NEUROwave - Extracorporeal Shock Wave Therapy (ESWT) in Acute Traumatic Complete (AIS A) and Incomplete (AIS B-D) Cross-sectional Lesions on Motor and Sensory Function Within Six Months After Injury

January 31, 2024 updated by: Wolfgang Schaden, AUVA

The Effect of Extracorporeal Shock Wave Therapy (ESWT) in Acute Traumatic Complete (AIS A) and Incomplete (AIS B-D) Cross-sectional Lesions on Motor and Sensory Function Within Six Months After Injury: A Two-arm Three-stage Adaptive, Prospective, Multi-center, Randomized, Double-blind, Placebo-controlled Clinical Trial

It has been hypothesized that there are two mechanisms of acute traumatic spinal cord injury (SCI): the primary mechanical damage and the secondary injury due to additional pathological processes initiated by the primary injury. Neurological damage due to laceration, contusion, distraction or compression of the spinal cord is called ''primary injury''. This mechanical injury leads to a cascade of biochemical and pathological changes, described as ''secondary injury'', which occurs minutes to weeks after the initial trauma and causes further neurological deterioration. This secondary cascade involves vascular changes, an inflammatory response, neurotoxicity, apoptosis and glial scarring, and further compromises neurological impairment after traumatic spinal cord injury. Edema, ischemia and loss of autoregulation continue to spread bi-directionally from the initial lesion along the spinal cord for up to 72 hours after the trauma.

It has been postulated that the damage caused by the primary injury mechanism is irreversible and therapeutic approaches in recent years have focused on modulating the secondary injury cascade.

Researchers found significantly greater numbers of myelinated fibers in peripheral nerves after a single ESWT application in an experimental model on rats after a homotopic nerve autograft into the sciatic nerve.

In another study a spinal cord ischemia model in mice was performed. ESWT was applied immediately after surgery and the treated animals showed a significantly better motor function and decreased neuronal degeneration compared to the control group within the first 7 days after surgery.

Researchers investigated the effect of low-energy ESWT for the duration of three weeks on a thoracic spinal cord contusion injury model in rats. Animals in the ESWT group demonstrated significantly better locomotor improvement and reduced neuronal loss compared to the control animals at 7, 35, and 42 days after contusion.

It has been postulated previously, that ESWT improves the metabolic activity of various cell types and induces an improved rate of axonal regeneration.

ESWT might be a promising therapeutic strategy in the treatment of traumatic SCI.

The underlying study aims to investigate the effect of ESWT after acute traumatic spinal cord injury in humans within 48 hours of trauma in order to intervene in the secondary injury phase with the objective to reduce the extent of neuronal damage.

Study Overview

Status

Recruiting

Study Type

Interventional

Enrollment (Estimated)

246

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

      • Bad Häring, Austria, 6323
        • Active, not recruiting
        • Rehazentrum Bad Häring
      • Feldkirch, Austria, 6807
        • Recruiting
        • Landeskarnkenhaus Feldkirch
        • Contact:
          • Rene El-Attal, Prim
      • Graz, Austria, 8020
        • Recruiting
        • Unfallkrankenhaus Graz
        • Contact:
          • Michael Plecko, Prim
      • Graz, Austria, 8144
        • Active, not recruiting
        • Rehazentrum Tobelbad
      • Klagenfurt, Austria, 9020
        • Recruiting
        • Unfallkrankenhaus Klagenfurt
        • Contact:
          • Rudolf Pranzl, Prim.
      • Klosterneuburg, Austria, 3400
        • Active, not recruiting
        • Rehazentrum Weißer Hof
      • Linz, Austria, 4010
        • Recruiting
        • Unfallkrankenhaus Linz
        • Contact:
          • Klaus Katzensteiner, Prim.
      • Salzburg, Austria, 5010
        • Recruiting
        • Unfallkrankenhaus Salzburg
        • Contact:
          • Arnold Suda, Prim.
      • Salzburg, Austria, 5020
        • Withdrawn
        • Universitätsklinik für Orthopädie und Traumatologie
      • St. Pölten, Austria, 3100
        • Withdrawn
        • Unfallkrankenhaus St. Pölten
      • Wien, Austria, 1090
        • Recruiting
        • Universitätsklinik Wien, AKH
        • Contact:
          • Stefan Hajdu, Prof.
      • Wien, Austria, 1120
        • Recruiting
        • Unfallkrankenhaus Meidling
        • Contact:
          • Christian Fialka, Prim.
      • Wien, Austria, 1220
        • Not yet recruiting
        • SMZ Ost, Donauspital Abteilung für Unfallchirurgie
        • Contact:
          • Medhi Mousavi, Prim
      • Wien, Austria, 1200
        • Withdrawn
        • Unfallkrankenhaus Lorenz Böhler
    • Tirol
      • Innsbruck, Tirol, Austria, 6020
        • Recruiting
        • Medical University Innsbruck
        • Contact:
          • Richard Lindtner, Dr
        • Contact:
          • Rene Schmid, Dr.

