Harnessing Neuroplasticity to Enhance Functional Recovery During Chronic Recovery From Upper Extremity Nerve Repair

Last updated: June 11, 2024
Sponsor: University of Missouri-Columbia
Overall Status: Active - Recruiting

Phase

N/A

Condition

N/A

Treatment

Modified Constraint Induced Movement Therapy

Transcranial Direct Current Stimulation

Clinical Study ID

NCT03610763
2008784
CDMRP-MR141043
  • Ages > 18
  • All Genders

Study Summary

This study adopts a strategy that has arisen from basic neuroscience research on facilitating adaptive brain plasticity and applies this to rehabilitation to improve functional recovery in peripheral nervous system injuries (including hand transplantation, hand replantation, and surgically repaired upper extremity nerve injuries). The technique involves combining behavioral training with transcranial direct current stimulation (tDCS)-a non-invasive form of brain stimulation capable of facilitating adaptive changes in brain organization.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • Individuals whom have received a unilateral allogeneic transplantation proximal tothe wrist and are at the chronic stage of recovery (approx. 12 - 18 months followingsurgery, when Tinel's sign reaches the distal fingertips).

  • Individuals whom have undergone a complete amputation the hand between the wrist andelbow followed by successful re-attachment and are at the chronic stage of recovery (approx. 12 - 18 months following surgery, when Tinel's sign reaches the distalfingertips).

  • Individuals whom have undergone repairs of the median, ulnar, or other related ornearby nerve(s) following complex volar forearm lacerations or other injuriesbetween the distal wrist crease and the flexor musculotendinous junctions.Individuals must be at the chronic stage of recovery (approx. 12 - 18 monthsfollowing surgery, when Tinel's sign reaches the distal fingertips).

Exclusion

Exclusion Criteria:

  • Individuals with significant/severe brain trauma

  • Serious psychiatric conditions

  • Chronic or severe neurological conditions.

  • Current pregnancy

  • History of seizures or unexplained loss of consciousness

  • Metallic implants above the chest

  • Certain implanted medical devices.

Study Design

Total Participants: 180
Treatment Group(s): 2
Primary Treatment: Modified Constraint Induced Movement Therapy
Phase:
Study Start date:
August 15, 2018
Estimated Completion Date:
June 01, 2025

Study Description

This study will implement and evaluate an innovative program of post hand transplant rehabilitation; one that harnesses recent discoveries in neuroscience to facilitate long-term, experience-dependent adaptations within the brain's sensory and motor systems. The current approach to rehabilitation of function in allogeneic hand transplant recipients is largely the same as standard-of-care following hand replantation (re-attachment) and peripheral nerve repairs. This involves an eclectic combination of traditional therapies. In seeking to improve on this approach, there is potentially much to be gained by considering evidence that limb amputation not only impacts the peripheral nervous system but also the brain, and tailoring interventions accordingly.

Connect with a study center

  • Christine Kleinert Institute for Hand & Microsurgery

    Louisville, Kentucky 40202
    United States

    Active - Recruiting

  • University of Missouri

    Columbia, Missouri 65211
    United States

    Active - Recruiting

  • Washington University School of Medicine

    Saint Louis, Missouri 63110
    United States

    Active - Recruiting

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