Brain stimulation training to strengthen wrist extension after cervical spinal cord injury
Can MEP Conditioning Improve Corticospinal Recruitment of Motoneurons in Chronic Cervical SCI?
This study will test whether MEP up-conditioning using transcranial magnetic stimulation can help people with incomplete cervical spinal cord injury improve wrist extension.
Quick facts
| Phase | Not applicable |
|---|---|
| Study type | Interventional |
| Enrollment | 15 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Medical University of South Carolina Academic / other |
| Locations | 1 site (Charleston, South Carolina) |
| Trial ID | NCT07179822 on ClinicalTrials.gov |
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.
Who should consider this trial
Good fit: Adults (≥18) with neurologically stable (>1 year) incomplete spinal cord injury at or above C6, medical clearance to participate, and at least unilateral weak wrist extension are ideal candidates.
Not a fit: People with motor neuron (lower motor neuron) injury, complete cervical injuries without elicitable MEPs, unstable medical conditions, or significant cognitive impairment are unlikely to benefit from this intervention.
Why it matters
Potential benefit: If successful, this approach could increase corticospinal control of wrist extensors and lead to measurable improvements in hand and forearm function for people with incomplete cervical SCI.
How similar studies have performed: Related MEP conditioning and noninvasive brain stimulation studies in stroke and small SCI cohorts have shown promise for improving corticospinal excitability and motor function, but larger confirmatory trials in SCI remain limited.
Eligibility criteria
Show full inclusion / exclusion criteria
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 this trial is running
Charleston, South Carolina
- 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
How to participate
- Review the eligibility criteria above with your treating physician.
- Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
- Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.