Spinal Cord Injuries
Conditions
Keywords
SCI, Spinal Cord Injury, Epidural Spinal Stimulation
Brief summary
The purpose of this pre-market clinical study is to assess the preliminary safety and efficacy of the ARC Therapy using the ARC-IM Lumbar System at supporting mobility in participants who have previously received a spinal array and an implantable pulse generator (IPG) either through the STIMO protocol (NCT02936453) or similar studies conducted abroad. They will be proposed to exchange their currently implanted system with components of the newly developed ARC-IM Lumbar system. The goal is to improve more effective lower-limb motor activities, while also simplifying the personal at-home use of the system. In addition, this study aims to evaluate the potential effect of ARC Therapy on muscle tone, bladder, bowel and sexual functions, and quality of life of the participants. Preliminary safety and efficacy will be assessed in both the short term and throughout the duration of the study (from the surgery to 36 months after the implantation of the ARC-IM Lumbar system).
Detailed description
Studies have shown that using Electrical Epidural Stimulation (EES) could improve considerably the functional movements after paralyzing SCI. In the STIMO study (NCT02936453), the investigational system was mainly composed of medical devices developed for other indications and used off-label, allowing only a limited tuning of EES protocols. To overcome this limitation, we propose to conduct a study in which a new platform will be investigated. This new therapy, named ARC Therapy, features the ARC-IM implantable pulse generator with an optimized communication system and the ARC-IM implantable leads supporting stimulation protocols specifically developed for effective activation of motor neurons. The study will take place at the CHUV (Lausanne, Switzerland). A maximum of 8 participants will be enrolled in the study and implanted with an ARC-IM IPG. Patients who previously received an implantation in international studies for continuous electrical stimulation can enroll in the current BoxSwitch study. Replacement of their currently implanted IPG and lead will be assessed on a case-by-case manner considering current status of their implanted devices, technical and surgical compatibility with the newly proposed ARC-IM Lumbar system components. The study intervention consists of several phases preceded by pre-screening: Screening and enrollment, baseline and pre-implantation assessments, surgery, optimization phase, short-term assessments, independent use phase and follow-up assessments at months 12, 24 and 36. Measures will be performed before surgical intervention and at regular intervals during the study. The total duration of the study will be approximately 48 months (up to 36 months/participant).
Interventions
DEVICEProcedure/Surgery
The intervention involves the replacement of parts of the current implanted system with components of the ARC-IM Lumbar system.
Sponsors
Ecole Polytechnique Fédérale de Lausanne
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Single-site, single-arm, non-blinded, non-randomized, interventional
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Implanted with a spinal array (Specify 5-6-5 or Go2 Lead) for lower limb mobility, as confirmed by imaging, videos, or neurophysiology recordings. 2. Age 18-65 3. SCI graded as American Spinal Injury Association Impairment Scale (AIS) A, B, C & D 4. SCI ≥ 12months 5. SCI lesion level T10 and above with preservation of conus function 6. SCI due to trauma 7. Stable medical, physical and psychological condition as considered by the investigators 8. Able to understand and interact with the study team in French or English 9. Agrees to comply in good faith with all conditions of the study and to attend all scheduled appointments 10. Must provide and sign the Informed Consent prior to any study-related procedures
Exclusion criteria
1. Diseases and conditions that would increase the morbidity and mortality of spinal cord injury surgery 2. History of myocardial infarction or cerebrovascular event within the past 6 months 3. Limitation of walking function based on accompanying (CNS) disorders (systemic malignant disorders, cardiovascular disorders restricting physical training, peripheral nerve disorders) 4. Any active implanted cardiac device such as pacemaker or defibrillator 5. Any indication that would require diathermy 6. Any indication that would require MRI 7. Any anatomical limitations in the implantation area as judged by the investigators 8. Other conditions that would make the subject unable to participate in testing in the judgement of the investigators 9. Clinically significant mental illness in the judgement of the investigators 10. Presence of indwelling baclofen or insulin pump 11. Other clinically significant concomitant disease states (e.g., renal failure, hepatic dysfunction, cardiovascular disease, etc.) 12. Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, or dementia of the participant 13. Enrolment of the investigator, his/her family members, employees, and other dependent persons 14. Women who are pregnant (pregnancy test obligatory for women of childbearing potential) or breastfeeding
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Preliminary safety of the ARC Therapy | Through study completion (expected 3 years) | Occurrence of Serious Adverse Events and Adverse Events that are deemed related or possibly related to the study procedure or to the ARC-IM system. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| 6 Minutes Walk test (meters) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The 6 minutes walk test is a performance measureused to assess aerobic capacity and endurance. |
| International Standards For Neurological Classification of Spinal Injury (ISNCSCI) | Baseline, 12 months, 24 months and 36 months | A neurological assessment and classification of a spinal cord injury |
| Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The SCI-FAI assesses functional walking ability in ambulatory individuals with SCI. |
| Neuromuscular Recovery Scale (NRS) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The NRS is used to measure quality of movement without compensatory movement patterns using a body weight support system and a treadmill. |
| 10 Meters Walk test (m/s) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The 10 Meters Walk Test is a performance measure used to assess walking speed in meters per second over a short distance. |
| Modified Ashworth Scale (MAS) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The modified Ashworth scale a universally accepted clinical tool used to measure the increase of muscle tone. |
| Spinal Cord Independence Measure (SCIM III) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The SCIM address specific areas of function in patients with spinal cord injuries (SCI). |
| Quality of Life questionnaires | Monthly during the first year | Questionnaires addressing bowel, bladder and sexual functions. |
| Walking Index for Spinal Cord Injury (WISCI II) | Baseline, Short-term (up to 6months), 12 months, 24 months and 36 months | The Walking Index for Spinal Cord Injury (WISCI) is a scale that measures the type and amount of assistance (in terms of requirements of assistive devices, or human helpers) required by a person with spinal cord injury (SCI) for walking. |
Countries
Switzerland
Contacts
Primary ContactGrégoire Courtine, Prof
Outcome results
None listed