Optimizing Spinal Cord Associative Plasticity to Enhance Response to Hand Training in Cervical Spinal Cord Injury
Bronx VA Medical Center
Summary
While physical exercise remains the foundation for any rehabilitation therapy, the team seeks to improve the benefits of exercise by combining it with the concept of "Fire Together, Wire Together" - when brain stimulation is synchronized with spinal cord stimulation, nerve circuits in the spinal cord strengthen - a phenomenon termed "Spinal Cord Associative Plasticity", or SCAP. This project will build on the team's promising preliminary findings. When one pulse of brain stimulation is synchronized with one pulse of cervical spinal stimulation, hand muscle responses are larger than with brain stimulation alone or unsynchronized stimulation. However, the team does not know the best ways to apply SCAP repetitively, especially in conjunction with exercise, to increase and extend improvements in clinical function. Do ideal intervention parameters vary across individuals, or do they need to be customized? The team will take a systematic approach with people who have chronic cervical SCI to determine each person's best combination of SCAP with task-oriented hand exercise. Participants will undergo up to 53 intervention, verification, and follow-up sessions over a period of 6 to 10 months each. The team will measure clinical and physiological responses of hand and arm muscles to each intervention. Regaining control over hand function represents the top priority for individuals with cervical SCI. Furthermore, this approach could be compatible with other future interventions, including medications and cell-based treatments.
Description
See above.
Eligibility
- Age range
- 18–85 years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age between 18-85 years. * Must have stable prescription medication for 30 days prior to screening * Must be able to: abstain from alcohol, smoking and heavy caffeine consumption on the day of each experiment; abstain from recreational drugs for the entirety of the study; commit to study requirements (i.e., 53 visits); provide informed consent. * Score of 1-4 (out of 5) on manual muscle testing of finger extension, finger flexion, or finger abduction in left or right hand. Exclusion Criteria: * Personal or extensive family history of seizures; * Ventilator dependence o…
Interventions
- ProcedureSynaptic Pairing Interval
Optimize interstimulus pairing between brain and spinal cord stimulation.
- ProcedureFrequency
Compare 2 Hz continuous to intermittent theta burst frequency
- ProcedureBouts
Compare effects of 1, 2, or 4 bouts of SCAP
- ProcedureSpacing
Compare 6 versus 12 minutes of rest in between bouts of SCAP
- ProcedureExercise
Task-oriented hand exercises
- ProcedureSCAP plus Exercise
Compare interleaved versus serial bouts of SCAP and exercise.
Location
- James J. Peters VA Medical Center, Bronx, NYThe Bronx, New York