SCI Acute Intermittent Hypoxia and Non-Invasive Spinal Stimulation Combined With Gait Training
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ClinicalTrials.gov Identifier: NCT03922802 |
Recruitment Status :
Recruiting
First Posted : April 22, 2019
Last Update Posted : July 29, 2021
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Condition or disease | Intervention/treatment | Phase |
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Spinal Cord Injuries Spinal Cord Diseases | Device: Acute Intermittent Hypoxia + Non Invasive Spinal Cord Stimulation + Gait Training Other: Sham Acute Intermittent Hypoxia + Non Invasive Spinal Cord Stimulation + Gait Training Other: Sham Acute Intermittent Hypoxia + Sham Non Invasive Spinal Cord Stimulation + Gait Training | Not Applicable |
OBJECTIVES:
- To determine whether acute intermittent hypoxia therapy (AIH) combined with transcutaneous spinal cord stimulation during ambulation training modulates spinal locomotor networks in individuals with spinal cord injury
- To determine whether acute intermittent hypoxia therapy (AIH) combined with transcutaneous spinal cord stimulation during ambulation training improves locomotor function in individuals with spinal cord injury
- To determine whether acute intermittent hypoxia therapy (AIH) combined with transcutaneous spinal cord stimulation during ambulation training improves symmetry of gait in individuals with spinal cord injury
- To determine whether acute intermittent hypoxia therapy (AIH) combined with transcutaneous spinal cord stimulation during ambulation training improves standing posture and balance in individuals with spinal cord injury
- To determine whether ambulation efficiency (improved cardiovascular conditioning) improves with a combination of AIH, transcutaneous spinal cord stimulation and ambulation training in individuals with spinal cord injury
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 36 participants |
Allocation: | Randomized |
Intervention Model: | Crossover Assignment |
Masking: | Single (Participant) |
Primary Purpose: | Treatment |
Official Title: | Locomotor Function Following Acute Intermittent Hypoxia (AIH) and Transcutaneous Electrical Spinal Cord Stimulation (tSCS) With Gait Therapy Versus Traditional Gait Therapy in Individuals With Spinal Cord Injury |
Actual Study Start Date : | December 1, 2020 |
Estimated Primary Completion Date : | December 2022 |
Estimated Study Completion Date : | December 2023 |

Arm | Intervention/treatment |
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Experimental: Acute Intermittent Hypoxia + Non Invasive Spinal Cord Stimulation + Gait Training
May receive up to 45 minutes of AIH prior to up to 50 min of locomotion training with transcutaneous spinal cord stimulation. However, the amount of time spent in side-lying locomotion training, treadmill training and overground training will depend on individual tolerance and progression. Intervention: Device: AIH prior to Noninvasive spinal stimulation during gait training |
Device: Acute Intermittent Hypoxia + Non Invasive Spinal Cord Stimulation + Gait Training
Subjects will receive up to 45 minutes of AIH prior to receiving transcutaneous electrical spinal cord stimulation delivered by a Transcutaneous Spinal Cord Neurostimulator while performing locomotor activities.
Other Name: AIH + tSCS+ Gait |
Sham Comparator: Sham Acute Intermittent Hypoxia + Non Invasive Spinal Cord Stimulation + Gait Training
May receive up to 45 minutes of Sham AIH prior to up to 50 min of locomotion training with transcutaneous spinal cord stimulation. However, the amount of time spent in side-lying locomotion training, treadmill training and overground training will depend on individual tolerance and progression.
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Other: Sham Acute Intermittent Hypoxia + Non Invasive Spinal Cord Stimulation + Gait Training
Subjects will perform locomotor activities with transcutaneous electrical spinal cord stimulation after receiving sham acute intermittent hypoxia
Other Name: SHAM AIH + tSCS + Gait |
Sham Comparator: Sham Acute Intermittent Hypoxia + Sham Non Invasive Spinal Cord Stimulation + Gait Training
May receive up to 45 minutes of Sham AIH prior to up to 50 min of locomotion training with sham transcutaneous spinal cord stimulation. However, the amount of time spent in side-lying locomotion training, treadmill training and overground training will depend on individual tolerance and progression.
|
Other: Sham Acute Intermittent Hypoxia + Sham Non Invasive Spinal Cord Stimulation + Gait Training
Subjects will perform locomotor activities with sham transcutaneous electrical spinal cord stimulation after receiving sham acute intermittent hypoxia
Other Name: SHAM AIH + SHAM tSCS + Gait |
- Change in 6 Minute Walk Test [ Time Frame: Session 1 (baseline test, initial visit), After 5 intervention sessions (Post Test), 1 week post (1 week follow up Post) ]The 6 Minute Walk Test (6MWT) measures the distance a subject can walk indoors on a flat, hard surface in a period of 6 minutes, using assertive devices, as necessary. The test is a reliable and valid evaluation of functional exercise capacity and is used as a sub-maximal test of aerobic capacity and endurance. The test will be used to determine participant's gait efficiency at baseline and at study completion. The walk test is patient self-paced and assesses the level of functional capacity. Patients are allowed to stop and rest during the test, however, the timer does not stop. If the patient is unable to complete the time, the time stopped is noted and reason for stopping prematurely is recorded.
- Change in 10 Meter Walk Test [ Time Frame: Session 1 (baseline test, initial visit), After 5 intervention sessions (Post Test), 1 week post (1 week follow up Post) ]This test will examine the patient's gait speed. Patients will be directed to walk at their preferred maximum but safe speed.
- Timed Up and Go Test: Assesses mobility, balance, walking ability and fall risk [ Time Frame: Session 1 (baseline test, initial visit), After 5 intervention sessions (Post Test), 1 week post (1 week follow up Post) ]The participant starts seated in a chair with his/her back against the chair back. On command, the participant rises from the chair, walks 3 meters, turns, walks back to the chair and sits down. Timing begins when the command to start is given and stops when the participant returns to a seated position. This test may be repeated up to 3 times during each assessment visit and during each training visit.

