microseconds.
|
1 year
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Overground ambulation [as appropriate to the subject] (1)
Time Frame: 1 year
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Measurement of changes in overground mobility as measured by the SCI Functional Ambulation Inventory.
Trainer ratings of various gait parameters and criteria are rated from 0 to 5, with a higher number indicating better walking mobility, and totaled for a score which characterizes overall functional ambulation.
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1 year
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Overground ambulation [as appropriate to the subject] (2)
Time Frame: 1 year
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Measurement of changes in overground mobility as measured by the Modified 6 Minute Walk Test.
Trainers will assess the distance in meters which the subject can cover in 6 minutes, with a greater distance characterizing better overground mobility.
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1 year
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Overground ambulation [as appropriate to the subject] (3)
Time Frame: 1 year
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Measurement of changes in overground mobility as measured by the Modified Timed Up and Go test.
Trainers will assess the time it takes, in minutes and seconds, for the subject to stand from a chair, move out to a 3 meter distance, return to the chair and sit down.
Less time will characterize better overground mobility.
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1 year
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Helpful Links
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 (Actual)
January 22, 2019
Primary Completion (Actual)
June 17, 2020
Study Completion (Actual)
June 17, 2020
Study Registration Dates
First Submitted
April 28, 2019
First Submitted That Met QC Criteria
May 9, 2019
First Posted (Actual)
May 10, 2019
Study Record Updates
Last Update Posted (Actual)
October 19, 2020
Last Update Submitted That Met QC Criteria
October 15, 2020
Last Verified
October 1, 2020
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 18-011086
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
Yes
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.
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