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RecruitingNCT03433599Updated Jun 30, 2022

Repetitive Acute Intermittent Hypoxia for Spinal Cord Repair

An interventional study of Repeated exposure to acute Intermittent Hypoxia (rAIH) and Normal Room Air in Spinal Cord Injuries, sponsored by Shirley Ryan AbilityLab. Recruiting at 1 site in United States. Open to participants aged 18 Years to 85 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2022-06-30.

Sponsored by Shirley Ryan AbilityLab · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
60
Allocation
Randomized
Ages
18 Years to 85 Years
Sex
All
01

Study summary

Our goal is to enhance repeated exposure to acute intermittent hypoxia (rAIH)/training-induced aftereffects on upper and lower limb function recovery in humans with chronic spinal cord injury (SCI).

Read the detailed description

The experiments in this study will test the following: Hypothesis 1.1(Experiment 1) that rAIH will enhance corticospinal excitability and upper and lower limb function in humans with incomplete SCI. Hypothesis 1.2 (Experiment 2) that enhancing the aftereffects of rAIH with exercise training will further enhance upper and lower limb motor function in humans with incomplete SCI. Measurements of corticospinal, cortical, and motoneuron excitability will be tested to further understand the mechanisms of this induced-plasticity. Persons with chronic (>6 months) spinal cord injury between the levels of C2 and T2. SCI subjects must possess either the ability to produce a visible precision grip force with one hand, and/or the ability to perform some small wrist flexion and extension. Additionally, subject must possess the ability to perform a small visible contraction with dorsiflexion and hip flexor muscles. Controls must be right handed due to potential differences in the organization of the brain in right handed and left handed individuals.

02

Conditions studied

  • Spinal Cord Injuries

Keywords

  • Acute Intermittent Hypoxia
  • Transcranial Magnetic Stimulation
03

Who can participate

Ages eligible
18 Years to 85 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Eligibility criteria

Inclusion criteria for SCI:

  1. Males and females between 18-85 years
  2. Chronic SCI (≥ 6 months post injury)
  3. SCI at or above L2
  4. ASIA A, B, C, or D, complete or incomplete
  5. Possess the following: The ability to produce a visible precision grip force with one hand, and/or the ability to perform some small wrist flexion and extension. The ability to perform a small visible contraction with dorsiflexion and hip flexor muscles.

Inclusion criteria for controls:

  1. Males and females between 18-85 years
  2. Right-handed (Only right-handed individuals will be accepted into this group because of the potential differences in the organization of the brain in right handed and left handed individuals)

Exclusion criteria for SCI and for controls:

  1. Uncontrolled medical problems including pulmonary, cardiovascular or orthopedic disease
  2. Any debilitating disease prior to the SCI that caused exercise intolerance
  3. Premorbid, ongoing major depression or psychosis, altered cognitive status
  4. History of head injury or stroke
  5. Metal plate in skull
  6. History of seizures
  7. Receiving drugs acting primarily on the central nervous system, which lower the seizure threshold such as antipsychotic drugs (chlorpromazine, clozapine) or tricyclic antidepressant
  8. Pregnant females
  9. Ongoing cord compression or a syrinx in the spinal cord or a spinal cord disease as spinal stenosis, spina bifida or herniated cervical disk.

AIH exclusion criteria (in addition to the above listed exclusion criteria)

  1. Resting heart rate ≥120 BPM
  2. Resting systolic blood pressure >180 mm Hg
  3. Resting diastolic Blood Pressure >100 mmHg
  4. Self-reported history of unstable angina or myocardial infarction within the previous month
  5. Resting SpO2 ≥ 95%
  6. Cardiopulmonary complications such as COPD
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Double (Participant, Care provider)
Enrollment
60 participants (estimated)

Study arms

  • Active comparator
    rAIH + training by research staff

    Participants will receive repeated exposure to acute Intermittent Hypoxia (rAIH) and training by research staff.

