Synergistic Effect of Non-invasive Brain and Spinal Cord Stimulation

NCT ID: NCT07334977

Last Updated: 2026-01-12

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

PHASE2

Total Enrollment

45 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-12-11

Study Completion Date

2027-12-31

Brief Summary

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The goal of this clinical study is to investigate the potential synergy between non-invasive brain and spinal cord stimulation administered during a cognitive-motor task, in terms of their immediate effects on sensorimotor and cognitive functions after neurological injuries affecting the upper limb (cervical spinal cord injury and stroke). Secondary objectives are to evaluate the relevance of anatomical MRI, functional MRI, and neurophysiological measurements for optimizing and predicting the effects of these different interventions.

Detailed Description

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Over the past decade, innovative electrical stimulation strategies have emerged to improve the effectiveness of conventional rehabilitation approaches following spinal cord injury or stroke. Transcranial direct current stimulation (tDCS) and transcutaneous spinal cord stimulation (tSCS) are two non-invasive stimulation techniques targeting respectively the brain and spinal cord. These techniques have demonstrated immediate and lasting positive effects on the recovery of lost neurological functions following damage to the brain (in the case of stroke) or the spinal cord (in the case of spinal cord injury). Functional improvements leading to a better quality of life have been demonstrated in response to tSCS or tDCS sessions combined with motor training. Recent studies suggest a potential synergistic effect of these two types of intervention, which we propose to characterize in control participants, participants with cervical spinal cord injury, and post-stroke participants.

OBJECTIVES: In this project, we seek to study the potential synergistic effects of an intervention combining non-invasive stimulation of the brain and spinal cord, administered during the performance of a cognitive-motor task, compared to a control intervention and each intervention administered separately, on the recovery of motor and cognitive-motor functions after neurological injury. Secondary objectives are to evaluate the relevance of anatomical MRI data and neurophysiological measurements for optimizing and predicting the effects of these different interventions.

METHODOLOGY/RESEARCH DESIGN: Single-center, prospective, comparative, randomized, crossover, and single-blind clinical study comparing four neuromodulation interventions: S1: tDCS, S2: tSCS, S3: tDCS-tSCS, S4: sham, administered during a cognitive-motor training task of the affected upper limb using the Armeo technology. Three groups of participants will be included: one control group, one group with cervical spinal cord injury, and one post-stroke group. The two groups with either spinal cord injury or stroke will participate in a total of nine visits: the inclusion visit, four testing visits, and four intervention visits. The control group will participate only in the inclusion and testing visits. Outcome measures will include neurophysiological and clinical performance measures.

Conditions

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Stroke Spinal Cord Injury Able Bodied

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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tDCS+CMT

tDCS administered during the performance of cognitive and motor task for 20 min

Group Type EXPERIMENTAL

tDCS

Intervention Type PROCEDURE

tDCS will be delivered using an electrical stimulation device d (1X1 tES, Soterix Medical Inc., USA, CE marked) delivering a direct current at 2 mA for a period of 20 minutes. Silicone electrodes are placed in sponges soaked in physiological saline (5 cm × 7 cm) (EASYpadTM, Soterix Medical Inc.), with the anode and cathode centered on the optimal cortical areas determined during testing visits.

Cognitive-Motor Task

Intervention Type BEHAVIORAL

The cognitive-motor task will be administered using the ArmeoControl software supplied with the ArmeoSping® or ArmeoPower® upper limb rehabilitation exoskeleton. Participants will be seated in a chair or their wheelchair and fitted into the exoskeleton.The exoskeleton is linked to a series of exercises performed on a computer via a virtual reality interface (ArmeoControl), which allows simultaneous training of the arms and hands in a large workspace. Two vertical and horizontal "visually guided reaching" tasks will be offered, each lasting 10 minutes. These tasks are chosen to provide training in cognitive-motor functions (grabbing a target moving in a virtual workspace) and sensorimotor functions (interacting with the exoskeleton to move the target).

tSCS+CMT

20-min tSCS administered during the performance of cognitive and motor task for 20 min

Group Type EXPERIMENTAL

tSCS

Intervention Type PROCEDURE

tSCS will be applied for 20 minutes using a constant current electrical stimulator (DS5 or DS7A, Digitimer Ltd, CE marked) delivering monophasic pulses at 30 Hz at stimulation sites and intensities specific to each participant and defined in advance during testing visits.

