Influence of Wearable Intensive Nerve Stimulation on Spasticity and Function in Persons With Spinal Cord Injury
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|ClinicalTrials.gov Identifier: NCT04130295|
Recruitment Status : Suspended (Covid-19)
First Posted : October 17, 2019
Last Update Posted : May 6, 2020
|Condition or disease||Intervention/treatment||Phase|
|Spinal Cord Injuries Spasticity, Muscle||Other: Wearable intensive nerve stimulator||Not Applicable|
Involuntary muscle activation, also referred to as spasticity is a common characteristic of spinal cord injuries. It can present as stiffness, clonus, and spasms that can impact a person's ability to perform daily tasks. Over half of individuals with spinal cord injuries that have spasticity report medication alone does not control the spasticity. Because of this clinical research is investigation different ways to manage spasticity.
Stretching and vibration have demonstrated the ability to reduce spasticity but only for short periods of time requiring repeated use of the intervention. Additionally, vibration devices are not very practical to implement at home due to their high cost. Due to these factors, a solution that could be used multiple times a day and remains cost effective is needed.
Transcutaneous electrical stimulation (TENS) has also demonstrated effectiveness in reducing spasticity after one session but shows greater benefit when it is able to be used for multiple sessions. A wearable intensive nerve stimulator (WINS) device has been shown to be safe for daily wear which makes it a feasible solution to address spasticity at home. Research has not yet looked at the efficacy of using the WINS device for spasticity and this study proposes to begin to fill that gap.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||12 participants|
|Intervention Model:||Single Group Assignment|
|Masking:||None (Open Label)|
|Official Title:||Influence of Wearable Intensive Nerve Stimulation on Spasticity and Function in Persons With Spinal Cord Injury|
|Actual Study Start Date :||October 15, 2019|
|Estimated Primary Completion Date :||October 25, 2020|
|Estimated Study Completion Date :||October 25, 2020|
Experimental: Wearable intensive nerve stimulation
The device will be worn on the upper calf with each session of stimulation lasting 60 minutes after which the device will turn off for 60 minutes before turning back on. Participants will be instructed to wear the device for 5 hours a day in order to receive three one our sessions of stimulation.
Other: Wearable intensive nerve stimulator
The wearbale device consists of 2 leads that provide biphasic, with alternating lead phase, asymemetrical rectangular current at a pulse duration of 0.28 msec, a randomly varying pulse frequency between 60-100 Hz, with a maximum intensity of 100mA.
- Change in Spasticity [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]Instrumented Pendulum Test: Participants will be in a semi-reclined position on a therapy mat. The examiner will then bring the participants knee into full extension before dropping the foot. The examiner will observe the number of oscillations to determine muscle stretch-induced activity
- Satisfaction and Adherence Questionnaire [ Time Frame: Week 7 ]Participant will answer questions about how likely they would be to continue to use the intervention at home.
- Spinal Cord Injury - Spasticity Evaluation Tool [ Time Frame: Twice per week ]a Questionnaire used to characterize the impact of spasticity on a participant's ability to perform everyday occupations.
- Manual Ankle Clonus Test [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]Participants are positioned in supine with legs extended. The examine will move each foot individually into dorsiflexion and observe the number of beats of clonus. This will be used to determine muscle-stretch induced activity of the lower limb
- Ankle Drop Test [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]Participants are seated on the edge of the table with one leg fully extended. The examiner holds the test leg 10 cm above a wooden block before dropping it onot the block to observe the duration of clonus if there is any. The test will determine muscle-stretch induced activity.
- Flexor Spasms [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]Participants are in supine with the hip and knee extended. The examiner will then stimulate the foot with a safety pin and observe movement of the great toe, ankle dorsiflexion, and hip and knee flexion. This tool is used to determine spasticity
- Instrumented Flexor Reflex Response [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]Participants will be positioned in supine with knee and hip extended. The examiner will stimulate the foot with an electrical stimulus and observe movement of the great toe, ankle dorsiflexion, and hip and knee flexion. The tool is used to determine spasticity in the lower limb.
- Global Impression of Change Scale [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]a self-report measure designed to quantify the participant's improvement or deterioration over time. This tool will be used to rate how spasticity is impacting the participant's function. The scale is an 11 point scale from -5, representing that spasticity is much worse, to 5, which reports that spasticity is much better. Participants will use this scale to evaluate spasticity at the ankle, hip, and knee.
- Adherence Data [ Time Frame: Week 3, Week 4, Week 5, and Week 7 ]Adherence data will be collected from the device, which stores data on duration and number of therapy sessions completed each day. This tool will be used to measure participant adherence.
- Assessing neurophysiological aspects of spasticity [ Time Frame: Week 1, Week 2, Week 3, and Week 7 ]Electrodes will be placed on the quadriceps, hamstring, tibialis anterior, and soleus muscles to observe muscle activity during rest and testing. Biomechanical measurements of lower extremity movement will be made using inertial motion capture equipment (Xsens)
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): NCT04130295
|United States, Georgia|
|Atlanta, Georgia, United States, 30309|