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Transformation of Paralysis to Stepping

Primary Purpose

Spinal Cord Injuries

Status
Recruiting
Phase
Early Phase 1
Locations
United States
Study Type
Interventional
Intervention
Buspirone
Non-invasive Spinal Cord Stimulation
Ekso Bionics Exoskeleton
Gravity Neutral Device
Body Weight Supported Treadmill Training
Rolling Walker
Sponsored by
University of Louisville
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Spinal Cord Injuries focused on measuring Walking, Transcutaneous Stimulation, Locomotion, Paralysis, Buspirone, Motor Control, Spinal Stimulation

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Ages 18-65 years old;
  2. Stable medical condition;
  3. More than 12 month's post injury;
  4. Non-progressive spinal cord injury, AIS grade of A, B or C;
  5. Neurological level of injury below T1 and above T8;
  6. Not taking anti-spasticity medications;
  7. Presence of active spinally evoked responses over the lumbo-sacral spinal cord using spinal stimulation;
  8. Discontinuation of monoamine oxidase inhibitor (if applicable) for at least 2 weeks prior to initiation of treatment with buspirone.

Exclusion Criteria:

  1. Active pressure sores;
  2. Unhealed bone fractures;
  3. Untreated active urinary tract infections;
  4. Peripheral neuropathies;
  5. Seizure disorders;
  6. Cardiopulmonary disease unrelated to spinal cord injury;
  7. Anemia;
  8. Painful musculoskeletal dysfunction;
  9. Contractures in the lower extremities;
  10. Lower extremity hardware implantation;
  11. Lower extremity lower motor neuron injury;
  12. Previous unhealed lower extremity musculoskeletal injuries or disorders, prior to or in conjunction with spinal cord injury;
  13. Ventilator dependency;
  14. Pregnancy or nursing;
  15. Healing wounds/surgical sites along the spine, levels T9-L5;
  16. Anti-spasticity implantable pumps;
  17. Clinically significant depression, psychiatric disorders, or ongoing drug abuse;
  18. Implantable suprapubic catheters;
  19. Individuals who are unable to support themselves and/or have difficulty standing;
  20. Individuals with abnormal blood panel results related to hepatic function. Up to 10 ml of venous blood will be obtained for the testing;
  21. Individuals with increased Creatinine Clearance (Clcr) levels above the normal range;
  22. Individuals who are taking drug(s) that interact(s) with Buspirone (BuSpar): Monoamine oxidase inhibitors (MAOIs) - Selegiline (Emsam), Isocarboxazid (Marplan), Phenelzine (Nardil), and Tranylcypromine (Parnate) /these medications must discontinue for at least 2 weeks prior to initiating treatment with Buspirone/; Selective serotonin reuptake inhibitors (SSRIs) - Nefazodone (Serzone) and Trazodone (Oleptro); the blood thinner - Warfarin (Coumadin); Unti-seizure drugs: Phenytoin (Dilantin) and Carbamazepine (Tegretol); Benzodiazepines - Diazepam (Valium) and Triazolam (Halcion); Muscle relaxant - Cyclobenzaprine (Flexeril); Anti-fungal drugs - Itraconazole (Sporanox, Onmel), Itraconazole (Sporanox), and Ketoconazole (Nizoral); Antibiotics - Erythromycin (E.E.S., E-Mycin, Erythrocin) and Rifampin (Rifadin, Rimactane); Steroids (Prednisone and others); Anti-HIV drug - Ritonavir (Norvir); Anti-hypertensive drugs - Diltiazem (Cardizem) and Verapamil (Calan, Verelan, Covera-HS); Anti-psychotic drug - Haloperidol (Haldol);
  23. Uncontrolled autonomic dysreflexia;
  24. Osteoporosis.

