Spinal Cord Injuries
Conditions
Keywords
Acute Intermittent Hypoxia, Upper Extremity Training
Brief summary
The purpose of this research study is to investigate the effectiveness of a combinatorial therapy of breathing low oxygen in short bursts-acute intermittent hypoxia (AIH) and upper limb training on arm strength and function, and comparing it with individual treatments in persons with spinal cord injuries. The investigators hypothesize that a combinatorial intervention with AIH therapy + upper limb training will be significantly more effective in improving hand function, compared to individual treatments alone. To test this hypothesis, the investigators will determine the impact of combined daily AIH therapy and high-repetition task-specific upper extremity training on arm strength and hand dexterity in persons with spinal cord injuries.
Detailed description
The objective of this research project is to determine the effect of a 5-day intervention with daily acute intermittent hypoxia (AIH) therapy, either alone or coupled with task-specific training, on upper extremity function in individuals with chronic, incomplete SCI. Previous work already determined that breathing low levels of oxygen for short periods of time (also known as acute intermittent hypoxia) can improve lower limb motor function in persons with spinal injury. Specifically, this study is being done to determine if pre-treatment with intermittent hypoxia can enhance the beneficial effects of upper limb training on the restoration of limb function in persons with spinal injury. This is a blinded study, which means that the subject will not know which treatment they are receiving. They will either receive intermittent periods of low oxygen (hypoxia) or a session composed of only normal room air. They will be randomly assigned to a treatment based on chance. Neither the subject nor the researcher chooses the assigned group. They will have an equal chance of being in either group. The participant will receive a daily 5-day intervention with either acute intermittent hypoxia (AIH) therapy or room air, either alone or coupled with task-specific training, on upper extremity function in individuals with chronic, incomplete SCI. This will be preceded by a baseline testing visit prior to the intervention, and followed by a 4 week follow up period to assess the effects of the interventions over time. The total duration of participation in the study intervention protocol is 1 week. Including the follow up period, the subjects will participate for a total of 6 weeks.
Interventions
This will consist of up to 90 seconds of 9-10% O2 (FiO2 0.09), alternating with up to 90 seconds of 21% O2 (normoxic air FiO2 0.21). The delivery of hypoxia and normoxic air mixtures will be repeated up to 18 times per session each, for a total of up to 45 minutes.
BEHAVIORALUpper extremity training
Subjects will receive 45 minutes of task-specific, high repetition upper extremity training, given using an upper-limb robotic rehabilitation device, the Armeo Spring®. Armeo Spring is a gravity support system based on an ergonomic arm exoskeleton with integrated springs. It cradles the entire arm, from shoulder to the hand, and counterbalances the weight of the user's arm. Therefore, it enhances any residual function and neuromuscular control, and assists in active movement across a large 3-D workspace. The Armeo software contains an extensive library of game-like movement exercises supported by a virtual-reality training environment that displays the functional task along with immediate performance feedback.
This will consist of up to 90 seconds of 21% O2 (FiO2 0.21), alternating with up to 90 seconds of 21% O2 (normoxic air FiO2 0.21). The delivery of alternating normoxic air will be repeated up to 18 times per session each, for a total of up to 45 minutes.
Sponsors
U.S. Department of Education
Shirley Ryan AbilityLab
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
This is a blinded study, which means the participant will not know which treatment they are receiving. They will either receive intermittent periods of low oxygen (hypoxia) or a session composed of only normal room air. They will be randomly assigned to a treatment based on chance, like a flip of a coin. Neither you nor the researcher chooses your assigned group. They will have an equal chance of being in either group. Upon acceptance into the study, subjects will be assigned an identification number. Data pertaining to each subject will only be identified by this number. Any forms/files containing the subject's personal information and their ID number will be housed in a locked office/laboratory space. The outcomes assessor will also be blinded to the intervention the subject received.
