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Noninvasive Spinal Cord Stimulation for Recovery of Autonomic Function After Spinal Cord Injury

Primary Purpose

Spinal Cord Injuries, Autonomic Dysfunction

Status

Not yet recruiting

Phase

Not Applicable

Locations

Canada

Study Type

Interventional

Intervention

TESCoN device - Thoracic stimulation

TESCoN device - Lumbosacral stimulation

About this trial

This is an interventional treatment trial for Spinal Cord Injuries

Eligibility Criteria

18 Years - 60 Years (Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Resident of British Columbia, Canada with active provincial medical services plan.
Male or female, 18-60 years of age.
Chronic traumatic SCI (non-progressive, with complete motor paralysis) at or above the T6 spinal segment.
>1-year post injury, at least 6 months from any spinal surgery.
American Spinal Injury Association Impairment Scale (AIS) A, B.
Stable management of spinal cord related clinical issues (i.e., spasticity management).
Documented impaired lower urinary tract, bowel or sexual function.
No painful musculoskeletal dysfunction, unhealed fracture, pressure sore, or active infection that may interfere with testing.
For women of childbearing potential, not intending to become pregnant, currently pregnant, or lactating. The following conditions apply:
1. A confirmed negative pregnancy test prior to the baseline visit. During the trial, all women of childbearing potential will undergo urine pregnancy tests at their monthly clinic visits as outlined in the schedule of events.
2. Use adequate contraception, or practice complete abstinence from sexual activities, during the period of the trial and for at least 28 days after completion of treatment.
3. If using combined hormonal contraceptives, a stable regimen during the period of the trial and for at least 28 days after completion of treatment.
For sexually active males with female partners of childbearing potential, use adequate contraception, or practice complete abstinence from sexual activities, during the period of the trial and for at least 28 days after completion of treatment.
Must provide informed consent.
Willing and able to comply with all clinic visits and study-related procedures.
Able to understand and complete study-related questionnaires (must be able to understand and speak English or have access to an appropriate interpreter as judged by the investigator).

Exclusion Criteria:

Ventilator dependent.
Signs of lower motor neuron damage (i.e. concomitant conus medullaris/cauda equina injury).
Severe anemia (Hgb<8 g/dl) or hypovolemia as measured by hematocrit via blood test in the last six months.
History of cardiovascular, respiratory, bladder, or renal disease unrelated to SCI or presence of hydronephrosis or presence of obstructive renal stones.
History of seizures/epilepsy or recurring headaches.
History of gastrointestinal atresia or stenosis.
Clinically significant, unmanaged, depression (PHQ-9 above 15) or ongoing drug abuse.
Intrathecal baclofen pump.
Oral baclofen dose > 60mg.
Individuals that have received intradetrusor or intrasphincter onabotulinumtoxinA injections within 9 months of baseline.
Any implanted metal (other than dental implants) in the skull or presence of pacemakers, stimulators, or medication pumps in the trunk.
Past electrode implantation surgery.
Member of the investigational team or his/her immediate family.
Presence of severe acute medical issue and use of any specific medication or treatment that, in the investigator's judgement, would adversely affect the participant's participation in the study.

Sites / Locations

Blusson Spinal Cord Centre
St Paul's Hospital

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Arm Label

Group 1 - Thoracic stimulation

Group 2- Lumbosacral stimulation

Arm Description

Participants will receive 8 weeks TCSCS at the mid/low thoracic spinal cord levels.

Participants will receive 8 weeks TCSCS at the lumbosacral spinal cord levels.

Outcomes

Primary Outcome Measures

Targeted TCSCS map modulate resting blood pressure (BP)

Using continuous beat-by beat BP monitoring via finger photoplethysmography during TCSCS, the researchers will identify the location and stimulation parameters to increase and decrease resting BP. Stimulation site will be either on the thoracic spinal cord (T7-T12) or the lumbosacral spinal cord (L1 - L3). Stimulation will be applied at various frequencies ranging between 1Hz and 90Hz. The outcome is an individualized TCSCS map (i.e. location and stimulation parameters) with change in systolic BP at rest during TCSCS.

