Imaging Lymphatic/CSF Drainage From the Head and Neck in Persons With Traumatic Brain Injury: Demonstration of Feasibility and Evaluation of Manual Therapy to Improve Drainage and Facilitate Cognitive Recovery
Trial Snapshot
- Phase
- Not Applicable
- Status
- Terminated
- Enrollment
- 2
- Locations
- 1
- Primary Endpoint
- change in Near-Infrared Fluorescence Lymphatic Imaging (NIRF-LI) assessment of lymphatic drainage
Study Overview
Brief Summary
The purpose of this study is to determine whether a course of daily manual lymphatic drainage over the course of 5 days can improve lymphatic drainage function and cognitive outcomes and to determine whether single sessions of manual lymphatic drainage improves lymphatic drainage in moderate to severe traumatic brain injury (TBI) patients.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Female participants must complete the Female Enrollment Form. Those subjects of childbearing potential must have a negative urine pregnancy within 36 hours of study drug administration and also agree to use one of the medically accepted methods of contraception listed on the form for a period of one month following the study. Female subjects of non-childbearing potential, defined as physiologically incapable of becoming pregnant, must meet the criteria listed on the Female Enrollment form, but are not restricted to the use of contraception following study participation.
- •Participants must be able to sit upright for periods of 30 minutes.
- •Participants should have a body mass index between 19 and 30 kg/m2
- •Initial post-resuscitation Glasgow Coma Scale score following blunt head trauma of 3 to 12 or coma (not due to sedation) greater than 6 hours. Emergence from Post-traumatic Amnesia as documented by serial administration of the Orientation-Log or Galveston Orientation and Amnesia Test
- •Have an anticipated hospital length of stay of 5 days or more following screening and consent.
- •Able to provide consent.
Exclusion Criteria
- •Women who are pregnant or breast-feeding
- •Persons who are known to be allergic to iodine
- •Persons who have extensive soft tissue damage to the neck region, including carotid artery dissection, spinal cord injury, or other conditions, that makes lymphatic drainage techniques undesirable.
- •Women who are of child bearing potential who do not agree to use medically acceptable contraceptives for one month following the study.
- •Subjects who are participating in another interventional trial.
Arms & Interventions
Manual Lymphatic Drainage (MLD)
Intervention: Manual Lymphatic Drainage (MLD) (Other)
Outcomes
Primary Outcomes
change in Near-Infrared Fluorescence Lymphatic Imaging (NIRF-LI) assessment of lymphatic drainage
Time Frame: day 1, day 5
2 NIRF-LI sessions will be conducted separated by 3 days.
change in cognitive test results as assessed by the learning trial
Time Frame: day1,day2,day3,day4,day5
This will be assessed by the number of words participants can remember
Change in processing speed, as assessed by the Wechsler Adult Intelligence Scale -IV
Time Frame: day1,day2,day3,day4,day5
Two subtests from the Wechsler Adult Intelligence Scale - IV are used (Coding and Symbol Search). Age-adjusted standard scores are calculated for each of subtest. The 2 subtest scores are then combined to create the Processing Speed Index. Processing Speed Index will be reported as a percentile (0% to 100%), with a higher percentile indicating a better outcome
change in cognitive test results as assessed by the Semantic Category learning trial
Time Frame: day1,day2,day3,day4,day5
There are 12 words that participants will categories as Four-legged Animals, precious stones and human dwellings for a total score from 0-12 a higher number indicates a better outcome
change in cognitive test results as assessed by the Patient-Reported Outcomes Measurement Information System (PROMIS)-Global health( GH) scale
Time Frame: day1,day2,day3,day4,day5
Nine of the 10 PROMIS GH items are scored on a Likert scale from 1 to 5, with 5 representing the best health. Pain which is the 10th question is scored from 0(no pain) to 10(worst imaginable pain).
change in cognitive test results as assessed by the Patient Health Questionnaire-9 (PHQ-9)
Time Frame: day1,day2,day3,day4,day5
This scale consists of a set of 9 questions each scored form 0(not at all) to 3 (nearly every day), a higher score indicating a worse outcome. Total score ranges form 0-27.
change in cognitive test results as assessed by the Multilingual Aphasia Examination III-Controlled Oral Word Association
Time Frame: day1,day2,day3,day4,day5
This is used to asses phonemic fluency. Participant is asked to name words that begin with a particular letter in one minute and examiner will write down the words said by the participant. This will be reported y the number of words participants say in one minute
change in cognitive test results as assessed by the Trail Making Test(TMT)
Time Frame: day1,day2,day3,day4,day5
Scores are reported as the number of seconds required to complete the task; therefore, higher scores reveal greater impairment.
change in cognitive test results as assessed by the delayed recall trial instructions
Time Frame: day1,day2,day3,day4,day5
This will be assessed by the number of words participants can remember after 20-25 minutes delay
Secondary Outcomes
- Change in NIRF-LI detected lymphatic drainage(day1,day5)
Investigators
Eva Sevick
Professor
The University of Texas Health Science Center, Houston