Non-Invasive Spinal Cord Stimulation After Injury

February 26, 2024 updated by: Alexander V Ovechkin, MD, PhD, University of Louisville

Non-Invasive Spinal Cord Stimulation and Respiratory Plasticity

The goal of this study is to assess the function of the lungs and the muscles are used to breathe after individuals receive respiratory training, spinal cord stimulation, a combination of respiratory training and stimulation, a combination of arm training and stimulation, or a combination of trunk training and stimulation. The respiratory, arm, and trunk training combined with the spinal stimulation interventions are being used to activate the spinal cord below the level of injury. Investigators will be looking for changes in the function of the lungs and trunk muscles before, during, and after these task-specific and non-task-specific interventions for breathing to determine which one has the greatest effect. The results of this study may aid in the development of treatments to help individuals with spinal cord injuries that have impaired lung, arm, and trunk function.

Study Overview

Detailed Description

Study Aim 1. This study is aimed to evaluate the effects of non-invasive transcutaneous electrical spinal-cord stimulation (TcESCS) applied below the neurological level of Spinal Cord Injury (SCI) on respiratory, upper extremity, and trunk functional and motor control properties and identify their underlying physiological mechanisms. Evaluation of the mechanisms of respiratory and motor control modulations evoked by the TcESCS will have important implications for the development of specific therapeutic strategies to fight complications of SCI. The objective of Aim 1 is to investigate whether TcESCS can significantly increase activation of motor networks. This work will be done by electrophysiological characterization of respiratory and other motor responses as assessed at rest and in response to the respiratory and other challenges in SCI individuals. Changes in functional measures will be assessed when the TcESCS device is turned "off" and "on". To evaluate "dose-dependent" effects, changes in surface electromyographic (sEMG) magnitude and muscle co-activation will be assessed when stimulation parameters and location are changed during respiratory efforts and motor tasks. The extent to which the stimulation is associated with the largest change in respiratory and sEMG parameters will be implemented as a strategy to be used during stimulation in combination with Respiratory Training (RT), Arm Training (AT), and Trunk Training (TT). To attain the objective of this aim, we will test the working hypothesis that TcESCS excites specific motor networks leading to amplified motor responses. We will test this hypothesis by applying TcESCS during our original approach of the Respiratory Motor Control Assessment (RMCA) and other sEMG-based assessments with kinematics to characterize respiratory, arm, and trunk motor function. During these assessments, beat-to-beat Blood Pressure/ Heart Rate (BP/HR), and respiratory rate will be recorded to evaluate respiratory-cardiovascular responses. The rationale for this aim is that successful completion of the proposed research will contribute fundamental elements to our basic knowledge, without which the therapeutic value of TcESCS cannot be understood. The acquisition of such knowledge is critical to the development of specific rehabilitative strategies. When the proposed studies for Aim 1 have been completed, we expect that motor and inter-related characteristics affected by TcESCS in patients with SCI will be established. Such findings would be important because it will allow us, for the first time, to evaluate the ability of non-invasive spinal cord stimulation to enhance the decreased state of spinal network activity thus demonstrating the potential for rehabilitation.

Study Aim 2. The goal is to evaluate the effectiveness and therapeutic mechanisms of the TcESCS combined with task-specific (Respiratory Training) and non-task-specific (Arm Training and Trunk Training) interventions for breathing. Identification of the physiological effects of potential rehabilitative approaches will have important implications for the development of specific therapeutic strategies. The objective of Aim 2 is to investigate the therapeutic effects of RT regimen in combination with TcESCS. This work will be done by using methods outlined in Aim 1 and additional clinical measures all assessed before training, and repeatedly during follow-up period. Working hypothesis that compare to RT alone and TcESCS alone, RT assisted by TcESCS leads to enhanced use-dependent plasticity of respiratory motor networks, leading the functional recovery will be tested by using the approach of detecting changes in respiratory and other motor control outcome measures in response to stimulation and training. The rationale for this aim is that successful completion of the proposed research will advance the field by providing new avenues for the application of activity-based therapy accompanied by the spinal cord stimulation. When the proposed studies for Aim 2 have been completed, it is expected that the rehabilitative capacity of RT with TcESCS will be determined. Such results are important, because, for the first time, identified therapeutic mechanisms of TcESCS will provide evidence that this intervention can enhance the effects of activity-based therapy in participants with SCI.

Study Type

Interventional

Enrollment (Estimated)

36

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 Contact

Study Contact Backup

Study Locations

    • Kentucky
      • Louisville, Kentucky, United States, 40202
        • Recruiting
        • Frazier Rehabilitation and Neuroscience Institute
        • Contact:
        • Principal Investigator:
          • Alexander V Ovechkin, MD, PhD

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 to 99 years (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Description

All SCI research participants, irrespective of gender, will be selected based on the following:

Inclusion Criteria:

  1. At least 18 years of age at the time of enrollment;
  2. Stable medical condition;
  3. Non-progressive SCI T5 or above;
  4. Sustained SCI at least 12 months prior to enrollment;
  5. At least a 15% deficit in pulmonary function outcomes (FVC or FEV1) as was detected by screening spirometry

Exclusion Criteria:

  1. Untreated musculoskeletal dysfunction;
  2. Unhealed fracture;
  3. Untreated contracture or pressure sore;
  4. Ventilator dependence;
  5. Untreated depression, psychiatric disorder, or ongoing drug abuse;
  6. Major pulmonary or cardiovascular disease;
  7. Major esophageal or gastrointestinal disease;
  8. Endocrine disorder, malignancy, marked obesity, deep vein thrombosis, or HIV/AIDS related illness;
  9. Secondary causes of orthostatic hypotension (anemia, hypervolemia, endocrine, or neurological);
  10. Pregnancy by self-report.

