Combined TMS-tSCS for Lower Limb Rehabilitation in Chronic Incomplete SCI
A Randomized Controlled Trial Comparing Combined TMS-tSCS Neuromodulation Versus tSCS Alone Lower Limb Rehabilitation in Chronic Incomplete SCI
he goal of this clinical trial is to learn if combined brain and spinal cord stimulation using TMS-tSCS can improve leg strength and walking recovery in adults with chronic incomplete spinal cord injury.
The main questions it aims to answer are:
Does combined TMS-tSCS improve lower limb motor function more than tSCS alone? Is combined TMS-tSCS safe and does it improve walking speed, independence, muscle activity, spasticity, and nerve pathway function?
Researchers will compare combined TMS-tSCS with tSCS alone with sham TMS to see if adding brain stimulation leads to better recovery than spinal stimulation alone.
Participants will:
Attend 32 treatment sessions over 16 weeks. Receive either combined TMS-tSCS or tSCS with sham TMS. Undergo assessments of leg strength, walking speed, daily function, muscle stiffness, muscle activity, and nerve pathway function before and after treatment.
Przegląd badań
Status
Status
Warunki
Warunki
Interwencja / Leczenie
Interwencja / Leczenie
Szczegółowy opis
Typ studiów
Typ studiów
Zapisy (Szacowany)
Zapisy
Faza
Faza
- Nie dotyczy
Kontakty i lokalizacje
Kontakt w sprawie studiów
Kontakt w sprawie studiów
- Nazwa: Gobinathan Chandran, MBBS
- Numer telefonu: +65 94575924
- E-mail: Gobinathan_CHANDRAN@nuhs.edu.sg
Kopia zapasowa kontaktu do badania
- Nazwa: Tang Ning, PhD
- E-mail: ning_tang@nuhs.edu.sg
Lokalizacje studiów
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Singapore, Singapur
- Alexandra Hospital/ National University Hospital, Singapore
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Kontakt:
- Gobinathan Chandran, MBBS
- Numer telefonu: +65 94575924
- E-mail: Gobinathan_CHANDRAN@nuhs.edu.sg
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Kryteria uczestnictwa
Kryteria kwalifikacji
Kryteria kwalifikacji
Wiek uprawniający do nauki
- Dorosły
- Starszy dorosły
Akceptuje zdrowych ochotników
Opis
Inclusion Criteria
- Age 18-65 years at enrolment
- Chronic traumatic spinal cord injury, defined as ≥12 months post-injury
- Incomplete spinal cord injury, AIS grade C or D
- Neurological level of injury from C2 to L1
- Baseline Lower Extremity Motor Score (LEMS) >10 points
- Medically stable
- Able to provide informed consent
- Able to commit to the full study duration
- Able to attempt the 10-Meter Walk Test and 6-Minute Walk Test, with or - without assistive devices and standby assistance
Exclusion Criteria
- History of seizures or epilepsy
- Implanted electronic devices, such as: Pacemaker, Cochlear implant, Deep brain stimulator, Spinal cord stimulator, Metallic implants in the head or spine
- Pregnancy or planned pregnancy
- Active psychiatric disorder or cognitive impairment
- Concomitant neurological conditions, such as: Stroke, Traumatic brain injury and Neuropathy
- Skin breakdown at electrode sites
- Current participation in another clinical trial
- History of skull surgery or craniotomy
- Use of medications that alter cortical excitability within the past 2 weeks
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
- Główny cel: Leczenie
- Przydział: Randomizowane
- Model interwencyjny: Przydział równoległy
- Maskowanie: Pojedynczy
Liczba ramion
Broń i interwencje
Grupa uczestników / ArmGrupa uczestników / Arm |
Interwencja / LeczenieInterwencja / Leczenie |
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Eksperymentalny: iTBS combined with tSCS plus standardized lower limb rehabilitation
Interventions are delivered twice weekly for 16 weeks (32 sessions): iTBS over M1 followed by combined tSCS plus lower limb rehabilitation (45-60 min).
tSCS uses a constant-current stimulator with 5×10 cm electrodes at placed at one level above and below the site of the spinal cord injury, with reference electrodes over the ASIS or clavicles.
Parameters: biphasic pulses at 30 Hz, 1 ms pulses with 10 kHz carrier frequency, intensity 40-120 mA, delivered continuously for ~45 minutes.The iTBS protocol consists of bursts of 3 pulses at 50 Hz, repeated at 5 Hz (200 ms between bursts), delivered in 2-second trains with 8-second inter-train intervals.
Each session will deliver 600 pulses total.
The stimulation target will be the leg motor area of the primary motor cortex, identified using established anatomical landmarks and confirmed by eliciting motor evoked potentials (MEPs) in lower extremity muscles.
