Corticospinal Function After Spinal Cord Injury

Last updated: March 1, 2024
Sponsor: Shirley Ryan AbilityLab
Overall Status: Active - Recruiting

Phase

N/A

Condition

Spinal Cord Injuries

Spinal Cord Disorders

Treatment

Electrophysiology Assessment of Location

Electrophysiology Assessment of Time Domain

Training with some stimulation

Clinical Study ID

NCT02451683
STU00210458
R01NS090622-01
  • Ages 18-85
  • All Genders

Study Summary

The investigator's overall goal is to develop new strategies to test optimization of Spike-timing-dependent plasticity (STDP) doses to maximize strategy to restore upper and lower-limb motor function in individuals with spinal cord injury (SCI). The investigator proposes to use modern electrophysiological methods to enhance the efficacy of residual corticospinal connections. Defining the neural basis by which corticospinal volleys generate muscle responses will provide crucial information required to maximize residual motor output. The investigator's specific goals are to: 1) determine the temporal and spatial organization of corticospinal volleys and motor cortical representations of upper-limb muscles after incomplete cervical SCI and 2) develop methodologies to promote recovery of function. The investigator's focus on reach and grasp movements because of their importance in daily life activities.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Inclusion criteria for individuals with SCI:
  1. Male and females between 18-85 years,
  2. Chronic SCI (≥ 6 months post injury),
  3. Cervical injury at C8 or above,
  4. Intact or impaired but not absent innervations in dermatomes C6, C7, and C8 usingthe American Spinal Injury Association sensory scores, and
  5. Ability to reach and grasp a small object located at least 8 cm forward, above,and laterally without leaning forward with the trunk Inclusion criteria for healthy controls:
  6. Male and females between 18-85 years,
  7. Right handed,
  8. Ability to reach and grasp a small object located at least 8 cm forward, above, andlaterally without leaning forward with the trunk

Exclusion

Exclusion Criteria:

  • Exclusion criteria for individuals with SCI and Healthy Controls:
  1. Uncontrolled medical problems including pulmonary, cardiovascular or orthopedicdisease
  2. Any debilitating disease prior to the SCI that caused exercise intolerance
  3. Premorbid, ongoing major depression or psychosis, altered cognitive status
  4. History of head injury or stroke
  5. Pacemaker
  6. Metal plate in skull
  7. History of seizures
  8. Receiving drugs acting primarily on the central nervous system, which lower theseizure threshold such as antipsychotic drugs (chlorpromazine, clozapine) ortricyclic antidepressants
  9. Pregnant females
  10. Ongoing cord compression or a syrinx in the spinal cord or who suffer from aspinal cord disease such as spinal stenosis, spina bifida or herniated cervicaldisk.
  11. History of brain tumor and or brain infection

Study Design

Total Participants: 300
Treatment Group(s): 3
Primary Treatment: Electrophysiology Assessment of Location
Phase:
Study Start date:
October 12, 2020
Estimated Completion Date:
December 30, 2026

Study Description

This study will determine the temporal organization of corticospinal volleys during reach and grasp movements. Multiple descending volleys in the corticospinal tract generate multiple peaks in muscle responses (indirect (I)-waves). I-waves are a mechanism by which corticospinal neurons are transynaptically activated at periodic intervals of ~1.5 ms. This periodic activation contributes to the recruitment of spinal motoneurons and generation of movement. we will use paired-TMS to examine I-waves in surface EMG recordings from upper-limb muscles during reach and grasp movements.

We will also identify motor cortical maps of upper-limb muscles involved in reach and grasp movements. We will use TMS guided by a frameless neuronavigation system to define the size and location of motor cortical maps of upper-limb muscles during reach and grasp movements. We will be able to determine overlaps and functional interactions between distal and proximal arm motor cortical representations. Our preliminary data shows that finger and biceps cortical maps largely overlap during reach and grasp movements in controls but considerable less in patients

Connect with a study center

  • Shirley Ryan AbilityLab

    Miami, Florida 33136
    United States

    Site Not Available

  • Shirley Ryan AbilityLab

    Chicago, Illinois 60611
    United States

    Active - Recruiting

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