Sites / Locations

  • Frazier Rehabilitation and Neuroscience InstituteRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Complete Spinal Cord Injury - Gravity Neutral Stepping

Complete Spinal Cord Injury - Exoskeleton Assisted Stepping

Incomplete Spinal Cord Injury - Overground Stepping

Arm Description

Group 1 will begin with a 3-4-month preparation phase and up to 12 sessions in the gravity neutral device (GND) will occur. The training sessions in the GND will be used to obtain the optimal stimulation parameters. Next, participants will enter Intervention Phase 1 where they will receive training sessions 3 days/week for approximately 2 hours. This will be done in the GND in the presence of stimulation. Afterwards, Intervention 2 will include the same training procedures with the addition of Buspirone or Placebo in a cross-over fashion halfway through this phase.

Group 2 will begin with a 3-month preparation phase and up to 12 sessions in the Ekso device stepping overground. Next, participants will enter Intervention Phase 1 where they will receive training sessions 3 days/week for approximately 2 hours in the Ekso overground, in the presence of stimulation and Buspirone/placebo. The second phase will include the same training procedures except for the removal of Buspirone/placebo administration. The third phase will include sessions twice per week in the Ekso overground with stimulation and one day per week using a rolling walker with stimulation. The last phase will include 2 sessions per week using the rolling walker and one day per week in the Ekso, both in the presence of stimulation and Buspirone/placebo.

Group 3 will begin with a 3-month preparation phase and up to 12 sessions in the Ekso device stepping overground. Next, participants will enter Intervention Phase 1 where they will receive training sessions 3 days/week for approximately 2 hours. The first hour will be done in the Ekso overground and the second hour will use the rolling walker overground, both in the presence of stimulation. Afterwards, the second phase will include the same training procedures with the addition of Buspirone/placebo.

Outcomes

Primary Outcome Measures

Lower Extremity Electromyography, change over time
Assessment of muscle activity, measured by electromyography, while the leg is suspended in a gravity neutral position.
Lower Extremity Kinematics, change over time
Assessment of low extremity 3D position, measured by motion analysis system, while the leg is suspended in a gravity neutral position.
Treadmill Electromyography Assessment, change over time
Muscle activity, measured by electromyography, will be recorded during weight supported stepping on a treadmill.
Spinal Pathway Electrophysiology, change over time
Evoked potentials in the lower extremities will recorded in response to nerve or spinal stimulation.
Voluntary Lower Extremity Angles, change over time
Assessments of knee, ankle, and toe movements will be performed by measuring angles produced during flexion and extension. The same units of measure will be used for each part of the leg.
Voluntary Lower Extremity Forces, change over time
Assessments of knee, ankle, and toe forces during movements will be performed by measuring forces produced during flexion and extension. The same units of measure will be used for each part of the leg.
Body Temperature, change over time
We will measure body temperature using standard methods to assess values at rest and during exercise.
Blood Pressure, change over time
We will measure blood pressure (systolic and diastolic) using standard methods to assess values at rest and during exercise.
Heart Rate, change over time
We will measure the heart rate using standard electrocardiography to assess values at rest and during exercise.
Respiration Rate, change over time
We will measure respiratory rate using standard methods to assess values at rest and during exercise.
Dual-energy X-ray absorptiometry, change over time
We will use dual-energy X-ray absorptiometry to measure bone and soft tissue density.
Acoustic Gastro-Intestinal Surveillance, change over time
We will use non-invasive sensors placed on the abdomen to detect signals related to the digestive state.
Bladder capacity, change over time
We will use a standard technique to measure bladder volume change during voiding.
Urodynamics, change over time
We will use a standard technique to measure the abdominal pressure change during voiding.
Cognitive interference, change over time
A cognitive assessment using Stroop test will be administered to assess cognitive function during stress.
Assessment of verbal fluency, change over time
Controlled Oral Word Association Test (COWAT) will be administered to assess verbal fluency that measures ability of spontaneous production of words.