Lower limb rehabilitation follows immediately, supervised by a physiotherapist.
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Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that enhances cortical excitability and corticospinal drive.
Intermittent theta burst stimulation (iTBS), a brief patterned form of rTMS, produces lasting facilitatory effects and is more time-efficient.
Evidence indicates rTMS improves motor function, reduces spasticity, and enhances neuroplasticity in SCI.
Transcutaneous spinal cord stimulation (tSCS) is a non-invasive neuromodulation technique that delivers electrical stimulation over the spine to activate sensory afferents and enhance spinal motor circuit excitability.
Early studies showed it can enable voluntary movement even in motor-complete spinal cord injury (SCI), with subsequent research demonstrating improvements in motor function, standing, and walking in incomplete SCI.
Evidence suggests tSCS modulates both spinal and corticospinal pathways, supporting neuroplasticity.
The Up-LIFT trial (2024) provided strong clinical evidence, showing that tSCS combined with rehabilitation significantly improved upper limb strength and function in chronic cervical SCI, with 72% of participants meeting effectiveness endpoints and no serious adverse events.
Later studies confirmed its safety in home and community settings, though standardization and larger trials remain needed.
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Aktywny komparator: tSCS plus standardized lower limb rehabilitation only
tSCS uses a constant-current stimulator with 5×10 cm electrodes at placed at one level above and below the site of the spinal cord injury, with reference electrodes over the ASIS or clavicles.
Parameters: biphasic pulses at 30 Hz, 1 ms pulses with 10 kHz carrier frequency, intensity 40-120 mA, delivered continuously for ~45 minutes.
Lower limb rehabilitation follows immediately, supervised by a physiotherapist.
|
Transcutaneous spinal cord stimulation (tSCS) is a non-invasive neuromodulation technique that delivers electrical stimulation over the spine to activate sensory afferents and enhance spinal motor circuit excitability.
Early studies showed it can enable voluntary movement even in motor-complete spinal cord injury (SCI), with subsequent research demonstrating improvements in motor function, standing, and walking in incomplete SCI.
Evidence suggests tSCS modulates both spinal and corticospinal pathways, supporting neuroplasticity.
The Up-LIFT trial (2024) provided strong clinical evidence, showing that tSCS combined with rehabilitation significantly improved upper limb strength and function in chronic cervical SCI, with 72% of participants meeting effectiveness endpoints and no serious adverse events.
Later studies confirmed its safety in home and community settings, though standardization and larger trials remain needed.
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Co mierzy badanie?
Podstawowe miary wyniku
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Lower Extremity Motor Score (LEMS)
Ramy czasowe: Week 0
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Description: The LEMS is a component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), representing the summed strength of five key muscle groups in each lower extremity (hip flexors, knee extensors, ankle dorsiflexors, great toe extensors, and ankle plantarflexors), graded on a 0-5 scale for each muscle group.
The total LEMS ranges from 0 to 50 points, with higher scores indicating greater motor strength
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Week 0
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Lower Extremity Motor Score (LEMS)
Ramy czasowe: Week 8
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The LEMS is a component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), representing the summed strength of five key muscle groups in each lower extremity (hip flexors, knee extensors, ankle dorsiflexors, great toe extensors, and ankle plantarflexors), graded on a 0-5 scale for each muscle group.
The total LEMS ranges from 0 to 50 points, with higher scores indicating greater motor strength
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Week 8
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Lower Extremity Motor Score (LEMS)
Ramy czasowe: Week 16
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Description: The LEMS is a component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), representing the summed strength of five key muscle groups in each lower extremity (hip flexors, knee extensors, ankle dorsiflexors, great toe extensors, and ankle plantarflexors), graded on a 0-5 scale for each muscle group.
The total LEMS ranges from 0 to 50 points, with higher scores indicating greater motor strength
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Week 16
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Lower Extremity Motor Score (LEMS)
Ramy czasowe: Week 20
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Description: The LEMS is a component of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), representing the summed strength of five key muscle groups in each lower extremity (hip flexors, knee extensors, ankle dorsiflexors, great toe extensors, and ankle plantarflexors), graded on a 0-5 scale for each muscle group.
The total LEMS ranges from 0 to 50 points, with higher scores indicating greater motor strength
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Week 20
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Miary wyników drugorzędnych
Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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10-Meter Walk Test (10MWT)
Ramy czasowe: Week 0
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Assess walking speed over a 10-meter distance at both comfortable and maximum speeds, with excellent reliability (ICC > 0.95) established for SCI populations.
