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Transcutaneous Spinal Stimulation and Exercise for Locomotion

Primary Purpose

Spinal Cord Injuries

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Transcutaneous spinal stimulation
Physical Therapy
Sponsored by
University of Washington
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Spinal Cord Injuries focused on measuring Spinal electrical stimulation

Eligibility Criteria

21 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Has spinal cord injury (T12 or higher level) of at least 1-year duration
  • Is between 21 and 70 years of age
  • Has difficulty with leg functions and mobility in activities of daily living (e.g. walking, transferring surface to surface, standing)
  • Has stable medical condition without cardiopulmonary disease or frequent autonomic dysreflexia that would contraindicate participation in lower extremity rehabilitation or testing activities
  • Is capable of performing simple cued motor tasks
  • Has ability to attend up to 5 sessions per week physical therapy sessions and testing activities
  • Has adequate social support to be able to participate in training and assessment sessions, up to 5 sessions per week, for the duration of up to 11 months within the study period.
  • Is volunteering to be involved in this study
  • Cleared for gait training by the primary physician of the subject
  • Has the ability to read and speak English

Exclusion Criteria:

  • Has autoimmune etiology of spinal cord dysfunction/injury
  • Has history of additional neurologic disease, such as stroke, multiple sclerosis, traumatic brain injury, etc.
  • Has peripheral neuropathy (diabetic polyneuropathy, entrapment neuropathy, etc.)
  • Has rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, etc.)
  • Has significant medical disease; including uncontrolled systemic hypertension with values above 170/100 mmHg; cardiac or pulmonary disease; uncorrected coagulation abnormalities or need for therapeutic anticoagulation.
  • Has active cancer
  • Has cardiovascular or musculoskeletal disease or injury that would prevent full participation in physical therapy intervention
  • Has unhealed fracture, contracture, pressure sore, urinary tract infection, or other illnesses that might interfere with lower extremity rehabilitation or testing activities
  • Has any condition that would render the patient unable to safely cooperate with the study tests as judged by the screening physician
  • is pregnant
  • is dependent on ventilation support
  • Has implanted stimulator (e.g. epidural stimulator, vagus nerve stimulator, pacemaker, cochlear implant, etc).
  • Has depression or anxiety based on the Center for Epidemiologic Studies Depression Scale (CESD) (score >16/60) and General Anxiety Disorder-7 item Questionnaire (score >9/21), respectively.
  • Has alcohol and/or drug abuse.
  • Has cognitive impairment based on Short Portable Mental Status Questionnaire (SPMSQ) (score >2/10).
  • is unable to read and/or comprehend the consent form.
  • is unable to understand the instructions given as part of the study
  • Has established osteoporosis and taking medication for osteoporosis treatment.
  • Has bone mineral density T scores ≤ -3.5 in the anteroposterior lumbar spine and/or proximal femur measured by DEXA (if participants are clear for other criteria and have not been examined by Dual Energy Xray Absorptiometry (DEXA) at the screening, we will ask participants to undergo DEXA to reveal any risk of weight bearing activity)
  • Has low-energy fracture history before or after spinal cord injury

Sites / Locations

  • University of WashingtonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Active Comparator

Arm Label

Transcutaneous spinal stimulation & Physical therapy

Physical therapy only

Arm Description

Transcutaneous electrical stimulation combined with physical therapy that targets rehabilitation of walking and standing functions

Physical therapy that targets rehabilitation of walking and standing functions

Outcomes

Primary Outcome Measures

Six-Minute Walk Test
Measurement of walking ability. The distance is reported in meter.