Targeted TCSCS map to activate to activate skeletal muscles and pelvic floor muscles

Using surface electromyography (EMG), the researchers will identify the motor threshold for skeletal muscles known to be involved in lower urinary tract, bowel and sexual control by delivering TCSCS at various spinal cord segments (T7 to conus medullaris). The outcome is an individualized TCSCS map (i.e. location and stimulation parameters) with pertinent motor thresholds for TCSCS-driven surface EMG.

Immediate change in BP during the head up tilt test (HUTT)

During HUTT, participants will be passively moved to approximately 60° upright stand position by the investigators using the tilt table. Using TCSCS to activate spinal sympathetic circuitry and mitigate low resting BP and orthostatic hypotension (OH) and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving OH triggered by HUTT.

Change in BP during the head up tilt test (HUTT) from baseline to after completion of 8 weeks of TCSCS

Using TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of long-term TCSCS in improving OH triggered by HUTT.

Change in BP during the head up tilt test (HUTT) from baseline to 8 weeks after cessation of TCSCS

Using TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of long-term TCSCS in improving OH triggered by HUTT after cessation of therapy.

Immediate change in BP during digital anorectal stimulation (DARS)

DARS is a routine procedure to initiate a bowel routine, with the participant laying on their right side and DARS will be delivered via an index finger inserted into the rectum, applying gentle pressure for 30-60s. Utilizing TCSCS to inhibit nociceptive afferent and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving autonomic dysreflexia (AD) triggered by DARS.

Change in BP during digital anorectal stimulation (DARS) from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of long-term TCSCS in improving AD triggered by DARS.

Change in BP during digital anorectal stimulation (DARS) from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of TCSCS in improving AD triggered by DARS after cessation of therapy.

Immediate change in rectal pressure measured by anorectal manometry (ARM)

ARM is well-established methodology that provides a direct assessment of anal sphincter pressure and anorectal coordination during simulated defecation. The test is performed by inserting a catheter, that contains a probe embedded with pressure sensors, through the anus and into the rectum. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing average max resting and squeeze pressure (mmHg).

Immediate change in high pressure anal canal zone measured by ARM

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing length of high pressure anal canal zone (cm).

Immediate change in recto-anal inhibitory reflex measured by ARM

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing recto-anal inhibitory reflex.

Immediate change in rectal sensation measured by ARM

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing rectal sensation (mL).

Change in rectal pressure measured by ARM from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing average max resting and squeeze pressure (mmHg).

Change in high pressure anal canal zone measured by ARM from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing length of high pressure anal canal zone (cm).

Change in rectal sensation measured by ARM from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing rectal sensation (mL).

Change in recto-anal inhibitory reflex measured by ARM from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing recto-anal inhibitory reflex.

Change in rectal pressure measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing average max resting and squeeze pressure (mmHg).

Change in high pressure anal canal zone measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing length of high pressure anal canal zone (cm).

Change in recto-anal inhibitory reflex measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing recto-anal inhibitory reflex.

Change in rectal sensation measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing rectal sensation (mL).

Immediate change in intravesical pressure at first sensation measured by urodynamic investigation (UDI)

Standard clinical procedures for UDI, including cystometry with water at 21°C and a filling rate of < 30 mL per minute through a 6F double lumen catheter with the participants in the supine position, provides a direct assessment of voiding and storage function. Abdominal pressure will be measured with a 10F intrarectal balloon catheter. Filling will be stopped when the participants report a sensation of fullness. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing intravesical pressure at first sensation (mmHg).

Immediate change in intravesical pressure at leakage point measured by UDI

Filling will be stopped at the moment of urine leakage. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing intravesical pressure at leakage point (mmHg).

Immediate change in intravesical pressure at maximal volume measured by UDI

Filling will be stopped at the moment of discomfort/per the request of patient. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing intravesical pressure at maximal volume (mmHg).

Change in intravesical pressure at first sensation measured by UDI from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of long-term TCSCS in changing intravesical pressure at first sensation (mmHg).

Change in intravesical pressure at leakage point measured by UDI from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of long-term TCSCS in changing intravesical pressure at leakage point (mmHg).