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Week 0
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10-Meter Walk Test (10MWT)
Ramy czasowe: Week 8
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Assess walking speed over a 10-meter distance at both comfortable and maximum speeds, with excellent reliability (ICC > 0.95) established for SCI populations.
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Week 8
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10-Meter Walk Test (10MWT)
Ramy czasowe: Week 16
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Assess walking speed over a 10-meter distance at both comfortable and maximum speeds, with excellent reliability (ICC > 0.95) established for SCI populations.
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Week 16
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6-Minute Walk Test (6MWT)
Ramy czasowe: Week 0
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6-Minute Walk Test (6MWT) will measure walking endurance as the total distance walked in 6 minutes on a standardized course.
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Week 0
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6-Minute Walk Test (6MWT)
Ramy czasowe: Week 8
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6-Minute Walk Test (6MWT) will measure walking endurance as the total distance walked in 6 minutes on a standardized course.
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Week 8
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6-Minute Walk Test (6MWT)
Ramy czasowe: Week 16
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6-Minute Walk Test (6MWT) will measure walking endurance as the total distance walked in 6 minutes on a standardized course.
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Week 16
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6-Minute Walk Test (6MWT)
Ramy czasowe: Week 20
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6-Minute Walk Test (6MWT) will measure walking endurance as the total distance walked in 6 minutes on a standardized course.
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Week 20
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Spinal Cord Independence Measure-III (SCIM-III)
Ramy czasowe: Week 0
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Spinal Cord Independence Measure-III (SCIM-III) is a disability scale specifically developed for persons with SCI, assessing self-care (0- 20 points), respiration and sphincter management (0-40 points), and mobility (0-40 points).
The total score ranges from 0-100, with higher scores indicating greater independence
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Week 0
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Spinal Cord Independence Measure-III (SCIM-III)
Ramy czasowe: Week 8
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Spinal Cord Independence Measure-III (SCIM-III) is a disability scale specifically developed for persons with SCI, assessing self-care (0- 20 points), respiration and sphincter management (0-40 points), and mobility (0-40 points).
The total score ranges from 0-100, with higher scores indicating greater independence
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Week 8
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Spinal Cord Independence Measure-III (SCIM-III)
Ramy czasowe: Week 16
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Spinal Cord Independence Measure-III (SCIM-III) is a disability scale specifically developed for persons with SCI, assessing self-care (0- 20 points), respiration and sphincter management (0-40 points), and mobility (0-40 points).
The total score ranges from 0-100, with higher scores indicating greater independence
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Week 16
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Spinal Cord Independence Measure-III (SCIM-III)
Ramy czasowe: Week 20
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Spinal Cord Independence Measure-III (SCIM-III) is a disability scale specifically developed for persons with SCI, assessing self-care (0- 20 points), respiration and sphincter management (0-40 points), and mobility (0-40 points).
The total score ranges from 0-100, with higher scores indicating greater independence
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Week 20
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Modified Ashworth Scale (MAS)
Ramy czasowe: Week 0
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Modified Ashworth Scale (MAS) will be used to assess spasticity in bilateral hip flexors, knee extensors, and ankle plantarflexors, graded from 0 (no increase in tone) to 4 (limb rigid in flexion or extension).
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Week 0
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Modified Ashworth Scale (MAS)
Ramy czasowe: Week 8
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Modified Ashworth Scale (MAS) will be used to assess spasticity in bilateral hip flexors, knee extensors, and ankle plantarflexors, graded from 0 (no increase in tone) to 4 (limb rigid in flexion or extension).
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Week 8
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Modified Ashworth Scale (MAS)
Ramy czasowe: Week 16
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Modified Ashworth Scale (MAS) will be used to assess spasticity in bilateral hip flexors, knee extensors, and ankle plantarflexors, graded from 0 (no increase in tone) to 4 (limb rigid in flexion or extension).
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Week 16
|
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Modified Ashworth Scale (MAS)
Ramy czasowe: Week 20
|
Modified Ashworth Scale (MAS) will be used to assess spasticity in bilateral hip flexors, knee extensors, and ankle plantarflexors, graded from 0 (no increase in tone) to 4 (limb rigid in flexion or extension).
|
Week 20
|
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10-Meter Walk Test (10MWT)
Ramy czasowe: Week 20
|
Assess walking speed over a 10-meter distance at both comfortable and maximum speeds, with excellent reliability (ICC > 0.95) established for SCI populations.
|
Week 20
|
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Peak-to-peak amplitude of motor evoked potential (MEP)
Ramy czasowe: Week 0
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Measured by transcranial magnetic stimulation (TMS).
Amplitude, latency, resting and active motor thresholds from FDI and APB will be recorded.
