Ninety-nine individuals meeting the study's inclusion/exclusion criteria will be enrolled in this study. The objective of this study is to evaluate three different therapeutic approaches to synergistically retrain functional movement patterns of the upper extremities in combination with trunk stabilization to promote neurologic and functional recovery after SCI. Each subject will complete 40 sessions of intervention. Subjects will also complete a Baseline Evaluation (week 0), Re-Evaluation (week 4), Post Treatment Evaluation (week 8), and a Follow-Up Evaluation (week 12).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
99
Participants will be challenged with training speed, weight, limited therapist support, and context variation (e.g., fine motor activities will vary using objects such as cards, dice, coins).
Participants will be challenged with training speed, weight, limited therapist support, and context variation (e.g., fine motor activities will vary using objects such as cards, dice, coins). Muscle groups will be stimulated at the same time they would be activated naturally in a pre-injury movement pattern utilizing conventional parameter FES.
Participants will be challenged with training speed, weight, limited therapist support, and context variation (e.g., fine motor activities will vary using objects such as cards, dice, coins). Muscle groups will be stimulated at the same time they would be activated naturally in a pre-injury movement pattern utilizing wide pulse, high frequency parameter FES.
Craig Hospital
Englewood, Colorado, United States
Capabilities of Upper Extremity Test (CUE-T)
32 item test, each item scored on a 0-4 point scale with total scores ranging from 0-128.
Time frame: Week 0 to Week 12
Graded Refined Assessment of Strength, Sensibility, and Prehension (GRASSP)
This multimodal test measures sensorimotor and prehension function in three domains important in describing arm and hand function
Time frame: Week 0, Week 8, and Week 12
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Sensory Level
The ISNCSCI involves a detailed examination to determine the sensory level for the right and left sides. The sensory level is the most caudal, intact dermatome. Scores range from 0-2. The higher the score the more intact the dermatome is.
Time frame: Week 0, Week 8, and Week 12
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Motor Level
The ISNCSCI involves a detailed examination to determine motor levels for the right and left sides. The motor level is defined as the lowest key muscle function that has a grade of at least a 3, providing key muscle functions represented by segments above that level are judged to be intact. Scores range from 0-5. The higher the score the more intact the muscle is.
Time frame: Week 0, Week 8, and Week 12
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Neurological Level of Injury
The ISNCSCI involves a detailed examination to determine the neurological level of injury. The neurological level of injury refers to the most caudal segment of the cord with intact sensation and antigravity muscle function strength, provided that there is normal sensory and motor function rostrally respectively. The neurological level of injury is the most cephalad of the sensory and motor levels.
Time frame: Week 0, Week 8, and Week 12
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Sacral Sparing
The ISNCSCI involves a detailed examination to determine whether a spinal cord injury is complete or incomplete. If an injury is considered complete there is an absence of voluntary anal contraction, absent sensory scores of S4-5, and absence of deep anal pressure.
Time frame: Week 0, Week 8, and Week 12
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Impairment Grade
The ISNCSCI involves a detailed examination to determine a spinal cord injury's grade according to the American Spinal Injury Association. Score ranges from A-E. ASIA classification A means spinal injury is considered complete with no sensory or motor function preserved in sacral segments. On the opposite end of the scale an ASIA classification E means 'normal'.
Time frame: Week 0, Week 8, and Week 12
Pinch Force
Pinch force will be measured by the Commander Echo Console with the JTech Pinch Dynamometer to quantify finger strength.
Time frame: Week 0, Week 8, and Week 12
Grasp Force
Grasp force will be measured by the Commander Echo Console with the JTech Hand Dynamometer to quantify grasp strength.
Time frame: Week 0, Week 8, and Week 12
Modified Functional Reach (MFR)
The MFR will be used to measure dynamic trunk stability
Time frame: Week 0, Week 8, and Week 12
Global Rating of Change (GRC)
The Global Rating of Change scale assesses perceived change from an intervention. 9 point Likert scale. Higher positive score reflects great improvement
Time frame: Week 0, Week 8, and Week 12
NeuroRecovery Scale (NRS)
The full NRS comprises of 16items. For the purpose of this upper extremity interventional study, only six items will be used that represent a variety of functional upper extremity movement patterns required for ADL management. These scores will be used to guide treatment across all 3 groups. Scores range from 1A-4C. Higher scores reflect greater recovery of spinal cord injury.
Time frame: Week 0 and Week 4
Demographic Information
Demographic information will include: age, sex, race/ethnic background, pre-injury education, employment status, marital status, and living situation.
Time frame: Week 0
Injury Information
Injury information will include: date of injury, cause of injury, baseline AIS classification, and injury level.
Time frame: Week 0
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