AIH for Spinal Cord Repair
Ključne riječi
Sažetak
Opis
The overall goal is to develop effective, clinically applicable, approaches to restore upper limb function (reach-and-grasp) after chronic contusive cervical spinal cord injury (cSCI). Impairments in upper limb function significantly reduce the quality of life for people with cSCI. Reach-and-grasp actions in animals and humans are largely controlled by the corticospinal tract (CST). The investigators argue that promoting plasticity within the CST may support the recovery of upper limb function after cSCI. Repetitive exposure to acute intermittent hypoxia (rAIH) combined with motor training is a safe, minimally invasive, treatment that elicits neuroplasticity resulting in improved recovery after cSCI, but its overall effects remain limited. The main goals are to: 1) enhance rAIH/training-induced aftereffects on forelimb function and increase the understanding of the neuronal substrates in an adult rat model of chronic contusive cSCI, and 2) use this knowledge to guide the development of more effective rAIH/training approaches to improve upper limb function in humans with chronic contusive cSCI.
In Specific Aim 1, using an adult rat model of chronic contusive cSCI, the investigators will investigate the effects of rAIH frequency and dose on rAIH/training-mediated functional recovery of the impaired forelimb. Also, the investigators will combine rAIH/training with N-methyl-D-aspartate receptor (NMDA)-mediated synaptic plasticity through D-cycloserine treatment and study the effects on recovery of forelimb function. Immunocytochemistry with imaging techniques will be used to assess structural neuronal plasticity in the CST after rAIH/training. In Specific Aim 2, in people with chronic incomplete cSCI, guided by the findings in Specific Aim 1, the investigators will study the effects of rAIH frequency and concurrent D-cycloserine treatment on rAIH/training-mediated upper limb function recovery. The investigators will comprehensively analyze the effects of rAIH on the strength of electrophysiological and functional aftereffects in the upper limb.
The proposed research will provide new knowledge on rAIH/training-mediated functional and anatomical aftereffects (Specific Aim 1), which will be used to develop effective rAIH/training protocols for people with contusive, functionally incomplete, cSCI (Specific Aim 2). The data from the investigators' experiments may lead to clinically applicable approaches that improve arm and hand function recovery after chronic contusive cSCI, which would positively impact the quality of life of Veterans with cSCI. The relevance of this proposal is emphasized by the limited efficacy of current strategies to improve upper limb function after cSCI.
Datumi
| Posljednja provjera: | 06/30/2020 |
| Prvo podneseno: | 12/11/2018 |
| Predviđena prijava predata: | 12/16/2018 |
| Prvo objavljeno: | 12/18/2018 |
| Zadnje ažuriranje poslato: | 07/08/2020 |
| Posljednje ažuriranje objavljeno: | 07/09/2020 |
| Stvarni datum početka studija: | 08/31/2020 |
| Procijenjeni datum primarnog završetka: | 01/30/2024 |
| Predviđeni datum završetka studije: | 01/30/2024 |
Stanje ili bolest
Intervencija / liječenje
Behavioral: hypoxia
Behavioral: sham hypoxia plus training
Drug: hypoxia plus training plus NMDA agonist
Drug: hypoxia plus training plus sham NMDA agonist
Behavioral: exercise training
Faza
Grupe ruku
| Arm | Intervencija / liječenje |
|---|---|
| Experimental: hypoxia plus training combined hypoxia treatment with exercise training | |
| Sham Comparator: sham hypoxia plus training combined sham hypoxia treatment with exercise training | Behavioral: sham hypoxia plus training intermittent cycles of sham hypoxia |
| Experimental: hypoxia plus training plus NMDA agonist combined hypoxia treatment with exercise training and with NMDA agonist treatment | Drug: hypoxia plus training plus NMDA agonist NMDA agonist treatment |
| Placebo Comparator: hypoxia plus training plus sham NMDA agonist combined hypoxia treatment with exercise training and with sham NMDA agonist treatment | Drug: hypoxia plus training plus sham NMDA agonist sham-NMDA agonist treatment |
Kriteriji prihvatljivosti
| Uzrast podoban za studiranje | 18 Years To 18 Years |
| Polovi podobni za studiranje | All |
| Prihvaća zdrave volontere | Da |
| Kriterijumi | Inclusion Criteria: - Male and females Veterans between 18-80 years - Chronic cSCI (1 yr of injury) - Cervical injury at C8 or above - Sensory function: impaired (score of 1) but not absent (score of 0) or intact (score of 2) innervations in dermatomes C6, C7 and C8 during light touch and pin prick stimulus using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) sensory scores - Motor function: Able to grasp small objects with one hand and able to perform a visible precision grasp between the index finger and thumb - Motor scores ISNCSCI: 1 to 4 but not 5 on finger flexors and finger abductors on the hand tested. - These criteria were selected to ensure that hand impairment will not interfere with the ability to perform training and proposed tests Inclusion criteria for controls: - Male and females (18-80 years) - Right handed - Able to complete precision and power grips Exclusion Criteria: - Uncontrolled medical problems including pulmonary, cardiovascular or orthopedic disease - Any debilitating disease prior to the SCI that caused exercise intolerance - Premorbid, ongoing major depression or psychosis, altered cognitive status - History of head injury or stroke - Pacemaker - Metal plate in skull - History of seizures - Receiving drugs acting primarily on the central nervous system, which lower the seizure threshold such as antipsychotic drugs - chlorpromazine - clozapine - or tricyclic antidepressants - Pregnant females - Ongoing cord compression or a syrinx in the spinal cord or who suffer from a spinal cord disease as spinal stenosis, spina bifida or herniated cervical disk - Presence of autonomic dysreflexia Exclusion criteria for healthy controls: - Same as for SCI individuals |
Ishod
Primarne mjere ishoda
1. Change in grip strength [baseline, 1st week, 2nd week, 4th week, 8th week, and 12th week]
2. Change in pinch strength [baseline, 1st week, 2nd week, 4th week, 8th week, and 12th week]
3. Change in motor evoked potential size [30 minutes before and 30 minutes after intervention]
