Combined Tactile and Proprioception Training After Spinal Cord Injury
Condition: Spinal Cord Injury
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      A novel rehabilitation bike has been developed for patients with incomplete spinal cord
      injuries that incorporates mechanical stimulators on the bike pedals to stimulate the sensory
      receptors in the soles of the feet; the effect of mechanical stimulator on muscle
      strengthening has been reported by NASA to improve muscle atrophy in astronauts in
      zero-gravity environments. Cycling also stimulates lower limb position sensors. We predict
      that the combination of mechanical stimulation with cycling may be similar enough to walking
      over ground to lead to gains in balance and mobility. The present study will evaluate the
      therapeutic effect of this bike on balance, walking, as well as cortical-spinal and spinal
      pathways in patients with incomplete spinal cord injuries.
    

Detailed description: 
      INTRODUCTION:

      Individuals with spinal cord injuries (SCI) experience balance impairments and limitations in
      walking. Newer research demonstrates that even after several years individuals with
      incomplete SCIs can make significant gains in function when they are engaged in targeted
      physical activity. Previous studies using functional electrical stimulation and locomotion
      training report reduced spasticity and reflex control, increased electromyography activity
      during stepping, and increased thigh muscles mass. However, these methods and instruments are
      bulky, expensive, need technical maintenance, and must be used in a clinical setting. A novel
      rehabilitation bicycle that uses simultaneous stimulation of plantar mechanoreceptors and hip
      joint proprioceptors was developed in the department of Biomedical Engineering of University
      of Manitoba. An advantage of this device is that patients can use it at home and with minimal
      assistance. Five patients completed initial pilot testing and exhibited an overall
      improvement on the Berg Balance Scale. Presently, the effect of rehabilitation bike training
      on the plasticity of the spinal and corticospinal neuronal circuitry and consequently its
      effects on the functional walking capacity are unclear.

      OBJECTIVES:

      The purpose of the present study is to evaluate the effect of the rehabilitation bike on
      corticospinal and spinal plasticity, and functional walking and balance in incomplete SCI
      individuals.

      METHODS:

      Ten individuals with chronic incomplete SCI will participate in this study. The protocol will
      include 30 minute training sessions, three times/week, for 8 weeks. The study design will be
      a before-after clinical trial with two baseline assessments prior to training. Post-training
      evaluation after two weeks will be done and there will be a post-training follow-up
      assessment after two weeks.

      Evaluations of functional recovery and independence include: Six -Minute and Ten-Meter Walk
      Tests, Walking index for spinal cord injury(WISCI II). The Berg Balance Scale(BBS) will be
      conducted to assess balance. Results will be compared before and after training. H-reflex and
      motor evoked potential (using transcranial magnetic stimulation ,TMS) will also be measured
      before and after cycling training to assess the plasticity at the level of the spine and in
      the corticospinal pathways respectively.

      ANTICIPATED RESULTS:

      Compared to locomotion training with treadmills and robotic devices, using the rehabilitation
      bike is affordable and patients are able to use it independently at home, without the help of
      a physical therapist or a caregiver. Results of this study will clarify the possible positive
      effect of training with the rehabilitation bike on the corticospinal reorganization as well
      as training effects on the functional recovery of balance and walking. If the findings from
      the present study are consistent with the initial pilot data, then it will provide incomplete
      SCI patients and their therapists with a new option for rehabilitation that is feasible and
      cost-effective. Considering the relatively high incidence of SCI in Manitoba, the findings
      from this study will directly improve quality of life for Manitobans and Canadians living
      with spinal cord injuries.
    

Intervention name(s): Cycling and Mechanical stimulation
Intervention type(s): Device
Intervention description(s): Cycling and Mechanical stimulation : 30 minute cycling training, 3 times a week for 8 weeks.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Spinal cord injury; rehabilitation; cycling