Transcutaneous Spinal Electrical Stimulation to Improve Exercise Function After Spinal Cord Injury.
Our overall objective is to decrease the prevalence of multiple sedentary-related diseases that are secondary consequences of spinal cord injury (SCI). SCI affects motor, sensory and autonomic systems and can cause very limited exercise capacity which then leads to very high rates of obesity, metabolic syndrome, type II diabetes and cardiovascular disease.
This randomized controlled study aims to determine whether and how transcutaneous spinal electrical stimulation (TSES) alters acute (immediate) exercise responses in people living with SCI. Exercise responses will be tested during incremental tests to fatigue, and during steady state tests. Testing will occur over several study visits and results will be compared within each individual as well as between groups (tetraplegia and paraplegia) and to a group of reference controls. A number of outcomes will be monitored, including whole-body metabolic responses using a metabolic cart, muscle responses using EMG sensors and muscle oxygenation using near infrared spectroscopy (NIRS) sensors, time to fatigue, power output, as well as perceptions about fatigue and effort.
The findings of this study are expected to provide evidence regarding whether and how TSES might improve acute exercise responses in people living with SCI.
Přehled studie
Postavení
Postavení
Podmínky
Podmínky
Intervence / Léčba
Intervence / Léčba
Detailní popis
It is well understood that SCI causes motor paralysis and sensory loss. However, it is the loss of autonomic regulation that confers the greatest morbidity to those living with SCI. Impaired exercise responses, including limited peak HR, oxygen uptake, limited catecholamine related to impaired activation of spinal sympathetic autonomic systems. Depending upon level of injury, and these sub-optimal exercise responses, there are limited exercise training effects which then leads to a calorie excess and related weight gain, cardiovascular, skeletal muscle and metabolic deconditioning that eventually causes obesity, type II diabetes and cardiovascular disease.
These sedentary-related diseases likely result in large part, because of inadequate activation of these tissues with sufficient duration or intensity to result in training effects. Therefore, we are interested in identifying means to improve acute exercise responses, with an ultimate goal of improving training responses and reducing the incidence of and/or trajectory of developing these sedentary-related diseases in individuals with SCI.
TSES has recently emerged as a potential therapeutic method to improve exercise responses. In case studies it has been shown to increase peak responses and time to fatigue during arm ergometry exercise tests.
This study is designed as a prospective, single-center, randomized controlled trial to examine whether and how TSES might alter exercise responses in two groups of people with SCI (tetraplegia and paraplegia) and a reference control group from the general population. The study is designed to assess within individual and between-group responses for a variety of outcome measures during peak and steady-state exercise tests. Study visits occur over several weeks for each participant, according to each person's time and convenience availability.
Outcomes are assessed during exercise with and without TSES in the following 4 experimental conditions:
- Comparing peak incremental tests to voluntary upper body exercise fatigue with or without TSES.
- Comparing steady state exercise responses performed at 40-45% peak power output with or without TSES.
- Comparing time to fatigue during neuromuscular electrical stimulation (NMES) evoked rhythmic leg contractions with or without TSES.
The primary hypothesis is that TSES will improve a variety of exercise outcomes under different experimental testing conditions and that those with tetraplegia will benefit most.
The results of this study are expected to contribute to whether and how TSES might alter acute exercise responses in those living with SCI.
The results of this study are expected to contribute to the evidence base regarding the effectiveness of TSES to alter peak and steady-state exercise responses in people with SCI and may support its integration into standard exercise training or competitive sport protocols for individuals with SCI.
Typ studie
Typ studie
Zápis (Odhadovaný)
Zápis
Fáze
Fáze
- Nelze použít
Kontakty a umístění
Studijní kontakt
Studijní kontakt
- Jméno: Kristine C Cowley, PhD
- Telefonní číslo: +1 204-789-3305
- E-mail: kristine.cowley@umanitoba.ca
Studijní záloha kontaktů
- Jméno: Rodrigo Villar, PhD
- Telefonní číslo: +1-204-474-8590
- E-mail: rodrigo.villar@umanitoba.ca
Studijní místa
-
-
Manitoba
-
Winnipeg, Manitoba, Kanada, R3E 0J9
- Nábor
- University of Manitoba
-
Kontakt:
- Kristine Cowley, PhD
- Telefonní číslo: +1-204-789-3305
- E-mail: kristine.cowley@umanitoba.ca
-
Vrchní vyšetřovatel:
- Kristine Cowley, PhD
-
Vrchní vyšetřovatel:
- Rodrigo Villar, PhD
-
-
Kritéria účasti
Kritéria způsobilosti
Kritéria způsobilosti
Věk způsobilý ke studiu
- Dospělý
- Starší dospělý
Přijímá zdravé dobrovolníky
Popis
Inclusion Criteria:
- traumatic or non-traumatic spinal cord injury
- Spinal cord injury of at least one year duration, C5 or lower, AIS A - D
- medically stable and healthy enough to engage in and complete exercise requirements
- willing and able to complete the exercise protocols and testing requirements
- able to understand and follow written and verbal instructions from study staff
- able to communicate with study staff about their exercise capabilities and preferences
Exclusion Criteria:
- current serious injury (ies) of the upper extremities
- known cardiovascular disease
- unsatisfactory results of EKG screening
- implanted electronic cardiac devices (e.g., pacemaker, defibrillator, etc.)
- current pressure ulcer(s)
- morbid obesity
- known thyroid dysfunction
- current cancer
- current uncontrolled high blood pressure
- uncontrolled epilepsy
- current deep vein thrombosis
- ventilator dependency
- cognitive impairment
Studijní plán
Jak je studie koncipována?