Secondary Outcome Measures

International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Examination
Standard neurologic examination that is routinely used to determine the levels and severity of spinal cord injury. Includes manual muscle strength testing and dermatomal light touch and pin prick sensory examination.
Somatosensory evoked potentials
Measurement of latency of electrical potentials that is recorded by surface electrodes over the scalp following electrical stimulation of peripheral nerve from the wrist. The latency of the response is reported in micro-seconds.
Somatosensory evoked potentials
Measurement of amplitude of electrical potentials that is recorded by surface electrodes over the scalp following electrical stimulation of peripheral nerve from the wrist. The amplitude of the response is reported in micro-volts.
Motor evoked potentials
Measurement of latency of electrical potentials that is recorded by surface electrodes over the skin of limb muscles following spinal stimulation or magnetic stimulation of brain over the scalp. The latency of the response is reported in micro-seconds.
Motor evoked potentials
Measurement of amplitude of electrical potentials that is recorded by surface electrodes over the skin of limb muscles following spinal stimulation or magnetic stimulation of brain over the scalp. The amplitude of the response is reported in micro-volts.
Berg Balance Test
Measurement of balance in standing and sitting. The balance score consists of 14 items and is reported in the scale of 56 (each items are score in 0-4).
Ten-minute walk test
Measurement of walking ability. The walking speed is reported in meter per second.
Kinetic and kinematic gait analysis using 3D camera system
Measurement of leg function and walking ability. Joint angle is reported in degree angle.
Kinetic and kinematic gait analysis using 3D camera system
Measurement of leg function and walking ability. Velocity is reported in meter per second.
Electromyography recording of lower extremity and trunk muscles
Measurement of muscle and nerve functions. The muscle activities are reported in micro-volts.
Spinal Cord Injury - Quality of Life (SCI-QOL) questionnaire
Patient reported quality of life scale. The SCI-QOL consists of 19 item banks, and is reported by T-score comparing the mean of the functional level in the population.
Spinal Cord Injury - Functional Index (SCI-FI) questionnaire
Patient reported functional scale. The SCI-QOL consists of 10 item banks, and is reported by T-score comparing the mean of the functional level in the population.
Modified Ashworth Scale
Measurement of spasticity. Tests resistance to passive movement about joints. Score range from 0-4, with 6 choices.
Neurogenic Bowel Dysfunction Score
self-report questionnaire designed to help healthcare professionals evaluate the effectiveness of their patient's current bowel management routine by assessing the impact it has on the patient's quality of life. Questions ask about background parameters (n=8), faecal incontinence (n=10), constipation (n=10), obstructed defecation (n=8), and impact on quality of life (QOL).
Neurogenic Bladder Symptom Score
objective and validated self-report questionnaire to assess bladder symptoms in patients with neurogenic bladder dysfunction.

Full Information

First Posted
March 24, 2018
Last Updated
November 14, 2022
Sponsor
University of Washington
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1. Study Identification

Unique Protocol Identification Number
NCT03509558
Brief Title
Transcutaneous Spinal Stimulation and Exercise for Locomotion
Official Title
Transcutaneous Spinal Stimulation With Intensive Physical Therapy for Locomotion
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Recruiting
Study Start Date
February 28, 2018 (Actual)
Primary Completion Date
September 30, 2023 (Anticipated)
Study Completion Date
December 31, 2023 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Washington

