Brain stimulation training to strengthen wrist extension after cervical spinal cord injury

Is this trial a fit for you?

A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.

What this trial studies

This study uses operant conditioning of motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation to try to increase corticospinal excitability to wrist extensor muscles. Participants with incomplete cervical SCI and unilateral or bilateral weak wrist extension will attend about 42 sessions over 14 weeks plus six follow-up visits over three months, with each visit lasting roughly 90 minutes. Training aims to improve motoneuron recruitment and motor unit firing so neurophysiological changes translate into better forearm and hand function. Outcomes include changes in MEP amplitude, measures of wrist extension strength and control, and functional upper-limb task performance.

Why it matters

Who can join: the full rules

Inclusion Criteria:

* Adult (≥18 yrs old)
* a history of injury to spinal cord at or above C6
* neurologically stable (\>1 year post SCI)
* medical clearance to participate
* weak wrist extension at least unilaterally
* expectation that current medication will be maintained without change for at least 3 months.

  * Stable use of anti-spasticity medication (e.g., baclofen, diazepam, tizanidine) is accepted. (Because only neurologically stable subjects will enter this study, medication changes will be unlikely.)
  * In participants with bilateral wrist extension weakness in whom Extensor Carpi Radialis (ECR) MEP can be elicited in both arms, the more severely impaired arm is studied. In participants with unilateral wrist weakness or in participants with bilateral wrist weakness in whom an ECR MEP can be elicited in only one arm, that arm is studied.

Exclusion Criteria:

* motoneuron injury
* unstable medical condition
* cognitive impairment (because the studied intervention is a learning-based intervention)
* a history of epileptic seizures
* a pre-existing or confounding neurological condition (e.g., history of MS, Stroke, Parkinson's disease)
* metal implants in the cranium
* implanted biomedical device in or above the chest (e.g., a cardiac pacemaker, cochlear implant)
* no measurable MEP elicited in the ECR
* inability to produce any voluntary ECR EMG activity
* extensive use of functional electrical stimulation to the arm on a daily basis (as it may interfere with or augment the effects of MEP conditioning itself)
* pregnancy (due to changes in posture and potential medical instability)
* inability or unwillingness of subject or legal guardian/representative to give informed consent

Where it's running

• Medical University of South Carolina
  Charleston, South Carolina, United States Recruiting

Study contacts

• Principal investigator: Aiko Thompson, PhD — Medical University of South Carolina
• Study coordinator: Occupational Therapist
• Email: stecb@musc.edu
• Phone: (843) 792-6313

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How to take part

1. Review the eligibility criteria above with your treating physician.
2. Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
3. Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.