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| Name | Class |
|---|---|
| National Multiple Sclerosis Society | OTHER |
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This study seeks to explore changes in the neural pathways and arm function following a breathing intervention in the multiple sclerosis (MS) population. The breathing intervention, known as Acute Intermittent Hypoxia (AIH), involves breathing brief bouts of low levels of oxygen. Research has found AIH to be a safe and effective intervention resulting in increased ankle strength in people with MS. Here, the study examines arm and hand function before and after AIH. In order to better understand the brain and spinal cord response to AIH, the investigators will measure muscle response, and signals sent from the brain to the arm muscles before and after AIH.
While AIH has shown potential in enhancing neuroplasticity in people with spinal cord injury (SCI), it has yet to be studied extensively in MS. Preliminary research in the MS population demonstrates that a single session of AIH enhances motor output, increasing voluntary muscle strength by as much as 15-20% within 60 minutes. This study will explore potential mechanisms of AIH in MS using measurements of arm function, as well as examination of corticospinal and spinal motoneuron excitability.
Over the past decade, studies have found that brief episodes of modest oxygen reduction (termed AIH) can rapidly enhance neural plasticity in persons with incomplete SCI. AIH activates the serotonergic pathway, leading to increased activity of serotonin receptors and the synthesis of plasticity-related proteins. This plasticity is manifested by a rapid increase in voluntary muscle strength, emerging within 60-90 minutes, in both lower- and upper-limb muscles. The actions of AIH appear to be biologically linked to systems designed to preserve breathing systems that are impaired by damage to the central nervous system (CNS).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AIH first | Experimental | Participants in the first arm will undergo 2 sessions of AIH each separated by a 1-week washout period. 1 week later, participants will undergo 2 sessions of Sham AIH also separated by a 1-week washout period. |
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| Sham First | Experimental | Participants in the this arm will undergo 2 sessions of Sham AIH each separated by a 1-week washout period. 1 week later, participants will undergo 2 sessions of AIH also separated by a 1-week washout period. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Acute Intermittent Hypoxia | Other | During AIH, the participant will be equipped with a non-rebreathing face mask, and provided with the AIH intervention. The AIH intervention involves alternating breathing cycles. One cycle involves breathing air with lower oxygen concentration (9-10% oxygen) for 30 and 90 seconds, followed by breathing normal room air (21% oxygen) for a similar duration. This cycle is repeated 15 times in one session. Blood oxygen and heart rate are monitored throughout. |
| Measure | Description | Time Frame |
|---|---|---|
| Motor Evoked Potentials (MEPs) in First Dorsal Interosseous (FDI) | The MEPs will be elicited by Transcranial Magnetic Stimulation (TMS), a procedure that uses magnetic fields to stimulate nerve cells in the brain. | Immediately before, immediately after, and 60 minutes after the intervention. |
| Changes in Spinal Reflex Threshold | Spinal reflect threshold will be measured by calculating the average change in threshold length recorded from the biceps tendon's indentation. A linear motor will be used to impose precise tendon indentations of the biceps brachii. | Immediately before the intervention and immediately after the intervention. |
| Threshold For Detecting Passive Joint Movement | An assisted movement with enhanced sensation (AMES) will be used to rotate the participant's joint. The difference between the reference and matching joint angles is used to measure joint position sense. The investigators will present three target positions, and subjects will perform ipsilateral matching for each target 5 times. | Immediately before the intervention and immediately after the intervention. |
| Accuracy of Direction Estimation of Passive Joint Movement | An AMES will be used to rotate the participant's joint. The difference between the reference and matching joint angles is used to measure joint position sense. The investigators will present three target positions, and subjects will perform ipsilateral matching for each target 5 times. | Immediately before the intervention and immediately after the intervention. |
| Measure | Description | Time Frame |
|---|---|---|
| Grip Strength | The participant will squeeze a calibrated dynamometer to measure grip strength. | Immediately before the intervention and immediately after the intervention. |
| Pinch Strength | The participant will pinch a calibrated pinch gauge to measure pinch strength. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Rachel Kalvakota, OTD, OTR/L | Contact | 3122383947 | rkalvakota@sralab.org |
| Name | Affiliation | Role |
|---|---|---|
| Milap Sandhu | Shirley Ryan Ability Lab | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Shirley Ryan AbilityLab | Recruiting | Chicago | Illinois | 60611 | United States |
We do not currently have a plan to share IPD.
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D020529 | Multiple Sclerosis, Relapsing-Remitting |
| D020528 | Multiple Sclerosis, Chronic Progressive |
| D000860 | Hypoxia |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
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| ID | Term |
|---|---|
| D007317 | Insemination, Artificial, Homologous |
| ID | Term |
|---|---|
| D007315 | Insemination, Artificial |
| D027724 | Reproductive Techniques, Assisted |
| D012099 | Reproductive Techniques |
| D013812 | Therapeutics |
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randomized, blinded, placebo-controlled, cross-over with repeated measures
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| Sham Acute Intermittent Hypoxia | Other | During Sham AIH, the participant will be equipped with a non-rebreathing face mask, and provided with the AIH intervention. The Sham AIH intervention involves alternating breathing cycles. One cycle involves breathing air closely resembling room air (~21% oxygen) for 30 and 90 seconds, followed by breathing normal room air (21% oxygen) for a similar duration. This cycle is repeated 15 times in one session. Blood oxygen and heart rate are monitored throughout. |
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| Immediately before the intervention and immediately after the intervention. |
| Index Finger Abduction Force | Index finger abduction force will be measured using a load cell. We will also record surface EMG activity from the FDI muscle. | Immediately before the intervention and immediately after the intervention. |
| Nine-Hole Peg Test | A dexterity measurement involving placing 9 pegs in corresponding holes. Time to complete is measured. | Immediately before the intervention and immediately after the intervention. |
| Symbol Digit Modalities Test | A cognition assessment. Using a key, the participant has 90 seconds to match numbers to given geometric figures. | Immediately before the intervention and immediately after the intervention. |
| Box and Block Test | A 60 second dexterity measurement involving translating small wooden blocks from one box to another box separated by a partition. | Immediately before the intervention and immediately after the intervention. |
| Modified Ashworth Scale | A grading system is applied to the amount of tone felt during a rapid high velocity stretch. The minimal value is 0, and the maximum value is 4. A higher score indicates a higher degree of spasticity. | Immediately before the intervention and immediately after the intervention. |
| Ipsilateral Joint Position Matching Task | The participant's hand will be passively moved to a target joint position and then returned to a base position. Participants are then asked to recreate the target joint angle with the same hand. The difference between the reference and matching joint angles is used to measure joint position sense. | Immediately before the intervention and immediately after the intervention. |
| Visual Analog Pain Scale | This is used to measure any changes in pain. It is a one-dimensional scale where the patient marks their pain on a 10-cm ruler. The minimal value is 0, and the maximum value is 10. The higher the score, the greater the pain is. | Immediately before the intervention and immediately after the intervention. |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D008919 | Investigative Techniques |
| D007314 | Insemination |
| D012098 | Reproduction |
| D055703 | Reproductive Physiological Phenomena |
| D012101 | Reproductive and Urinary Physiological Phenomena |