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The purpose of this study is to examine the relationship between common clinical assessments and measurements of the function of brain-spinal cord-muscle connections, and to examine the effects of training a brain-spinal cord-muscle response in individuals with incomplete spinal cord injury. A transcranial magnetic stimulator (TMS) is used for examining brain-to-muscle pathways. This stimulator produces a magnetic field for a very short period of time and indirectly stimulates brain cells with little or no discomfort. The target muscle is the wrist extensor (extensor carpi radialis) muscle that bends the wrist back. It is hypothesized that training the wrist extensor muscle response to transcranial magnetic stimulation will increase the strength of the brain-to-muscle pathway, which will improve the ability to move the arm.
It is hoped that the results of this training study will help in developing therapy strategies for individuals, promoting better understanding of clinical assessments, and understanding treatments that aim to improve function recovery in people with spinal cord injury (SCI).
This study requires 30 visits, and each visit will last approximately 1.5 hours.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| MEP Wrist Extensor Up-Conditioning | Experimental |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| MEP Operant Up-conditioning of the Wrist Extensor | Behavioral | This is a training intervention in which the brain-spinal cord-muscle pathways are strengthened in individuals with incomplete spinal cord injury. Transcranial magnetic stimulation (TMS), a type of brain stimulation, will be used to elicit a muscle response from the wrist extensor (extensor carpi radialis), the muscle the bends the wrist back. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in the excitability/strength of the brain-spinal cord-muscle pathway at the brain level as measured by the Motor Evoked Potential | An increased average MEP size (mV) would indicate increased excitability/strength of the brain-spinal cord-muscle pathway | Baseline and final training session (approximately 2.5 months) |
| Change in ability to move the arm as measured by the Action Research Arm Test (ARAT). Maximum score of 57 points | An increase in ARAT score indicates an improvement in the ability to move the arm | change from baseline to immediately after completing the training protocol |
| Change in ability to move the arm as measured by the Fugl-Meyer Assessment (FMA) | An increase in the FMA score indicates better movement of the arm. Maximum score of 66 points | change from baseline to immediately after completing the training protocol |
| Change in gross manual dexterity as measured by the Box and Block Test (BBT) | An increased number of blocks moved in 60s indicates increased gross manual dexterity | change from baseline to immediately after completing the training protocol |
| Change in fine motor ability and finger dexterity as measured by the Nine Hole Peg Test | Decreased amount of time (s) to place and remove pegs in a peg board indicates improved fine motor ability and finger dexterity | change from baseline to immediately after completing the training protocol |
| Change in strength as measured by Manual Muscle Testing (MMT) | Increased score on MMT indicates increased strength in the muscle being tested. The examiner grades the patient's strength on a 0 to 5 scale. 0: No muscle activation; 1: Trace muscle activation, such as a twitch, without achieving full range of motion; 2: Muscle activation with gravity eliminated, achieving full range of motion; 3: Muscle activation against gravity, full range of motion; 4: Muscle activation against some resistance, full range of motion; 5: Muscle activation against examiner's full resistance, full range of motion. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Blair Dellenbach, MSOT | Contact | 843-792-6313 | stecb@musc.edu |
| Name | Affiliation | Role |
|---|---|---|
| Blair Dellenbach, MSOT | Medical University of South Carolina | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical University of South Carolina | Recruiting | Charleston | South Carolina | 29425 | United States |
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| ID | Term |
|---|---|
| D013119 | Spinal Cord Injuries |
| D011782 | Quadriplegia |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020196 | Trauma, Nervous System |
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| change from baseline to immediately after completing the training protocol |
| Change in sensation on the back and palm of the hand as measured by the Semmes Weinstein Monofilament Test | Ability to detect increasingly thinner monofilaments indicates increased sensation | change from baseline to immediately after completing the training protocol |
| Change in spasticity as measured by the Modified Ashworth Scale (mAS) | The mAS score ranges from 0: normal muscle tone to 4: rigid in flexion or extension. A decrease in mAS indicates decreased spasticity. | change from baseline to immediately after completing the training protocol |
| D014947 | Wounds and Injuries |
| D010243 | Paralysis |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |