Neuro-Rehabilitation Research

Investigator: Noam Y. Harel, MD, Ph.D

 

Individuals with SCI usually have residual nerve connections, even if they do not have conscious control over these neural pathways. We are utilizing sophisticated approaches to identify these spared nerve pathways. To strengthen spared nerve pathways, different combinations of physical exercises, magnetic stimulation, and electrical stimulation are being employed in an effort to improve function.


Paired Stimulation to Increase Cortical Transmission to Hand Muscles: Pilot Study
clinicaltrials.gov NCT02469675

BACKGROUND

People with cervical spinal cord injury (SCI) or amyotrophic lateral sclerosis (ALS) have reduced connections in the nerve circuits between the brain and the hands.

  • The pathway between the brain and hands contains two nerve cells: the ‘upper motor neuron’ goes from the brain to the spinal cord. The ‘lower motor neuron’ goes from the spinal cord to the hands.
  • We are testing different combinations of magnetic brain stimulation paired with electrical spinal cord stimulation to see if we can improve hand function by strengthening connections between upper and lower motor neurons.
  • This is a preliminary study aimed to detect temporary changes in nerve transmission.

ELIGIBILITY CRITERIA (summary)

  • Age 21-65
  • SCI between levels C2-C8, OR diagnosis of ALS; or volunteers without neurological injury
  • Must have weakness but some spared ability to use fingers in at least one hand
  • No history of seizures
  • No history of cardiac disease, arrhythmia, or autonomic dysreflexia
  • Not dependent on ventilator
  • No implanted electrical devices (pacemaker, spine stimulator, baclofen pump, etc)

PROCEDURES

  • Two baseline testing visits (approx. 3 hr): clinical and electrical tests to measure connections between the brain and hand muscles.
  • Seven stimulation visits (approx. 3 hr): Different combinations of brain, spinal cord, or nerve stimulation will be delivered for 20 minutes each. We will measure hand function and nerve transmission before and after each of these sessions.

WHAT YOU SHOULD KNOW

  • There are several potential risks associated with brain and spinal cord stimulation. We will conduct a thorough medical history and physical examination to determine if potential participants meet all of the inclusion and exclusion criteria. This process is designed to prevent anyone at increased risk from participating in the study.

Contacts

Tiffany Santiago: 718-584-9000 x3123;
tiffany.santiago@va. gov


A Hebbian Approach to Regaining Control of Spared Circuits After Spinal Cord Injury
clinicaltrials.gov NCT01740128

THIS STUDY IS CURRENTLY CLOSED TO NEW ENROLLMENT

BACKGROUND

Most spinal cord injuries spare some neural tissue at the injury site.

  • We are looking for ways to improve control over these spared nerve circuits using combinations of targeted physical exercises.
  • Two types of exercise programs are being compared in people with chronic spinal injury:
  • Body weight-supported treadmill training.
    • This is designed to activate a spinal walking circuit called the central pattern generator.
  • A combination of weight-supported balance training plus skilled hand exercises.
    • This is designed to activate a combination of ‘cortical’ skilled movement circuits at the same time as ‘subcortical’ balance control circuits.

The goal is to improve people’s ability to regain voluntary (cortical) control over involuntary (subcortical) leg movements. We will measure clinical outcomes and electrical outcomes of nerve transmission between the brain and legs.

ELIGIBILITY CRITERIA (summary)

  • Age 21-65;
  • SCI between levels C2-T12;
  • SCI occurred greater than 12 months prior to study;
  • At least anti-gravity strength in upper arm muscles on both sides;
  • No history of seizures or implanted electrical devices (pacemaker, stimulator, etc).

PROCEDURES

  • Baseline testing visit (approx. 6 hr): clinical and electrical tests to measure connections between the brain and hand muscles. This is also a test to determine eligibility for the rehabilitation phase of the study.
  • Training visits (two blocks of 50 visits each (1-2 hr per visit)):
    • You must have at least a small amount of movement ability in at least one leg or rectal muscle
    • You must be able to commit to coming to our center at least 3 days per week for 6-8 months (with one 6-week break).
    • TREADMILL phase – robotic-assisted walking on a treadmill using a weight-support harness
    • MULTIMODAL phase – balance training combined with skilled arm/hand exercises
    • 30 min sessions.
    • 3-5 sessions per week
    • 48 sessions each (with testing visits before and after)
    • 6 week “washout” period between training phases, then perform second training phase

WHAT YOU SHOULD KNOW

  • There are several potential risks associated with magnetic and electrical nerve testing. We will conduct a thorough medical history and physical examination to determine if potential participants meet all of the inclusion and exclusion criteria. This process is designed to prevent anyone at increased risk from participating in the study.

Contacts

Nunu Nguyen: 718-584-9000 x1732; Nhuquynh.Nguyen@va.gov
Tiffany Santiago: 718-584-9000 x3123;
tiffany.santiago@va.gov


Seated Balance Testing in Individuals with Spinal Cord Injury

BACKGROUND
Two problems that affect daily life in people with spinal cord injury are difficulty with seated balance, and problems with muscle spasms.
This study performs detailed computerized assessments of seated balance ability, as well as clinical and survey measurements of how spasticity affects daily function.

ELIGIBILITY CRITERIA (summary)

  • Age 18-89
  • SCI between levels C2-S5;
  • SCI occurred greater than 12 months prior to study;

PROCEDURES (one visit, approx. 2-2.5 hr)

  • ASIA physical exam: clinical and electrical tests to measure connections between the brain and hand muscles. This is also a test to determine eligibility for the rehabilitation phase of the study.
  • Balance testing: Several tests of balance will be performed. This includes computerized balance testing.
  • Spasticity testing: During your physical exam, several tests of leg muscle tightness and spasms will be performed. You will also fill out several surveys about spasticity and how it affects your quality of life.

 Contact

Tiffany Santiago: 718-584-9000 x3123;
tiffany.santiago@va.gov