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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Participants have been diagnosed with a spinal cord injury below level C2
- ASIA Impairment Scale Grade A-D
- Participants are 18 years of age or older
- Participants are at least 6 months post spinal cord injury
- Participants with paraplegia or tetraplegia secondary to a single spinal cord injury
- Participants are able to provide informed consent
- Participants are not currently receiving regular physical therapy services
Exclusion Criteria:
- Individuals less than 18 years of age
- Individuals less than 6 months post spinal cord injury
- Individuals with ataxia
- Individuals with multiple spinal cord injury history
- Pregnancy or nursing
- Pacemaker or anti-spasticity implantable pumps
- Active pressure sores
- Unhealed bone fractures
- Peripheral neuropathies
- Painful musculoskeletal dysfunction due to active injuries or infections
- Severe contractures in the lower extremities
- Active urinary tract infection
- Clinically significant depression, psychiatric disorders, or ongoing drug abuse
- Diagnosed with any of the following medical conditions: congestive heart failure, cardiac arrhythmias, uncontrolled hypertension, uncontrolled diabetes mellitus, chronic obstructive pulmonary disease, emphysema, severe asthma, previous myocardial infraction, or known carotid/intracerebral artery stenosis
- Individuals with a tracheostomy or who utilize mechanical ventilation.
- Individuals who are currently enrolled in another interventional research study or in therapy related to upper extremity function.
- Participants will be excluded if they have had a botulinum toxin injection to lower extremity musculature within the last 3 months. Participants will need to refrain from lower extremity botulinum toxin injections for the duration of the study. If participants wean off antispasticity medications to successfully complete the responsiveness to AIH screening session, they will need to refrain from the medications for the duration of the study.
- Documented sleep apnea.
- Orthopedic injuries or surgeries that would impact an individual's ability to use the lower extremity.
- Traumatic brain injury or other neurological conditions that would impact the study.
- Blood hemoglobin levels less than 10g/dL.
We will not include the following populations:
- Adults unable to consent, unless accompanied by a legally authorized representative.
- Individuals who are not yet adults (infants, children, teenagers)
- Pregnant women
- Prisoners

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03922802
Contact: Kelly A McKenzie, PT, DPT, NCS | 312-238-7111 | kmckenzie@sralab.org |
United States, Illinois | |
Shirley Ryan AbilityLab | Recruiting |
Chicago, Illinois, United States, 60611 | |
Contact: Kelly A McKenzie, PT, DPT, NCS | |
Principal Investigator: Arun Jayaraman, PT, PhD |
Principal Investigator: | Arun Jayaraman, PT, PhD | Shirley Ryan AbilityLab |
Responsible Party: | Arun Jayaraman, PT, PhD, Director Max Nader Laboratory, Shirley Ryan AbilityLab |
ClinicalTrials.gov Identifier: | NCT03922802 |
Other Study ID Numbers: |
STU00211806 |
First Posted: | April 22, 2019 Key Record Dates |
Last Update Posted: | July 29, 2021 |
Last Verified: | July 2021 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | Yes |
Device Product Not Approved or Cleared by U.S. FDA: | Yes |
Product Manufactured in and Exported from the U.S.: | No |
Spinal Cord Injury Stimulation Spinal Stimulation |
Noninvasive stimulation Acute intermittent hypoxia Hypoxia |
Spinal Cord Injuries Spinal Cord Diseases Hypoxia Wounds and Injuries |
Central Nervous System Diseases Nervous System Diseases Trauma, Nervous System Signs and Symptoms, Respiratory |