Spinal Cord Injuries Clinical Trial
Official title:
Activity-Dependent Plasticity After Spinal Cord Injury
Incomplete spinal cord injury often results in difficulty walking. Training on a treadmill with body weight support may improve walking ability after spinal cord injury. The purpose of this study is to examine the effect of treadmill speed on spinal cord function and walking performance.
Conventional rehabilitation following spinal cord injury (SCI) emphasizes functional gains
through strengthening and compensation, using braces and assistive devices to achieve
mobility. Rehabilitation practice using compensatory approaches is based on the prevailing
assumption that neural recovery is not possible following SCI.
Recent evidence contradicts this assumption. Stimulated by the proper activation of
peripheral afferents associated with walking, neuronal circuits may reorganize by
strengthening of existing and previously inactive descending connections and local neural
circuits. New approaches to locomotor recovery after SCI utilize sensory information related
to locomotion to improve treadmill and overground walking.
Locomotor training velocity may be a critical, task-specific, and activity-dependent
parameter affording appropriate phasic, afferent input to the neural system and promoting
neural plasticity. The purpose of this study is to evaluate the effects of training velocity
in a long-term locomotor training program on both neurophysiological and behavioral
plasticity in individuals with incomplete SCI.
Sixteen patients with incomplete SCI will be recruited to participate in this study.
Baseline evaluations will include American Spinal Injury Association classification,
rate-sensitive depression, phase-dependent H-reflex modulation at self-selected and fast
overground walking velocities, and MRI of the spine. Patients will wear a step activity
monitor for a 48-hour period, quantifying baseline walking activity level.
All patients will participate in a locomotor training program. Patients will be randomly
assigned to either training at self-selected treadmill velocity or at a normal walking
velocity. Patients will have 45 training sessions over 9 weeks. Each training session will
include 30 minutes of walking. Interim testing of rated depression, spatial-temporal
parameters of walking, MRI, and walking activity will occur through the 9-week training
period. Post-testing will occur within 2 days of the last training session and at a 1 month
after completion of the training. During the month following long-term training, patients
will be instructed to return to their self-selected routine activities of daily living.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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