Active tDCS Versus Sham tDCS for Upper Limb Recovery in Incomplete Tetraplegic Patients

NCT ID: NCT05390853

Last Updated: 2024-10-22

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-05-24
• Study Completion Date: 2025-11-30

Brief Summary

Spinal Cord Injury (SCI) at the cervical level results in motor and sensory impairment below the lesion level and may determine a consistent loss of the use of the upper limbs, with a substantial impact on daily life activities. Therefore, functionality recovery of the upper limbs, of the hands in particular, represents a priority rehabilitation target. Studies in the literature show that the most relevant recovery occurs in the first months after SCI and that neuromodulation techniques may facilitate it. Transcranial Direct Current Stimulation (tDCS ) is a non-invasive neuromodulation technique. The present pilot, randomized controlled study aims at exploring the feasibility and efficacy of an early application of tDCS, in addition to the traditional physiotherapy treatment for the functional recovery of the upper limb, in incomplete traumatic tetraplegic subjects in the sub-acute phase after SCI occurrence. Patients hospitalized at the Montecatone Rehabilitation Institute are randomly assigned to Active tDCS or Sham tDCS.

Detailed Description

Spinal Cord Injury (SCI) at the cervical level results in motor and sensory impairment below the lesion level and may determine a consistent loss of the use of the upper limbs, with a substantial impact on daily life activities. Therefore, functionality recovery of upper limbs, of the hands in particular, represents a priority rehabilitation target. In cases of incomplete tetraplegia, the main rehabilitation goal is the recovery of the maximum functional capacity, in order to improve autonomy or, in the most serious cases, avoid complications due to immobilization.

Studies in the literature show that the most relevant recovery occurs in the first months after SCI and that neuromodulation techniques may facilitate it.

Transcranial Direct Current Stimulation (tDCS ) is a non-invasive neuromodulation technique capable of modifying cortical excitability through direct, low intensity current, generated by a programmable medical device and delivered through electrodes placed on the scalp. Some authors have explored its potential role in facilitating functional recovery and treating spasticity in SCI subjects, however there are few studies on the use of neuromodulation induced by tDCS as an aid for the functional recovery of upper limbs in tetraplegic subjects. Moreover, most of such studies are on chronic SCI persons only.

The present pilot, randomized controlled study aims at exploring the feasibility and efficacy of an early application of tDCS, in the sub-acute phase after SCI occurrence, for the functional recovery of the upper limb, in addition to the traditional physiotherapy treatment, in incomplete traumatic tetraplegic patients, hospitalized at the Montecatone Rehabilitation Institute. They are randomly assigned to Active tDCS (A) or Sham tDCS (S) (parallel arms design,1:1 allocation ratio). Two tDCS daily sessions for 5 days a week, for 2 consecutive weeks, are carried out simultaneously with the usual rehabilitation treatment of the upper limb, that is administered also at least 4 weeks before and 4 weeks after the tDCS treatment period.

Most outcomes are measured up to 4 weeks after the completion of the tDCS treatment period.

Conditions

Spinal Cord Injury Cervical

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: TRIPLE

Study Groups

Active tDCS (A)

Two daily tDCS sessions for 5 days a week, for 2 consecutive weeks, are carried out, simultaneously with the usual rehabilitation physiotherapy of the upper limbs.

Patients will receive the usual rehabilitation physiotherapy of the upper limbs at least in the 4 weeks before and in the 4 weeks after the tDCS treatment period too.

Group Type: EXPERIMENTAL

Active tDCS

Intervention Type: PROCEDURE

tDCS application is anodic, in the M1 area (Primary Motor Cortex) right or left, contralateral to the pre-defined target limb. The cathode is positioned in the supraorbital area, contralateral to the anode.

Active stimulation is carried out with a current intensity of 2 milliAmpere. Each tDCS session lasts 20 minutes. tDCS is administered simultaneously during the first 20 minutes of the usual upper limb rehabilitation physiotherapy, which will continue for a further 20 minutes.

During the whole study period (10 weeks) each patient is not subjected to any focal treatments in the target upper limb.

In the study period, the contralateral limb is rehabilitated and evaluated according to usual practice.

Sham tDCS (S)

Two daily tDCS sessions for 5 days a week, for 2 consecutive weeks, are carried out, simultaneously with the usual rehabilitation physiotherapy of the upper limbs.

Patients will receive the usual rehabilitation physiotherapy of the upper limbs at least in the 4 weeks before and in the 4 weeks after the tDCS treatment period too.

