Amputation Clinical Trial
— SENSATIONOfficial title:
multiSENSory Stimulation to tArgeT Sensory Loss and chronIc Pain in neurOpathic patieNts
Neuropathy is a costly and disabling health issue, which consists of a degeneration of the peripheral nerves. Even though the causes may be different, such as diabetes or amputation, the consequences for neuropathic patients are multiple and extremely debilitating. Among the alarming symptoms it implicates, chronic pain and sensory loss are among the most severe ones. Because of the loss of sensations, patients are forced to have an altered gait strategy, an impaired balance and a fivefold increased risk of falling. Furthermore, since they lose sensations and feel numbness in their extremity, they are discouraged in walking, hence leading to a sedentary lifestyle. All of this is worsened by the development of neuropathic pain, which has a high comorbidity with psychological issues, such as depression and anxiety. Today, proper treatments for neuropathic pain that exclude pharmacological solutions are still missing. This is due to the complexity of the neurobiological mechanisms underlying the origin of neuropathy, the multifaceted physical and psychological nature of pain and the lack of reliable biomarkers. The aim of this project is to tackle the major problems connected to neuropathy thanks to non-invasive stimulation of the peripheral nervous system. The system is composed of an insole with pressure sensors that captures in real time the force exerted by the subject on the foot and couples this information with parameters of electrical stimulation. Thanks to optimal electrode placement and intensity modulation, subjects are able to perceive in real-time in a somatotopic manner (i.e., under their foot) how they are walking. The aim now is twofold: first the investigators want to couple this stimulation with Virtual Reality (VR) to develop a neuroadaptive non-invasive brain computer interface (BCI) to treat pain and secondly the investigators want to measure through fMRI scans whether the use of the sensory feedback system allows any beneficial plastic changes in the brain. Finally, the investigators want to measure through fMRI scans whether the use of the sensory feedback system allows any beneficial plastic changes in the brain.
Status | Recruiting |
Enrollment | 80 |
Est. completion date | February 28, 2024 |
Est. primary completion date | February 28, 2023 |
Accepts healthy volunteers | Accepts Healthy Volunteers |
Gender | All |
Age group | 18 Years to 80 Years |
Eligibility | for healthy: - Inclusion: - Age 18-80 - Visual acuity>6 on Snellen visual acuity chart - Exclusion: - Pregnancy - Cognitive deficits (Mini Mental State Examination<23) - Cyber-sickness - Prior or current psychological diseases - Pacemakers - Epilepsy - Claustrophobia - Other MRI contraindications - Unhealed fractures - Unhealed wounds - Cancerous growth in proximity to feet - Swollen, infected or inflamed areas on feet or skin eruptions on feet such as phlebitis, thrombophlebitis or varicose veins for patients: - Inclusion: - Age 18-80 - Visual acuity>6 on Snellen visual acuity chart - Diagnosis of peripheral neuropathy - Pain in lower limbs>4 cm on VAS scale - Exclusion: - Pregnancy - Relevant comorbidities that would affect the outcomes of the study (by judgement of physicians) - Ulcers - Cognitive deficits (Mini Mental State Examination<23) - Cyber-sickness - Prior or current psychological diseases - Pacemakers - Epilepsy - Claustrophobia - Other MRI contraindications - Unhealed fractures - Unhealed wounds - Cancerous growth in proximity to feet |
Country | Name | City | State |
---|---|---|---|
Switzerland | ETH Zurich | Zurich |
Lead Sponsor | Collaborator |
---|---|
ETH Zurich | Neural Control of Movement laboratory ETH Zurich |
Switzerland,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Changes in Sensory assessment through Quantitative Sensory Testing (QST) | QST: quantitative sensory testing is a set of measurements that measure the sensitivity of subjects. The include: light touch, vibration, hot and cold. | baseline, during the intervention, post-intervention | |
Other | Changes in sensory acuity | Sensory discrimination: an object with two extremities distant from 2 to 60 mm are placed on the subject's tested area and the subjects are asked to rate whether they feel 1 or 2 points. | baseline, during the intervention, post-intervention | |
Other | Changes in reflex | Reflexes: the ability to have intact reflexes corresponds to healthy nerves. Of particular interest will be the H reflex, where the tibial nerve is stimulated behind the knee and the reflex is measured through electromyography at the calf. We will measure it's latency, amplitude and ratio between M wave and H reflex | baseline, during the intervention, post-intervention | |
Primary | Change in pain level | Change in pain level reported by the subjects, 10 cm Visual Analogue Scale (VAS) scale with anchor points 0 = No pain and 10 = Worst imaginable pain, Numerical Pain Rating Scale (NPRS), and the Neuropathic Pain Symptom Inventory (NPSI) | Through study completion, up to 10 days | |
Primary | Changes in brain activity and connectivity through functional Magnetic Resonance Imaging (fMRI) before and after the treatment | will be measured through functional Magnetic Resonance Imaging (fMRI) sessions | baseline and 1 week follow-up | |
Primary | Changes in brain activity and connectivity through functional Magnetic Resonance Imaging (fMRI) between somatotopic and non somatotopic stimulation at feet | The brain activity will be measured while stimulating the subjects in three different locations: 1.somatotopic 2. in-loco 3. at the ankle | baseline, pre-intervention | |
Secondary | Changes in EEG | EEG: electroencephalography is a non-invasive measure. A cap is placed on the subject's head and detects the brain activity. In order to do so, a conduction gel (washable with water) is placed on each electrode. We will measure: general Power Spectral Density, frequency bands power (delta, theta, alpha, beta, gamma), connectivity, phase locking value, entropy. | Through study completion, up to 10 days | |
Secondary | Changes in Skin Conductance signatures | Skin Conductance (SC): skin conductance is a measure of the electrodermal activity. It is measured through a couple of non invasive electrodes on the palm of the patient. We will extract features such as peak amplitude, latency, variation, derivative. | Through study completion, up to 10 days | |
Secondary | Percentage of session completed | Compliance = % of each session completed. | post-intervention | |
Secondary | Changes in Anxiety and Depression | measured through validated questionnaires: Beck Anxiety Inventory and Beck Depression inventory | baseline, post-intervention | |
Secondary | Changes in Quality of life | measured through validated questionnaires Neuro-Quality of life | baseline, post-intervention | |
Secondary | changes in balance | Balance will be measured by validated tests (Berg Balance Scale), that range between 0 and 56 (lower values=higher impairment) | baseline, during the intervention, post-intervention | |
Secondary | changes in the speed to perform the Timed Up and Go (TUG) test | Functional mobility will be measured by the Timed Up and Go (TUG) test which measures the time that it takes a person to rise from a chair, walk 7 m, turn around and return and sit in the chair. | baseline, during the intervention, post-intervention | |
Secondary | changes in the ankle dorsiflexion angle is derived from gait analysis | The ankle dorsiflexion angle is derived from gait analysis. The angle of the ankle at the time the foot contacts the floor during a step is derived. This is repeated for at least 5 different walks, and the average of those 5 walks is calculated for further analysis. | baseline, during the intervention, post-intervention | |
Secondary | changes in speed and cadence in the 10 meter and 6 min walk test | In the 10 meter walk test, the time taken by the participant to walk 10 meters is recorded. The test is repeated and the average is taken for analysis.
In the 6 min walk test, the steps taken by the participant in 6 min walking are recorded. |
baseline, during the intervention, post-intervention |
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