Improving Spinal Cord Injury Rehabilitation Interventions by Retraining the Brain With Stimulation
Condition: Spinal Cord Injury
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      The purpose of this study is to investigate whether combining a noninvasive method of brain
      stimulation, called Transcranial Direct Current Stimulation (tDCS), enhances the effect of
      training of the affected upper limbs in patients with incomplete Spinal Cord Injury.
    

Detailed description: 
      The long-term objective of this study is to optimize the rehabilitative potential in spinal
      cord injury (SCI) by maximally harnessing the potential available for functional neural
      plasticity. SCI is an important cause of serious, long-term disability in young adults. This
      fact, further complicated by rising disability-related costs, makes SCI a significant
      economic and social burden. Upper limb dysfunction is one of the most prevalent and
      debilitating impairments. More than 75% of patients with quadriplegia (paralysis of all 4
      limbs following spinal cord injury in neck and upper back) prioritize return of upper limb
      function over any other lost function. Alleviating deficits of the upper limb may represent a
      cost-effective stategy to reducing the burden of SCI.

      Although various exercise programs and neuromuscular stimulation methods have been employed
      to mitigate functional impairments of the arm and hand, success of these modalities is still
      debated. Evidence for efficacy of rehabilitation is inconclusive as outcomes are variable,
      confounded by methodological issues, and have shown poor generalizability. It is now
      speculated that limited succcess of rehabilitation emerges from inability of current methods
      to adequately harness the potential for significant neuroplasticity available in SCI.

      Even though the site of damage in SCI does not involve the brain, the neural networks in the
      brain that control movement of the arm and hand are markedly affected. These regions lose
      their territory that the investigators argue could hamper effects of upper limb therapy. The
      Investigators objective is to directly modulate adaptive plasticity in these regions of the
      brain to enhance function of the upper limb in iSCI. The Investigators central hypothesis is
      that noninvasive brain stimulation, called transcranial direct current stimulation (tDCS),
      when delivered concurrently with rehabilitation will generate synergistic functional
      advantage. Adaptive plasticty would be obeserved as changes in structure of pathways emerging
      from the brain and the individual's function.
    

Intervention name(s): Rehabilitation; Noninvasive brain stimulation: tDCS; Sham tDCS: placebo noninvasive brain stimulation
Intervention type(s): Behavioral; Procedure; Procedure
Intervention description(s): Patients will receive training upon tasks of daily living. Patients will perform these exercises in our laboratory under the supervision of qualified personnel.; TDCS is a method of noninvasive stimulation of the brain. Using electrodes placed in saline-soaked sponges, low level of direct current (2mA) is delivered over the scalp. This intervention is considered safe and noninvasive because it does not involve implantation or injection or any skin penetration. In the present study, tDCS will be delivered to patients in the experimental group for 2 hr each day for 5 days a week for 2 weeks in conjunction with therapy for the affected hand.; Placebo set-up for noninvasive brain stimulation will be similar to that for the active tDCS; sponge electrodes would be placed on the scalp and connected to a batter-operated device. Patients will not receive the effective level of direct current as would delivered in active tDCS intervention. But patients will not be able to decipher whether they are receiving active or placebo tDCS.
Other intervention name(s): tDCS; Transcranial Stimulation; Transcranial Direct Current Stimulation; Brain stimulation; sham tDCS; placebo tDCS
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Incomplete Spinal Cord Injury; Quadriplegia; Tetraplegia; SCI; Spinal Cord Disease; Spinal Cord Injury; iSCI; Transcranial Direct Current Stimulation; tDCS; SCI recovery; brain stimulation; rehabilitation