Group Type: PLACEBO_COMPARATOR

Sham tDCS

Intervention Type: PROCEDURE

tDCS application is anodic, in the M1 area (Primary Motor Cortex) right or left, contralateral to the pre-defined target limb. The cathode is positioned in the supraorbital area, contralateral to the anode.

Sham stimulation is carried out through a dedicated program, which increases the current for several seconds up to the target intensity and then decreases it gradually in a few seconds, so that subjects experience the same itching and tingling experience as in active stimulation, but they do not receive any significant therapeutic currents.

Each tDCS session lasts 20 minutes. tDCS is administered simultaneously during the first 20 minutes of the usual upper limb rehabilitation physiotherapy, which will continue for a further 20 minutes.

During the whole study period (10 weeks) each patient is not subjected to any focal treatments in the target upper limb.

In the study period, the contralateral limb is rehabilitated and evaluated according to usual practice.

Interventions

Active tDCS

tDCS application is anodic, in the M1 area (Primary Motor Cortex) right or left, contralateral to the pre-defined target limb. The cathode is positioned in the supraorbital area, contralateral to the anode.

Active stimulation is carried out with a current intensity of 2 milliAmpere. Each tDCS session lasts 20 minutes. tDCS is administered simultaneously during the first 20 minutes of the usual upper limb rehabilitation physiotherapy, which will continue for a further 20 minutes.

During the whole study period (10 weeks) each patient is not subjected to any focal treatments in the target upper limb.

In the study period, the contralateral limb is rehabilitated and evaluated according to usual practice.

Intervention Type: PROCEDURE

Sham tDCS

tDCS application is anodic, in the M1 area (Primary Motor Cortex) right or left, contralateral to the pre-defined target limb. The cathode is positioned in the supraorbital area, contralateral to the anode.

Sham stimulation is carried out through a dedicated program, which increases the current for several seconds up to the target intensity and then decreases it gradually in a few seconds, so that subjects experience the same itching and tingling experience as in active stimulation, but they do not receive any significant therapeutic currents.

Each tDCS session lasts 20 minutes. tDCS is administered simultaneously during the first 20 minutes of the usual upper limb rehabilitation physiotherapy, which will continue for a further 20 minutes.

During the whole study period (10 weeks) each patient is not subjected to any focal treatments in the target upper limb.

In the study period, the contralateral limb is rehabilitated and evaluated according to usual practice.

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• Traumatic SCI;
• SCI neurological level, according to the American Spinal Injury Association (ASIA) definitions, from C3 to C7, included;
• incomplete SCI (i.e. ASIA Impairment Scale: B, C or D);
• distance from the SCI event: from 3 to 6 months;
• residual motor ability of the target upper limb;
• stable clinical conditions;
• tolerance to sitting position for at least 45 minutes;
• subjects capable and collaborating, able to give informed consent in person.

Exclusion Criteria

• presence of implanted devices (e.g. pacemakers, intrathecal infusers, neurostimulators, hearing aids);
• positive history of brain lesions;
• presence of cerebral metallic implants (clips) or intracranial implants (e.g. ventriculoperitoneal shunt);
• history of epilepsy or previous state of epileptic disease;
• mechanical ventilation in place;
• history of psychotic disorders;
• history of severe neurodegenerative disease;
• concomitant pre-existing clinical conditions that may interfere with movements of the target arm or hand (e.g. severe osteoarthritis, joint injuries, plexus injuries, peripheral nerve injuries, partial amputations);
• use of antiepileptic drugs blocking Sodium o Calcium channels (e.g. Carbamazepine) or N-Methyl-D-Aspartate receptor antagonists (e.g. Dextromethorphan);
• history of drugs abuse;
• further contraindications to the use of TMS for PEMs elicitation (e.g. migraine with aura, permanent head / face tattoos);
• presence of brain tumor;
• pregnancy in progress.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 74 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Montecatone Rehabilitation Institute S.p.A.

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Silvia Olivi, MD

Role: PRINCIPAL_INVESTIGATOR

Montecatone Rehabilitation Institute S.p.A.

Locations

Montecatone Rehabilitation Institute S.p.A.

Imola, BO, Italy

Site Status: RECRUITING

Countries

Italy

Central Contacts

Silvia Olivi, MD

Role: CONTACT

silvia.olivi@montecatone.com

+39 0542 632811

Facility Contacts

Silvia Olivi, MD

Role: primary

silvia.olivi@montecatone.com

+39 0542 632811

Other Identifiers

CE AVEC_96-2022-SPER-AUSLIM

Identifier Type: -

Identifier Source: org_study_id