Wrist Extensor MEP Up-conditioning for Individuals With Incomplete Spinal Cord Injury

Medical University of South Carolina5 enrolled

Overview

The purpose of this study is to examine the relationship between common clinical assessments and measurements of the function of brain-spinal cord-muscle connections, and to examine the effects of training a brain-spinal cord-muscle response in individuals with incomplete spinal cord injury. A transcranial magnetic stimulator (TMS) is used for examining brain-to-muscle pathways. This stimulator produces a magnetic field for a very short period of time and indirectly stimulates brain cells with little or no discomfort. The target muscle is the wrist extensor (extensor carpi radialis) muscle that bends the wrist back. It is hypothesized that training the wrist extensor muscle response to transcranial magnetic stimulation will increase the strength of the brain-to-muscle pathway, which will improve the ability to move the arm. It is hoped that the results of this training study will help in developing therapy strategies for individuals, promoting better understanding of clinical assessments, and understanding treatments that aim to improve function recovery in people with spinal cord injury (SCI). This study requires 30 visits, and each visit will last approximately 1.5 hours.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Spinal Cord Injuries Quadriplegia

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. a history of injury to spinal cord at or above C6 2. neurologically stable (\>6 mo post SCI) 3. medical clearance to participate 4. weak wrist extension at least unilaterally 5. expectation that current medication will be maintained without change for at least 3 months. Stable use of anti-spasticity medication (e.g., baclofen, diazepam, tizanidine) is accepted. In participants with bilateral wrist extension weakness, the more severely impaired arm is studied. Exclusion Criteria: 1. motoneuron injury 2. medically unstable condition 3. cognitive impairment 4. a history of epileptic seizures 5. metal implants in the cranium 6. implanted biomedical device in or above the chest (e.g., a cardiac pacemaker, cochlear implant) 7. no measurable MEP elicited in the ECR 8. unable to produce any voluntary ECR EMG activity 9. extensive use of functional electrical stimulation to the arm on a daily basis 10. pregnancy (due to changes in posture and potential medical instability).

Outcomes

Primary Outcomes

Change in the excitability/strength of the brain-spinal cord-muscle pathway at the brain level as measured by the Motor Evoked Potential

An increased average MEP size (mV) would indicate increased excitability/strength of the brain-spinal cord-muscle pathway

Time frame: Baseline and final training session (approximately 2.5 months)

Change in ability to move the arm as measured by the Action Research Arm Test (ARAT). Maximum score of 57 points

An increase in ARAT score indicates an improvement in the ability to move the arm