- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04854057
Pairing Intermittent Hypoxia and Transcutaneous Electrical Spinal Cord Stimulation to Promote Arm Use After Cervical SCI
Combinatorial Treatment of Acute Intermittent Hypoxia and Transcutaneous Electrical Spinal Cord Stimulation to Improve Hand Function in People With Cervical Spinal Cord Injury
Study Overview
Status
Conditions
Detailed Description
The goal of this study is to determine the effectiveness of repeatedly breathing mild bouts of low oxygen for brief periods (termed acute intermittent hypoxia (AIH)) combined with non-invasive transcutaneous electrical spinal cord stimulation (TESS) on restoring hand function in persons with chronic incomplete SCI.
The fundamental hypothesis guiding this proposal is that daily AIH+TESS engage excitatory and inhibitory pathways, which converge on a common plasticity-promoting cascade that induces greater recovery of hand function than either one alone.
Both treatments appear to enhance motor function in persons with cervical SCI. Despite their independent effects on promoting functional benefits, it is not yet know if they may promote greater functional benefits when combined. To be effective as a long-term rehabilitation strategy, it is essential to determine the efficacy of combined protocols of recurring AIH+TESS.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Stella Barth, BA
- Phone Number: 617-952-6822
- Email: sbarth@partners.org
Study Locations
-
-
Massachusetts
-
Cambridge, Massachusetts, United States, 02138
- Spaulding Rehabilitation Hospital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 18 to 65 years old
- medically stable with medical clearance from physician to participate
- SCI at or below C3 and at or above C7
- non-progressive etiology of spinal injury
- American Spinal Injury Association Impairment Scale (AIS) C-D at initial screen
- at least 1 year post-injury (chronic)
- difficulty independently performing hand functions in activities of daily living
Exclusion Criteria:
- dependence on ventilation support
- implanted stimulator (e.g. diaphragm pacing by phrenic nerve stimulation, vagus nerve stimulator, pacemaker, cochlear implant, epidural stimulator, baclofen pump, etc.)
- spinal cord injury related complications including unhealed pressure sore, severe neuropathic or chronic pain syndrome, history of frequent autonomic dysreflexia, infection (e.g. urinary tract), cardiovascular disease (e.g. deep vein thrombosis), pulmonary disease, heterotopic ossification in the upper extremities, severe osteoporosis, unhealed fracture, contracture of the upper extremity joints
- received botulinum toxin injections in upper extremity muscles in the prior 6 months
- history of tendon or nerve transfer surgery in the upper extremity
- history of additional neurologic disease, such as stroke, multiple sclerosis, traumatic brain injury, peripheral neuropathy (diabetic polyneuropathy, entrapment neuropathy, etc.) or peripheral nerve injury in the upper extremity
- history of concomitant diseases that would prevent full participation in intensive exercise therapy, such as uncontrolled hypertension, rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, etc.), pulmonary disease, active cancer, chronic contagious disease, etc.
- anticoagulation medication
- pregnancy
- history of allergic reaction or any skin reaction to use of adhesive electrodes
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intermittent Hypoxia (AIH) + Transcutaneous Electrical Spinal Cord Stimulation (TESS) First
Round 1 1st Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice alone for 45 mins. Round 1 2nd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after AIH (15x 1.5 mins bouts of 10% oxygen with 1 min intervals of room air). Round 1 3rd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after SHAM (15x 1.5 mins bouts of 21% oxygen with 1 min intervals of room air). Washout (1 month) Round 2 1st Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice alone for 45 mins. Round 2 2nd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after SHAM. Round 2 3rd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after AIH. |
Participants will breathe intermittent low oxygen via air generators.
The generators will fill reservoir bags attached to a non-rebreathing face mask.
Oxygen concentration will be continuously monitored to ensure delivery of fraction of inspired oxygen (FIO2)=0.10±0.02
(hypoxia).
Participants will receive treatment 4 times per week.
Participants will receive transcutaneous electrical stimulation to the cervical spinal cord using the TESCoN device developed by SpineX, Inc. Training will consist of progressive functional task practice for upper extremity motor training.
A total of 24 treatment sessions, which will last 45 minutes per session, will be completed in 3 weeks (4 days/week) per crossover arm.
Participants will breathe intermittent room air via air generators.
The generators will fill reservoir bags attached to a non-rebreathing face mask.
Oxygen concentration will be continuously monitored to ensure delivery of fraction of inspired oxygen (FIO2)=0.21±0.02
(normoxia).
