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Spinal Cord InjuriesNCT04029974

Speed of Robotic Leg Movements and Orthostatic Hypotension in Subacute SCI

A study testing ErigoPro in people with Spinal Cord Injuries and Orthostatic Hypotension, run by Methodist Rehabilitation Center at 1 site in United States.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

This study seeks to evaluate whether the speed (cadence) of lower extremity robotic movement has an impact on orthostatic hypotension and upright tolerance when training with the ErigoPro robotic tilt-stepper. Read more about this study

Who is it for?
Ages 16 to 70 yearsHealthy volunteers can take part
Conditions the study is for
Spinal Cord Injuries, Orthostatic Hypotension
What is being tested?
ErigoPro
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
35 participants
Where
1 siteUnited States
Study dates
20 Aug 2019to Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 16 to 70 years
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • Reported overt signs/symptoms of OH during and/or outside of therapy sessions or primary therapist reports a drop in blood pressure consistent with OH during therapy sessions (SCI)
  • Age 16 - 70 years (Healthy \& SCI)
  • Traumatic SCI AIS A - C or non-traumatic SCI, all levels of injury (SCI)
  • Time since SCI ≤ 12 weeks (SCI)
  • Weight ≤ 297 lb, leg length 29" - 39" (per ErigoPro manual) (Healthy \& SCI)
  • Systolic BP >80 mmHg and <140 mmHg in supine measured by nursing staff in the 24 hours prior to recruitment. (Healthy \& SCI)

Who cannot join

  • Weight bearing precautions per medical record or primary therapist report (SCI)
  • Skin lesions preventing fitting on the tilt-table or in robot cuffs (Healthy \& SCI)
  • History of uncontrolled diabetes (diabetic autonomic issues) (Healthy \& SCI)
  • Increase in pain/spasticity during passive leg movements during a hands-on eligibility assessment (SCI)
  • Severe fixed contractures affecting the lower limbs (hip, knee, ankle joints) (SCI)

Trial locations and contacts

1 site in 1 country.

United States1 site
  • Methodist Rehabilitation Center

    Jackson, Mississippi, 39216

Other trials in United States

About this study

Official title: Does the Speed of Robotic Leg Movements During Tilt-table Verticalization Affect Orthostatic Hypotension in Persons With Subacute SCI

This study seeks to evaluate whether the speed (cadence) of lower extremity robotic movement has an impact on orthostatic hypotension and upright tolerance when training with the ErigoPro robotic tilt-stepper. It is hypothesized more frequent short-lasting leg movements (faster cadence) reduces the occurrence/severity of orthostatic hypotension better than less frequent longer-lasting leg movements (slower cadence).

Read the detailed description

Orthostatic hypotension (OH) refers to a drop in blood pressure as a result of sitting up or standing up (moving against gravity). OH has been defined as a decrease in systolic (≥20 mmHg) or diastolic (≥10 mmHg) blood pressure upon transition from lying down to an upright position regardless of the presence or absence of overt symptoms (dizziness, lightheadedness, blurred vision, loss of consciousness).

OH is quite common after a spinal cord injury (SCI), especially with more severe injuries above the T6 level. OH can significantly interfere with activities of daily living and it can also interfere with participation during inpatient rehabilitation. Nearly 75% of acute SCI subjects were found to have OH and ~60% reported symptoms of OH during physical therapy activities, which limited almost 50% of the treatment sessions. Developments in rehabilitation technology have culminated in a device, a robotic tilt-stepper (RTS), e.g., known as the Erigo (Hocoma). In an RTS, the robot moves the legs through a pre-selected range of motion at different speeds to limit blood pooling during verticalization. This can be augmented by patterned functional electrical stimulation (FES), e.g., the ErigoPro.

The proof-of-principle study by the developers of the Erigo showed that passive leg movements can stabilize hemodynamic responses in healthy subjects who exhibited near-syncope when placed at 75-deg. for 30 min. Two earlier studies that examined the effect of passive leg movements on hemodynamic responses in healthy subjects used only one movement speed. Two other studies in chronic SCI (which compared the hemodynamic effects of passive leg movements alone or in combination with FES during a tilt-table verticalization) also used only one movement speed. Chi et al. showed no difference in vital signs between application of passive leg movements, FES, or the combination thereof in comparison to baseline.

Based on the literature review, it appears that no previous study has systematically examined the effects of different speeds of robotic leg movements on hemodynamic responses, which is the simplest and most user-friendly way to use RTS in a busy clinical setting. Moreover, no study recruited the most relevant target population, that is, persons with a subacute SCI who often develop OH when moved from lying down to a sitting or standing position. Therefore, it is the intent of this study to determine whether the speed of leg movement during progressive movement towards an upright position has a meaningful impact on a subjects blood pressure and onset of OH.

