ClinicalTrials.gg
WithdrawnNCT04627441Service-LineUpdated Oct 4, 2022

Transcutaneous and Epidural Stimulation in SCI

An interventional study of Transcutaneous spinal cord stimulator and Epidural spinal cord stimulator system in Paraplegia, Spinal, Paraplegia, Complete and Paraplegia; Traumatic, sponsored by Kristin Zhao, PhD. Withdrawn. Open to participants aged 22 Years and older. Per ClinicalTrials.gov, last updated 2022-10-04.

Sponsored by Kristin Zhao, PhD · Not applicable, Interventional, and Basic science

Why this study was withdrawn
COVID-related delays and insufficient funding.
Phase
Not applicable
Study type
Interventional
Enrollment
0
Allocation
Not applicable
Ages
22 Years and older
Sex
All
01

Study summary

The study seeks to improve the scientific understanding of how two electrical stimulation techniques, one which delivers electricity to the skin surface over the spine (transcutaneous electrical spinal stimulation [TESS]) and another which is implanted onto the dura mater of the spinal cord (epidural electrical stimulation [EES]), facilitate spinal circuitry to enable function after SCI.

Read the detailed description

The study will compare motor activity and clinical outcomes over the course of TESS and EES in combination with physical rehabilitation.

The primary outcome data collected will be used to characterize and compare spinal sensorimotor activity in muscles below the level of injury during TESS and EES-enabled motor tasks in persons with chronic motor complete paralysis of the lower extremities due to traumatic SCI. Furthermore, data collected will be used as a proof of concept that TESS can be used to determine recovery of function during EES-enabled motor tasks. Following exposure to each stimulation intervention, data collection will include changes to spasticity, body composition, metabolic variables, and spinal imaging to assess the effect of either TESS or EES stimulation.

02

Conditions studied

  • Paraplegia, Spinal
  • Paraplegia, Complete
  • Paraplegia; Traumatic

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03

In context

Paraplegia

151 studies on the registry are indexed under Paraplegia; 36 are open to participants now.

Browse Paraplegia studies →

Lead sponsor

Kristin Zhao, PhD is the lead sponsor of 7 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
22 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Spinal cord injury due to trauma located between the seventh cervical (C7) and tenth thoracic vertebrae (T10)
  • American Spinal Injury Association grading scale of A or B (4 each of A and B) below the level of SCI
  • Intact spinal reflexes below the level of SCI
  • At least 1-year post-SCI
  • At least 22 years of age
  • Willing to use medically acceptable methods of , if female and of

Exclusion criteria

Exclusion Criteria:

  • Currently a prison inmate, or awaiting trial, related to criminal activity
  • Pregnancy at the time of enrollment
  • Dual energy x-ray absorptiometry (DEXA) t-score \<-3.5 at spine and femur head
  • History of chronic and/or treatment resistant urinary tract infection
  • Unhealed decubitus ulcer
  • Unhealed skeletal fracture
  • Untreated clinical diagnosis of depression
  • Presence of joint contractures or an Ashworth spasticity score of 4
  • Active anti-spasticity medication regimen within 3 months prior to study enrollment
  • Presence of transcranial magnetic stimulation-evoked potentials in leg muscles
  • Undergoing, or planning to undergo, diathermy treatment
  • Active participation in another interventional clinical trial
  • Presence of conditions or disorders which require MRI monitoring
  • A history of coagulopathy or other significant cardiac or medical risk factors for surgery
  • Current use of a ventilator
  • Clinically diagnosed cardiopulmonary complications such as , cardiac failure, or heart arrhythmia that contraindicate changes in body position such as supine-to-sit-to-stand activities, prolonged standing, or stepping
  • Mass > 113 kg (250 pounds)
  • History of frequent hypotension characterized by light headedness, or loss of consciousness
  • History of frequent hypertension characterized by headache, or bradycardia
  • History of frequent, severe, autonomic dysreflexia
  • Any illness or condition which, based on the research team's assessment, will compromise with the patient's ability to comply with the protocol, patient safety, or the validity of the data collected during this study.
Terms in these criteria, in plain language(3)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

COPD

Chronic obstructive pulmonary disease: long-term lung disease that makes it hard to breathe out, including emphysema and chronic bronchitis.

05

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
0 participants (actual)

Study arms

  • Experimental
    TESS-EES

    Transcutaneous Electrical Spinal Stimulation (TESS), used during the first month of training sessions, followed by Epidural Electrical Stimulation (EES) during the final 6-month training period.

    Device: Transcutaneous spinal cord stimulator · Device: Epidural spinal cord stimulator system

Interventions

  • DeviceTranscutaneous spinal cord stimulator

    DS8R Electrical Stimulator For Human Research

  • DeviceEpidural spinal cord stimulator system

    Spectra WaveWriter Epidural Spinal Cord Stimulator System with CoverEdge 32 Electrode Surgical Lead

06

What researchers measure

Primary outcomes

  1. Kinematics

    Change in measurements of joint angles, measured in degrees.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  2. Electromyography

    Change in measurements of electrical activity at major muscle groups below the level of injury.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  3. Foot pressure

    Change in measurements of foot pressure through shoe-insole pressure sensors.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  4. Overground ambulation [as appropriate to the subject] (1)

    Measurement of changes in overground mobility as measured by the Modified 6 Minute Walk Test. Trainers will assess the distance in meters which the subject can cover in 6 minutes, with a greater distance characterizing better overground mobility.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  5. Overground ambulation [as appropriate to the subject] (2)

    Measurement of changes in walking impairment as measured by the Walking Index for Spinal Cord Injury. Trainers will assess overall level of impairment, ranging from most severe impairment (0) to least severe impairment (20), based on the use of devices, braces, and physical assistance of one or more persons.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  6. Somatosensory evoked potentials

    Change in measurements of change in conduction in the peripheral nerves, cervical and lumbosacral spinal cord, deep brain structures, and sensory cortex, through surface electrodes.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  7. Transcranial magnetic stimulation motor evoked potentials

    Change in measurements of stimulus intensity required to elicit muscle responses in muscle groups known to elicit optimal motor evoked potential responses, both above and below the level of injury.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  8. Monosynaptic spinal reflex testing

    Change in measurements of stimulation intensity H and F wave thresholds and maximal responses through surface electrodes.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  9. Trunk stability

    Change in measurements of trunk stability using the modified functional reach test (mFRT).

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  10. Injury severity: American Spinal Injury Association (ASIA) Impairment Scale

    Change in measurements of impairment of sensory and motor functions using the American Spinal Injury Association Impairment Scale. Individuals are classified from A" (complete spinal cord injury) to "E" (normal function). 28 dermatomes and 10 key muscles are assessed bilaterally. Results are summed to produce overall sensory and motor scores and are used in combination with evaluation of anal sensory and motor function as a basis for the determination of ASIA classification. Sensory scores are rated 0 (sensation absent) to 2 (normal), bilaterally for each of 28 dermatomes. Muscle function is rated 0 (total paralysis) to 5 (active movement, full range of motion against significant resistance) for each myotome. Upper Extremity Motor Subscores and Lower Extremity Motor Subscores are each scored from 0 to 50; the ASIA Motor Score is scored from 0 to 100. The presence of anal sensation and voluntary anal contraction are assessed as a yes/no.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

Secondary outcomes

  1. Spasticity

    Change in measurements of spasticity using the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET). Answers to qualitative questions are rated from -3 to +3, with a higher positive number indicating more helpful symptoms, and a lower negative number indicating more problematic symptoms. Scores are totaled for a score which categorizes the overall positive or negative impact of a subject's spasticity symptoms.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  2. Bone mineral density

    Measurement by dual-energy x-ray absorptiometry (DEXA) of change in bone mineral content and bone density.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  3. Body composition - body fat mass

    Measurement by dual-energy x-ray absorptiometry (DEXA) of change in regional and total body fat mass.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  4. Body composition - lean mass

    Measurement by dual-energy x-ray absorptiometry (DEXA) of change in regional and total lean mass.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  5. Body composition - android and gynoid fat percentage

    Measurement by dual-energy x-ray absorptiometry (DEXA) of change in regional and total android and gynoid fat percentage.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  6. Body composition - bone mass

    Measurement by dual-energy x-ray absorptiometry (DEXA) of change in regional and total bone mass.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  7. Metabolics - CBC

    Measurement of changes in complete blood count with differential.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  8. Metabolics - glucose

    Measurement of change in fasting glucose value.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  9. Metabolics - total cholesterol

    Measurement of change in total cholesterol value.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  10. Metabolics - HDL cholesterol

    Measurement of change in HDL cholesterol value.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  11. Metabolics - calculated LDL cholesterol

    Measurement of change in calculated LDL cholesterol value.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  12. Metabolics - triglycerides

    Measurement of change in triglycerides value.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  13. Metabolics - non-HDL cholesterol

    Measurement of change in non-HDL cholesterol value.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  14. Neurostimulator array location and migration

    Evaluation of current array location via CT.