Change in intravesical pressure at maximal volume measured by UDI from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of long-term TCSCS in changing intravesical pressure at maximal volume (mmHg).

Change in intravesical pressure at first sensation measured by UDI from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of TCSCS in changing intravesical pressure at first sensation (mmHg).

Change in intravesical pressure at leakage point measured by UDI from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of TCSCS in changing intravesical pressure at leakage point (mmHg).

Change in intravesical pressure at maximal volume measured by UDI from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of TCSCS in changing intravesical pressure at maximal volume (mmHg).

Immediate change in BP during penile or clitoral vibrostimulation

Genital vibration will be applied by an experienced physician using one or more handheld vibrators placed about the glans penis or the clitoral area with an amplitude of 1.0-3.5 mm and a frequency of 70-100 Hz. Utilizing TCSCS to inhibit nociceptive afferent and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of short-term TCS in reproducibly improving AD triggered by vibrostimulation.

Change in BP during penile or clitoral vibrostimulation from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of long-term TCSCS in improving AD triggered by vibrostimulation.

Change in BP during penile or clitoral vibrostimulation from baseline to 8 weeks after cessation of TCSCS

Utilizing TCSCS to inhibit nociceptive afferent and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of TCSCS in improving AD triggered by vibrostimulation.

Baseline assessment of colonic motility using the wireless motility capsule

The wireless motility capsule will be ingested and pass naturally through the GI tract, and data will be sent wirelessly to the data receiver. Researchers will use the collected data to assess baseline transit times.

Change in colonic motility using the wireless motility capsule from baseline to after completion of 8 weeks of TCSCS

Utilizing TCSCS and the wireless motility capsule, researchers will test the safety and efficacy of long-term TCSCS in improving transit times.

Change in colonic motility using the wireless motility capsule from baseline to 8 weeks after TCSCS cessation.

Utilizing TCSCS and the wireless motility capsule, researchers will test the safety and efficacy of TCSCS in improving transit times after cessation of therapy.

Secondary Outcome Measures

Immediate change in cerebral blood flow (CBF) measured by trans-cranial doppler (TCD) during HUTT

TCD is a non-invasive ultrasound technique used to measure real-time CBF velocity. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving CBF during HUTT.

Change in CBF measured by TCD during HUTT from baseline to after completion of 8 weeks of TCSCS

Researchers will test the safety and efficacy of long-term TCSCS in improving CBF during HUTT.

Change in CBF measured by TCD during HUTT from baseline to 8 weeks after TCSCS cessation

Researchers will test the safety and efficacy of TCSCS in improving CBF during HUTT after cessation of therapy.

Immediate change in performance on the verbal fluency test (VFT) during HUTT

Phonetic/letter fluency, specifically total number of words, will be measured using the verbal fluency test (VFT). Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving cognitive function during HUTT.

Change in performance on the VFT from baseline to after completion of 8 weeks of TCSCS

Researchers will test the safety and efficacy of long-term TCSCS in improving phonetic/letter fluency using the VFT.

Change in performance on the VFT from baseline to 8 weeks after TCSCS cessation

Researchers will test the safety and efficacy of TCSCS in improving phonetic/letter fluency after cessation of therapy.

Immediate change in performance on the Stroop Color and Word (SCW) test during HUTT

Ability to inhibit cognitive interference, specifically completion time, will be measured using the Stroop Color and Word (SCW) test. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving completion time of the SCW.

Change in performance on SCW from baseline to after completion of 8 weeks of TCSCS

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving completion time of the SCW.

Change in performance on SCW from baseline to 8 weeks after TCSCS cessation

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving completion time of the SCW after cessation of therapy.

