Restorative Neuromodulation for Upper Extremity Functions
Condition: Traumatic Brain Injury; Cervical Spinal Cord Injury
MeSH terms: Brain Injuries; Spinal Cord Injuries; Brain Injuries, Traumatic; Wounds and Injuries
Study type: Interventional

Summary: 
      The objective of this research study is to find the efficacy of trans-spinal electrical
      stimulation, a non-invasive neurostimulation method to modulate the functions of spinal cord
      neurocircuits, on improving upper-extremity functions such as reaching and grasping in
      individuals suffering with traumatic brain injury (TBI) or cervical spinal cord injury (SCI);
      and to find the physiological changes in the neuromuscular systems after this new
      intervention with high-resolution electrophysiology and biomedical imaging.
    

Detailed description: 
      Spinal cord is composed of specialized neural networks, capable of executing different
      functions. Although the command for upper-limb functions such as reaching and grasping is
      delivered from the brain, the cervical spinal cord circuits work as an important hub for not
      only executing the task, but also amplify the command and maintain the dynamics with proper
      feedback mechanisms with it's reflex circuitry. A simple reaching and grasping function
      requires spatiotemporal coordination of upper-limb joints and the neuromuscular systems,
      their adaptation and control in gravity. For human, these physiological activities are well
      choreographed by sets of neural networks. In combination with afferent sensory inputs, these
      network circuits work with the motor periphery to generate a series of motor acts during each
      task. Normally, the activity of these spinal networks are regulated supraspinally and by
      peripheral sensory inputs. In case of the loss of supraspinal inputs, resultant of a
      traumatic brain injury (TBI) or cervical spinal cord injury (SCI), upper-limb motor tasks
      maybe enabled by directly activating these specialized cervical cord networks via external
      stimuli. Recent studies have demonstrated that neuromodulation via spinal cord stimulation
      can effectively restore upper-limb motor function in patients with chronic neurological
      injuries.

      Traumatic injuries to the central nervous system (CNS) such as TBI and SCI are devastating
      events leaving patients with impairment of motor, sensory and autonomic functions. Mainstay
      for the treatment is still limited to rehabilitation by physical therapy and training. In few
      patients, however, neuroplasticity and repair mechanisms are considered to contribute to
      recovery of paresis in the acute stage of the injury and stops in the chronic stage. But,
      three recent groundbreaking pilot studies have shown that the recovery can be further
      amplified in the chronic stage by the novel treatment of trans-spinal electrical stimulation.
      However, the rehabilitation related to this recovery is not well understood, and thus it is a
      challenge to be convinced with the efficacy of this new therapy. A deeper understanding of
      the physiology in a larger trial of two different but related neurological patient groups,
      proposed in this study, will significantly help the researcher to prove the efficacy and
      understand the mechanism of trans-spinal electrical stimulation therapy for the patients.
      This study will further assist the researchers to design even a better therapeutic
      intervention for neurological impaired patients.
    

Intervention name(s): Trans-spinal Electrical Stimulation (tsES)
Intervention type(s): Other
Intervention description(s): Stimulation will be achieved with two self-adhesive stimulation electrodes attached to the dorsal aspect of the neck overlying the cervical vertebrae and two self-adhesive rectangular return electrodes placed over the shoulders. Spinal motor evoked potentials (sMEP) induced by trans-spinal electrical stimulation (parameters, 1 Hz with a 0.1-1 ms pulse width and monophasic waveform) to determine recruitment profiles of proximal and distal motor pools with increasing stimulation intensity ranging from 10 to 200 milliampere. Stimulation parameters for the therapeutic stimulation will be ranged from 5-40 Hz and 20-100 milliampere.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment