Random Noise Stimulation to Enhance Cortical Drive & Improve Hand Function
Condition: Spinal Cord Injuries; Tetraplegia; Cervical Spinal Cord Injury
MeSH terms: Spinal Cord Injuries; Quadriplegia; Wounds and Injuries
Study type: Interventional

Summary: 
      Cervical spinal cord injury (SCI) results in hand and arm function impairments and decreased
      independence in performance of daily activities such as bathing, eating, dressing, writing,
      or typing. Recent approaches that involve the application of non-invasive brain stimulation
      have the potential to strengthen the remaining connections between the brain and the spinal
      cord for improved hand function. Combining brain stimulation with performing upper limb
      functional tasks may further increase the ability of individuals with tetraplegia to use
      their hands. The purpose of this study is to investigate if "random noise", a special type of
      brain stimulation that most people cannot feel, can be used to enhance upper limb function in
      individuals with spinal cord injury. Specifically, the investigators will examine if a
      combined treatment protocol of random noise and fine motor training results in greater
      improvements in motor and sensory hand function compared to fine motor training alone.
    

Detailed description: 
      Cervical spinal cord injury (SCI) results in upper extremity (UE) functional impairments that
      can restrict independence, social participation, and overall quality of life. Evidence shows
      that short duration of non-invasive brain stimulation (NIBS) can strengthen the transmission
      of information through the spared corticospinal pathways and improve UE functional recovery
      in individuals with tetraplegia. Transcranial direct current stimulation (tDCS), which is a
      clinically accessible NIBS approach, has been used to modulate cortical plasticity and
      improve hand function. However, the high variability in the reported effects of tDCS raises
      questions about its clinical value and highlights the need to investigate more robust NIBS
      protocols. Transcranial random noise stimulation (tRNS) is a novel NIBS approach that
      produces more consistent facilitatory effects compared to tDCS. TRNS delivers a low
      alternating current with a continuously changing intensity over a wide frequency range.
      Further, tRNS has excellent tolerability and no risk of skin burns since it is a polarity
      independent stimulation approach. When tRNS is applied over the motor cortex, it increases
      cortical excitability in the hand representation area and enhances motor learning in healthy
      adults. Despite the potential promise of tRNS in increasing corticomotor drive for improved
      motor performance, its application in persons with SCI is novel. Therefore, in this study,
      the investigators propose to use tRNS to augment the therapeutic effects of functional task
      practice (FTP). Our aim is to compare the efficacy of a 3-day tRNS+FTP protocol on cortical
      excitability, UE motor, and sensory function to tDCS+FTP and to sham-stimulation+FTP in
      individuals with tetraplegia.
    

Intervention name(s): transcranial Random Noise Stimulation (tRNS); transcranial Direct Current Stimulation (tDCS); sham-stimulation
Intervention type(s): Other; Other; Other
Intervention description(s): Two electrodes will be placed over the targeted areas on participant's head. A current of random frequency and intensity will be delivered. TRNS will be applied during the first 20 min of functional task practice.; Two electrodes will be placed over the targeted areas on participant's head. A continuous low intensity current will be delivered. TDCS will be applied during the first 20 min of functional task practice.; Two electrodes will be placed over the targeted areas on participant's head. A continuous low intensity current will be delivered for 1- 2 min.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Wash-in control design
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Non-invasive brain stimulation; Hand function; Random noise