Incomplete Spinal Cord Injury (SCI), SCI - Spinal Cord Injury
Conditions
Brief summary
Spinal cord injuries (SCI) impair neural communication, leading to difficulties in walking due to muscle weakness, altered reflexes, and impaired muscle activation below the injury. Functional electrical stimulation (FES) has been shown to enhance voluntary control, strength, and walking performance when used during gait training. This study aims to assess whether the FES yields superior improvements in walking ability compared to conventional gait training without stimulation.
Detailed description
Background: Spinal cord injury (SCI) disrupts neural communication, resulting in impaired walking ability due to muscle weakness, altered reflex modulation, and reduced voluntary muscle activation below the lesion level. Functional electrical stimulation (FES) applied during gait training has been shown to enhance muscle activation and improve gait performance. However, it remains unclear whether gait training with automated multi-channel FES provides additional benefits beyond conventional treadmill gait training in individuals with chronic incomplete SCI (iSCI). Objectives: (1) To determine whether gait training combined with FES leads to greater improvements in overground walking speed compared to improvements observed during the preceding period of conventional gait training alone. (2) To evaluate retention of walking improvements following the FES intervention. (3) To explore whether changes in gait performance are associated with changes in muscle coordination and muscle strength. Methods: This study is a prospective single-group, repeated-measures study with two sequential intervention phases: 10 weeks of conventional treadmill gait training followed by 10 weeks of gait training with FES. Individuals with chronic iSCI (≥12 months post-injury; AIS C or D; neurological level C2-T12) will participate in a 23-week program. Assessments will be performed at baseline (T0), after conventional training (T1), after FES gait training (T2), and at 10-weeks post intervention (T3). The primary outcome is the 10-Meter Walk Test (10MWT) walking speed (m/s). The primary analysis compares the change in 10MWT performance during the FES-assisted phase (T2-T1) with the change during the conventional phase (T1-T0). Secondary outcomes include spatiotemporal gait parameters, Walking Index for Spinal Cord Injury II, Hoffer classification, treadmill gait performance, muscle activity, and isometric leg muscle strength.
Interventions
Following completion of the conventional training phase, participants continue with 20 sessions of gait training combined with FES. Training frequency, duration, and treadmill procedures remain identical to the conventional training phase, including the use of the safety harness system and the option for seated breaks during walking. During sessions, participants wear the trousers part of a full-body garment (Teslasuit, Deep Divers, London, UK), which delivers FES through integrated textile electrodes positioned over the target muscle groups.
Sponsors
Stichting Reade
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
17 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Have a non-progressive chronic (\>1 yrs) incomplete SCI between C4 and T12 with an ASIA score of C or D. * Be at least 18 years of age. * Be able to take some steps (with assistive devices or in the bridge). * As part of the inclusion process, responsiveness to electrical stimulation will be assessed using a Compex electrical stimulator (Compex SP 4.0; Compex Medical SA, Switzerland) to ensure potential participant's respond well to ES, and to ensure that the sensitivity threshold is not reached before motor response in all target muscles.
Exclusion criteria
* Flaccid paralysis. * Musculoskeletal dysfunction, uncured fractures, contractures, pressure injuries, or infections that could impede the intended training. * Botox injections in the lower extremities during the last six months. * Women who are (planning to get) pregnant during the study period. * Implanted neurostimulator or stimulator of any kind that can have an influence on the safe use of ES. * Pacemaker, or other device, present in the body that prevents the safe use of ES. * Inability to communicate well or have cognitive disorders. * Currently being enrolled in another training study or participated in a training study in the previous six months. * Having an illness that has a high chance of preventing them to be able to perform the training at a sufficient frequency.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| walking speed | From enrollment to the end of study at 33 weeks | The primary outcome is walking speed (m/s) on the 10MWT, assessed at T0, T1, T2, and T3. The primary analysis compares the change during the FES-assisted phase (T2-T1) with the change during the conventional phase (T1-T0). If a participant cannot complete the full 10 meters, the trial is excluded from the primary analysis and recorded as missing data |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Spatiotemporal gait parameters - step length | From enrollment to the end of study at 33 weeks | Step length (cm) will be assessed during the 10MWT using a markerless 3D full-body motion registration system (the Interactive Walkway; four Microsoft Kinect v2 sensors, 30Hz; Geerse et al., 2015). The gait parameters will be determined between the 2 and 8-meter line on the walkway to reduce the effect of gait acceleration and deceleration. |