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Growing evidence indicates that electrical spinal cord stimulation improves motor functions both immediately and over the long term via modulating the excitability of spinal circuitry in patients with spinal cord injury. Recently, a novel, non-invasive, well-tolerated, and painless lumbosacral transcutaneous electrical stimulation strategy was demonstrated to be effective in improving lower limb motor function in participants with spinal cord injury. Our current project, cervical transcutaneous electrical stimulation and intensive exercise for arms and hands are also revealing a significant improvement in upper extremity function. Additionally, the subject and caregiver noted that stair climbing ability has been substantially enhanced starting from the first week of cervical stimulation treatment and continues to date. This study is a prospective efficacy trial of combined transcutaneous cervical and lumbosacral electrical stimulation with intensive physical therapy for improving locomotion in people with incomplete tetraplegia and paraplegia. This experiment design consists of two to four-phase intervention programs, including one-month physical therapy only followed by one-month spinal stimulation combined with physical therapy. Between each intervention, washout periods of up to one month may be used to determine any after-effects of the interventions. The intervention arms will be repeated if the functional improvement does not reach a plateau during the first two months of interventions. Sessions will last up to 2 hours/day, 2 to 5 days/week for each arm. Both immediate and lasting improvements in lower extremity function and autonomic function via transcutaneous spinal stimulation and intensive physical therapy will be evaluated.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Cord Injuries
Keywords
Spinal electrical stimulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
10 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Transcutaneous spinal stimulation & Physical therapy
Arm Type
Active Comparator
Arm Description
Transcutaneous electrical stimulation combined with physical therapy that targets rehabilitation of walking and standing functions
Arm Title
Physical therapy only
Arm Type
Active Comparator
Arm Description
Physical therapy that targets rehabilitation of walking and standing functions
Intervention Type
Device
Intervention Name(s)
Transcutaneous spinal stimulation
Other Intervention Name(s)
Physical Therapy
Intervention Description
Non-invasive electrical stimulation of spinal cord over the skin combined with physical therapy to improve walking and standing functions
Intervention Type
Other
Intervention Name(s)
Physical Therapy
Intervention Description
physical therapy to improve walking and standing functions
Primary Outcome Measure Information:
Title
Six-Minute Walk Test
Description
Measurement of walking ability. The distance is reported in meter.
Time Frame
8-11 months
Secondary Outcome Measure Information:
Title
International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) Examination
Description
Standard neurologic examination that is routinely used to determine the levels and severity of spinal cord injury. Includes manual muscle strength testing and dermatomal light touch and pin prick sensory examination.
Time Frame
8-11 months
Title
Somatosensory evoked potentials
Description
Measurement of latency of electrical potentials that is recorded by surface electrodes over the scalp following electrical stimulation of peripheral nerve from the wrist. The latency of the response is reported in micro-seconds.
Time Frame
8-11 months
Title
Somatosensory evoked potentials
Description
Measurement of amplitude of electrical potentials that is recorded by surface electrodes over the scalp following electrical stimulation of peripheral nerve from the wrist. The amplitude of the response is reported in micro-volts.
Time Frame
8-11 months
Title
Motor evoked potentials
Description
Measurement of latency of electrical potentials that is recorded by surface electrodes over the skin of limb muscles following spinal stimulation or magnetic stimulation of brain over the scalp. The latency of the response is reported in micro-seconds.
Time Frame
8-11 months
Title
Motor evoked potentials
Description
Measurement of amplitude of electrical potentials that is recorded by surface electrodes over the skin of limb muscles following spinal stimulation or magnetic stimulation of brain over the scalp. The amplitude of the response is reported in micro-volts.
Time Frame
8-11 months
Title
Berg Balance Test
Description
Measurement of balance in standing and sitting. The balance score consists of 14 items and is reported in the scale of 56 (each items are score in 0-4).
Time Frame
8-11 months
Title
Ten-minute walk test
Description
Measurement of walking ability. The walking speed is reported in meter per second.
Time Frame
8-11 months
Title
Kinetic and kinematic gait analysis using 3D camera system
Description
Measurement of leg function and walking ability. Joint angle is reported in degree angle.
Time Frame
8-11 months
Title
Kinetic and kinematic gait analysis using 3D camera system
Description
Measurement of leg function and walking ability. Velocity is reported in meter per second.
Time Frame
8-11 months
Title
Electromyography recording of lower extremity and trunk muscles