To test this hypothesis, healthy subjects and subjects with SCI will be recruited to participate in a one time training session with the ErigoPro. The study will occur in the SCI floor of a large rehab center. The sit-up test will be performed to assess if transitioning from supine to sitting position provokes symptoms/signs of OH. All prescribed medication will be noted and allowed as to not interfere with regular care and to reflect a real clinical practice. Each subject will then be transferred to the Erigo and secured to the device. Once secured to the device, the trial will be initiated and the subject will remain in supine for a resting period of approximately 5 minutes (to allow the subjects cardiovascular system to reach steady state) followed by another 2 minutes with their hemodynamic values continuously monitored by a beat-to-beat monitoring device (the Finapres Nova) which will aid in establishment of baseline hemodynamic thresholds. The assigned cadence (either 0, 40, or 80 steps per minute) will be initiated and the subject will then be progressed through angles of elevation including 0, 25, 50, and 75 degrees, spending approximately 2 minutes in each position with hemodynamic responses continuously monitored. If the subject demonstrates any signs/symptoms of OH or their blood pressure falls below or exceeds the established thresholds for safety or any other significant issues arise, they will be immediately returned to the supine position (0 degrees), the assigned cadence discontinued, and that portion of the trial terminated. If the subject demonstrates a return to baseline hemodynamic values within 5 - 10 minutes and they agree to continuation of the trial, they will be progressed to the next assigned speed. Should they not return to baseline values, the medical team will be contacted and the attending physician consulted. Any signs noted by the investigator or symptoms reported by the patient will be recorded and should a portion of the trial be terminated, the cause will be investigated to determine if it was truly due to OH or another issue. If the subject achieves 75 degrees for 2 minutes with no significant issues, they will be returned to supine followed by the next assigned speed being tested in the same fashion as the previously tested assigned speed.

Being tested
ErigoPro
Keywords
Spinal cord injury, Orthostatic hypotension, Verticalization, ErigoPro, Finapres Nova
Medical subject headings
Spinal Cord Injuries, Hypotension, Orthostatic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ErigoProDevice

    Robotic tilt-stepper lower extremity movements at the cadence of 0, 40, and 80 steps/minute.

Study groups in NCT04029974
Study groupRoleWhat they receive
TreatmentExperimentalProgressive elevation (0 degrees, 25 degrees, 50 degrees, 75 degrees; x2 minutes in each position) while on robotic tilt-stepper at the cadence of 0, 40, and 80 steps/minute.
Receives: Device: ErigoPro

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Systolic blood pressure variation

    Systolic blood pressure will be beat-to-beat monitored. At each assigned cadence, systolic blood pressure is compared to 0-degrees elevation.

    Measured: From enrollment to end of session, approximately 2 Hours

Secondary outcomes (3)
  1. Heart rate variation

    Heart rate will be beat-to-beat monitored. At each assigned cadence, heart rate is compared to 0-degrees elevation.

    Measured: From enrollment to end of session, approximately 2 Hours

  2. Frequency of orthostatic hypotension symptoms

    Subject will be instructed to report subjective symptoms (dizziness, lightheadedness, blurred vision, etc) during each elevation angle for each assigned cadence and will be prompted by open ended questions. The investigator(s) will document any additional signs of symptoms (sweating, loss of consciousness, etc) that may not have been reported by the subject.

    Measured: From enrollment to end of session, approximately 2 Hours

  3. Frequency of discontinuation of a portion of the study or termination of the entire study

    Investigator(s) will record the presence or absence of events requiring discontinuation of a portion of the study or termination of the entire study at each elevation angle for each assigned cadence.

    Measured: From enrollment to end of session, approximately 2 Hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted23 Jul 2019
  2. Study start20 Aug 2019
  3. Primary completionDec 2026 (estimated)
  4. Study completionDec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Model description
Within-subject repeated measures design
Masking
None (open label)
Enrolment
35 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04029974
Sponsor's protocol ID
MRC_ErigoPro_in_SCI
Status last verified
May 2025
First submitted
12 Jul 2019
Last updated
8 May 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes

Publications

  • Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology. 1996 May;46(5):1470. doi: 10.1212/wnl.46.5.1470. No abstract available.

    PubMed 8628505
  • Ravensbergen HJ, de Groot S, Post MW, Slootman HJ, van der Woude LH, Claydon VE. Cardiovascular function after spinal cord injury: prevalence and progression of dysfunction during inpatient rehabilitation and 5 years following discharge. Neurorehabil Neural Repair. 2014 Mar-Apr;28(3):219-29. doi: 10.1177/1545968313504542. Epub 2013 Nov 15.

