Spinal Cord Injuries Clinical Trial
Official title:
A Selective Adenosine 2a Antagonist to Enhance Training-related Gains in Walking Function for Persons With Chronic, Incomplete Spinal Cord Injury
Breathing brief, moderate bouts of low oxygen trigger (low oxygen therapy, LOT) spinal plasticity (the ability of the nervous system to strengthen neural pathways based on new experiences), and improve walking after spinal cord injury (SCI). The greatest improvements in walking ability occur when LOT is administered prior to skill-based walking practice (WALK). However, the enduring benefits of LOT on walking recovery may be undermined by the accumulation of LOT-induced increase in extracellular adenosine. The goal of the study is to understand the extent to which istradefylline (adenosine 2a receptor antagonist) may limit the competing mechanisms of adenosine on LOT-induced walking recovery following SCI.
Status | Not yet recruiting |
Enrollment | 40 |
Est. completion date | June 30, 2027 |
Est. primary completion date | December 30, 2026 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 75 Years |
Eligibility | Inclusion Criteria: 1. age 18 and 75 years (the latter to reduce the likelihood of heart disease) medical clearance to participate 2. lesion at or below C2 and above T12 with non-progressive etiology 3. classified as motor-incomplete with visible volitional leg movement 4. injury greater than 12 months 5. ability to advance one step overground without human assistance Exclusion Criteria: 1. Concurrent severe medical illness (i.e., infection, cardiovascular disease, ossification, recurrent autonomic dysreflexia, unhealed decubiti, and history of pulmonary complications) 2. Pregnant women because of the unknown effects of AIH on pregnant women and fetus 3. History of seizures, brain injury, and/or epilepsy 4. Undergoing concurrent physical therapy 5. Diabetes 6. Cirrhosis Caffeine and/or NSAID allergies or intolerances |
Country | Name | City | State |
---|---|---|---|
United States | Spaulding Rehabilitation Hospital | Cambridge | Massachusetts |
Lead Sponsor | Collaborator |
---|---|
Randy Trumbower, PT, PhD |
United States,
Hayes HB, Jayaraman A, Herrmann M, Mitchell GS, Rymer WZ, Trumbower RD. Daily intermittent hypoxia enhances walking after chronic spinal cord injury: a randomized trial. Neurology. 2014 Jan 14;82(2):104-13. doi: 10.1212/01.WNL.0000437416.34298.43. Epub 2013 Nov 27. — View Citation
Tan AQ, Barth S, Trumbower RD. Acute intermittent hypoxia as a potential adjuvant to improve walking following spinal cord injury: evidence, challenges, and future directions. Curr Phys Med Rehabil Rep. 2020 Sep;8(3):188-198. doi: 10.1007/s40141-020-00270-8. Epub 2020 Jun 24. — View Citation
Tan AQ, Papadopoulos JM, Corsten AN, Trumbower RD. An automated pressure-swing absorption system to administer low oxygen therapy for persons with spinal cord injury. Exp Neurol. 2020 Nov;333:113408. doi: 10.1016/j.expneurol.2020.113408. Epub 2020 Jul 17. — View Citation
Tan AQ, Sohn WJ, Naidu A, Trumbower RD. Daily acute intermittent hypoxia combined with walking practice enhances walking performance but not intralimb motor coordination in persons with chronic incomplete spinal cord injury. Exp Neurol. 2021 Jun;340:113669. doi: 10.1016/j.expneurol.2021.113669. Epub 2021 Feb 27. — View Citation
Trumbower RD, Hayes HB, Mitchell GS, Wolf SL, Stahl VA. Effects of acute intermittent hypoxia on hand use after spinal cord trauma: A preliminary study. Neurology. 2017 Oct 31;89(18):1904-1907. doi: 10.1212/WNL.0000000000004596. Epub 2017 Sep 29. — View Citation
Trumbower RD, Jayaraman A, Mitchell GS, Rymer WZ. Exposure to acute intermittent hypoxia augments somatic motor function in humans with incomplete spinal cord injury. Neurorehabil Neural Repair. 2012 Feb;26(2):163-72. doi: 10.1177/1545968311412055. Epub 2011 Aug 5. — View Citation
Vivodtzev I, Tan AQ, Hermann M, Jayaraman A, Stahl V, Rymer WZ, Mitchell GS, Hayes HB, Trumbower RD. Mild to Moderate Sleep Apnea Is Linked to Hypoxia-induced Motor Recovery after Spinal Cord Injury. Am J Respir Crit Care Med. 2020 Sep 15;202(6):887-890. doi: 10.1164/rccm.202002-0245LE. No abstract available. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Pre-Treatment Walking Speed | Pre-Treatment Walking Speed; 10MWT (time, seconds) | within 5 days of first treatment | |
Primary | Walking Speed Post-Treatment 1 | Post-Treatment Walking Speed; 10MWT (time, seconds) | within 1 day after last treatment | |
Primary | Walking Speed Post-Treatment 2 | Post-Treatment Walking Speed; 10MWT (time, seconds) | between 7-10 days after Post-Treatment 1 | |
Primary | Walking Speed Post-Treatment 3 | Post-Treatment 10MWT (time, seconds) | between 17-20 days after Post-Treatment 1 | |
Secondary | Pre-Treatment Walking Distance | Pre-Treatment 6MWT (distance, meters) | within 5 days of first treatment | |
Secondary | Walking Distance Post-Treatment 1 | Post-Treatment 6MWT (distance, meters) | within 1 day after last treatment | |
Secondary | Walking Distance Post-Treatment 2 | Post-Treatment 6MWT (distance, meters) | between 7-10 days after Post-Treatment 1 | |
Secondary | Walking Distance Post-Treatment 3 | Post-Treatment 6MWT (distance, meters) | between 17-20 days after Post-Treatment 1 | |
Secondary | Pre-Treatment Timed Up-and-Go Test | Pre-Treatment TUG (walking balance) | within 5 days of first treatment | |
Secondary | Timed Up-and-Go Test Post-Treatment 1 | Post-Treatment TUG (walking balance) | within 1 day after last treatment | |
Secondary | Timed Up-and-Go Test Post-Treatment 2 | Post-Treatment TUG (walking balance) | between 7-10 days after Post-Treatment 1 | |
Secondary | Timed Up-and-Go Test Post-Treatment 3 | Post-Treatment TUG (walking balance) | between 17-20 days after Post-Treatment 1 | |
Secondary | Pre-treatment Ankle Strength | Pre-Treatment Plantarflexion Torque (strength, torque) | within 5 days of first treatment | |
Secondary | Ankle Strength Post-Treatment 1 | Post-Treatment Plantarflexion Torque (strength, torque) | within 1 day after last treatment | |
Secondary | Ankle Strength Post-Treatment 2 | Post-Treatment Plantarflexion Torque (strength, torque) | between 7-10 days after Post-Treatment 1 | |
Secondary | Ankle Strength Post-Treatment 3 | Post-Treatment Plantarflexion Torque (strength, torque) | between 17-20 days after Post-Treatment 1 |
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