Training to boost brain-to-spine signals for better wrist and hand control
Operant Conditioning of the Wrist Extensor Motor Evoked Potential to Target Corticospinal Plasticity and Upper Limb Motor Recovery After Cervical Spinal Cord Injury
This trial will test whether 10 weeks of non-invasive brain stimulation with feedback can strengthen brain-to-spinal-cord signals and improve wrist and hand function in adults with chronic cervical spinal cord injury and weak wrist extension.
Quick facts
| Phase | Early Phase 1 |
|---|---|
| Study type | Interventional |
| Enrollment | 11 (estimated) |
| Ages | 18 Years and up |
| Sex | All |
| Sponsor | Medical University of South Carolina Academic / other |
| Locations | 1 site (Charleston, South Carolina) |
| Trial ID | NCT06989905 on ClinicalTrials.gov |
What this trial studies
Participants with chronic cervical spinal cord injury will complete a 10-week operant up-conditioning protocol targeting the wrist extensor motor evoked potential (MEP) using non-invasive transcranial magnetic stimulation and real-time feedback. Investigators will measure changes in corticospinal excitability by tracking MEP size and voluntary muscle activation, and will test arm and hand motor function before and after the intervention. Brain and spine MRI will be acquired pre- and post-training to relate structural and functional imaging measures to motor status and responsiveness to the protocol. The study focuses on people at least six months post-injury with some residual wrist extensor activity and uses a single-site outpatient program at an academic center.
Who should consider this trial
Good fit: Ideal candidates are adults (≥18) at least six months after a spinal cord injury at or above C6 with at least some weak wrist extension and stable medication use, who can produce measurable wrist extensor EMG and an MEP.
Not a fit: Patients unlikely to benefit include those with no measurable MEP or voluntary wrist extensor activity, motoneuron injury, implanted cranial/thoracic biomedical devices, uncontrolled medical or seizure conditions, pregnancy, or contraindications to MRI.
Why it matters
Potential benefit: If successful, the protocol could increase wrist extensor activation and lead to measurable improvements in arm and hand function by enhancing corticospinal plasticity.
How similar studies have performed: Early feasibility studies have shown MEP up-conditioning can increase MEP size and corticospinal excitability, but its ability to improve arm and hand function in cervical SCI remains unproven.
Eligibility criteria
Show full inclusion / exclusion criteria
Inclusion Criteria: * Adult (≥18 yrs old) * A history of injury to spinal cord at or above C6 * \>6 months post SCI * 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. Exclusion Criteria: * Motoneuron injury * Medically unstable condition * Cognitive impairment * A history of epileptic seizures * Metal implants in the cranium * Implanted biomedical device in or above the chest (e.g., a cardiac pacemaker, cochlear implant) * Extensive use of functional electrical stimulation to the arm on a daily basis * Pregnancy (due to changes in posture and potential medical instability) * Contraindications to MRI * No measurable MEP elicited in the ECR * Unable to produce any voluntary ECR EMG activity
Where this trial is running
Charleston, South Carolina
- Medical University of South Carolina — Charleston, South Carolina, United States (Recruiting)
Study contacts
- Principal investigator: Allison Lewis, DPT, PhD — Medical University of South Carolina
- Study coordinator: Recruitment Contact
- 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.