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

No

Description

Inclusion Criteria:

  • Patients with acute traumatic spinal injuries who are awake, responsive, and oriented at admission
  • Patients from the age of 18 years
  • Admission to hospital within 24 hours after injury
  • Written consent to participate in the study
  • Participation in the Austrian Spinal Cord Injury Study (ASCIS)-Registry (only for the Austrian hospitals)

Exclusion Criteria:

  • Patients who cannot cooperate or are not capable to give consent to participate
  • Serious traumatic brain injuries that prevent accurate participation in study procedures and/or adequacy of informed consent Participation in other interventional clinical trials
  • Serious concomitant injuries that prevent the neurological initial assessment
  • Preexisting neurological conditions that affect the primary endpoint of the study and potentially mask or reduce the therapeutic effect of the ESWT application
  • High dose administration of corticosteroids
  • Complete spinal cord transection
  • Patients with pacemakers or implantable defibrillators
  • Patients who are using devices which are sensitive to electromagnetic radiation
  • (potential) Pregnancy
  • Patients with tumors
  • Patients with severe coagulation disorders

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: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: ESWT
The extracorporeal shockwave therapy is applied once at the level of lesion and 5 segments above and below; or below the occiput (in lesions higher than C6) and above the sacrum (in lesions lower than T12). In addition, the ESWT is applied to the soles of both feet on the medial side of the plantar surface. The ESWT is applied as soon as possible within 48 hours post-injury.
The shockwave generator orthogold 100® generates high-energy acoustic waves that behave much like other sound waves except that they have much greater pressure and energy. As with sound waves, Spark Waves® can easily travel great distance as long as the acoustic impedance stays the same.
Sham Comparator: Control
In the control group, the same procedure is performed, but without the device emitting extracorporeal shock waves using a dummy head.
The shockwave generator orthogold 100® will be used in combination with a dummy head, to Refrain shock waves

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
changes in total motor scores (TMSC) = TMSC after 6 month minus TMSC at baseline
Time Frame: day 0 to 6 month
greater improvement in motor and sensory function (the AIS grade) can be achieved in patients after spinal trauma (AIS A-D) by applying a single extracorporeal shockwave therapy compared to the control group.
day 0 to 6 month

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
American Spinal Injury Association (ASIA) Impaiment Scale (AIS) grade
Time Frame: day 0 to 6 month
the AIS grade ranges from AIS A to AIS D, whereby AIS A are complete lesions and AIS B-D represent incomplete lesions
day 0 to 6 month
degree of spasticity
Time Frame: day 0 to 6 month
self-rated degree of spasticity according to Penn Spasm Frequency Scale (PSFS); the scale ranges from 0 to 4, whereby 0 refers to no spasticity and 4 refers to more than 10 spasms per hour
day 0 to 6 month
Walking ability (yes/no)
Time Frame: day 0 to 6 month
walking ability is being assessed using different walking tests as part of standard clinical routine: Walking Index for Spinal Cord Injury (WISCI) II, Timed up and go test (TUG), 10 Meter-Timed-Walk, 6 Minute-Walk-Test
day 0 to 6 month
Urological function
Time Frame: day 0 to 6 month

Urological function will be assessed by several questions which should be answered with yes or no:

  • Permanent catheter: yes/no
  • Sensation of urinary bladder filling: yes/no
  • Documentation of the first attempt of bladder emptying: pos/neg, date
  • Self-catheterization: yes/no
  • Do you feel sensory innervation of the external genitalia (penis / labia)?
  • Do you feel the change of the catheter or manipulations on the catheter?
  • Do you feel the urge to defecate?
  • Do you feel stool evacuation?
  • Male patients: Have you had an erection since your injury?
  • Female patients: Have you felt sexually aroused since your injury?
day 0 to 6 month
Plantar reflex (left/right: yes/no)
Time Frame: day 0 to 6 month
The plantar reflex (also called Babinski Test) will be performed separately on each foot to assess if pathological reflexes are present.
day 0 to 6 month
Independence in everyday life
Time Frame: day 0 to 6 month
of patients is assessed with the Spinal Cord Independence Measure (SCIM II)
day 0 to 6 month
adverse events (AEs)
Time Frame: day 0 to 21 days
The number of study related adverse events (AEs) are measured according to NCI CTCAE, version 5.0.
day 0 to 21 days
Nine-Hole Peg Test (NHPT) (if feasible)
Time Frame: day 0 to 6 month
An evaluation of hand motor function is assessed in those patients who have their lesions above the level T5
day 0 to 6 month
Grasp and Release Test (GRT)
Time Frame: day 0 to 6 month
An evaluation of hand motor function is assessed in those patients who have their lesions above the level T5
day 0 to 6 month
Pinch grip: yes/no
Time Frame: day 0 to 6 month
An evaluation of hand motor function is assessed in those patients who have their lesions above the level T5
day 0 to 6 month
Clenched grip: yes/no
Time Frame: day 0 to 6 month
An evaluation of hand motor function is assessed in those patients who have their lesions above the level T5
day 0 to 6 month
Pencil grip: yes/no
Time Frame: day 0 to 6 month
An evaluation of hand motor function is assessed in those patients who have their lesions above the level T5
day 0 to 6 month
Lumbrical grip: yes/no
Time Frame: day 0 to 6 month
An evaluation of hand motor function is assessed in those patients who have their lesions above the level T5
day 0 to 6 month

Collaborators and Investigators

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

Sponsor

Investigators

  • Principal Investigator: Wolfgang Schaden, Dr., AUVA

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)

July 2, 2020

Primary Completion (Estimated)

December 31, 2026

Study Completion (Estimated)

December 31, 2026

Study Registration Dates

First Submitted

June 30, 2020

First Submitted That Met QC Criteria

July 15, 2020

First Posted (Actual)

July 16, 2020

Study Record Updates

Last Update Posted (Estimated)

February 1, 2024

Last Update Submitted That Met QC Criteria

January 31, 2024

Last Verified

January 1, 2024

More Information

Terms related to this study

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

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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