Improving Motor Function After Spinal Cord Injury

This study will consist of electromyography (surface and intramuscular), peripheral nerve
stimulation, and transcranial magnetic stimulation, electrical stimulation, of the hand,
arm, leg, and foot representation of the primary motor cortex, as well as MRI scans of the
brain. The investigators will examine the physiological measurements of upper and lower
extremity muscles (such as in the first dorsal interosseous (FDI), biceps brachii (BIC),
anterior deltoid (AD), tibialis anterior (TA), hamstring (HAMS) and quadriceps (QUAD)). This
study may occur at the Miami Project to cure Paralysis at the University of Miami. The
investigators will include subjects between the ages of 18 and 85, both healthy controls and
individuals with chronic spinal cord injuries that occurred at least 6 months prior to
recruitment. Both healthy controls and those with spinal cord injuries will be able to
perform small hand and arm movements and small leg and foot movements. The primary outcome
measures of this study are muscle responses to stimulation with magnetic pulses using TMS
and electrical stimulation of a peripheral nerve in the arm or leg. The investigators
propose to enhance the recovery of motor function by using new protocols of high frequency
non-invasive repetitive TMS (rTMS) and motor training. Repetitive TMS will be used during
hand, arm, leg and foot movements in a task-dependent manner to induce cortical plasticity
and enhance voluntary output of the muscles associated with those movements. Second, rTMS
will be applied in a task-dependent manner during a visuo-motor training task that also
involves movements of the hands, arms, legs or feet.

Inclusion Criteria:

Male and female veterans and non veterans with spinal cord injury at least 6 months after
injury was sustained. We also plan to enroll control subjects who do not have any history
of spinal cord injury.

Participants who are unimpaired healthy controls:

1. Male and females between ages 18-85 years

2. Right handed

3. Able to complete precision grips with both hands

4. Able to complete full wrist flexion-extension bilaterally

5. Able to walk unassisted

6. Able to complete full ankle flexion-extension bilaterally

Participants who have had a spinal cord injury:

1. Male and females between ages 18-85 years

2. Chronic SCI (≥ 6 months of injury)

3. Spinal Cord injury at or above L5

4. The ability to produce a visible precision grip force with one hand

5. Individuals who have the ability to pick up a small object (large paperclip) from a
table independently

6. Able to perform some small wrist flexion and extension (measured by a goniometer)

7. The ability to perform a small visible contraction with dorsiflexor and hip flexor
muscles

8. No subjects will be excluded based on their race, religion, ethnicity, gender or HIV
status.

Exclusion Criteria:

- Exclusion criteria for enrollment For SCI and Healthy Control Subjects (for
stimulation):

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. Metal plate in skull

6. History of seizures

7. Receiving drugs acting primarily on the central nervous system, which lower the
seizure threshold (see appendix 2)

8. Pregnant females

9. Ongoing cord compression or a syrinx in the spinal cord or who suffer from a
spinal cord disease such as spinal stenosis, spina bifida, MS, or herniated
cervical disk

10. Individuals with scalp shrapnel, cochlear implants, or aneurysm clips.