Secondary Outcome Measures

International Standards of Neurological Classification of Spinal Cord Injury, change over time
This standard clinical assessment assess the level and severity of a spinal cord injury. The neurological level of injury is rated from A-E. "A" is a motor and sensory complete injury. "E" is completely normal at each spinal segment. Sensory function is rated as 0-2, or Not Testable. Motor function is rated as 0-5 or Not Testable.
Spinal Cord Injury Functional Ambulation Inventory, change over time
This 3-part scale measures gait parameters, use of assistive devices, and distances traveled during walking. The gait parameters are scored on a 20-point scale, the assistive device use on a 14-point scale, and the walking distance on a 5-point scale.
Spinal Cord Independence Measure III, change over time
This 3-part scale is scored out of 100 points possible. The first part (self-care) is scored out of 20. The second part (respiration and sphincter management) is scored out of 40. And the last part (mobility) is scored out of 40.
Walking Index for Spinal Cord Injury-II, change over time
This is a 20-point scale used to assess the amount of physical assistance needed during walking.
Ashworth Scale, change over time
This is a 6-part scale to measure and quantify the amount of muscle tone experienced when a joint is moved through a full range of motion.

Full Information

First Posted
September 10, 2019
Last Updated
February 13, 2023
Sponsor
University of Louisville
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
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1. Study Identification

Unique Protocol Identification Number
NCT04105114
Brief Title
Transformation of Paralysis to Stepping
Official Title
Transformation of Paraplegic Paralysis to Overground Stepping in Humans
Study Type
Interventional

2. Study Status

Record Verification Date
February 2023
Overall Recruitment Status
Recruiting
Study Start Date
September 30, 2019 (Actual)
Primary Completion Date
August 31, 2024 (Anticipated)
Study Completion Date
December 31, 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Louisville
Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The main goal of the project is to develop multiple noninvasive neuromodulatory strategies to facilitate full weight bearing stepping overground in people with paralysis. We will determine the effectiveness of combining noninvasive spinal cord stimulation and the administration of buspirone (a monoaminergic agonist) in facilitating locomotor activity in a gravity-neutral apparatus, during body weight supported stepping on a treadmill, when stepping overground in an assistive robotic exoskeleton, or during full weight bearing stepping overground in a rolling walker. Our objective is to identify the experimental variables that define the efficacy of these novel neuromodulatory techniques over a 5 year period in 15 participants with severe spinal cord injury who are at least one year post-injury.
Detailed Description
Aim 1: Define the relative effectiveness of transcutaneous electrical stimulation at multiple stimulation spinal sites and oral Buspirone in facilitating nonweight-bearing (gravity neutral device, GND) and weight-bearing (treadmill) stepping in individuals with chronic motor complete paralysis. Aim 1.1: Define the relative effectiveness of transcutaneous electrical stimulation at multiple spinal sites to facilitate non-weight-bearing (GND) and weight-bearing (treadmill) stepping in spinal cord injury subjects. Aim 1.2: Define the relative effectiveness of transcutaneous electrical stimulation at multiple spinal sites plus oral Buspirone to facilitate nonweight-bearing (gravity neutral device, GND) and weight-bearing (treadmill) stepping in spinal cord injury subjects. Aim 2: Determine the relative effectiveness of Ekso-technology combined with transcutaneous electrical stimulation and/or oral Buspirone in lowering the robotic assistance and enhancing the ability to step self-assisted in a rolling walker during over-ground stepping in individuals with a chronic, severe (AIS A/B) spinal injury. Aim 3: Determine the relative effectiveness of Ekso-technology combined with transcutaneous electrical stimulation and/or oral Buspirone in lowering the robotic assistance and enhancing the ability to step self-assisted in a rolling walker during over-ground stepping in individuals with motor incomplete (AIS C) paralysis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Cord Injuries
Keywords
Walking, Transcutaneous Stimulation, Locomotion, Paralysis, Buspirone, Motor Control, Spinal Stimulation