    PubMed 24243916
  • Sahota IS, Ravensbergen HR, McGrath MS, Claydon VE. Cerebrovascular responses to orthostatic stress after spinal cord injury. J Neurotrauma. 2012 Oct 10;29(15):2446-56. doi: 10.1089/neu.2012.2379. Epub 2012 Sep 20.

    PubMed 22720841
  • Illman A, Stiller K, Williams M. The prevalence of orthostatic hypotension during physiotherapy treatment in patients with an acute spinal cord injury. Spinal Cord. 2000 Dec;38(12):741-7. doi: 10.1038/sj.sc.3101089.

    PubMed 11175374
  • Gillis DJ, Wouda M, Hjeltnes N. Non-pharmacological management of orthostatic hypotension after spinal cord injury: a critical review of the literature. Spinal Cord. 2008 Oct;46(10):652-9. doi: 10.1038/sc.2008.48. Epub 2008 Jun 10.

    PubMed 18542098
  • Sampson EE, Burnham RS, Andrews BJ. Functional electrical stimulation effect on orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2000 Feb;81(2):139-43. doi: 10.1016/s0003-9993(00)90131-x.

    PubMed 10668765
  • Elokda AS, Nielsen DH, Shields RK. Effect of functional neuromuscular stimulation on postural related orthostatic stress in individuals with acute spinal cord injury. J Rehabil Res Dev. 2000 Sep-Oct;37(5):535-42.

    PubMed 11322152
  • Faghri PD, Yount JP, Pesce WJ, Seetharama S, Votto JJ. Circulatory hypokinesis and functional electric stimulation during standing in persons with spinal cord injury. Arch Phys Med Rehabil. 2001 Nov;82(11):1587-95. doi: 10.1053/apmr.2001.25984.

    PubMed 11689980
  • Faghri PD, Yount J. Electrically induced and voluntary activation of physiologic muscle pump: a comparison between spinal cord-injured and able-bodied individuals. Clin Rehabil. 2002 Dec;16(8):878-85. doi: 10.1191/0269215502cr570oa.

    PubMed 12501950
  • Chao CY, Cheing GL. The effects of lower-extremity functional electric stimulation on the orthostatic responses of people with tetraplegia. Arch Phys Med Rehabil. 2005 Jul;86(7):1427-33. doi: 10.1016/j.apmr.2004.12.033.

    PubMed 16003676
  • Hamzaid NA, Tean LT, Davis GM, Suhaimi A, Hasnan N. Electrical stimulation-evoked contractions blunt orthostatic hypotension in sub-acute spinal cord-injured individuals: two clinical case studies. Spinal Cord. 2015 May;53(5):375-9. doi: 10.1038/sc.2014.187. Epub 2014 Nov 4.

    PubMed 25366533
  • Chi L, Masani K, Miyatani M, Adam Thrasher T, Wayne Johnston K, Mardimae A, Kessler C, Fisher JA, Popovic MR. Cardiovascular response to functional electrical stimulation and dynamic tilt table therapy to improve orthostatic tolerance. J Electromyogr Kinesiol. 2008 Dec;18(6):900-7. doi: 10.1016/j.jelekin.2008.08.007. Epub 2008 Oct 2.

    PubMed 18835189
  • Czell D, Schreier R, Rupp R, Eberhard S, Colombo G, Dietz V. Influence of passive leg movements on blood circulation on the tilt table in healthy adults. J Neuroeng Rehabil. 2004 Oct 25;1(1):4. doi: 10.1186/1743-0003-1-4.

    PubMed 15679913
  • Yoshida T, Masani K, Sayenko DG, Miyatani M, Fisher JA, Popovic MR. Cardiovascular response of individuals with spinal cord injury to dynamic functional electrical stimulation under orthostatic stress. IEEE Trans Neural Syst Rehabil Eng. 2013 Jan;21(1):37-46. doi: 10.1109/TNSRE.2012.2211894. Epub 2012 Aug 9.

    PubMed 22899587
  • Sarabadani Tafreshi A, Riener R, Klamroth-Marganska V. Distinctive Steady-State Heart Rate and Blood Pressure Responses to Passive Robotic Leg Exercise and Functional Electrical Stimulation during Head-Up Tilt. Front Physiol. 2016 Dec 9;7:612. doi: 10.3389/fphys.2016.00612. eCollection 2016.

    PubMed 28018240

Questions about this trial

What is this clinical trial studying?

A study testing ErigoPro in people with Spinal Cord Injuries and Orthostatic Hypotension, run by Methodist Rehabilitation Center at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 8 May 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Systolic blood pressure variation (time frame: From enrollment to end of session, approximately 2 Hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04029974, which also lists 17 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2025.

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