A Pilot Clinical Trial to Examine Immersive Virtual Walking as Treatment for Neuropathic Pain in Incomplete Spinal Cord Injury
Abstract
What Are the Objectives and Rationale for the Proposed Research? Chronic neuropathic pain (NP) can be debilitating for persons with SCI and does not respond to available treatments. We have developed a promising new treatment -- immersive interactive virtual reality walking -- for SCI NP. Our interactive VR platform (VRWalk) allows persons with SCI NP to walk through virtual worlds by controlling movement of virtual legs. VRWalk builds on mirror therapies for phantom limb pain, which provide amputees with visual representation of their missing limb(s). These therapies are understood to work by affecting maladaptive brain changes that accompany NP. We initially tested VRWalk specifically in persons with complete injury and found it strikingly effective in reducing pain and even facilitating positive brain changes. Because of these promising findings and because incomplete injury affects more than half of all people with SCI, we want to make this treatment available to people with incomplete injury who have neuropathic pain. We are currently running a large study, funded by SCIRP, to examine VRWalk in individuals with compete SCI. Here, we propose to attach a smaller pilot study, focusing specifically of individuals with incomplete SCI, to this large project. We want to focus on persons with incomplete injury because, clinically and biologically, they are unique from people with complete SCI and thus may differ in their response to the intervention. We will capitalize on the existing infrastructure of our larger study to carry out the smaller project, which will greatly help us carry it out. This bundling of investigations enhances efficiency and accelerates tangible applications. As part of the study, individuals with incomplete SCI and NP will be randomized to the interactive VRWalk Treatment condition or a passive viewing Control condition, which will not allow participants to control their virtual legs. Participants in both conditions will receive 20 5–10–minute VR sessions within their home environment. SCI NP intensity will be measured prior to and immediately following treatment and at 3, 6, and 12 months after treatment. Brain imaging measures will be collected prior to, immediately following, and 6 months after treatment. Follow-up measures will allow us to see the duration of potential treatment effects. We will then statically test our hypothesis that participation in the VRWalk Treatment condition will have greater reduction in SCI NP intensity and greater adaptive changes in the brain. What Is the Ultimate Applicability of the Research? The intervention is expected to have immediate short- and long-term applications within clinical care settings across early and late stages of treatment, and across various types of SCI injury. Findings will also inform research regarding other possible applications of this platform. The platform will be immediately available to individuals with a broader spectrum of injuries. We ultimately aim to expand the platform to higher levels of injury (i.e., high tetraplegia) that may require use of eye-tracking or brain-computer interface. What Persons with SCI Will It Help and How Will It Help Them? We aim to provide a readily-accessible treatment for individuals with various levels of injury and physical ability who have SCI NP. Currently, this intervention is only available to individuals with complete injury; the purpose of this project is to broaden access to other types of injury (i.e., incomplete paraplegia and incomplete low tetraplegia). What Are the Potential Clinical Applications, Benefits, and Risks? The VR walking intervention may provide one of the only accessible nonpharmacological treatments for an otherwise refractory condition and is readily adaptable for clinic/rehabilitation or self-guided home use. Although there is a risk that some individuals may experience nausea or negative emotional reactions to the virtual images, this was no
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311019
Entities
People
- Zina Trost
Organizations
- Texas A&M Health Science Center
- United States Army