7. Study Design

Primary Purpose
Basic Science
Study Phase
Early Phase 1
Interventional Study Model
Crossover Assignment
Model Description
This is a double blinded crossover study with three experimental groups. Each group will receive a combination of activity based neuromodulation interventions while receiving oral Buspirone or placebo. The crossover between drug or placebo administration will occur at the study phase midpoint.
Masking
ParticipantInvestigatorOutcomes Assessor
Masking Description
Due to the objectives of the study, the identity of test and control treatments will not be known to investigators, research staff, or participants during the Treatment Phase. The following study procedures will be in place to ensure double-blind administration of study treatments. Access to the randomization code will be strictly controlled. Packaging and labeling of test and control treatments will be identical to maintain the blind. The study blind will be broken on completion of the clinical study and after the study database has been locked. BuSpar (buspirone) and matching placebo tablets (2x/day) will be obtained and dispensed by the investigational pharmacy. Study drug and placebo will be labeled with the required FDA warning statement, the protocol number, a treatment number, the name of the sponsors, and directions for patient use and storage.
Allocation
Non-Randomized
Enrollment
15 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Complete Spinal Cord Injury - Gravity Neutral Stepping
Arm Type
Experimental
Arm Description
Group 1 will begin with a 3-4-month preparation phase and up to 12 sessions in the gravity neutral device (GND) will occur. The training sessions in the GND will be used to obtain the optimal stimulation parameters. Next, participants will enter Intervention Phase 1 where they will receive training sessions 3 days/week for approximately 2 hours. This will be done in the GND in the presence of stimulation. Afterwards, Intervention 2 will include the same training procedures with the addition of Buspirone or Placebo in a cross-over fashion halfway through this phase.
Arm Title
Complete Spinal Cord Injury - Exoskeleton Assisted Stepping
Arm Type
Experimental
Arm Description
Group 2 will begin with a 3-month preparation phase and up to 12 sessions in the Ekso device stepping overground. Next, participants will enter Intervention Phase 1 where they will receive training sessions 3 days/week for approximately 2 hours in the Ekso overground, in the presence of stimulation and Buspirone/placebo. The second phase will include the same training procedures except for the removal of Buspirone/placebo administration. The third phase will include sessions twice per week in the Ekso overground with stimulation and one day per week using a rolling walker with stimulation. The last phase will include 2 sessions per week using the rolling walker and one day per week in the Ekso, both in the presence of stimulation and Buspirone/placebo.
Arm Title
Incomplete Spinal Cord Injury - Overground Stepping
Arm Type
Experimental
Arm Description
Group 3 will begin with a 3-month preparation phase and up to 12 sessions in the Ekso device stepping overground. Next, participants will enter Intervention Phase 1 where they will receive training sessions 3 days/week for approximately 2 hours. The first hour will be done in the Ekso overground and the second hour will use the rolling walker overground, both in the presence of stimulation. Afterwards, the second phase will include the same training procedures with the addition of Buspirone/placebo.
Intervention Type
Drug
Intervention Name(s)
Buspirone
Other Intervention Name(s)
Buspar
Intervention Description
Oral Buspirone 7.5mg - 10mg daily during the treatment phase.
Intervention Type
Device
Intervention Name(s)
Non-invasive Spinal Cord Stimulation
Intervention Description
A non-invasive transcutaneous electrical spinal cord stimulator, which can be used a multiple spinal locations.
Intervention Type
Device
Intervention Name(s)
Ekso Bionics Exoskeleton
Intervention Description
This robotic exoskeleton is designed to assist people with neurological injuries for balance, standing, and stepping overground.
Intervention Type
Device
Intervention Name(s)
Gravity Neutral Device
Intervention Description
This device is used to train and assess non-weight bearing stepping movements. When using the device, participants will be lying on their side with their legs suspended off the end of a table supported by small slings that are anchored securely to the apparatus.
Intervention Type
Device
Intervention Name(s)
Body Weight Supported Treadmill Training
Intervention Description
Participants will be supported by a special harness while they are stepping on a treadmill. Trained technicians or therapists will be assist the trunk and legs during stepping as needed.
