Effects of Paired Associative Nerve Stimulation on Spinal Cord Injury Subjects

NCT ID: NCT04194099

Last Updated: 2023-01-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-12-09

Study Completion Date

2023-12-31

Brief Summary

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This study is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with trans-spinal electrical stimulation (tsES) intervention on cortical excitability, brain structure, motor ability of lower limb in individuals with incomplete spinal cord injury. Twelve participants will be recruited in this study.

Detailed Description

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Spinal cord injury (SCI) impairs motor and sensory function and affects numerous body functions and daily activities. Insufficient central nervous system plasticity can result in maladaptive changes that prevent full recovery. It's a challenge to guide this plasticity to optimize the functional outcome for individuals with SCI.

Transcranial magnetic stimulation (TMS) and trans-spinal electric stimulation (tsES) may modulate cortical excitability, corticospinal output and spinal circuit. However, few studies investigated the effectiveness of paired nerve stimulation (PNS) on neuroplasticity and functional outcome in persons with SCI. Therefore, this study aim to examine the effects of the combination of these two different non-invasive nerve stimulation with the cycling exercise on the motor cortex and corticospinal circuit excitability as well as functional recovery.

Present study clarifies the effects of five different settings of combined with TMS and tsES intervention and then undergo cycling exercise after PNS on spinal cord and cortical excitability in SCI participants.

It is expected that this project will successfully establish a new neuromodulation technology to enhance cortical, corticospinal and spinal circuit excitability as well as to improve the outcome of lower-limb function and quality of life in persons with SCI. Therefore, this project can not only publish scientific papers, but also can enhance the neuroplasticity and improve function in persons with SCI.

Conditions

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Spinal Cord Injuries

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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rTMS (Brain) + tsES (Spinal)

First part 20 Hz rTMS (Brain) + Anode tsDCS (Spinal)

Brain:

1. Train pulse: 2 sec
2. Inter-train: 28 sec
3. Total time: 1200 sec

Spinal:

Continuous direct current (DC): 1200 sec

Second part iTBS rTMS(Brain) + 2.5-mA tsDCS (Spinal)

Brain:

1. Train pulse: 2 sec
2. Inter-train: 8 sec
3. Total time: 200 sec

Spinal:

Continuous direct current (DC): 600 sec

Group Type EXPERIMENTAL

20 Hz rTMS (Brain)

Intervention Type DEVICE

Higher frequency (\>5 Hz) trains increase cortical excitability.

Anode tsDCS (Spinal)

Intervention Type DEVICE

Anodal tsDCS increased the spinal reflex amplitude, as well as corticospinal excitability.

rTMS (Brain) + tsES (Spinal) or sham stimulation

First part 20 Hz rTMS (Brain) + 20 Hz current square-wave pulses (Spinal)

Brain and spinal:

1. Train pulse: 2 sec
2. Inter-train: 28 sec
3. Total time: 1200 sec

Second part iTBS rTMS(Brain) + sham 2.5-mA tsDCS (Spinal)

Brain:

1. Train pulse: 2 sec
2. Inter-train: 8 sec
3. Total time: 200 sec

Spinal:

Sham direct current (DC) stimulation

Group Type EXPERIMENTAL

20 Hz rTMS (Brain)

Intervention Type DEVICE

Higher frequency (\>5 Hz) trains increase cortical excitability.

20 Hz current square-wave pulses (Spinal)

Intervention Type DEVICE

Higher frequency (\>5 Hz) of current increase cortical excitability.

iTBS rTMS or sham (Brain) + tsES or sham (Spinal)

First part

Brain:

1. Train pulse: 2 sec
2. Inter-train: 8 sec
3. Total time: 200 sec

Spinal:

Continuous direct current (DC): 190 sec

Second part Sham iTBS rTMS (Brain) + 2.5-mA tsDCS (Spinal)

Sham iTBS rTMS Brain:

Spinal:

Continuous direct current (DC): 600 sec

Group Type EXPERIMENTAL

iTBS rTMS (Brain)

Intervention Type DEVICE

Intermittent theta burst stimulation (iTBS) is a newer rTMS approach.

Anode tsDCS (Spinal)

Intervention Type DEVICE

Anodal tsDCS increased the spinal reflex amplitude, as well as corticospinal excitability.

iTBS rTMS or sham (Brain) + iTBS or sham (Spinal)

First part

Brain and spinal:

1. Train pulse: 2 sec
2. Inter-train: 8 sec
3. Total time: 200 sec

Second part Sham iTBS rTMS (Brain) + Sham 2.5-mA tsDCS (Spinal)

Brain:

Sham iTBS rTMS

Spinal:

Sham direct current (DC) stimulation

Group Type EXPERIMENTAL

iTBS rTMS (Brain)

Intervention Type DEVICE

Intermittent theta burst stimulation (iTBS) is a newer rTMS approach.

iTBS (Spinal)

Intervention Type DEVICE

Intermittent theta-burst stimulation (iTBS) is a newer approach. it may increase corticospinal excitability.

sham (no stimulation on brain nor spinal)

First part Sham stimulation.

No second part

Group Type SHAM_COMPARATOR

sham

Intervention Type DEVICE

with sham stimulation on brain and spinal.

Interventions

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20 Hz rTMS (Brain)

Higher frequency (\>5 Hz) trains increase cortical excitability.

Intervention Type DEVICE

iTBS rTMS (Brain)

Intermittent theta burst stimulation (iTBS) is a newer rTMS approach.

Intervention Type DEVICE

Anode tsDCS (Spinal)

Anodal tsDCS increased the spinal reflex amplitude, as well as corticospinal excitability.

Intervention Type DEVICE

20 Hz current square-wave pulses (Spinal)

Higher frequency (\>5 Hz) of current increase cortical excitability.

Intervention Type DEVICE

iTBS (Spinal)

Intermittent theta-burst stimulation (iTBS) is a newer approach. it may increase corticospinal excitability.

Intervention Type DEVICE

sham

with sham stimulation on brain and spinal.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

1. Age 20 to 65 years incomplete SCI (American Spinal Injury Association Impairment Scale (ASIA) B to D)
2. Lesion area above the tenth thoracic vertebra (T10)
3. Injury time more than one year
4. Without range of motion (ROM) limitation
5. Medical condition stable

Exclusion Criteria

1. Having pacemaker, cochlear implants, metal in the brain or skull, open wound of brain, or history of epilepsy.
2. Having seizure history
3. Having other neurological, mental, medical problems affect this study
Minimum Eligible Age

20 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Taipei Medical University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Lai chien hung

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Chien-Hung Lai, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Taipei Medical University Hospital

Locations

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Taipei Medical university Hospital

Taipei, , Taiwan

Site Status RECRUITING

Countries

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Taiwan

Central Contacts

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Chien-Hung Lai, MD PhD

Role: CONTACT

886-2-27372181 ext. 3538

Facility Contacts

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Chien-Hung Lai

Role: primary

Other Identifiers

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N201905031

Identifier Type: -

Identifier Source: org_study_id

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