Improving Spinal Cord Injury Rehabilitation Interventions by Retraining the Brain With Stimulation
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 3/10/2019 |
| Start Date: | November 2011 |
| End Date: | October 2019 |
| Contact: | Ela B Plow, PhD PT |
| Email: | plowe2@ccf.org |
| Phone: | 216-445-4589 |
Improving Spinal Cord Injury Rehabilitation Interventions by Retraining the Brain With Stimulation: Applying Concepts From Stroke
The purpose of this study is to investigate whether combining a noninvasive method of brain
stimulation, called Transcranial Direct Current Stimulation (tDCS), enhances the effect of
training of the affected upper limbs in patients with incomplete Spinal Cord Injury.
stimulation, called Transcranial Direct Current Stimulation (tDCS), enhances the effect of
training of the affected upper limbs in patients with incomplete Spinal Cord Injury.
The long-term objective of this study is to optimize the rehabilitative potential in spinal
cord injury (SCI) by maximally harnessing the potential available for functional neural
plasticity. SCI is an important cause of serious, long-term disability in young adults. This
fact, further complicated by rising disability-related costs, makes SCI a significant
economic and social burden. Upper limb dysfunction is one of the most prevalent and
debilitating impairments. More than 75% of patients with quadriplegia (paralysis of all 4
limbs following spinal cord injury in neck and upper back) prioritize return of upper limb
function over any other lost function. Alleviating deficits of the upper limb may represent a
cost-effective stategy to reducing the burden of SCI.
Although various exercise programs and neuromuscular stimulation methods have been employed
to mitigate functional impairments of the arm and hand, success of these modalities is still
debated. Evidence for efficacy of rehabilitation is inconclusive as outcomes are variable,
confounded by methodological issues, and have shown poor generalizability. It is now
speculated that limited succcess of rehabilitation emerges from inability of current methods
to adequately harness the potential for significant neuroplasticity available in SCI.
Even though the site of damage in SCI does not involve the brain, the neural networks in the
brain that control movement of the arm and hand are markedly affected. These regions lose
their territory that the investigators argue could hamper effects of upper limb therapy. Our
objective is to directly modulate adaptive plasticity in these regions of the brain to
enhance function of the upper limb in iSCI. Our central hypothesis is that noninvasive brain
stimulation, called transcranial direct current stimulation (tDCS), when delivered
concurrently with rehabilitation will generate synergistic functional advantage. Adaptive
plasticty would be obeserved as changes in structure of pathways emerging from the brain and
the individual's function.
cord injury (SCI) by maximally harnessing the potential available for functional neural
plasticity. SCI is an important cause of serious, long-term disability in young adults. This
fact, further complicated by rising disability-related costs, makes SCI a significant
economic and social burden. Upper limb dysfunction is one of the most prevalent and
debilitating impairments. More than 75% of patients with quadriplegia (paralysis of all 4
limbs following spinal cord injury in neck and upper back) prioritize return of upper limb
function over any other lost function. Alleviating deficits of the upper limb may represent a
cost-effective stategy to reducing the burden of SCI.
Although various exercise programs and neuromuscular stimulation methods have been employed
to mitigate functional impairments of the arm and hand, success of these modalities is still
debated. Evidence for efficacy of rehabilitation is inconclusive as outcomes are variable,
confounded by methodological issues, and have shown poor generalizability. It is now
speculated that limited succcess of rehabilitation emerges from inability of current methods
to adequately harness the potential for significant neuroplasticity available in SCI.
Even though the site of damage in SCI does not involve the brain, the neural networks in the
brain that control movement of the arm and hand are markedly affected. These regions lose
their territory that the investigators argue could hamper effects of upper limb therapy. Our
objective is to directly modulate adaptive plasticity in these regions of the brain to
enhance function of the upper limb in iSCI. Our central hypothesis is that noninvasive brain
stimulation, called transcranial direct current stimulation (tDCS), when delivered
concurrently with rehabilitation will generate synergistic functional advantage. Adaptive
plasticty would be obeserved as changes in structure of pathways emerging from the brain and
the individual's function.
Inclusion Criteria:
- Diagnosed with incomplete spinal cord injury (iSCI) that occurred at least 6 months
ago
Exclusion Criteria:
- History of epilepsy in a first degree relative
- Use of anticonvulsants
- Pregnant
- Implanted pumps, shunts, or neurostimulators
- Neurologic condition affecting sensorimotor systems
- Brain tumor
- Dementia
- Substance abuse
- Stroke
- Damaged skin on the scalp
- Concurrent upper limb rehabilitation
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