Sham

Intervention Type PROCEDURE

For the sham stimulation interventions, the current slowly increases to the intensity used during the active interventions for 30 seconds, then slowly decreases over the next 30 seconds, at the beginning and end of the stimulation. The sham interventions use the same electrode placements as during the active ones for a total duration of 20 min.

tDCS-tSCS+CMT

tDCS associated with tSCS administered during the performance of cognitive and motor task for 20 min

Group Type ACTIVE_COMPARATOR

tDCS

Intervention Type PROCEDURE

tDCS will be delivered using an electrical stimulation device d (1X1 tES, Soterix Medical Inc., USA, CE marked) delivering a direct current at 2 mA for a period of 20 minutes. Silicone electrodes are placed in sponges soaked in physiological saline (5 cm × 7 cm) (EASYpadTM, Soterix Medical Inc.), with the anode and cathode centered on the optimal cortical areas determined during testing visits.

tSCS

Intervention Type PROCEDURE

tSCS will be applied for 20 minutes using a constant current electrical stimulator (DS5 or DS7A, Digitimer Ltd, CE marked) delivering monophasic pulses at 30 Hz at stimulation sites and intensities specific to each participant and defined in advance during testing visits.

Cognitive-Motor Task

Intervention Type BEHAVIORAL

The cognitive-motor task will be administered using the ArmeoControl software supplied with the ArmeoSping® or ArmeoPower® upper limb rehabilitation exoskeleton. Participants will be seated in a chair or their wheelchair and fitted into the exoskeleton.The exoskeleton is linked to a series of exercises performed on a computer via a virtual reality interface (ArmeoControl), which allows simultaneous training of the arms and hands in a large workspace. Two vertical and horizontal "visually guided reaching" tasks will be offered, each lasting 10 minutes. These tasks are chosen to provide training in cognitive-motor functions (grabbing a target moving in a virtual workspace) and sensorimotor functions (interacting with the exoskeleton to move the target).

Sham-tDCS-tSCS+CMT

Sham tDCS associated with Sham tSCS administered during the performance of cognitive and motor task for 20 min

Group Type SHAM_COMPARATOR

tDCS

Intervention Type PROCEDURE

tDCS will be delivered using an electrical stimulation device d (1X1 tES, Soterix Medical Inc., USA, CE marked) delivering a direct current at 2 mA for a period of 20 minutes. Silicone electrodes are placed in sponges soaked in physiological saline (5 cm × 7 cm) (EASYpadTM, Soterix Medical Inc.), with the anode and cathode centered on the optimal cortical areas determined during testing visits.

tSCS

Intervention Type PROCEDURE

tSCS will be applied for 20 minutes using a constant current electrical stimulator (DS5 or DS7A, Digitimer Ltd, CE marked) delivering monophasic pulses at 30 Hz at stimulation sites and intensities specific to each participant and defined in advance during testing visits.

Sham

Intervention Type PROCEDURE

For the sham stimulation interventions, the current slowly increases to the intensity used during the active interventions for 30 seconds, then slowly decreases over the next 30 seconds, at the beginning and end of the stimulation. The sham interventions use the same electrode placements as during the active ones for a total duration of 20 min.

Cognitive-Motor Task

Intervention Type BEHAVIORAL

The cognitive-motor task will be administered using the ArmeoControl software supplied with the ArmeoSping® or ArmeoPower® upper limb rehabilitation exoskeleton. Participants will be seated in a chair or their wheelchair and fitted into the exoskeleton.The exoskeleton is linked to a series of exercises performed on a computer via a virtual reality interface (ArmeoControl), which allows simultaneous training of the arms and hands in a large workspace. Two vertical and horizontal "visually guided reaching" tasks will be offered, each lasting 10 minutes. These tasks are chosen to provide training in cognitive-motor functions (grabbing a target moving in a virtual workspace) and sensorimotor functions (interacting with the exoskeleton to move the target).

Interventions

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tDCS

tDCS will be delivered using an electrical stimulation device d (1X1 tES, Soterix Medical Inc., USA, CE marked) delivering a direct current at 2 mA for a period of 20 minutes. Silicone electrodes are placed in sponges soaked in physiological saline (5 cm × 7 cm) (EASYpadTM, Soterix Medical Inc.), with the anode and cathode centered on the optimal cortical areas determined during testing visits.

