Lower Limb Function After Spinal Cord Injury
| Status: | Recruiting |
|---|---|
| Conditions: | Hospital, Orthopedic |
| Therapuetic Areas: | Orthopedics / Podiatry, Other |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 3/7/2019 |
| Start Date: | October 2015 |
| End Date: | October 2020 |
| Contact: | Monica Perez, PT PhD |
| Email: | perezmo@miami.edu |
| Phone: | 305-243-7119 |
Corticospinal Excitability of Leg Muscles After Spinal Cord Injury
This is a randomized, experimental study that examines the physiology of central nervous
system pathways contributing to the control of bilateral movements in individuals with spinal
cord injuries and promotes the recovery of lower-limb motor function through the use of
stimulation and locomotor training.
system pathways contributing to the control of bilateral movements in individuals with spinal
cord injuries and promotes the recovery of lower-limb motor function through the use of
stimulation and locomotor training.
This study plans to examine plasticity in corticospinal synapses of lower-limb muscles. it
has been demonstrated that plasticity elicited at corticospinal synapses in the spinal cord
result in enhancements in electromyographic (EMG) and force activity in upper-limb muscles.
The first step in this proposal is to determine if synaptic plasticity can be elicited in
corticospinal projections targeting lower-limb muscles in humans with SC.
We will also study methods to strengthen corticospinal plasticity to promote recovery of leg
clearance during training. We will use two novel strategies to enhance plasticity in
corticospinal synapses of lower-limb muscles after SCI: a). administration of an
N-methyl-D-aspartate (NMDA) receptor agonist (i.e. D-cycloserine), and b). Combine
NMDA-induced corticospinal plasticity with training (2D lower limb training and locomotor
training. Corticospinal synaptic plasticity is thought to depend on activation of NMDA
receptors and D-cycloserine enhances motor skill behaviors in animals and humans will be
enhanced by NMDA-induced corticospinal plasticity. An important strength of this aim is the
combination of training and strategies that aimed at enhancing the synaptic efficacy of
residual corticospinal projections. Training effects on physiological pathways will be
explored and correlated with locomotor function
has been demonstrated that plasticity elicited at corticospinal synapses in the spinal cord
result in enhancements in electromyographic (EMG) and force activity in upper-limb muscles.
The first step in this proposal is to determine if synaptic plasticity can be elicited in
corticospinal projections targeting lower-limb muscles in humans with SC.
We will also study methods to strengthen corticospinal plasticity to promote recovery of leg
clearance during training. We will use two novel strategies to enhance plasticity in
corticospinal synapses of lower-limb muscles after SCI: a). administration of an
N-methyl-D-aspartate (NMDA) receptor agonist (i.e. D-cycloserine), and b). Combine
NMDA-induced corticospinal plasticity with training (2D lower limb training and locomotor
training. Corticospinal synaptic plasticity is thought to depend on activation of NMDA
receptors and D-cycloserine enhances motor skill behaviors in animals and humans will be
enhanced by NMDA-induced corticospinal plasticity. An important strength of this aim is the
combination of training and strategies that aimed at enhancing the synaptic efficacy of
residual corticospinal projections. Training effects on physiological pathways will be
explored and correlated with locomotor function
Inclusion Criteria:
- 4. Inclusion criteria for individuals with SCI:
- Male and females between ages 18-85 years of age
- SCI ( ≥1 month of injury)
- ASIA A, B,C and D
- SCI above L5
- Able to perform a visible contraction with dorsiflexor and hip flexor muscles
(allowing testing of largely impaired patients)
- Able to ambulate a few steps with or without an assistive device
Inclusion criteria for healthy controls:
- Male and females between ages 18-85 years of age
- Able to walk and complete lower-limb tests with both legs
Exclusion Criteria:
Exclusion criteria for individuals with SCI
- Uncontrolled medical problems including pulmonary, cardiovascular or orthopedic
disease,
- Any debilitating disease prior to the SCI that caused exercise intolerance
- Premorbid, ongoing major depression or psychosis, altered cognitive status
- History of head injury or stroke,
- Metal plate in skull
- History of seizures
- Receiving drugs acting primarily on the central nervous system, which lower the
seizure threshold such as antipsychotic drugs (chlorpromazine, clozapine) or tricyclic
antidepressants.
- Pregnant females, and
- 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.
Exclusion criteria for healthy controls:
- Uncontrolled medical problems including pulmonary, cardiovascular or orthopedic
disease,
- Any debilitating disease that causes exercise intolerance
- Premorbid, ongoing major depression or psychosis, altered cognitive status
- History of head injury or stroke,
- Metal plate in skull
- History of seizures
- Receiving drugs acting primarily on the central nervous system, which lower the
seizure threshold such as antipsychotic drugs (chlorpromazine, clozapine) or tricyclic
antidepressants.
- Pregnant females, and
- 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.
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