Rebuilding Inter-limb Transfer in Cervical SCI

NCT ID: NCT06440538

Last Updated: 2025-09-24

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

EARLY_PHASE1

Total Enrollment

17 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-02-15

Study Completion Date

2026-07-30

Brief Summary

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The purpose of this study in people living with cervical Spinal Cord Injury (SCI) is to examine the effects of paired neurostimulation (i.e., PCMS) combined with contralateral motor training on inter-limb transfer of ballistic motor and hand dexterity skills.

Detailed Description

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Cervical spinal cord injury (SCI) is the most common and severe type of SCI that can lead to paralysis of the trunk and all four limbs, also known as tetraplegia. People with tetraplegia place a high priority on regaining upper limb motor function to be independent in daily life. Despite intensive therapies, upper limb motor gains are slow to emerge, especially in chronic cases.

A critical barrier to effective and efficient upper limb rehabilitation in cervical SCI lies in the motor deficits of inter-limb transfer. Inter-limb transfer refers to a natural innate process within the human neuromotor system that motor skills acquired in one limb can transfer to the opposite, untrained limb, and is believed to play a key role in maximizing and accelerating post-injury recovery. Inter-limb transfer however is deficient following cervical SCI due to a breakdown of inter-limb neural connections at the cortical and spinal levels. Prior studies in uninjured people reveal that one can upregulate inter-limb neural mechanisms and hence augment inter-limb transfer effects by giving neurostimulation to augment corticomotoneuronal pathways to the untrained arm just before motor training in the contralateral arm.

This study aims to rebuild inter-limb transfer of motor gains in chronic cervical SCI using a novel non-invasive neurostimulation method called paired corticospinal-motor neuronal stimulation (PCMS). We will test the central hypothesis that PCMS given to an untrained hand immediately before the visuomotor ballistic motor training at the other hand will improve inter-limb transfer of ballistic motor and dexterity skills to the untrained hand, based on potentiation of inter-limb neural mechanisms.

Conditions

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Cervical Spinal Cord Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Participants

Study Groups

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PCMS + Contralateral Motor Training

Group Type EXPERIMENTAL

PCMS + Contralateral Motor Training

Intervention Type DEVICE

PCMS + Contralateral Motor Training will involve delivering 360 pairs of TMS-PNS pulses (30min, 0.2 Hz) to the weaker first dorsal interosseous (FDI) muscle immediately before a session of ballistic index finger abduction training at the opposite, stronger FDI muscle.

PCMS + Rest

Group Type ACTIVE_COMPARATOR

PCMS + Rest

Intervention Type DEVICE

PCMS + Rest will involve delivering 360 pairs of TMS-PNS pulses (30min, 0.2Hz) to the weaker FDI followed by a 30-min rest.

Sham PCMS + Contralateral Motor Training

Group Type SHAM_COMPARATOR

Sham PCMS + Contralateral Motor Training

Intervention Type DEVICE

360 TMS pulses will be delivered at a location 10-cm posterior to the participant's head (into the air, 0.2Hz) and no PNS pulses will be generated, followed by a session of 30-min ballistic index finger abduction training at the opposite, stronger FDI muscle.

Interventions

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PCMS + Contralateral Motor Training

PCMS + Contralateral Motor Training will involve delivering 360 pairs of TMS-PNS pulses (30min, 0.2 Hz) to the weaker first dorsal interosseous (FDI) muscle immediately before a session of ballistic index finger abduction training at the opposite, stronger FDI muscle.

Intervention Type DEVICE

PCMS + Rest

PCMS + Rest will involve delivering 360 pairs of TMS-PNS pulses (30min, 0.2Hz) to the weaker FDI followed by a 30-min rest.

Intervention Type DEVICE

Sham PCMS + Contralateral Motor Training

360 TMS pulses will be delivered at a location 10-cm posterior to the participant's head (into the air, 0.2Hz) and no PNS pulses will be generated, followed by a session of 30-min ballistic index finger abduction training at the opposite, stronger FDI muscle.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Neurological Level of Injury C4, C5, C6, C7, C8
* American Spinal Injury Association Impairment Scale (AIS) C-D
* greater than or equal to 1 year time post injury
* residual motor sparing of bilateral FDI muscles, defined as medical research council (MRC) grade 2 to 5

Exclusion Criteria

* contraindications to transcranial magnetic stimulation (TMS) and peripheral nerve stimulation (PNS) including pacemaker, metal in the skull, seizure history, pregnancy, etc.
* history of alcohol and/or drug abuse
* current usage of medications that can potentially lower the seizure threshold such as bupropion, amphetamines, etc.
* history of other neurological conditions such as stroke, Parkinson's, and traumatic brain injury (TBI)
* active pressure ulcers to avoid disruption of ongoing medical treatments
* participation of on-going upper-limb therapies to minimize confounding effects
* excessive tone/spasticity (Modified Ashworth Scale \[MAS\] \>3) and severe contractures or soft tissue shortening at elbow/wrist/fingers
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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The Craig H. Neilsen Foundation

OTHER

Sponsor Role collaborator

The Cleveland Clinic

OTHER

Sponsor Role lead

Responsible Party

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Ela B. Plow

Associate Proffesor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ela Plow, PhD

Role: PRINCIPAL_INVESTIGATOR

The Cleveland Clinic

Locations

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Lerner Research Institute; Cleveland Clinid Foundation

Cleveland, Ohio, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Kyle J O'Laughlin, MS

Role: CONTACT

216-445-6728

Jia Liu, PhD

Role: CONTACT

216-445-6728

Facility Contacts

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Kyle J O'Laughlin, MS

Role: primary

216-445-7841

Ela Plow, PhD

Role: backup

216-445-4589

Other Identifiers

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23-415

Identifier Type: -

Identifier Source: org_study_id

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