Spinal Cord Transcutaneous Stimulation Effect on Blood Pressure in Acute Spinal Cord Injury (SCI)

Официальное название

Neuromodulation of Blood Pressure Using Transcutaneous Spinal Stimulation in Individuals With an Acute Spinal Cord Injury - A Safety, Feasibility and Efficacy Study

Обзор

The goal of this clinical trial is to evaluate the effect of transcutaneous spinal cord stimulation on blood pressure in individuals with an acute spinal cord injury (within 30 days of injury). Blood pressure instability, specifically orthostatic hypotension (a drop in blood pressure when moving lying flat on your back to an upright position), appears early after the injury and often significantly interferes with participation in the critical rehabilitation time period. The main questions it aims to answer are: 1. Can optimal spinal stimulation increase blood pressure and resolve orthostatic symptoms (such as dizziness and nausea) when individuals undergo an orthostatic provocation (a sit-up test)? Optimal stimulation and sham stimulation (which is similar to a placebo treatment) will be compared. 2. What are the various spinal sites and stimulation parameters that can be used to increase and stabilize blood pressure to the normal range of 110-120 mmHg? Participants will undergo orthostatic tests (lying on a bed that starts out flat and then moved into an upright seated position by raising the head of bed by 90° and dropping the base of the bed by 90° from the knee) with optimal and sham stimulation, and their blood pressure measurements will be evaluated and compared.

Подробное описание

Blood pressure (BP) control in persons with a spinal cord injury (SCI) is often impaired, resulting in short and long-term health complications and a decline in quality of life. Cardiovascular (CV) dysfunction develops early after SCI and often continues a lifetime. Orthostatic hypotension (OH), a 20/10 mmHg decrease in systolic/diastolic BP when moving from a supine to an upright position, is especially prevalent in the early phase, and frequently accompanied by symptoms of dizziness, weakness, fatigue, and syncope. Affecting up to 75% of therapy treatments during inpatient rehabilitation, OH significantly interferes with participation during the critical rehab time-period, especially as length of stay in rehabilitation has substantially shortened in the past decades.

The compelling rationale for early identification and treatment of OH is met by several pharmacological and non-pharmacological interventions, however, the majority have limited effect, and increase the risk of adverse drug effects due to polypharmacy. In recent years, epidural and transcutaneous spinal cord stimulation has been explored with promising results as a potential treatment to CV dysfunction in SCI. To date, only individuals with a chronic SCI (\>1 year) were included in these studies.

The objective of this study is to investigate the effect of spinal cord transcutaneous stimulation (scTS) on BP in individuals with an acute/sub-acute SCI (7-30 days after injury), during their inpatient rehabilitation. Optimal stimulation sites and parameters that increase and stabilize systolic BP (SBP) within the normotensive range (110-120 mmHg) during an orthostatic challenge will be sought. In this crossover randomized controlled trial (RCT), the effect of optimal CV stimulation and sham stimulation on BP and orthostatic symptoms will be assessed and compared.

The information gleaned from this work will allow design and implementation of scTS interventions in the early phase following an SCI, allowing full participation in inpatient rehabilitation programs, which are often hindered by the patients' autonomic dysfunction.

Вмешательства

• Диагностический тест Orthostatic challenge
  Designed to invoke an orthostatic response. It begins with the participants lying supine on a specialized bed. The bed is then converted into a chair by raising the head of the bed by 90° and dropping the base of the bed by 90° from the knee. This position will be maintained for 15 minutes, while hemodynamic measures are continuously recorded. Some of these sessions will be accompanied by spinal stimulation.
• Устройство Biostim-5 transcutaneous spinal stimulation - Mapping
  Transcutaneous stimulation of the spinal cord. Two days of mapping will be performed to determine sites for modulation of blood pressure. During each day, with the participant in a supine or seated position, electrodes will be placed on the midline of one of the following spinous processes: C3/4, C5/6, C7/T1, T7/8, T11/12, L1/2 and S1/2. Stimulation intensity will start at 5 mA and gradually increase by 5 mA increments up to 100 mA. The frequency will be two or 30 Hz.
• Устройство Biostim-5 transcutaneous spinal stimulation - "Optimal" testing
  Based on the mapping sessions, profiles will be established to guide the selection of an optimal site location for blood pressure modulation (within the range of 110-120 mmHg).
• Устройство Biostim-5 transcutaneous spinal stimulation - "Sham" testing
  Based on the mapping sessions, a profile that does not elicit a significant blood pressure response, will be used for the sham stimulation.

Первичные конечные точки

• Optimal stimulation sites [Срок оценки: Through Mapping and testing sessions, average of 2 weeks]
• Optimal stimulation frequency [Срок оценки: Through Mapping and testing sessions, average of 2 weeks]
• Systolic blood pressure measurements (mmHg) - Mean and SD of beat-to-beat BP [Срок оценки: Throughout the experiment, average of 2 weeks]
• Change in Orthostatic symptoms when stimulation is applied [Срок оценки: Will be performed every 5 minutes during the orthostatic tests, average of 2 weeks]

Вторичные конечные точки (8)

• Numeric Rating Scale (NRS) for pain [Срок оценки: Throughout the experiment, average of 2 weeks]
• Skin integrity assessment [Срок оценки: Throughout the experiment, average of 2 weeks]
• Feasibility of applying scTS in inpatient settings - compliance [Срок оценки: Throughout the experiment, average of 2 weeks]
• Feasibility of applying scTS in inpatient settings - session duration [Срок оценки: Throughout the experiment, average of 2 weeks]
• Feasibility of applying scTS in inpatient settings - effect on therapy [Срок оценки: Throughout the experiment, average of 2 weeks]
• Electromyography (EMG) of leg muscles - muscle activation (analysis of mean and peak amplitudes) [Срок оценки: Through Mapping and testing sessions, average of 2 weeks]
• Additional hemodynamic measure - diastolic blood pressure [Срок оценки: throughout the trial, average of 2 weeks]
• Additional hemodynamic measure - heart rate [Срок оценки: throughout the trial, average of 2 weeks]

Критерии участия

Критерии включения

• 7-30 days after injury
• Injury level ≥T2 (thoracic level)
• American Spinal Injury Association Impairment Scale (AIS) A-C
• Exhibits at least one of the following hypotensive symptoms:

• Baseline hypotension - resting supine or seated SBP < 90mmHg;
• SBP drop ≥ 20 mmHg within 5 minutes of assuming seated position;
• Symptoms of orthostasis with a drop of SBP (<90mmHg) from supine to sitting.

Критерии исключения

• Current illness (e.g., a recent diagnosis of a deep vein thrombosis (DVT) or pulmonary embolism (PE), a pressure injury that might interfere with the intervention, etc.) or infection
• Ventilator-dependent
• History of implanted brain/spine/nerve stimulators
• Cardiac pacemaker/defibrillator or intra-cardiac lines
• Significant coronary artery or cardiac conduction disease, a recent history of myocardial infarction
• Initiated on new cardiac medications within the past 5 days
• Insufficient mental capacity to understand and independently provide consent
• Pregnancy
• Cancer
• Deemed unsuitable by study physician

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Перекрёстный дизайн

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

США · 1 центр

• Kessler Foundation — West Orange

Идентификаторы

NCT: NCT05731986 · CSCR23FEL002 · CSCR23FEL002

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

Открыть это исследование на ClinicalTrials.gov ↗