Temporary Inactivation of Strong Muscle Sensation to Improve Rehabilitation Interventions in SCI
Abstract
Rationale: An injury to the spinal cord can result in paralysis to the arms and legs. Therapy has the potential to improve arm and leg function after such paralysis. However, less than 1% of individuals with an injury to the spinal cord show full recovery after traditional therapy routines. One key reason therapeutic exercise remains limited is that the portions of the brain that control paralyzed muscles become overshadowed by the portions of the brain that control non-paralyzed muscles. As such, the brain comes to represent only non-paralyzed muscles and favors them preferentially after injury, while "forgetting" its association with paralyzed muscles. Therapy does have the ability to reverse negative changes that occur in the brain, however, changes can take over 9 months to appear. We aim to identify an adjunct that could be paired with therapy to accelerate the reversal of negative changes that occur in the brain. Of note, we have found that one such approach may be through temporarily numbing non-paralyzed muscles during therapy. Temporarily numbing non-paralyzed muscles silences their representations in the brain, thus allowing brain representations of paralyzed muscles to become "unmasked." Our work and others has shown that temporarily "unmasking" representations of paralyzed muscles can improve motor and sensory function by 10% to 48% after a single application. Thus, we hypothesize that temporarily numbing non-paralyzed muscles for several sessions can improve strength, function, and sensation of paralyzed muscles after a spinal cord injury. Tasks to be completed during CRDA: Our preliminary data suggests that temporarily numbing non-paralyzed muscles is safe, feasible, and effective in those with an injury to the spinal cord. But before we perform a large-scale clinical trial evaluating our approach, several items need to be completed. For example, how long should the numbing agent be delivered in a single session? How many sessions of numbing should be delivered for maximum benefit? In addition, it is critical for us to establish a protocol to ascertain safety and feasibly of our approach. The goal of the proposed CRDA is to complete all tasks necessary to initiate our future clinical study. This results in the following specific aims: Aim 1: Obtain regulatory approval and perform training procedures at study site Aim 2: Identify the dose of temporary muscle inactivation and associated safety and feasibility issues Aim 3: Identify additional subject recruitment resources for future clinical study By the end of the CRDA we anticipate that we will have identified how long and how many sessions the non-paralyzed muscle will need to be temporarily numbed to achieve significant improvements in movement control and sensation function in paralyzed muscles of the upper limb. What persons with SCI will we help? We will target individuals with high-level damage to their spinal cord that results in partial paralysis of the torso and all the limbs. This is the most common type of spinal cord injury. Within this population, we focus our intervention on the weaker upper limb. This is because the subjective wellbeing of individuals with such wide-spread paralysis is most related to the capacity to use their upper limbs. Thus, we aim to improve functional independence and quality of life in those with widespread paralysis by targeting the area of greatest need. Potential Benefits and Risks: Our approach will use an over-the-counter topical anesthetic cream to cause temporary numbing of the non-paralyzed muscle. As such, minimal side effects should be observed, thereby easing translation to the clinical environment. Further, since our approach can be applied readily during conventional therapy, no additional visits will be required further easing translation to clinical practice. We anticipate that our approach will result in substantial improvements in upper-limb movement and thereby improve daily life in thos
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810708
Entities
People
- Kelsey Baker
Organizations
- Louis Stokes Cleveland VA Medical Center
- United States Army