Sensorimotor Integration Underlying Balance Control in Individuals With Incomplete Spinal Cord Injury

Study Overview
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Brief Summary
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The objectives of the study are to evaluate a 4-week mixed training paradigm consisting of explosive strength training and balance perturbation training efficacy on balance control during standing and locomotion, and to understand the mechanisms of neuroplasticity that would improve sensorimotor integration at supraspinal and spinal levels.

Detailed Description
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After obtaining their consent, participants will undertake evaluations at different times: Assessment 1 week prior to training Training over 4 weeks (nature of the training depends on the group) Assessment 1 week after training Assessment 1 month after training (follow-up) Each assessment will be divided in 2 sessions and data will be collected over 2 days, at one session per day. Days can be consecutive or non-consecutive but will be within a given week. The assessment consists of: Session 1 (S1; duration: 3h) will include presentation of the Study and obtainment of consent, clinical tests, galvanic vestibular stimulation testing, postural reactions and gait assessment. Session 2 (S2; duration: 3h) will include muscle strength, short-afference inhibition, paired pulse and trans cranial magnetic stimulation conditioning of H reflex. After the initial assessment, iSCI participants will be separated in 2 groups and will receive combination of explosive strength and balance training or no intervention. The training will span over 12 sessions (3 times per week for 4 weeks) and each training session will last approximately 1h (including effective training and installation periods).

Official Title
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Sensorimotor Integration Underlying Balance Control in Individuals With Incomplete Spinal Cord Injury: Assessing Neural Changes After the Injury and Promoting Recovery Through Specific Training

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Other: Combined explosive strength and specific balance training group


Participation Criteria
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Eligibility Criteria
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FOR PARTICIPANTS WITH SPINAL CORD INJURY Inclusion Criteria: Have an incomplete lesion of spinal cord Level of spinal cord lesion between C5 and T12 At least, 6 months post-injury Be considered as AIS C or D Be able to stand without support for 15 seconds Be able to provide informed consent in English or in French Exclusion Criteria: To have cognitive deficits To have personal or family history of epilepsy To have suffered moderate or severe traumatic brain injury To have cochlear implant FOR CONTROL PARTICIPANTS Exclusion Criteria: To have orthopedics problems To have cognitive deficits To have neurological problems

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Combined explosive strength and specific balance training group<br>This group will be formed with participants with incomplete spinal cord injury. This group will perform 4 weeks of combined explosive strength and specific balance training. | Other: Combined explosive strength and specific balance training group<br>* Training will consist to perform one hour of combined ankle explosive strength training and specific balance training using randomized perturbations. Explosive strength training: Participants will perform only 2 sets of 3 min (12 contractions for each set) for both lower limbs and both ankle plantar- and dorsiflexion movements. Balance specific training: Participants will be standing, secured by an adjusted harness, which do not support the weight but is strictly there to prevent a fall. They will have online visual feedback of their CoP via an avatar on the screen in front of them. Each training session will consist of 10 sequences of 3 min, including the 5 different conditions: Forward tilt of base of support; Backward tilt of base of support; Translation forward; Translation backward; Without moving their feet, participants will have to move their avatar to reach different targets placed around them on the screen, at different distance from the center.<br>|
| No Intervention: Spinal cord injury control group<br>This group will be formed with participants with incomplete spinal cord injury. They will perform all the evaluation before and after a 4-week period of rest (no training). | |
| No Intervention: Healthy control group<br>Healthy participants will be recruited based on the age and sex of the participants with incomplete spinal cord injury to realize clinical and neurophysiological cortical evaluations. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in muscles EMG responses following balance perturbation | Evaluation of the latency on Soleus and Tibialis anterior muscles EMG following backward and forward perturbations will be done. | Pre-intervention, immediately after and one-month after intervention | 
| Change in center of pressure displacement following balance perturbation using a force platform | Excursion of centre of pressure will be analyzed following forward and backward perturbation. | Pre-intervention, immediately after and one-month after intervention | 
| Change in ankle muscle strength using force transducer | Evaluation of isometric dorsi- and planti-flexors muscle strength in Newton will be done using a force transducer attached to the participant's feet. | Pre-intervention, immediately after and one-month after intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in intracortical mechanisms using transcranial magnetic stimulation (TMS) | A paired-pulses paradigm (two trans cranial magnetic stimulations at motor cortex level) will be used to evaluate the intracortical mechanisms | Pre-intervention, immediately after and one-month after intervention | 
| Change in the influence of peripheral afferents on cortical output using short-afference inhibition | A stimulation (using TMS) at motor cortex level will be triggered just after a peripheral electrical stimulation of tibial nerve to evaluate the peripheral afferents on cortical output. | Pre-intervention, immediately after and one-month after intervention | 
| Change in the modulation of the H reflex by the corticospinal tract | A stimulation (using TMS) at motor cortex level will be triggered just before a tibial nerve stimulation to evaluate the modulation of the H reflex by the corticospinal tract. | Pre-intervention, immediately after and one-month after intervention | 
| Change in EMG responses following vestibular stimulations during quiet standing | Galvanic vestibular stimulation will be triggered during quiet standing. EMG responses of Soleus and Tibialis Anterior muscles will be analyzed. | Pre-intervention, immediately after and one-month after intervention | 
| Change in the excursion of the center of pressure following vestibular stimulations | Galvanic vestibular stimulation will be triggered during quiet standing. The displacement of the center of pressure will be analyzed using a force platform. | Pre-intervention, immediately after and one-month after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Combined explosive strength and balance training, Balance control, Corticospinal tract, Intracortical mechanisms, Vestibular system