Intervention Type
Device
Intervention Name(s)
Rolling Walker
Intervention Description
A standard rolling walker will be used for balance support and stability during stepping overground.
Primary Outcome Measure Information:
Title
Lower Extremity Electromyography, change over time
Description
Assessment of muscle activity, measured by electromyography, while the leg is suspended in a gravity neutral position.
Time Frame
Before and after each study phase, 1 year per group.
Title
Lower Extremity Kinematics, change over time
Description
Assessment of low extremity 3D position, measured by motion analysis system, while the leg is suspended in a gravity neutral position.
Time Frame
Before and after each study phase, 1 year per group.
Title
Treadmill Electromyography Assessment, change over time
Description
Muscle activity, measured by electromyography, will be recorded during weight supported stepping on a treadmill.
Time Frame
Before and after each study phase, 1 year per group.
Title
Spinal Pathway Electrophysiology, change over time
Description
Evoked potentials in the lower extremities will recorded in response to nerve or spinal stimulation.
Time Frame
Before and after each study phase, 1 year per group.
Title
Voluntary Lower Extremity Angles, change over time
Description
Assessments of knee, ankle, and toe movements will be performed by measuring angles produced during flexion and extension. The same units of measure will be used for each part of the leg.
Time Frame
Before and after each study phase, 1 year per group.
Title
Voluntary Lower Extremity Forces, change over time
Description
Assessments of knee, ankle, and toe forces during movements will be performed by measuring forces produced during flexion and extension. The same units of measure will be used for each part of the leg.
Time Frame
Before and after each study phase, 1 year per group.
Title
Body Temperature, change over time
Description
We will measure body temperature using standard methods to assess values at rest and during exercise.
Time Frame
Before and after each study phase, 1 year per group.
Title
Blood Pressure, change over time
Description
We will measure blood pressure (systolic and diastolic) using standard methods to assess values at rest and during exercise.
Time Frame
Before and after each study phase, 1 year per group.
Title
Heart Rate, change over time
Description
We will measure the heart rate using standard electrocardiography to assess values at rest and during exercise.
Time Frame
Before and after each study phase, 1 year per group.
Title
Respiration Rate, change over time
Description
We will measure respiratory rate using standard methods to assess values at rest and during exercise.
Time Frame
Before and after each study phase, 1 year per group.
Title
Dual-energy X-ray absorptiometry, change over time
Description
We will use dual-energy X-ray absorptiometry to measure bone and soft tissue density.
Time Frame
Before and after each study phase, 1 year per group.
Title
Acoustic Gastro-Intestinal Surveillance, change over time
Description
We will use non-invasive sensors placed on the abdomen to detect signals related to the digestive state.
Time Frame
Before and after each study phase, 1 year per group.
Title
Bladder capacity, change over time
Description
We will use a standard technique to measure bladder volume change during voiding.
Time Frame
Before and after each study phase, 1 year per group.
Title
Urodynamics, change over time
Description
We will use a standard technique to measure the abdominal pressure change during voiding.
Time Frame
Before and after each study phase, 1 year per group.
Title
Cognitive interference, change over time
Description
A cognitive assessment using Stroop test will be administered to assess cognitive function during stress.
Time Frame
Before and after each study phase, 1 year per group.
Title
Assessment of verbal fluency, change over time
Description
Controlled Oral Word Association Test (COWAT) will be administered to assess verbal fluency that measures ability of spontaneous production of words.
Time Frame
Before and after each study phase, 1 year per group.
Secondary Outcome Measure Information:
Title
International Standards of Neurological Classification of Spinal Cord Injury, change over time
Description
This standard clinical assessment assess the level and severity of a spinal cord injury. The neurological level of injury is rated from A-E. "A" is a motor and sensory complete injury. "E" is completely normal at each spinal segment. Sensory function is rated as 0-2, or Not Testable. Motor function is rated as 0-5 or Not Testable.
Time Frame
Before and after each study phase, 1 year per group.
Title
