Epidural Stimulation and Resistance Training for Overground Locomotion After Spinal Cord Injury
United States Department of Defense
Summary
Spinal cord injury (SCI) is a devastating health problem for tens of thousands of military personnel, Veterans and civilians annually. Many persons with SCI must use a wheelchair for their entire life. A new scientific breakthrough called "lumbosacral epidural stimulation" or "ES" can help people with SCI to stand, step and even walk again. At present, for ES to work, people must train with a specialized treadmill that requires several other qualified personnel to train them, which makes it hard for many people with SCI to benefit from this technology. On the other hand, there are wearable "robot suits" that can be used with ES, which would make it easier to use. Our research team has already used this "ES Robot Suit" for 3 months in one person with tetraplegia and showed remarkable improvements in motor control. Furthermore, the investigators are aiming to enhance overground motor recovery by adding 6 months of resistance training (RT). The addition of RT will likely to enhance muscle quality as indicated by increasing lean mass, peak torque and increase sensory flux to the central nervous system. Other additional benefits may include improvement in cardiovascular profile and bladder functions. The specific objectives of the current proposal are to compare the impact of EAW+ES following improving lower extremity muscle quality compared to those who will only undergo EAW+ ES without conducting RT on motor recovery, cardio-metabolic health and bladder control in persons with complete SCI. At the conclusion of the current proposal, the work will be readily available for translation into clinical setting to serve Veterans and Civilian survivors with SCI.
Description
Spinal cord epidural stimulation (ES) is a neuromodulation modality that can facilitate standing, stepping and walking with and without assistive devices in individuals with SCI, however; ES must be accompanied with locomotor training that at present requires a labor-intensive commitment from multiple well-trained personnel using specialized treadmill equipment. Exoskeletal assisted walking (EAW) on the other hand can be safely and efficiently used for ambulation after SCI in combination with ES without the use of other specialized equipment and multiple personnel. The investigators demonstrat…
Eligibility
- Age range
- 18–60 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: 1. All participants will be between 18-60 years old, male or female, with traumatic motor complete SCI and level of injury of T10 and above, as determined by EMG testing and International Standards for Neurological Classification of SCI (ISNCSCI) exam. 2. Participants' knee extensors must respond to standard surface NMES procedures (frequency: 30 Hz; pulse duration:450 μs and amplitude of the current:200 mA) to ensure intact neural circuitry below the level of SCI. 3. All participants will undergo ISNCSCI examination for neurological level and function and only those with…
Interventions
- DeviceExoskeletal assisted walking
Exoskeletal assisted walking includes the use of robotic suit to train participant to walk with different level of assistance.
- DeviceEpidural Stimulation
lumbo-sacral epidural simulation at the beginning of the study.
- ProcedureResistance Training
Using two forms of resistance training to increase muscle size. The first form includes seated leg extension exercise for 12 weeks followed by a second form that includes sit-to-stand exercise using participant's body weight.
- Devicedelayed-ES
lumbo-sacral epidural simulation starting 6 months after the beginning of the study.
- Procedureno-Resistance training
The participants will perform 24 weeks of passive movement or passive stretching from seated position.
Location
- Hunter Holmes McGuire VA Medical CenterRichmond, Virginia