The bigger value of peak-to peak amplitude of MEP indicates better outcome
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Week 0
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Peak-to-peak amplitude of motor evoked potential (MEP)
Ramy czasowe: Week 8
|
Measured by transcranial magnetic stimulation (TMS).
Amplitude, latency, resting and active motor thresholds from FDI and APB will be recorded.
The bigger value of peak-to peak amplitude of MEP indicates better outcome
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Week 8
|
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Peak-to-peak amplitude of motor evoked potential (MEP)
Ramy czasowe: Week 16
|
Measured by transcranial magnetic stimulation (TMS).
Amplitude, latency, resting and active motor thresholds from FDI and APB will be recorded.
The bigger value of peak-to peak amplitude of MEP indicates better outcome
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Week 16
|
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Peak-to-peak amplitude of motor evoked potential (MEP)
Ramy czasowe: Week 20
|
Measured by transcranial magnetic stimulation (TMS).
Amplitude, latency, resting and active motor thresholds from FDI and APB will be recorded.
The bigger value of peak-to peak amplitude of MEP indicates better outcome
|
Week 20
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Root-Mean-Square (RMS) of Electromyography (EMG)
Ramy czasowe: Week 0
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Surface electromyography (EMG) will be recorded bilaterally from the tibialis anterior, medial gastrocnemius, rectus femoris, and biceps femoris muscles.
EMG signals will be recorded during resting state for 10s and isometric muscle contraction for 5s.
Normalized EMG RMS will be calculated accordingly.
Higher normalized EMG RMS during isometric muscle contraction indicates more muscle engagement.
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Week 0
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Root-Mean-Square (RMS) of Electromyography (EMG)
Ramy czasowe: Week 8
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Surface electromyography (EMG) will be recorded bilaterally from the tibialis anterior, medial gastrocnemius, rectus femoris, and biceps femoris muscles.
EMG signals will be recorded during resting state for 10s and isometric muscle contraction for 5s.
Normalized EMG RMS will be calculated accordingly.
Higher normalized EMG RMS during isometric muscle contraction indicates more muscle engagement.
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Week 8
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Root-Mean-Square (RMS) of Electromyography (EMG)
Ramy czasowe: Week 16
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Surface electromyography (EMG) will be recorded bilaterally from the tibialis anterior, medial gastrocnemius, rectus femoris, and biceps femoris muscles.
EMG signals will be recorded during resting state for 10s and isometric muscle contraction for 5s.
Normalized EMG RMS will be calculated accordingly.
Higher normalized EMG RMS during isometric muscle contraction indicates more muscle engagement.
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Week 16
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Root-Mean-Square (RMS) of Electromyography (EMG)
Ramy czasowe: Week 20
|
Surface electromyography (EMG) will be recorded bilaterally from the tibialis anterior, medial gastrocnemius, rectus femoris, and biceps femoris muscles.
EMG signals will be recorded during resting state for 10s and isometric muscle contraction for 5s.
Normalized EMG RMS will be calculated accordingly.
Higher normalized EMG RMS during isometric muscle contraction indicates more muscle engagement.
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Week 20
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Współpracownicy i badacze
Sponsor
Sponsor
Śledczy
Śledczy
- Główny śledczy: Gobinathan Chandran, MBBS, NUH
Daty zapisu na studia
Główne daty studiów
Rozpoczęcie studiów (Szacowany)
Rozpoczęcie studiów
Zakończenie podstawowe (Szacowany)
Zakończenie podstawowe
Ukończenie studiów (Szacowany)
Ukończenie studiów
Daty rejestracji na studia
Pierwszy przesłany
Pierwszy przesłany
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy przesłany, który spełnia kryteria kontroli jakości
Pierwszy wysłany (Rzeczywisty)
Pierwszy wysłany
Aktualizacje rekordów badań
Ostatnia wysłana aktualizacja (Rzeczywisty)
Ostatnia wysłana aktualizacja
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia przesłana aktualizacja, która spełniała kryteria kontroli jakości
Ostatnia weryfikacja
Ostatnia weryfikacja
Więcej informacji
Terminy związane z tym badaniem
Słowa kluczowe
Dodatkowe istotne warunki MeSH
Inne numery identyfikacyjne badania
Inne numery identyfikacyjne badania
- 1773917
Plan dla danych uczestnika indywidualnego (IPD)
Planujesz udostępniać dane poszczególnych uczestników (IPD)?
Opis planu IPD
Informacje o lekach i urządzeniach, dokumenty badawcze
Bada produkt leczniczy regulowany przez amerykańską FDA
Bada produkt urządzenia regulowany przez amerykańską FDA
produkt wyprodukowany i wyeksportowany z USA
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