    Other: Repeated exposure to acute Intermittent Hypoxia (rAIH) · Other: Upper-limb Training by Research Staff · Other: Lower-limb Training by Research Staff

  • Sham comparator
    sham rAIH + training

    Participants will sham receive repeated exposure to acute Intermittent Hypoxia (rAIH) and training by the research staff.

    Other: Normal Room Air · Other: Upper-limb Training by Research Staff · Other: Lower-limb Training by Research Staff

Interventions

  • OtherRepeated exposure to acute Intermittent Hypoxia (rAIH)

    Participants will be fitted with a mask that will be placed over mouth and nose. Tubing will be attached to the front of the mask. The session will last approximately 30-45 minutes with 60-90 seconds of lower oxygen (tubing attached, 9-10% oxygen level), alternating with 60-90 sec of normal room air (no tubing attached).

  • OtherNormal Room Air

    Participants will be fitted with a mask that will be placed over mouth and nose. Tubing will be attached to the front of the mask. The session will last approximately 30-45 minutes with 60-90 seconds of normal room air (with tubing attached to the mask) and 60-90 sec of normal room air (without the tubing attached to the mask).

    Also known as: Sham repeated exposure to acute Intermittent Hypoxia (rAIH)

  • OtherUpper-limb Training by Research Staff

    Training sessions will last for approximately 30 minutes, with additional time for set up. During these sessions, participants will be asked to complete a variety of tasks related to general arm/hand movement, gross grasping, fine grasping, and hand cycle using an arm ergometer. The number of repetitions will be monitored and adjust the difficulty to ensure appropriate task difficulty.

  • OtherLower-limb Training by Research Staff

    Training sessions will last for approximately 30 minutes, with additional time for set up. During these sessions, participants will be asked to complete a variety of tasks related to general leg/foot movement, over-ground walking, treadmill walking, stair climbing training, leg cycling, standing frame, and NuStep. The number of repetitions will be monitored and adjust the difficulty to ensure appropriate task difficulty.

05

What researchers measure

Primary outcomes

  1. Upper limb functional measurement

    The Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) will be used to assess sensation, strength, and prehension.

    Time frame: 45 minutes to 1 hour

  2. Lower limb functional measurement

    10-meter walk test will be used to assess walking speed

    Time frame: 5-10 minutes

  3. MEP/CMEP recruitment curves using TMS

    Ten Transcranial magnetic stimuli (TMS) will be delivered to plot the mean peak-to-peak amplitude of the motor and cervicomedullary evoked potentials (MEPs and CMEPs, respectively) from the non-rectified response against the TMS intensity in each subject (MEP/CMEP recruitment curves).

    Time frame: 30 minutes to 1 hour

  4. EMG and force voluntary output

    EMG surface electrodes will be placed over target muscles (deltoid, biceps brachii, first dorsal interosseous, abductor pollicis brevis, quadriceps femoris, tibialis anterior and/or soleus) to measure maximum voluntary contraction (MVC)

    Time frame: 30 minutes to 1 hour

06

Study locations

1 of 1 sites recruiting
  • Shirley Ryan AbilityLab
    Chicago, Illinois 60611, United States
    • Monica Perez, PhD, PT · Contact · mperez04@sralab.org · 312-238-2886
    • Monica A Perez, PhD · Principal investigator
    Recruiting
07

Registry details

Key details

Study ID
NCT03433599
Lead sponsor
Shirley Ryan AbilityLab
Collaborators
U.S. Department of Education
Responsible party
Monica Perez (Scientific Chair Arms + Hands AbilityLab, Shirley Ryan AbilityLab) — Principal investigator
First posted
Feb 14, 2018
Start date
Apr 9, 2020
Primary completion
Dec 28, 2024 (estimated)
Completion
Dec 28, 2025 (estimated)
Last update
Jun 30, 2022

Study contacts

Monica Perez, PhD
Contact
mperez04@sralab.org
312-238-2886
Monica A Perez, PhD
principal investigator · Shirley Ryan AbilityLab

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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