Corticospinal Function After Spinal Cord Injury
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 3/8/2019 |
| Start Date: | April 2015 |
| End Date: | December 2020 |
| Contact: | Monica A Perez, PhD, PT |
| Email: | perezmo@miami.edu |
| Phone: | 305-243-7119 |
The investigator's overall goal is to develop new strategies to enhance the recovery of
upper-limb function after spinal cord injury (SCI). The investigator proposes to use modern
electrophysiological methods to enhance the efficacy of residual corticospinal connections.
Defining the neural basis by which corticospinal volleys generate muscle responses will
provide crucial information required to maximize residual motor output. The investigator's
specific goals are to: 1) determine the temporal and spatial organization of corticospinal
volleys and motor cortical representations of upper-limb muscles after incomplete cervical
SCI and 2) develop methodologies to promote recovery of function. The investigator's focus on
reach and grasp movements because of their importance in daily life activities.
upper-limb function after spinal cord injury (SCI). The investigator proposes to use modern
electrophysiological methods to enhance the efficacy of residual corticospinal connections.
Defining the neural basis by which corticospinal volleys generate muscle responses will
provide crucial information required to maximize residual motor output. The investigator's
specific goals are to: 1) determine the temporal and spatial organization of corticospinal
volleys and motor cortical representations of upper-limb muscles after incomplete cervical
SCI and 2) develop methodologies to promote recovery of function. The investigator's focus on
reach and grasp movements because of their importance in daily life activities.
This study will determine the temporal organization of corticospinal volleys during reach and
grasp movements. Multiple descending volleys in the corticospinal tract generate multiple
peaks in muscle responses (indirect (I)-waves). I-waves are a mechanism by which
corticospinal neurons are transynaptically activated at periodic intervals of ~1.5 ms. This
periodic activation contributes to the recruitment of spinal motoneurons and generation of
movement. we will use paired-TMS to examine I-waves in surface EMG recordings from upper-limb
muscles during reach and grasp movements.
We will also identify motor cortical maps of upper-limb muscles involved in reach and grasp
movements. We will use TMS guided by a frameless neuronavigation system to define the size
and location of motor cortical maps of upper-limb muscles during reach and grasp movements.
We will be able to determine overlaps and functional interactions between distal and proximal
arm motor cortical representations. Our preliminary data shows that finger and biceps
cortical maps largely overlap during reach and grasp movements in controls but considerable
less in patients
grasp movements. Multiple descending volleys in the corticospinal tract generate multiple
peaks in muscle responses (indirect (I)-waves). I-waves are a mechanism by which
corticospinal neurons are transynaptically activated at periodic intervals of ~1.5 ms. This
periodic activation contributes to the recruitment of spinal motoneurons and generation of
movement. we will use paired-TMS to examine I-waves in surface EMG recordings from upper-limb
muscles during reach and grasp movements.
We will also identify motor cortical maps of upper-limb muscles involved in reach and grasp
movements. We will use TMS guided by a frameless neuronavigation system to define the size
and location of motor cortical maps of upper-limb muscles during reach and grasp movements.
We will be able to determine overlaps and functional interactions between distal and proximal
arm motor cortical representations. Our preliminary data shows that finger and biceps
cortical maps largely overlap during reach and grasp movements in controls but considerable
less in patients
Inclusion Criteria:
- Inclusion criteria for individuals with SCI:
1. Male and females between 18-85 years,
2. Chronic SCI (≥ 6 months post injury),
3. Cervical injury at C8 or above,
4. Intact or impaired but not absent innervations in dermatomes C6, C7, and C8 using
the American Spinal Injury Association sensory scores, and
5. Ability to reach and grasp a small object located at least 8 cm forward, above,
and laterally without leaning forward with the trunk
Inclusion criteria for healthy controls:
1. Male and females between 18-85 years,
2. Right handed,
3. Ability to reach and grasp a small object located at least 8 cm forward, above, and
laterally without leaning forward with the trunk
Exclusion Criteria:
- Exclusion criteria for individuals with SCI and Healthy Controls:
1. Uncontrolled medical problems including pulmonary, cardiovascular or orthopedic
disease
2. Any debilitating disease prior to the SCI that caused exercise intolerance
3. Premorbid, ongoing major depression or psychosis, altered cognitive status
4. History of head injury or stroke
5. Pacemaker
6. Metal plate in skull
7. History of seizures
8. Receiving drugs acting primarily on the central nervous system, which lower the
seizure threshold such as antipsychotic drugs (chlorpromazine, clozapine) or
tricyclic antidepressants
9. Pregnant females
10. Ongoing cord compression or a syrinx in the spinal cord or who suffer from a
spinal cord disease such as spinal stenosis, spina bifida or herniated cervical
disk.
11. History of brain tumor and or brain infection
We found this trial at
1
site
Miami, Florida 33131
Principal Investigator: Monica A Perez, PhD
Phone: 312-238-7549
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