Spasticity After Spinal Cord Injury
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Spinal Cord Injuries
- Sponsor
- Shirley Ryan AbilityLab
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- MEP recruitment curves
- Last Updated
- 3 years ago
Overview
Brief Summary
Very often, people who have a SCI have difficulty doing things with their arms or hands as a result of muscle stiffness , or spasticity. Spastacity can cause problems performing even the simplest of everyday tasks. This research will help us understand how the body recovers and changes neurologically after SCI.
Detailed Description
After spinal cord injury (SCI), damage to descending motor pathways has been associated with the development of spasticity (Frigon and Rossignol, 2006; Trompetto et al., 2014). Self-reported questionnaires and clinical exams indicate that individuals with incomplete SCI, who showed residual descending connectivity, have a high prevalence of spasticity compared to individuals with complete SCI (Little et al., 1989; Holtz et al., 2017). In agreement, our recent electrophysiological and spinal cord imaging data in humans with a diagnosis of a clinically motor complete SCI showed the presence of descending motor pathway connectivity in individuals with spasticity compared to those without spasticity (Sangari et al., 2019). However, which descending motor pathways influence spasticity following SCI, and to what extent, remains poorly understood. This proposal has two main goals: 1) to examine the contribution of cortico- and reticulo-spinal pathways to spasticity in upper and lower limb muscles, and 2) to develop strategies to promote functional recovery of upper and lower limb spastic muscles in humans with chronic incomplete SCI. The aims below will test two main hypotheses. In Aim 1, we will use transcranial magnetic stimulation and startle acoustic stimuli to examine the contribution of the cortico- and reticulo-spinal pathway to upper and/or lower limb muscles electromyographic activity. Spinal cord atrophy and morphological characterization of cortico- and reticulo-spinal pathways will be assessed with high-resolution magnetic resonance imaging. Physiological and neuroimaging outcomes will be associated with clinical assessment of spasticity. In Aim 2, we propose to enhance cortico- and reticulo-spinal contribution to upper and/or lower limb function in spastic muscles by using a novel intervention combining startle acoustic stimuli with motor training. This research will provide new knowledge about the contribution of descending motor pathways to the control of spasticity in upper and lower limb muscles following incomplete cervical SCI (Aim1) and might lead to the development of a novel rehabilitation intervention to improve upper and lower limb motor function recovery by enhancing residual descending control over spinal networks (Aim 2).
Investigators
Monica Perez
Scientific Chair Arms + Hands Lab
Shirley Ryan AbilityLab
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
MEP recruitment curves
Time Frame: 3-4 hours
Ten stimuli (0.2 Hz) will be delivered at each intensity to plot the mean peak-to-peak amplitude of the MEP from the non-rectified response against the TMS intensity in each subject (MEP recruitment curve).
Modified Ashworth Scale (MAS)
Time Frame: 3-4 hours
This scale measures resistance encountered during manual passive muscle stretching using a six-point ordinal scale.
StartReact
Time Frame: 3-4 hours
Here, participants will be asked to observe a light-emitting diode (LED) located in front of their head. When the LED will illuminate, individuals will be asked to move their arm or leg. In some trials, the LED will be presented with either a quiet acoustic stimulus (80 dB, 500 Hz, 50 ms) or a startling acoustic stimulus (SAS, 120 dB, 500 Hz, 50 ms) delivered through a headphone.
Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT)
Time Frame: 3-4 hours
This exam measures gross motor function frequently used to manipulate objects that participants may encounter in their daily lives.
Participant reported spasticity
Time Frame: 3-4 hours
Spasticity questionnaire
Pendulum Test
Time Frame: 3-4 hours
As part of the physical exam, we will use the pendulum test to measure muscle tone at the knee by using gravity to provoke muscle stretch reflexes during passive swinging of the lower limb.
Portable Spasticity Assessment Device (PSAD)'
Time Frame: 3-4 hours
The PSAD combine biomechanical and electrophysiological measurements for an objective quantification of active and passive component of muscle stiffness
10-meter walk test
Time Frame: 3-4 hours
10-meter walk test will be used to assess walking speed
Ipsilateral MEPs (iMEPs)
Time Frame: 3-4 hours
Ten stimuli will be delivered during head straight and ten stimuli will be delivered during lateral head rotation, randomly alternated (0.2 Hz).
Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP).
Time Frame: 3-4 hours
This exam measures clinical impairment that incorporates three domains vital to upper-limb function: sensation, strength, and prehension.