Full Information

NCT ID

NCT05369520

First Posted

March 21, 2022

Last Updated

October 18, 2022

Sponsor

University of British Columbia

Collaborators

United States Department of Defense

1. Study Identification

Unique Protocol Identification Number

NCT05369520

Brief Title

Noninvasive Spinal Cord Stimulation for Recovery of Autonomic Function After Spinal Cord Injury

Official Title

Noninvasive Spinal Cord Stimulation for Recovery of Autonomic Function After Spinal Cord Injury: Moving From Mechanisms to Clinical Practice

Study Type

Interventional

2. Study Status

Record Verification Date

October 2022

Overall Recruitment Status

Not yet recruiting

Study Start Date

January 2023 (Anticipated)

Primary Completion Date

September 2025 (Anticipated)

Study Completion Date

September 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title

Principal Investigator

Name of the Sponsor

University of British Columbia

Collaborators

United States Department of Defense

4. Oversight

Studies a U.S. FDA-regulated Drug Product

Studies a U.S. FDA-regulated Device Product

Yes

Device Product Not Approved or Cleared by U.S. FDA

Yes

Product Manufactured in and Exported from the U.S.

Yes

Data Monitoring Committee

Yes

5. Study Description

Brief Summary

This study is a pilot clinical trial to explore the efficacy of transcutaneous spinal cord stimulation (TCSCS) (proof-of-concept) in mitigating crucial autonomic dysfunctions that impact the health-related quality of life of individuals with spinal cord injury (SCI).

Detailed Description

This is a pilot clinical trial to explore the efficacy of TCSCS (proof-of-concept) in mitigating crucial autonomic dysfunctions that impact the health-related quality of life of individuals with SCI. A total of 30 eligible participants will be recruited and attend forty-two visits. All experiments will be performed at ICORD (Primary site) and the Brenda and David McLean Integrated Spine Clinic (SCI clinic), with the exception of anorectal manometry testing conducted at the Gastroenterology Clinic, St Paul's Hospital (GI clinic). Following completion of screening and signing informed consent forms, participants will undergo spatiotemporal mapping of spinal cord segments known to be involved in blood pressure, lower urinary tract and bowel control (visit 2). Following mapping, all individuals will undergo baseline functional assessments during 5 visits (visits 3-7), over a period of 4 weeks. To minimize the order effect, the functional assessments will be performed in a randomized order. Following baseline assessments, using a randomized counter-balanced approach, individuals will be allocated in two distinct pathways; the participants in Groups 1 and 2 will receive 8 weeks of TCSCS (3 times/week) at either mid/low thoracic or lumbosacral spinal cord levels respectively (visits 8- 31). Following long-term TCSCS, participants will undergo functional assessments during 5 visits (visits 32- 36) over a period of 4 weeks. In order to evaluate the persistent effects of TCSCS, all assessments will be repeated 8 weeks after cessation of the therapy.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study

Spinal Cord Injuries, Autonomic Dysfunction

7. Study Design

Primary Purpose

Treatment

Study Phase

Not Applicable

Interventional Study Model

Parallel Assignment

Model Description

Using a randomized counter-balanced approach, individuals will be allocated in two distinct pathways; the participants in Groups 1 (thoracic stimulation) and Group 2 (lumbosacral stimulation) will receive 8 weeks of TCSCS (3 times/week) at either mid/low thoracic or lumbosacral spinal cord levels respectively.

Masking

None (Open Label)

Allocation

Randomized

Enrollment

30 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title

Group 1 - Thoracic stimulation

Arm Type

Experimental

Arm Description

Participants will receive 8 weeks TCSCS at the mid/low thoracic spinal cord levels.

Arm Title

Group 2- Lumbosacral stimulation

Arm Type

Experimental

Arm Description

Participants will receive 8 weeks TCSCS at the lumbosacral spinal cord levels.

Intervention Type

Device

Intervention Name(s)

TESCoN device - Thoracic stimulation

Intervention Description

TCSCS will be delivered using a non-invasive central nervous system stimulator (TESCoN, SpineX Inc., CA, USA). The stimulation site will be over the thoracic spinal cord (T7-T12, Group 1).

Intervention Type

Device

Intervention Name(s)

TESCoN device - Lumbosacral stimulation

Intervention Description

TCSCS will be delivered using a non-invasive central nervous system stimulator (TESCoN, SpineX Inc., CA, USA). The stimulation site will be over the lumbosacral spinal cord (L1 - L3, Group 2).