Detaily designu
- Primární účel: Základní věda
- Přidělení: Randomizované
- Intervenční model: Crossover Assignment
- Maskování: Dvojnásobek
Počet zbraní
Zbraně a zásahy
Skupina účastníků / ArmSkupina účastníků / Arm |
Intervence / LéčbaIntervence / Léčba |
|---|---|
|
Jiný: Upper body exercise in participants with tetraplegia
TSES during peak and steady state exercise in those with tetraplegia
|
TSES will typically involve constant current rectangular pulse bipolar stimulation delivered at 20 Hz with stimulation durations of 900 microseconds delivered at or slightly above motor threshold.
|
|
Jiný: Upper body exercise in participants with paraplegia
TSES during peak and steady state exercise in those with paraplegia
|
TSES will typically involve constant current rectangular pulse bipolar stimulation delivered at 20 Hz with stimulation durations of 900 microseconds delivered at or slightly above motor threshold.
|
|
Jiný: Upper body exercise in reference control participants
TSES during peak and steady state exercise in reference controls
|
TSES will typically involve constant current rectangular pulse bipolar stimulation delivered at 20 Hz with stimulation durations of 900 microseconds delivered at or slightly above motor threshold.
|
|
Jiný: Rhythmic lower limb neuromuscular electrical stimulation evoked exercise
Does TSES alter time to fatigue during NMES-evoked rhythmic lower limb exercise?
|
TSES will typically involve constant current rectangular pulse bipolar stimulation delivered at 20 Hz with stimulation durations of 900 microseconds delivered at or slightly above motor threshold.
|
Co je měření studie?
Primární výstupní opatření
Primární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Oxygen uptake
Časové okno: During individual study visits lasting between 1 and 2.5 hours
|
Oxygen uptake, in mL/min
|
During individual study visits lasting between 1 and 2.5 hours
|
|
Perceived Exertion
Časové okno: Tested intermittently during individual voluntary exercise study visits lasting between 1 and 2.5 hours
|
Ratings of perceived exertion, on a Borg scale of 6 to 20 with 6 being resting to 20 which is very very hard.
|
Tested intermittently during individual voluntary exercise study visits lasting between 1 and 2.5 hours
|
|
Time to fatigue during incremental exercise tests to fatigue
Časové okno: Time to fatigue will be monitored during study visits lasting between 1 and 2.5 hours.
|
Does TSES alter time to fatigue during NMES-evoked rhythmic lower limb exercise, measured in seconds.
|
Time to fatigue will be monitored during study visits lasting between 1 and 2.5 hours.
|
|
Heart rate
Časové okno: During exercise testing study visits, lasting between 1 and 3 hours
|
Heart rate, beats per minute
|
During exercise testing study visits, lasting between 1 and 3 hours
|
|
Power output
Časové okno: During exercise in study visits lasting 1 to 3 hours.
|
Watts
|
During exercise in study visits lasting 1 to 3 hours.
|
Sekundární výstupní opatření
Sekundární výstupní opatření
Měření výsledku |
Popis opatření |
Časové okno |
|---|---|---|
|
Muscle tissue oxygen saturation levels
Časové okno: Oxygen saturation levels will be assessed during study visits lasting between 1 and 2.5 hours.
|
Does TSES alter muscle tissue oxygen saturation levels during exercise, expressed as a percentage.
|
Oxygen saturation levels will be assessed during study visits lasting between 1 and 2.5 hours.
|
Spolupracovníci a vyšetřovatelé
Sponzor
Sponzor
Vyšetřovatelé
Vyšetřovatelé
- Vrchní vyšetřovatel: Kristine Cowley, Phd, University of Manitoba
- Vrchní vyšetřovatel: Rodrigo Villar, PhD, University of Manitoba
Termíny studijních záznamů
Hlavní termíny studia
Začátek studia (Aktuální)
Začátek studia
Primární dokončení (Odhadovaný)
Primární dokončení
Dokončení studie (Odhadovaný)
Dokončení studie
Termíny zápisu do studia
První předloženo
První předloženo
První předloženo, které splnilo kritéria kontroly kvality
První předloženo, které splnilo kritéria kontroly kvality
První zveřejněno (Aktuální)
První zveřejněno
Aktualizace studijních záznamů
Poslední zveřejněná aktualizace (Aktuální)
Poslední zveřejněná aktualizace
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Odeslaná poslední aktualizace, která splnila kritéria kontroly kvality
Naposledy ověřeno
Naposledy ověřeno
Více informací
Termíny související s touto studií
Klíčová slova
Další relevantní podmínky MeSH
- Onemocnění centrálního nervového systému
- Nemoci nervového systému
- Rány a zranění
- Poruchy výživy
- Nadměrná výživa
- Tělesná hmotnost
- Nadváha
- Trauma, nervový systém
- Nemoci míchy
- Zranění zad
- Patologické stavy, příznaky a symptomy
- Chování
- Nutriční a metabolické nemoci
- Příznaky a symptomy
- Obezita
- Kardiovaskulární choroby
- Poranění míchy
- Poranění páteře
- Motorická aktivita
Další identifikační čísla studie
Další identifikační čísla studie
- HS26003
Plán pro data jednotlivých účastníků (IPD)
Plánujete sdílet data jednotlivých účastníků (IPD)?
Popis plánu IPD
Informace o lécích a zařízeních, studijní dokumenty
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Studuje produkt zařízení regulovaný americkým úřadem FDA
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