Spinal Cord Injury
Conditions
Keywords
Spinal cord injury, neural control, motor function, hand movement
Brief summary
The overall goals of this proposal are to examine the contribution of physiological pathways to the control of grasping behaviors after cervical SCI, and to maximize the recovery of grasping by using tailored non-invasive brain stimulation and acoustic startle protocols with motor training. The investigators propose to study two basic grasping behaviors, which are largely used in most daily-life activities: a precision grip and a power grip.
Detailed description
Grasping behaviors, which are essential for daily-life functions, are largely impaired in individuals with cervical spinal cord injury (SCI). Although rehabilitative interventions have shown success in improving the ability to grasp following injury their overall effects remain limited. The goals of this proposal are to examine the contribution of physiological pathways to the control of grasping behaviors after cervical SCI, and to maximize the recovery of grasping by using tailored non-invasive stimulation protocols with motor training. The investigators propose to study two basic grasping behaviors: a precision grip and a power grip. These behaviors are crucial because they provide the basis for a number human prehensile manipulations and are also necessary skills for eating, writing, dressing, and many other functions. Thus, the study results may have a direct impact on the quality of life for Veterans and their caregivers by enhancing their independence and level of care. In Aim 1, the investigators will investigate the contribution of corticospinal and brainstem pathways to the control of hand muscles involved in precision and power grip after cervical SCI. Transcranial magnetic stimulation (TMS) will be used to examine transmission in corticospinal and intracortical pathways targeting finger muscles and an acoustic startle stimulus with and without TMS will be used to examine the contribution from brainstem pathways. In Aim 2, the investigators propose to enhance the recovery of grasping by using novel tailored protocols of non-invasive repetitive TMS targeting late indirect (I) descending volleys (iTMS) and an acoustic startle stimuli. iTMS and startle will be used during precision and power grip movements in a task-dependent manner to induce cortical and subcortical plasticity and enhance voluntary output of hand muscles. Later, iTMS and startle will be applied in a task-dependent manner during a motor training task that involves precision and power grip. These unique approaches aim at promoting neuroplasticity during functionally relevant grasping movements has not been used before.
Interventions
DEVICEiTMS
Small magnetic pulse will be given to the brain in a non invasive manner.
OTHERMotor Task
Participants will be asked to perform specific motor tasks or movements with their fingers, hands, and arms.
DEVICESham iTMS
Sham or fake stimulation will be given to the brain in a non invasive manner.
OTHERTraining
The participant will be instructed to do repetitive motor movements with their arm or hand.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
Participants will not know if they receive real or sham Stimulation and/or real or sham Startle
Intervention model description
Magnetic Stimulation and Acoustic Startle
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
Yes
Inclusion criteria
Participants who are unimpaired healthy controls: * Male and females between ages 18-85 years * Right handed * Able to complete precision grips with both hands * Able to complete full wrist flexion-extension bilaterally Participants who have had a spinal cord injury: * Male and females between ages 18-85 years * Chronic SCI (\> 1 year post injury) * Spinal Cord injury at C8 or above * Intact or impaired but not absent innervations in dermatomes C6. C7 and C8 during light touch and pin prick stimulus using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) sensory scores * The ability to produce a visible precision grip force with one hand * Able to perform some small wrist flexion and extension * ASIA A,B,C, or D
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in amplitude of Motor evoked potential size | Post treatment at minute 0, minute 10, minute30, minute 60. | At the stated minute interval TMS measurements are reassessed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Grip Strength and 9-hole peg test | Post treatment at minute 0, minute 10, minute30, minute 60. | At the stated minute interval the following measurements are reassessed: Force is measured during a grip task as muscle electrical activity (electromyography) is recorded in millivolts (mV) and 9-hole peg test is a dexterity measure, estimated as the time required to complete the task (seconds). |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMonica A Perez, PhD
Edward Hines Jr. VA Hospital, Hines, IL
Outcome results
None listed