Primary Outcome Measure Information:

Title

Targeted TCSCS map modulate resting blood pressure (BP)

Description

Time Frame

Week 1-2 (once)

Title

Targeted TCSCS map to activate to activate skeletal muscles and pelvic floor muscles

Description

Time Frame

Week 1-2 (once)

Title

Immediate change in BP during the head up tilt test (HUTT)

Description

Time Frame

Week 3 - 6 (once)

Title

Change in BP during the head up tilt test (HUTT) from baseline to after completion of 8 weeks of TCSCS

Description

Using TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of long-term TCSCS in improving OH triggered by HUTT.

Time Frame

Week 15-18 (once)

Title

Change in BP during the head up tilt test (HUTT) from baseline to 8 weeks after cessation of TCSCS

Description

Time Frame

Week 27-30 (once)

Title

Immediate change in BP during digital anorectal stimulation (DARS)

Description

Time Frame

Week 3 - 6 (once)

Title

Change in BP during digital anorectal stimulation (DARS) from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and continuous beat-by beat BP monitoring via finger photoplethysmography, researchers will test the safety and efficacy of long-term TCSCS in improving AD triggered by DARS.

Time Frame

Week 15-18 (once)

Title

Change in BP during digital anorectal stimulation (DARS) from baseline to 8 weeks after cessation of TCSCS

Description

Time Frame

Week 27-30 (once)

Title

Immediate change in rectal pressure measured by anorectal manometry (ARM)

Description

Time Frame

Week 3 - 6 (once)

Title

Immediate change in high pressure anal canal zone measured by ARM

Description

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing length of high pressure anal canal zone (cm).

Time Frame

Week 3 - 6 (once)

Title

Immediate change in recto-anal inhibitory reflex measured by ARM

Description

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing recto-anal inhibitory reflex.

Time Frame

Week 3 - 6 (once)

Title

Immediate change in rectal sensation measured by ARM

Description

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing rectal sensation (mL).

Time Frame

Week 3 - 6 (once)

Title

Change in rectal pressure measured by ARM from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing average max resting and squeeze pressure (mmHg).

Time Frame

Week 15-18 (once)

Title

Change in high pressure anal canal zone measured by ARM from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing length of high pressure anal canal zone (cm).

Time Frame

Week 15-18 (once)

Title

Change in rectal sensation measured by ARM from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing rectal sensation (mL).

Time Frame

Week 15-18 (once)

Title

Change in recto-anal inhibitory reflex measured by ARM from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of long-term TCSCS in changing recto-anal inhibitory reflex.

Time Frame

Week 15-18 (once)

Title

Change in rectal pressure measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing average max resting and squeeze pressure (mmHg).

Time Frame

Week 27-30 (once)

Title

Change in high pressure anal canal zone measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing length of high pressure anal canal zone (cm).

Time Frame

Week 27-30 (once)

Title

Change in recto-anal inhibitory reflex measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing recto-anal inhibitory reflex.

Time Frame

Week 27-30 (once)

Title

Change in rectal sensation measured by anorectal manometry (ARM) from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and ARM, researchers will test the safety and efficacy of TCSCS in changing rectal sensation (mL).

Time Frame

Week 27-30 (once)

Title

Immediate change in intravesical pressure at first sensation measured by urodynamic investigation (UDI)

Description

Time Frame

Week 3 - 6 (once)

Title

Immediate change in intravesical pressure at leakage point measured by UDI

Description

Filling will be stopped at the moment of urine leakage. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly changing intravesical pressure at leakage point (mmHg).

Time Frame

Week 3 - 6 (once)

Title

Immediate change in intravesical pressure at maximal volume measured by UDI

Description

Time Frame

Week 3 - 6 (once)

Title

Change in intravesical pressure at first sensation measured by UDI from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of long-term TCSCS in changing intravesical pressure at first sensation (mmHg).

Time Frame

Week 15-18 (once)

Title

Change in intravesical pressure at leakage point measured by UDI from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of long-term TCSCS in changing intravesical pressure at leakage point (mmHg).

Time Frame

Week 15-18 (once)

Title

Change in intravesical pressure at maximal volume measured by UDI from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of long-term TCSCS in changing intravesical pressure at maximal volume (mmHg).