    Time frame: Start of EES, End month 6 EES

  15. Patient-reported bowel function (1)

    Measurement of change in bowel function using the Neurogenic Bowel Dysfunction Score. Answers to qualitative questions are rated from 0 to 5, with a higher number indicating more problematic symptoms, and totaled for a score which categorizes severity of neurogenic bowel symptoms.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  16. Patient-reported bowel function (2)

    Measurement of change in bowel function using the International Spinal Cord Injury Bowel Function Basic Data Set (v2.0). Answers to qualitative questions are rated from 0 to 13, with a higher number indicating more problematic symptoms, and totaled for a score which categorizes neurogenic bowel dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  17. Patient-reported bladder function (1)

    Measurement of change in bladder function using the Neurogenic Bladder Symptom Score. Answers to qualitative questions are rated from 0 to 5, with a higher number indicating more problematic symptoms, and totaled for a score which categorizes severity of neurogenic bladder symptoms.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  18. Patient-reported bladder function (2)

    Assessment of change in bowel function using the International Spinal Cord Injury Urodynamic Basic Data Set. Data from various urodynamic variables are aggregated into a single-page format for an abstract overview of bladder dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  19. Male patient-reported sexual function (1)

    Assessment of change in sexual function using the International Spinal Cord Injury Male Sexual Function Basic Data Set (v2.0). Data from various male sexual function variables are aggregated into a single-page format for an abstract overview of male sexual dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  20. Male patient-reported sexual function (2)

    Measurement of change in erectile dysfunction using the Sexual Health Inventory for Men (SHIM). Answers to qualitative questions are rated from 0 to 5, with a higher number indicating better erectile function, and totaled for a score which categorizes severity of erectile dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  21. Male patient-reported sexual function (3)

    Measurement of change in erectile dysfunction using the International Index for Erectile Function (IIEF). Answers to qualitative questions are rated from 0 to 5, with a higher number indicating better erectile function, and totaled for a score which categorizes severity of erectile dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  22. Female patient-reported sexual function (1)

    Assessment of change in sexual function using the International Spinal Cord Injury Female Sexual and Reproductive Function Basic Data Set (v2.0). Data from various female sexual and reproductive function variables are aggregated into a single-page format for an abstract overview of female sexual and reproductive dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  23. Female patient-reported sexual function (2)

    Measurement of change in sexual function using the Female Sexual Function Index (FSFI). Answers to qualitative questions are rated from 0 to 5, with a higher number indicating better sexual function, and totaled for a score which categorizes severity of sexual dysfunction.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

Other outcomes

  1. Volitional movement (1)

    Measurement of change in volitional movement through recordings of training time in minutes.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  2. Volitional movement (2)

    Measurement of change in volitional movement through recordings body weight support measured as a percentage of total body weight supported.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  3. Volitional movement (3)

    Measurement of change in volitional movement through recordings of speed in miles per hour.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  4. Volitional movement (4)

    Measurement of changes in volitional movement through recordings of assistive devices used.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  5. Volitional movement (5)

    Measurement of changes in volitional movement through recordings of stimulator electrode location.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  6. Volitional movement (6)

    Measurement of changes in volitional movement through recordings of stimulator intensity, measured in milliamps per volt.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  7. Volitional movement (7)

    Measurements of changes in volitional movement through recordings of stimulator frequency measured in Hertz.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  8. Volitional movement (8)

    Measurement of changes in volitional movement through recordings of pulse width, measured in microseconds.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  9. Overground ambulation [as appropriate to the subject] (1)

    Measurement of changes in severity of walking impairment as measured by the Walking Index for Spinal Cord Injury (WISCI II). Trainers combine the type of assistive device(s) used, use or no use of orthotic braces, number of persons assisting ambulation, and distance subject is able to walk (up to 10 meters), into a single score ranging from 0 to 20, with a lower number indicating more severe impairment.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  10. Overground ambulation [as appropriate to the subject] (2)

    Measurement of changes in overground mobility as measured by the Modified 6 Minute Walk Test. Trainers will assess the distance in meters which the subject can cover in 6 minutes, with a greater distance characterizing better overground mobility.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

  11. Overground ambulation [as appropriate to the subject] (3)

    Measurement of changes in overground mobility as measured by the Modified Timed Up and Go test. Trainers will assess the time it takes, in minutes and seconds, for the subject to stand from a chair, move out to a 3 meter distance, return to the chair and sit down. Less time will characterize better overground mobility.

    Time frame: Baseline, End of TESS, Start of EES, End month 6 EES

07

Study locations

No study locations are listed for this record.

08

References and documents

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Start is estimated for Dec 2022; primary completion for Dec 2025, 36 months later.

How these figures are worked out, and which studies are left out of them.

Registered
Oct 15, 2020
First posted
Nov 13, 2020
StartEst.
Dec 16, 2022
Primary completionEst.
Dec 16, 2025
CompletionEst.
Dec 16, 2025
Last update
Oct 4, 2022
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Oct 4, 2022, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT04627441
Lead sponsor
Kristin Zhao, PhD
Responsible party
Kristin Zhao, PhD (Principal Investigator, Mayo Clinic) — Sponsor-investigator
First posted
Nov 13, 2020
Start date
Dec 16, 2022 (estimated)
Primary completion
Dec 16, 2025 (estimated)
Completion
Dec 16, 2025 (estimated)
Last update
Oct 4, 2022

Study contacts

Kristin D. Zhao, Ph.D.
principal investigator · Mayo Clinic

Oversight

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

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This study is withdrawn, as verified in Oct 2022. You cannot join it, but the record below documents what was studied.

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