Multi-site study of noninvasive brain stimulation to improve upper limb function after spinal cord injury

Kessler Foundation is one of three sites participating in a study of noninvasive brain stimulation to improve upper limb function funded by the U.S. Department of Defense Congressionally Directed Medical Research Programs (CDMRP) titled, "Improving Spinal Cord Injury Rehabilitation Interventions by Retraining the Brain." Ela Plow, PhD, is principal investigator for the Cleveland Clinic; Svetlana Pundik, PhD, is principal investigator for the Louis B. Stokes VA Cleveland Medical Center; and Gail Forrest, PhD, is principal investigator for the Foundation, which received a sub award of $778,000. Dr. Forrest is director of the new Center for Spinal Stimulation at Kessler Foundation.

The randomized, double-blinded multi-site study will test the safety, feasibility and efficacy of pairing transcranial direct current stimulation (tDCS) with exercise therapies to improve upper limb function among individuals with cervical incomplete spinal cord injury.

For this study, researchers plan to recruit 44 individuals with chronic spinal cord injury and upper limb impairments. Participants will receive 15 2-hour sessions (5 days/week for 3 weeks) of upper limb training to their weaker limb, combined with either active or sham tDCS. During the 2-hour sessions, participants will practice task-oriented exercises. Researchers will collect neurophysiological data and measure motor function at baseline, at four treatment visits, and at 3-month follow-up. They will use a number of measures, including the Upper Extremity Motor Score, GRASSP, Modified Ashworth Scale, and the Spinal Cord Independence Measure.

Noninvasive brain stimulation is a promising approach to improving upper limb function in individuals with disabilities caused by spinal cord injury. This study is an opportunity to learn more about how the brain influences upper extremity recovery, and the potential to channel that control to aid recovery after spinal cord injury. We will be looking at the effects of this protocol of stimulation and exercise on strength and dexterity and whether that can translate into greater independence and better quality of life for individuals with spinal cord injury."

Gail Forrest, PhD, principal investigator