Intervention model description
Subjects will then be randomized to one of the four arms. The four arms of interventions are: 1. Acute intermittent hypoxia (AIH) therapy 2. AIH therapy + Upper extremity training 3. Sham AIH therapy + Upper extremity training 4. Sham Hypoxia
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
1. Motor incomplete SCI at or below C2 and above T2 with non-progressive etiology 2. Age between 18 to 70 years 3. More than 1 year since SCI 4. Ability to close and open one's hand without assistance. 5. Ability to understand and the willingness to sign a written informed consent.
Exclusion criteria
1. Presence of any of the following medical conditions: congestive heart failure, arrhythmia, uncontrolled high blood pressure, uncontrolled diabetes mellitus, COPD/emphysema and severe asthma. 2. Weight over 250 pounds. 3. Persons with known coronary artery disease, a history of myocardial infarction and known carotid or intracerebral artery stenosis. 4. A medical clearance will be required if patients are taking any other investigational agents. 5. Women who are pregnant or nursing will be excluded, as the potential effects of intermittent hypoxia on pregnant women and fetus are unknown. 6. Individuals with tracheostomy will be excluded. 7. Subjects cannot pursue other research studies which may interfere with our treatment. 8. Subjects with diagnosed obstructive sleep apnea will be excluded as that may affect the response or sensitivity to AIH, 9. Orthopedic injuries or recent surgeries affecting the mobility of upper extremity and shoulder We will not include the following populations: * Adults unable to consent, unless accompanied by a legally authorized representative. * Individuals who are not yet adults (infants, children, teenagers) * Pregnant women * Prisoners
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Grip strength (Hydraulic Handheld Dynamometer) | 10-12 minutes | A dynamometer measures maximum gross grasp (kg) averaged over attempt with each hand. The minimum possible value of zero kg will be assigned when the participant cannot actively flex the fingers or grasp the dynamometer |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Box and Block Test (BBT) | 5 min, with time to instruct | Measure of manual dexterity that requires repeatedly moving 1-inch blocks from one side of a box to another in 60 seconds. |
| Nine Hole Peg Test | Upto 10-12 minutes, dependent on their ability to complete the test. | A test of upper extremity dexterity which involves picking up pegs from a container and placing them, one by one, into holes on a board, as quickly as possible. Participants must then remove the pegs, one by one, and replace them into the original container. The total time in seconds is recorded. |
| Spinal Cord Independence Measure (SCIM III) | 10-15 minutes | An outcome measure that is specifically designed to evaluate functional ability in individuals with spinal cord injury. It has established reliability, internal consistency, and construct validity (when compared to the Functional Independence Measure, and the Walking Index for Spinal Cord Injury). It consists of 19 items in 3 separate domains, including self-care, respiration and sphincter management, and mobility. |
| Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) | 45-60 minutes | This is a clinical impairment measure used to evaluate sensory and motor hand function in individuals with cervical spinal cord injuries. It is composed of different domains, including: strength, sensation (dorsal and palmar), prehension ability, and prehension performance. |
| Pinch grip (Strength gauge Dynamometry) | 10-12 minutes | A pinch gauge measures maximum pinch force (kg) averaged over attempt with each hand. The minimum possible value of zero kg will be assigned when the participant cannot actively squeeze the pinch meter between thumb and index finger. |
| California Verbal Learning Test | 45 minutes | The California Verbal Learning Test (CVLT) is a neuropsychological test which can be used to assess an individual's verbal memory abilities. |
| Delis-Kaplan Executive Function System (D-KEFS™) | 10-12 minutes | Neurophysological test that assesses key components of executive functions within verbal and spatial modalities. |
| N-back test | 45 minutes | The n -back task is a continuous performance task that is commonly used as an assessment in cognitive neuroscience to measure a part of working memory and working memory capacity. |
| Capabilities of Upper Extremity Questionnaire | 10 minutes | This is a structured interview that serves to evaluate functional limitations in individuals with tetraplegia. Participants are provided with questions regarding the difficulty of a given task as it relates to using their more-affected and less-affected sides. This outcome measure has established minimal detectable change and standard error of measure values. It also has demonstrated excellent criterion validity. |
Countries
United States
Contacts
Primary ContactMilap Sandhu, PT, PhD
Outcome results
None listed