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Paraplegia, SpinalService-LineNCT04627441

Transcutaneous and Epidural Stimulation in SCI

A study testing Transcutaneous spinal cord stimulator and Epidural spinal cord stimulator system in people with Paraplegia, Spinal and Paraplegia, Complete, run by Kristin Zhao, PhD.

Withdrawn

Withdrawn. The study stopped before anyone enrolled.

Official record
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Trial 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… Read more about this study

Who is it for?
Ages 22 years and older
What is being tested?
Transcutaneous spinal cord stimulator and Epidural spinal cord stimulator system
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
0 participants
Where
No sites listed yet
Study dates
16 Dec 2022to 16 Dec 2025
Phase
Interventional
Are there results?
None posted in the registry

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 22 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 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 contraception, if female and of child-bearing potential

Who cannot join

  • 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
Show all 21Show fewer
  • 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 chronic obstructive pulmonary disease, 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.

About this study

Official title: A Pilot Study of the Characterization of Transcutaneous and Epidural Spinal Stimulation for Enabling Motor Function in Humans With Motor Complete Paraplegia

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.

Being tested
Transcutaneous spinal cord stimulator, Epidural spinal cord stimulator system
Medical subject headings
Paraplegia

What participants receive

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

  • Transcutaneous spinal cord stimulatorDevice

    DS8R Electrical Stimulator For Human Research

  • Epidural spinal cord stimulator systemDevice

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

Study groups in NCT04627441
Study groupRoleWhat they receive
TESS-EESExperimentalTranscutaneous 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.
Receives: Device: Transcutaneous spinal cord stimulator; Device: Epidural spinal cord stimulator system

What is being measured

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

  1. Kinematics

    Change in measurements of joint angles, measured in degrees.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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).

    Measured: 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.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

Secondary outcomes (23)
  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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  7. Metabolics - CBC

    Measurement of changes in complete blood count with differential.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  8. Metabolics - glucose

    Measurement of change in fasting glucose value.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  9. Metabolics - total cholesterol

    Measurement of change in total cholesterol value.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  10. Metabolics - HDL cholesterol

    Measurement of change in HDL cholesterol value.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  11. Metabolics - calculated LDL cholesterol

    Measurement of change in calculated LDL cholesterol value.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  12. Metabolics - triglycerides

    Measurement of change in triglycerides value.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  13. Metabolics - non-HDL cholesterol

    Measurement of change in non-HDL cholesterol value.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

  14. Neurostimulator array location and migration

    Evaluation of current array location via CT.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: 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.

    Measured: Baseline, End of TESS, Start of EES, End month 6 EES

Timeline

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

  1. First posted13 Nov 2020
  2. Study start16 Dec 2022 (estimated)
  3. Primary completion16 Dec 2025 (estimated)
  4. Study completion16 Dec 2025 (estimated)

Why it stopped: COVID-related delays and insufficient funding.

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
Basic science
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrolment
0 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04627441
Sponsor's protocol ID
20-006477
Acronym
Service-Line
Status last verified
Oct 2022
First submitted
15 Oct 2020
Last updated
4 Oct 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Transcutaneous spinal cord stimulator and Epidural spinal cord stimulator system in people with Paraplegia, Spinal and Paraplegia, Complete, run by Kristin Zhao, PhD.

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 21 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: withdrawn, as of the sponsor's last update on 4 Oct 2022. Status can change between updates, so confirm with the study contact before making plans.

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?

The study was withdrawn before enrolling participants, so there are no results.

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?

Kinematics (time frame: Baseline, End of TESS, Start of EES, End month 6 EES). The study lists 10 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 4 Oct 2022; AzTrials last refreshed its copy on 28 Oct 2026.

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