Combined Robotic Training and tDCS in Chronic SCI
- Conditions
- Spinal Cord InjuriesTetraplegia
- Interventions
- Other: sham transcranial direct current stimulationOther: transcranial direct current stimulation
- Registration Number
- NCT03555838
- Lead Sponsor
- Burke Medical Research Institute
- Brief Summary
The purpose of this study is to establish the value of combined non-invasive stimulation (tDCS) and behavioral training (robotics) in SCI rehabilitation, and understand the mechanisms of this interaction and its relationship to functional outcome. The investigators hypothesize that supplementary tDCS will augment the functional improvement from robot-training, in chronic SCI.
- Detailed Description
Study design: Using a within-subjects repeated measures design, up to 40 SCI participants will be randomized to receive 6-week hand robotic training preceded by 20 min anodal 2mA tDCS or sham (3 sessions/week, 18 sessions total). Clinical and functional scales, robotic kinematics and neurophysiological data (TMS evaluation) will be collected before and after the combined intervention period, and a month later (pre, post and follow up evaluations). Randomization will be done using a randomized block design with a block size of 2. All participants, raters, and experimenters will be blinded to treatment allocation.
AIM 1. To determine whether combining non-invasive brain stimulation (tDCS) and behavioral training (robotics) in SCI can lead to functional improvement. The investigators hypothesize that the group receiving the real stimulation will obtain a greater clinical improvement in hand motor function. Using a within subjects repeated measures design, baseline clinical hand function (Box and Blocks test) will be compared to post 6-week robotic training intervention, and then a month later (follow up), each session preceded by real (2mA anodal M1) or sham tDCS.
AIM 2. To examine the kinematic changes (from robotic measures) associated with the combined training. Quantitative measurements obtained from robotics are highly sensitive, precise and reliable. The investigators predict an enhancement of motor performance in all participants, measured by 5 key parameters: mean speed, peak speed, smoothness, aim and deviation; with greater improvements in the intervention group receiving the pre-conditioning effect of transcranial stimulation. These data will identify features of motor control that underlie improvements in clinical function, when comparing the two intervention groups.
AIM 3. To identify and compare the neurophysiological mechanisms (by TMS) associated with the combined training. The relationship between clinical improvement in neurophysiological measures pertaining to robotic motor training alone and combined with tDCS will be assessed. Measuring changes in MEP amplitude of hand muscles before and after the training will establish a) the plasticity associated with training alone and with supplementary brain stimulation, b) the neurophysiological characteristics of patients who respond better to the training. By understanding how brain excitability changes underpin motor dysfunction, and motor recovery, interventions can be more effectively prescribed and prognoses established.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 13
- Tetraplegia (cervical lesion) with some degree of motor dysfunction in the hand (ability to pick up at least 1 block on the Box and Blocks Test)
- Motor incomplete lesion (measured by the ASIA Impairment Scale, B, C, D)
- Chronic lesion (>6 months after the injury)
- Motor and sensory complete lesion (AIS A)
- Presence of potential risk factor for brain stimulation (TMS and tDCS): history of seizures, presence of surgically implanted foreign bodies such as a pacemaker, metal plate in the skull, and metal inside the skull
- History of head trauma and/or cognitive deficit
- Medically unstable
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Sham tDCS sham transcranial direct current stimulation Participants in this arm will receive 20 minutes of sham transcranial direct current stimulation over the primary motor cortex of the more affected arm prior to robotic training. Active tDCS transcranial direct current stimulation Participants in this arm will receive 20 minutes of 2 mA transcranial direct current stimulation over the primary motor cortex of the more affected arm prior to robotic training.
- Primary Outcome Measures
Name Time Method Change in Box and Blocks Test Baseline, immediately post-intervention, and 1 month follow up A timed functional test to determine gross manual dexterity
- Secondary Outcome Measures
Name Time Method Modified Ashworth Scale Baseline, immediately post-intervention, and 1 month follow up Measures spasticity; Each muscle assessed is scored between 0-4, with 4 indicating rigid limbs or very severely affected.
Nine Hole Peg Test Baseline, immediately post-intervention, and 1 month follow up Timed measure of fine motor skills and dexterity
Upper Extremity Motor Score Baseline, immediately post-intervention, and 1 month follow up Manual muscle test of arm muscles; Score range from 0= no movement to 5= normal movement.
Spinal Cord Independence Measure (SCIM III) Baseline, immediately post-intervention, and 1 month follow up Evaluates patient's ability to complete activities of daily living; 19 questions in 3 domains; Scored 0 (severely impaired) -100 (independent)
Questionnaire of von Korff et al Grading the Severity of Chronic Pain Baseline, immediately post-intervention, and 1 month follow up Self-evaluation of pain; 7 questions in total; 0= no pain, 100= severe pain
Quadraplegia Index of Function- Short Form Baseline, immediately post-intervention, and 1 month follow up Global function scale; 6 items dcored on a 5 point scale from 0 (dependent) to 4 (independent).
Trial Locations
- Locations (1)
Burke Medical Research Institute
🇺🇸White Plains, New York, United States