Time Frame

Week 15-18 (once)

Title

Change in intravesical pressure at first sensation measured by UDI from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of TCSCS in changing intravesical pressure at first sensation (mmHg).

Time Frame

Week 27-30 (once)

Title

Change in intravesical pressure at leakage point measured by UDI from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of TCSCS in changing intravesical pressure at leakage point (mmHg).

Time Frame

Week 27-30 (once)

Title

Change in intravesical pressure at maximal volume measured by UDI from baseline to 8 weeks after cessation of TCSCS

Description

Utilizing TCSCS and UDI, researchers will test the safety and efficacy of TCSCS in changing intravesical pressure at maximal volume (mmHg).

Time Frame

Week 27-30 (once)

Title

Immediate change in BP during penile or clitoral vibrostimulation

Description

Time Frame

Week 3 - 6 (once)

Title

Change in BP during penile or clitoral vibrostimulation from baseline to after completion of 8 weeks of TCSCS

Description

Time Frame

Week 15-18 (once)

Title

Change in BP during penile or clitoral vibrostimulation from baseline to 8 weeks after cessation of TCSCS

Description

Time Frame

Week 27-30 (once)

Title

Baseline assessment of colonic motility using the wireless motility capsule

Description

Time Frame

Week 3 - 6 (once)

Title

Change in colonic motility using the wireless motility capsule from baseline to after completion of 8 weeks of TCSCS

Description

Utilizing TCSCS and the wireless motility capsule, researchers will test the safety and efficacy of long-term TCSCS in improving transit times.

Time Frame

Week 15-18 (once)

Title

Change in colonic motility using the wireless motility capsule from baseline to 8 weeks after TCSCS cessation.

Description

Utilizing TCSCS and the wireless motility capsule, researchers will test the safety and efficacy of TCSCS in improving transit times after cessation of therapy.

Time Frame

Week 27-30 (once)

Secondary Outcome Measure Information:

Title

Immediate change in cerebral blood flow (CBF) measured by trans-cranial doppler (TCD) during HUTT

Description

TCD is a non-invasive ultrasound technique used to measure real-time CBF velocity. Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving CBF during HUTT.

Time Frame

Week 3 - 6 (once)

Title

Change in CBF measured by TCD during HUTT from baseline to after completion of 8 weeks of TCSCS

Description

Researchers will test the safety and efficacy of long-term TCSCS in improving CBF during HUTT.

Time Frame

Week 15-18 (once)

Title

Change in CBF measured by TCD during HUTT from baseline to 8 weeks after TCSCS cessation

Description

Researchers will test the safety and efficacy of TCSCS in improving CBF during HUTT after cessation of therapy.

Time Frame

Week 27-30 (once)

Title

Immediate change in performance on the verbal fluency test (VFT) during HUTT

Description

Time Frame

Week 3 - 6 (once)

Title

Change in performance on the VFT from baseline to after completion of 8 weeks of TCSCS

Description

Researchers will test the safety and efficacy of long-term TCSCS in improving phonetic/letter fluency using the VFT.

Time Frame

Week 15-18 (once)

Title

Change in performance on the VFT from baseline to 8 weeks after TCSCS cessation

Description

Researchers will test the safety and efficacy of TCSCS in improving phonetic/letter fluency after cessation of therapy.

Time Frame

Week 27-30 (once)

Title

Immediate change in performance on the Stroop Color and Word (SCW) test during HUTT

Description

Time Frame

Week 3 - 6 (once)

Title

Change in performance on SCW from baseline to after completion of 8 weeks of TCSCS

Description

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving completion time of the SCW.

Time Frame

Week 15-18 (once)

Title

Change in performance on SCW from baseline to 8 weeks after TCSCS cessation

Description

Researchers will test the safety and efficacy of short-term TCSCS in reproducibly improving completion time of the SCW after cessation of therapy.

Time Frame

Week 27-30 (once)

Other Pre-specified Outcome Measures:

Title

Frequency of urinary incontinence will be measured using The Incontinence-Quality of Life (I-QoL) questionnaire.

Description

Assessment of urinary incontinence will be performed to assess the impact of long term TCSCS on this measure. The scale is a 100 point scale where 0 is most severe incontinence.

Time Frame