Intervention Type PROCEDURE

tSCS

tSCS will be applied for 20 minutes using a constant current electrical stimulator (DS5 or DS7A, Digitimer Ltd, CE marked) delivering monophasic pulses at 30 Hz at stimulation sites and intensities specific to each participant and defined in advance during testing visits.

Intervention Type PROCEDURE

Sham

For the sham stimulation interventions, the current slowly increases to the intensity used during the active interventions for 30 seconds, then slowly decreases over the next 30 seconds, at the beginning and end of the stimulation. The sham interventions use the same electrode placements as during the active ones for a total duration of 20 min.

Intervention Type PROCEDURE

Cognitive-Motor Task

The cognitive-motor task will be administered using the ArmeoControl software supplied with the ArmeoSping® or ArmeoPower® upper limb rehabilitation exoskeleton. Participants will be seated in a chair or their wheelchair and fitted into the exoskeleton.The exoskeleton is linked to a series of exercises performed on a computer via a virtual reality interface (ArmeoControl), which allows simultaneous training of the arms and hands in a large workspace. Two vertical and horizontal "visually guided reaching" tasks will be offered, each lasting 10 minutes. These tasks are chosen to provide training in cognitive-motor functions (grabbing a target moving in a virtual workspace) and sensorimotor functions (interacting with the exoskeleton to move the target).

Intervention Type BEHAVIORAL

Other Intervention Names

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transcranial Direct Current Stimulation transcutaneous Spinal Cord Stimulation

Eligibility Criteria

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Inclusion Criteria

CONTROL GROUP:

* Over 18 years of age
* Participant who has signed an informed consent form
* Participant who is affiliated with and covered by the social security system

POST-STROKE GROUP:

* Over 18 years of age
* Who sustained a stroke more than 3 weeks ago
* Considered medically stable by the medical investigator
* Who has signed an informed consent form
* Affiliated with and covered by the social security system

SCI GROUP:

* Over 18 years of age
* Considered to have a complete or incomplete spinal cord injury (i.e., with a score on the Spinal Injury Association (ASIA) Impairment Scale (AIS) score from A to D)
* Considered medically stable by the investigating physician
* Presenting with quadriplegia due to cervical injury
* Who has signed an informed consent form
* Affiliated with and covered by the social security system.

Exclusion Criteria

* Suffering from a chronic condition
* Skin problems or open wounds
* History of epilepsy or seizures
* Presence of a contraindication to the use of magnetic/electrical stimulation or MRI, including: cardiac pacemaker; implanted hearing aid; intraocular foreign body, shrapnel, or bullets; metal worker; pacemaker or neurostimulator; claustrophobia
* Presence of implanted medical devices (cardiac valve, endovascular devices, ventricular shunt valve, surgical clips, metallic sutures, staples, stent, osteosynthesis or arthrodesis hardware) not classified as "MR Conditional" according to ASTM F2503.
* Individuals who are legally incompetent, under judicial protection, guardianship, or trusteeship
* Pregnant and/or breastfeeding women
* Individuals who refuse to be informed of any abnormalities that may be detected by MRI.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University Hospital, Bordeaux

OTHER

Sponsor Role collaborator

Centre de la Tour de Gassies

UNKNOWN

Sponsor Role collaborator

Institute of Neurodegenerative Diseases, CNRS UMR 5293

UNKNOWN

Sponsor Role collaborator

Centre National de la Recherche Scientifique, France

OTHER

Sponsor Role lead

Responsible Party

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Fabien Wagner

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fabien Wagner, PhD

Role: PRINCIPAL_INVESTIGATOR

Institute of Neurodegenerative Diseases, CNRS UMR 5293

Nabila Brihmat, PhD

Role: PRINCIPAL_INVESTIGATOR

Institute of Neurodegenerative Diseases, CNRS UMR 5293

Hélène Cassoudesalle, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University Hospital, Bordeaux

Locations

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Service de Médecine Physique & Réadaptation - CHU Bordeaux

Bordeaux, , France

Site Status RECRUITING

Centre de la Tour de Gassies

Bruges, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Nabila Brihmat, PhD

Role: CONTACT

+33 5 33 51 48 46

Fabien Wagner, PhD

Role: CONTACT

+33 5 33 51 48 46

Facility Contacts

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Hélène Cassoudesalle, MD, PhD

Role: primary

Christophe Roth, MD

Role: primary

+33556163191

Other Identifiers

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ARF202309017508

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2024-A00724-43

Identifier Type: -

Identifier Source: org_study_id

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