Improving Hand and Arm Function After Spinal Cord Injury (SCI)

The long-term goal of this project is to develop rehabilitation strategies that facilitate
optimal restoration of skilled hand use in individuals with spinal cord injury (SCI). The
objective of the studies proposed in this application is to determine whether a protocol of
massed practice + somatosensory stimulation (MP+SS) is more effective for improving skilled
hand use compared to a somatosensory stimulation (SS) alone, and to determine whether these
approaches are each more effective than traditional therapy (consisting of conventional
resistance training; CRT).

Specific Aim I: In individuals with chronic incomplete tetraplegia, quantify changes in
skilled hand use and sensory function associated with either: massed practice training
combined with somatosensory stimulation (MP+SS), somatosensory stimulation (SS), or control
(conventional resistance training [CRT]), and compare differences among groups. The
investigators hypothesize that:

H1.1: At the end of 4 weeks, gains in scores on standardized tests of skilled hand motor
function (Jebsen-Taylor Hand Function Test and Chedoke-McMaster Arm and Hand Activity
Inventory) and sensory function (quantitative sensory tests; QST) will be greater in
individuals who are trained using MP+SS compared to the SS and RT groups.

H1.2: At the end of 4 weeks, gains in scores on standardized tests of skilled hand motor
function and sensory function tests will be greater in individuals who are trained using SS
compared to CRT.

H1.3: At 6 months post training, motor and sensory gains will be retained by the MP+SS and
SS groups.

Specific Aim 2: In individuals with chronic incomplete tetraplegia, quantify changes in
cortical and spinal neurophysiology associated with either: massed practice combined with
somatosensory stimulation (MP+SS), somatosensory stimulation (SS), or control (conventional
resistance training [CRT]), and compare differences among groups. The investigators
hypothesize that, after 4 weeks:

H2.1: Measures representing cortical neurophysiologic function (i.e., motor-evoked potential
amplitude and location of cortical map) will show greater change in the direction of more
normal values in individuals who are trained using MP+SS compared to the SS and the CRT
groups.

H2.2: Measures representing spinal neurophysiologic function (i.e., F-wave and H-reflex
amplitude) will show greater change in the direction of more normal values in individuals
who are trained using SS compared to the MP+SS and the CRT groups.

H2.3: There will be a positive relationship between change scores associated with functional
outcome measures and cortical neurophysiologic outcome measures in the MP+SS group; there
will be a positive relationship between change scores associated with the functional outcome
measures and spinal neurophysiologic outcome measures in the SS group.

Specific Aim 3: In individuals with chronic incomplete tetraplegia, quantify changes in
self-assessment of quality of life and societal participation associated with massed
practice combined with somatosensory stimulation (MP+SS), somatosensory stimulation (SS) or
control (conventional resistance training [CRT]), and compare difference among groups. The
investigators hypothesize that:

H3.1: Gains in scores on standardized measures of quality of life (Medical Outcomes Study
Short Form 36 [SF-36]) and societal participation (Impact on Participation and Autonomy
Questionnaire [IPAQ]) will be greater in individuals who are trained using MP+SS compared to
both the SS and the CRT groups.

H3.2: Gains in scores on standardized measures of quality of life and societal participation
will be greater in individuals who are trained using SS compared to the CRT group.

H3.3: At 6 months post training, gains in the quality of life and the societal participation
measures will be retained by the MP+SS and SS groups.

Risks: This is a low risk study that investigates the effects of standard rehabilitation and
exercise interventions on hand/arm function in individuals with SCI. All devices are
considered minimal risk devices by the FDA.