Spinal Cord Injury Functional Ambulation Inventory, change over time
Description
This 3-part scale measures gait parameters, use of assistive devices, and distances traveled during walking. The gait parameters are scored on a 20-point scale, the assistive device use on a 14-point scale, and the walking distance on a 5-point scale.
Time Frame
Before and after each study phase, 1 year per group.
Title
Spinal Cord Independence Measure III, change over time
Description
This 3-part scale is scored out of 100 points possible. The first part (self-care) is scored out of 20. The second part (respiration and sphincter management) is scored out of 40. And the last part (mobility) is scored out of 40.
Time Frame
Before and after each study phase, 1 year per group.
Title
Walking Index for Spinal Cord Injury-II, change over time
Description
This is a 20-point scale used to assess the amount of physical assistance needed during walking.
Time Frame
Before and after each study phase, 1 year per group.
Title
Ashworth Scale, change over time
Description
This is a 6-part scale to measure and quantify the amount of muscle tone experienced when a joint is moved through a full range of motion.
Time Frame
Before and after each study phase, 1 year per group.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Ages 18-65 years old; Stable medical condition; More than 12 month's post injury; Non-progressive spinal cord injury, AIS grade of A, B or C; Neurological level of injury below T1 and above T8; Not taking anti-spasticity medications; Presence of active spinally evoked responses over the lumbo-sacral spinal cord using spinal stimulation; Discontinuation of monoamine oxidase inhibitor (if applicable) for at least 2 weeks prior to initiation of treatment with buspirone. Exclusion Criteria: Active pressure sores; Unhealed bone fractures; Untreated active urinary tract infections; Peripheral neuropathies; Seizure disorders; Cardiopulmonary disease unrelated to spinal cord injury; Anemia; Painful musculoskeletal dysfunction; Contractures in the lower extremities; Lower extremity hardware implantation; Lower extremity lower motor neuron injury; Previous unhealed lower extremity musculoskeletal injuries or disorders, prior to or in conjunction with spinal cord injury; Ventilator dependency; Pregnancy or nursing; Healing wounds/surgical sites along the spine, levels T9-L5; Anti-spasticity implantable pumps; Clinically significant depression, psychiatric disorders, or ongoing drug abuse; Implantable suprapubic catheters; Individuals who are unable to support themselves and/or have difficulty standing; Individuals with abnormal blood panel results related to hepatic function. Up to 10 ml of venous blood will be obtained for the testing; Individuals with increased Creatinine Clearance (Clcr) levels above the normal range; Individuals who are taking drug(s) that interact(s) with Buspirone (BuSpar): Monoamine oxidase inhibitors (MAOIs) - Selegiline (Emsam), Isocarboxazid (Marplan), Phenelzine (Nardil), and Tranylcypromine (Parnate) /these medications must discontinue for at least 2 weeks prior to initiating treatment with Buspirone/; Selective serotonin reuptake inhibitors (SSRIs) - Nefazodone (Serzone) and Trazodone (Oleptro); the blood thinner - Warfarin (Coumadin); Unti-seizure drugs: Phenytoin (Dilantin) and Carbamazepine (Tegretol); Benzodiazepines - Diazepam (Valium) and Triazolam (Halcion); Muscle relaxant - Cyclobenzaprine (Flexeril); Anti-fungal drugs - Itraconazole (Sporanox, Onmel), Itraconazole (Sporanox), and Ketoconazole (Nizoral); Antibiotics - Erythromycin (E.E.S., E-Mycin, Erythrocin) and Rifampin (Rifadin, Rimactane); Steroids (Prednisone and others); Anti-HIV drug - Ritonavir (Norvir); Anti-hypertensive drugs - Diltiazem (Cardizem) and Verapamil (Calan, Verelan, Covera-HS); Anti-psychotic drug - Haloperidol (Haldol); Uncontrolled autonomic dysreflexia; Osteoporosis.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Andrea Willhite, MS
Phone
502-582-8675
Email
andrea.willhite@louisville.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Alexander V Ovechkin, PhD
Organizational Affiliation
University of Louisville
Official's Role
Study Director
Facility Information:
Facility Name
Frazier Rehabilitation and Neuroscience Institute
City
Louisville
State/Province
Kentucky
ZIP/Postal Code
40202
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Andrea Willhite, MS
Phone
502-582-8675
Email
andrea.willhite@louisville.edu
First Name & Middle Initial & Last Name & Degree
Alexander V Ovechkin, MD, PhD
First Name & Middle Initial & Last Name & Degree
Yury P Gerasimenko, PhD

12. IPD Sharing Statement

Learn more about this trial

Transformation of Paralysis to Stepping

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