Finding the Best Combination of Brain and Spinal Cord Stimulation With Hand Training After Spinal Cord Injury

NCT ID: NCT06104735

Last Updated: 2025-10-22

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

RECRUITING

Clinical Phase

NA

Total Enrollment

12 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-05-24

Study Completion Date

2026-12-31

Brief Summary

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While physical exercise remains the foundation for any rehabilitation therapy, the team seeks to improve the benefits of exercise by combining it with the concept of "Fire Together, Wire Together" - when brain stimulation is synchronized with spinal cord stimulation, nerve circuits in the spinal cord strengthen - a phenomenon termed "Spinal Cord Associative Plasticity", or SCAP.

This project will build on the team's promising preliminary findings. When one pulse of brain stimulation is synchronized with one pulse of cervical spinal stimulation, hand muscle responses are larger than with brain stimulation alone or unsynchronized stimulation. However, the team does not know the best ways to apply SCAP repetitively, especially in conjunction with exercise, to increase and extend improvements in clinical function. Do ideal intervention parameters vary across individuals, or do they need to be customized?

The team will take a systematic approach with people who have chronic cervical SCI to determine each person's best combination of SCAP with task-oriented hand exercise. Participants will undergo up to 53 intervention, verification, and follow-up sessions over a period of 6 to 10 months each. The team will measure clinical and physiological responses of hand and arm muscles to each intervention.

Regaining control over hand function represents the top priority for individuals with cervical SCI. Furthermore, this approach could be compatible with other future interventions, including medications and cell-based treatments.

Detailed Description

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See above.

Conditions

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Spinal Cord Injuries

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Each participant will undergo multiple conditions and verifications in an "n-of-1" design.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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All participants

Each participant will undergo varying conditions in separate phases to determine optimal: Pairing interval; Frequency; Number of bouts, Inter-bout spacing, and the order of SCAP when given in conjunction with task-oriented hand exercise.

Group Type EXPERIMENTAL

Synaptic Pairing Interval

Intervention Type PROCEDURE

Optimize interstimulus pairing between brain and spinal cord stimulation.

Frequency

Intervention Type PROCEDURE

Compare 2 Hz continuous to intermittent theta burst frequency

Bouts

Intervention Type PROCEDURE

Compare effects of 1, 2, or 4 bouts of SCAP

Spacing

Intervention Type PROCEDURE

Compare 6 versus 12 minutes of rest in between bouts of SCAP

Exercise

Intervention Type PROCEDURE

Task-oriented hand exercises

SCAP plus Exercise

Intervention Type PROCEDURE

Compare interleaved versus serial bouts of SCAP and exercise.

Interventions

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Synaptic Pairing Interval

Optimize interstimulus pairing between brain and spinal cord stimulation.

Intervention Type PROCEDURE

Frequency

Compare 2 Hz continuous to intermittent theta burst frequency

Intervention Type PROCEDURE

Bouts

Compare effects of 1, 2, or 4 bouts of SCAP

Intervention Type PROCEDURE

Spacing

Compare 6 versus 12 minutes of rest in between bouts of SCAP

Intervention Type PROCEDURE

Exercise

Task-oriented hand exercises

Intervention Type PROCEDURE

SCAP plus Exercise

Compare interleaved versus serial bouts of SCAP and exercise.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age between 18-85 years.
* Must have stable prescription medication for 30 days prior to screening
* Must be able to: abstain from alcohol, smoking and heavy caffeine consumption on the day of each experiment; abstain from recreational drugs for the entirety of the study; commit to study requirements (i.e., 53 visits); provide informed consent.
* Score of 1-4 (out of 5) on manual muscle testing of finger extension, finger flexion, or finger abduction in left or right hand.

Exclusion Criteria

* Personal or extensive family history of seizures;
* Ventilator dependence or patent tracheostomy site;
* History of stroke, brain tumor, brain abscess, or multiple sclerosis;
* History of severe head trauma requiring neurosurgery;
* History of implanted brain/spine/nerve stimulators, aneurysm clips, ferromagnetic metallic implants in the head (except for inside mouth); cochlear implants; cardiac pacemaker/defibrillator; intracardiac lines; currently increased intracranial pressure; or other contraindications to brain or spine stimulation;
* Significant coronary artery or cardiac conduction disease; recent history of myocardial infarction and heart failure with an ejection fraction of less than 30% or with a New York Heart Association Functional Classification of Class III or IV;
* Recent history (within past 6 months) of recurrent autonomic dysreflexia, defined as a syndrome of sudden rise in systolic pressure greater than 20 mm Hg or diastolic pressure greater than 10 mm Hg, without rise in heart rate, accompanied by symptoms such as headache, facial flushing, sweating, nasal congestion, and blurry vision (this will be closely monitored during all screening and testing procedures);
* History of significant hearing problems;
* History of bipolar disorder;
* History of suicide attempt;
* Active psychosis;
* Recent history (\>1 year) of chemical substance dependency or significant psychosocial disturbance;
* Heavy alcohol consumption (greater than equivalent of 5oz of liquor) within previous 48 hours;
* Open skin lesions over the face, neck, shoulders, or arms;
* Pregnancy; and
* Unsuitable for study participation as determined by study physician.
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bronx Veterans Medical Research Foundation, Inc

OTHER

Sponsor Role collaborator

New York State Department of Health

OTHER_GOV

Sponsor Role collaborator

Bronx VA Medical Center

FED

Sponsor Role lead

Responsible Party

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Noam Y. Harel

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Noam Y Harel, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

JAMES J. PETERS VAMC

Locations

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James J. Peters VA Medical Center, Bronx, NY

The Bronx, New York, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Francisco Castano, MPH

Role: CONTACT

718-584-9000 ext. 5824

Facility Contacts

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Francisco Castano, MPH

Role: primary

718-584-9000 ext. 5824

Other Identifiers

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1777667

Identifier Type: -

Identifier Source: org_study_id

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