| Spatiotemporal gait parameters - step width | From enrollment to the end of study at 33 weeks | Step width (cm) will be assessed during the 10MWT using a markerless 3D full-body motion registration system (the Interactive Walkway; four Microsoft Kinect v2 sensors, 30Hz; Geerse et al., 2015). The gait parameters will be determined between the 2 and 8-meter line on the walkway to reduce the effect of gait acceleration and deceleration. |
| Spatiotemporal gait parameters - Cadence | From enrollment to the end of study at 33 weeks | Cadence (steps/min) will be assessed during the 10MWT using a markerless 3D full-body motion registration system (the Interactive Walkway; four Microsoft Kinect v2 sensors, 30Hz; Geerse et al., 2015). The gait parameters will be determined between the 2 and 8-meter line on the walkway to reduce the effect of gait acceleration and deceleration. |
| Functional ambulation - WISCI II | From enrollment to the end of study at 33 weeks | Evaluated at T0, T1, T2, and T3 using the WISCI II (0-20). |
| Functional ambulation - Hoffer classification | From enrollment to the end of study at 33 weeks | Evaluated at T0, T1, T2, and T3 using the Hoffer classification (5-point scale). |
| Muscle activity and neuromuscular coordination - Center of Activity | From enrollment to the end of study at 33 weeks | Surface EMG (Trigno Wireless EMG System, Delsys Inc., Natick, USA) will be used to record muscle activity from eight muscles bilaterally during the 10MWTs. The muscle set comprises bilateral tibialis anterior (TA), gastrocnemius medialis (GAM), soleus (SOL), peroneus longus (PL), rectus femoris (RF), vastus lateralis (VL), gluteus maximus (GLM), and semitendinosus (ST). This selection provides a comprehensive overview of lower-limb muscle activity and is consistent with standard practices in gait research and clinical motor control studies (Agostini et al., 2020; Kotov-Smolenskiy et al., 2021). Center of Activity will be calculated for each muscle at T0, T1 and T2. |
| Muscle activity and neuromuscular coordination - full width at half maximum | From enrollment to the end of study at 33 weeks | Surface EMG (Trigno Wireless EMG System, Delsys Inc., Natick, USA) will be used to record muscle activity from eight muscles bilaterally during the 10MWTs. The muscle set comprises bilateral tibialis anterior (TA), gastrocnemius medialis (GAM), soleus (SOL), peroneus longus (PL), rectus femoris (RF), vastus lateralis (VL), gluteus maximus (GLM), and semitendinosus (ST). This selection provides a comprehensive overview of lower-limb muscle activity and is consistent with standard practices in gait research and clinical motor control studies (Agostini et al., 2020; Kotov-Smolenskiy et al., 2021). The full width at half maximum (FWHM) will be calculated at T0, T1 and T2. |
| Muscle activity and neuromuscular coordination - Co-contraction | From enrollment to the end of study at 33 weeks | Surface EMG (Trigno Wireless EMG System, Delsys Inc., Natick, USA) will be used to record muscle activity from eight muscles bilaterally during the 10MWTs. The muscle set comprises bilateral tibialis anterior (TA), gastrocnemius medialis (GAM), soleus (SOL), peroneus longus (PL), rectus femoris (RF), vastus lateralis (VL), gluteus maximus (GLM), and semitendinosus (ST). This selection provides a comprehensive overview of lower-limb muscle activity and is consistent with standard practices in gait research and clinical motor control studies (Agostini et al., 2020; Kotov-Smolenskiy et al., 2021). The Co-contraction will be calculated at T0, T1 and T2. |
| Muscle strength | From enrollment to the end of study at 33 weeks | Peak isometric knee extension and flexion torque (Nm) are assessed bilaterally using a load cell, with participants seated at 90° hip and knee flexion. Participants exert force against a fixed horizontal strap attached to a wall, with the force measured using the load cell. The lower leg is positioned perpendicular to the strap such that joint torque can be computed as load cell force × moment arm, where the moment arm (distance from the knee joint center to the strap attachment point on the lower leg) is measured at each trial. Three maximal trials per direction are performed; the highest value is the primary outcome and the mean of three trials is reported as a secondary consistency measure. |
| Treadmill walking performance - Distance Covered | During the 20 weeks training sessions | Treadmill walking performance is monitored across all 40 training sessions. Distance covered (m) is recorded by the treadmill software at the end of each session. |
| Treadmill walking performance - Walking Speed | During the 20 weeks training sessions | Treadmill walking performance is monitored across all 40 training sessions. Walking speed (km/h) is recorded by the treadmill software at the end of each session. |
| Treadmill walking performance - Duration | During the 20 weeks training sessions | Treadmill walking performance is monitored across all 40 training sessions. Duration (min) is recorded by the treadmill software at the end of each session. |
| Gait kinematics during FES-assisted gait training | During the 10 week gait training with FES | Ankle and knee joint angles are recorded continuously across all 20 FES-assisted sessions using the six lower-body IMUs of the Teslasuit (femur, tibia, and foot bilaterally; 100 Hz). Raw data are stored for offline processing; all kinematic analyses are exploratory. |
Countries
Netherlands
Contacts
PRINCIPAL_INVESTIGATORThomas Janssen, Prof. Dr.
Vrije Universiteit Amsterdam / Stichting Reade
Outcome results
None listed