Participants will receive treatment 4 times per week.
|
Experimental: Intermittent Room Air (SHAM) + Transcutaneous Electrical Spinal Cord Stimulation (TESS) First
Round 1 1st Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice alone for 45 mins. Round 1 2nd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after SHAM. Round 1 3rd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after AIH. Washout (1 month) Round 2 1st Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice alone for 45 mins. Round 2 2nd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after AIH (15x 1.5 mins bouts of 10% oxygen with 1 min intervals of room air). Round 2 3rd Intervention (4 days): Participants receive 4 consecutive days of TESS during functional task practice for 45 mins after SHAM (15x 1.5 mins bouts of 21% oxygen with 1 min intervals of room air). |
Participants will breathe intermittent low oxygen via air generators.
The generators will fill reservoir bags attached to a non-rebreathing face mask.
Oxygen concentration will be continuously monitored to ensure delivery of fraction of inspired oxygen (FIO2)=0.10±0.02
(hypoxia).
Participants will receive treatment 4 times per week.
Participants will receive transcutaneous electrical stimulation to the cervical spinal cord using the TESCoN device developed by SpineX, Inc. Training will consist of progressive functional task practice for upper extremity motor training.
A total of 24 treatment sessions, which will last 45 minutes per session, will be completed in 3 weeks (4 days/week) per crossover arm.
Participants will breathe intermittent room air via air generators.
The generators will fill reservoir bags attached to a non-rebreathing face mask.
Oxygen concentration will be continuously monitored to ensure delivery of fraction of inspired oxygen (FIO2)=0.21±0.02
(normoxia).
Participants will receive treatment 4 times per week.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Upper Extremity Function
Time Frame: Once each intervention week (days 5, 10, and 15), and once at follow-up (week 8)
|
Change compared to baseline in upper extremity function performance metrics after treatment assessed using the Graded Redefined Assessment of Strength, Sensation and Prehension test (GRASSP v2).
Range: -188 to 188.
Higher values represent a better outcome.
|
Once each intervention week (days 5, 10, and 15), and once at follow-up (week 8)
|
Change in Upper Extremity Strength - Cylindrical Grip - Less Impaired Hand
Time Frame: Once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Change in upper extremity strength compared to baseline assessed using dynamometers to measure grip forces.
|
Once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Change in Upper Extremity Strength - Cylindrical Grip - More Impaired Hand
Time Frame: Once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Change in upper extremity strength compared to baseline assessed using dynamometers to measure grip forces.
|
Once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Superiority of combined AIH + TESS Therapy vs. TESS alone to improve upper extremity function
Time Frame: Baseline, once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Superiority as demonstrated by statistically significant difference in the improvement of subjects' upper extremity function between the AIH and SHAM treatment arms assessed using the Graded Redefined Assessment of Strength, Sensation and Prehension test (GRASSP).
|
Baseline, once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Superiority of combined AIH + TESS Therapy vs. TESS alone to improve upper extremity strength
Time Frame: Baseline, once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Superiority as demonstrated by statistically significant difference in the improvement of subjects' upper extremity strength between the AIH and SHAM treatment arms assessed using dynamometers to measure pinch and grip forces.
|
Baseline, once each intervention week (days 5, 10, and 15), and once at followup (week 8)
|
Collaborators and Investigators
Investigators
- Principal Investigator: Randy Trumbower, PT, PhD, Harvard Medical School (HMS and HSDM)
Publications and helpful links
General Publications
- Trumbower RD, Hayes HB, Mitchell GS, Wolf SL, Stahl VA. Effects of acute intermittent hypoxia on hand use after spinal cord trauma: A preliminary study. Neurology. 2017 Oct 31;89(18):1904-1907. doi: 10.1212/WNL.0000000000004596. Epub 2017 Sep 29.
- Inanici F, Samejima S, Gad P, Edgerton VR, Hofstetter CP, Moritz CT. Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia. IEEE Trans Neural Syst Rehabil Eng. 2018 Jun;26(6):1272-1278. doi: 10.1109/TNSRE.2018.2834339.
- Hoffman L, Field-Fote E. Effects of practice combined with somatosensory or motor stimulation on hand function in persons with spinal cord injury. Top Spinal Cord Inj Rehabil. 2013 Fall;19(4):288-99. doi: 10.1310/sci1904-288.
- Gad P, Lee S, Terrafranca N, Zhong H, Turner A, Gerasimenko Y, Edgerton VR. Non-Invasive Activation of Cervical Spinal Networks after Severe Paralysis. J Neurotrauma. 2018 Sep 15;35(18):2145-2158. doi: 10.1089/neu.2017.5461.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2020P003328
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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