All Non-Disabled research participants, irrespective of gender, will be selected based on the following:

Inclusion Criteria:

  1. At least 21 years of age at the time of enrollment.
  2. FVC and FEV1 values 80% of predicted or above indicating healthy pulmonary function by screening spirometry.

Exclusion Criteria:

  1. History of respiratory disease by self-report,
  2. History of cardiovascular disease by self-report.

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: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Non-Disabled (ND) and Spinal Cord Injured (SCI) controls
The ND Control group (n=6) and SCI Control group (n=6) will be used to assess related values as acute effects of transcutaneous electrical spinal cord stimulation (TcESCS) itself and will not receive any training intervention. The ND group will receive baseline assessments, then up to 12 (4-Respiratory function, 4-Arm function, and 4-Trunk function) TcESCS mapping experiments, followed by repeating the assessments in the presence of TcESCS. The investigators will decide which stimulation type should be used for the post-mapping assessments.
TcESCS is a non-invasive DC battery powered device. Investigators and/or research team members will continually assess the appropriate stimulation parameters including configurations, current, voltage and frequency delivered by up to five active electrodes applied on skin of the back from cervical to lumbar levels. Stimulation parameters used during experimental assessments and interventions will be closely monitored by the research team. Every research participant will be slowly acclimated to stimulation. Blood pressure, heart rate, respiratory rate, and electromyography will be closely monitored while we are determining the correct stimulation parameters in the lab. During the stimulation training sessions, we will monitor blood pressure regularly throughout the session.
Other Names:
  • Non-invasive spinal cord stimulation
Experimental: Spinal Cord Injured (SCI) intervention groups
The respiratory training (RT) group (n=6) will receive the respiratory training intervention only); the transcutaneous electrical spinal cord stimulation (TcESCS) group (n=6) will receive transcutaneous spinal cord stimulation only; TcESCS + RT group (n=6) will receive TcESCS combined with RT; TcESCS + Arm Training (AT) group (n=6) will receive TcESCS combined with AT; and TcESCS + Trunk Training (TT) group (n=6) will receive TcESCS combined with TT.
TcESCS is a non-invasive DC battery powered device. Investigators and/or research team members will continually assess the appropriate stimulation parameters including configurations, current, voltage and frequency delivered by up to five active electrodes applied on skin of the back from cervical to lumbar levels. Stimulation parameters used during experimental assessments and interventions will be closely monitored by the research team. Every research participant will be slowly acclimated to stimulation. Blood pressure, heart rate, respiratory rate, and electromyography will be closely monitored while we are determining the correct stimulation parameters in the lab. During the stimulation training sessions, we will monitor blood pressure regularly throughout the session.
Other Names:
  • Non-invasive spinal cord stimulation

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Non-invasive respiratory electromyography
Time Frame: Through study completion, an average of 1 year.
Respiratory muscle activity evaluated using vector analysis outcome measure.
Through study completion, an average of 1 year.
Spirometry
Time Frame: Through study completion, an average of 1 year.
Respiratory activity evaluated using airflow outcome measure.
Through study completion, an average of 1 year.
Maximum airway pressure
Time Frame: Through study completion, an average of 1 year.
Respiratory activity evaluated using airway pressure measurement.
Through study completion, an average of 1 year.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Functional Neurophysiological Assessment (FNPA)
Time Frame: Through study completion, an average of 1 year.
The FNPA assesses the motor capacity and control of the upper and lower extremities and trunk .
Through study completion, an average of 1 year.
Multisegmental Motor Response (MMR)
Time Frame: Through study completion, an average of 1 year.
MMRs in response to non-invasive stimulation of the dorsal spinal cord assessed electromyographically
Through study completion, an average of 1 year.
Transcranial Magnetic Stimulation (TMS)
Time Frame: Through study completion, an average of 1 year.
TMS of the cortex to assess the integrity of the descending corticospinal tracts
Through study completion, an average of 1 year.
Aerobic Endurance Test (VO2Peak)
Time Frame: Through study completion, an average of 1 year.
Oxygen consumption during exercise
Through study completion, an average of 1 year.
Spinal Cord Independence Measure (SCIM)
Time Frame: Through study completion, an average of 1 year.
Questionnaire to assess Self-Care and Mobility
Through study completion, an average of 1 year.
The Craig Handicap Assessment & Reporting Technique (CHART)
Time Frame: Through study completion, an average of 1 year.
Questionnaire to measure the level of handicap in a community setting: physical independence, mobility, occupation, social integration, and economic self-sufficiency
Through study completion, an average of 1 year.
Beat-by-beat arterial blood pressure
Time Frame: During assessments.
Non-invasive blood pressure monitoring
During assessments.

Collaborators and Investigators

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

Investigators

  • Principal Investigator: Alexander Ovechkin, MD, PhD, University of Louisville

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.

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)

May 17, 2018

Primary Completion (Estimated)

December 31, 2029

Study Completion (Estimated)

December 31, 2029

Study Registration Dates

First Submitted

June 20, 2019

First Submitted That Met QC Criteria

June 24, 2019

First Posted (Actual)

June 26, 2019

Study Record Updates

Last Update Posted (Actual)

February 28, 2024

Last Update Submitted That Met QC Criteria

February 26, 2024

Last Verified

February 1, 2024

More Information

Terms related to this study

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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