Description
Measurement of muscle and nerve functions. The muscle activities are reported in micro-volts.
Time Frame
8-11 months
Title
Spinal Cord Injury - Quality of Life (SCI-QOL) questionnaire
Description
Patient reported quality of life scale. The SCI-QOL consists of 19 item banks, and is reported by T-score comparing the mean of the functional level in the population.
Time Frame
8-11 months
Title
Spinal Cord Injury - Functional Index (SCI-FI) questionnaire
Description
Patient reported functional scale. The SCI-QOL consists of 10 item banks, and is reported by T-score comparing the mean of the functional level in the population.
Time Frame
8-11 months
Title
Modified Ashworth Scale
Description
Measurement of spasticity. Tests resistance to passive movement about joints. Score range from 0-4, with 6 choices.
Time Frame
8-11 months
Title
Neurogenic Bowel Dysfunction Score
Description
self-report questionnaire designed to help healthcare professionals evaluate the effectiveness of their patient's current bowel management routine by assessing the impact it has on the patient's quality of life. Questions ask about background parameters (n=8), faecal incontinence (n=10), constipation (n=10), obstructed defecation (n=8), and impact on quality of life (QOL).
Time Frame
8-11 months
Title
Neurogenic Bladder Symptom Score
Description
objective and validated self-report questionnaire to assess bladder symptoms in patients with neurogenic bladder dysfunction.
Time Frame
8-11 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
21 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Has spinal cord injury (T12 or higher level) of at least 1-year duration Is between 21 and 70 years of age Has difficulty with leg functions and mobility in activities of daily living (e.g. walking, transferring surface to surface, standing) Has stable medical condition without cardiopulmonary disease or frequent autonomic dysreflexia that would contraindicate participation in lower extremity rehabilitation or testing activities Is capable of performing simple cued motor tasks Has ability to attend up to 5 sessions per week physical therapy sessions and testing activities Has adequate social support to be able to participate in training and assessment sessions, up to 5 sessions per week, for the duration of up to 11 months within the study period. Is volunteering to be involved in this study Cleared for gait training by the primary physician of the subject Has the ability to read and speak English Exclusion Criteria: Has autoimmune etiology of spinal cord dysfunction/injury Has history of additional neurologic disease, such as stroke, multiple sclerosis, traumatic brain injury, etc. Has peripheral neuropathy (diabetic polyneuropathy, entrapment neuropathy, etc.) Has rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, etc.) Has significant medical disease; including uncontrolled systemic hypertension with values above 170/100 mmHg; cardiac or pulmonary disease; uncorrected coagulation abnormalities or need for therapeutic anticoagulation. Has active cancer Has cardiovascular or musculoskeletal disease or injury that would prevent full participation in physical therapy intervention Has unhealed fracture, contracture, pressure sore, urinary tract infection, or other illnesses that might interfere with lower extremity rehabilitation or testing activities Has any condition that would render the patient unable to safely cooperate with the study tests as judged by the screening physician is pregnant is dependent on ventilation support Has implanted stimulator (e.g. epidural stimulator, vagus nerve stimulator, pacemaker, cochlear implant, etc). Has depression or anxiety based on the Center for Epidemiologic Studies Depression Scale (CESD) (score >16/60) and General Anxiety Disorder-7 item Questionnaire (score >9/21), respectively. Has alcohol and/or drug abuse. Has cognitive impairment based on Short Portable Mental Status Questionnaire (SPMSQ) (score >2/10). is unable to read and/or comprehend the consent form. is unable to understand the instructions given as part of the study Has established osteoporosis and taking medication for osteoporosis treatment. Has bone mineral density T scores ≤ -3.5 in the anteroposterior lumbar spine and/or proximal femur measured by DEXA (if participants are clear for other criteria and have not been examined by Dual Energy Xray Absorptiometry (DEXA) at the screening, we will ask participants to undergo DEXA to reveal any risk of weight bearing activity) Has low-energy fracture history before or after spinal cord injury
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Soshi Samejima, DPT, MS
Phone
206 221-8961
Email
soshis@uw.edu
First Name & Middle Initial & Last Name or Official Title & Degree
Chet Moritz, PhD
Phone
206 221-2842
Email
ctmoritz@uw.edu
Facility Information:
Facility Name
University of Washington
City
Seattle
State/Province
Washington
ZIP/Postal Code
98195
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Soshi Samejima
Email
soshis@uw.edu
First Name & Middle Initial & Last Name & Degree
Chet Moritz
Email
ctmoritz@uw.edu
First Name & Middle Initial & Last Name & Degree
Chet Moritz, PhD

12. IPD Sharing Statement

Plan to Share IPD
No

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Transcutaneous Spinal Stimulation and Exercise for Locomotion

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