[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"health-study-detail:100608948":3},{"organization":4,"outcomesModule":7,"designInfo":66,"detailedDescription":76,"studyPopulation":65,"armGroups":77,"interventions":90,"overallOfficials":100,"centralContacts":108,"locations":117,"responsibleParty":140,"collaborators":142,"id":147,"slug":65,"hasResults":148,"nctId":149,"briefTitle":150,"officialTitle":151,"acronym":152,"eligibilityCriteria":153,"healthyVolunteers":148,"sex":154,"minAge":155,"maxAge":65,"enrollmentInfo":156,"targetDuration":65,"studyType":159,"phases":160,"briefSummary":162,"conditions":163,"keywords":165,"overallStatus":171,"whyStopped":65,"lastUpdateSubmitDate":172,"lastUpdatePostDateStruct":173,"startDateStruct":176,"completionDateStruct":178,"leadSponsor":180,"locationsCount":181},{"fullName":5,"class":6},"NHS Greater Glasgow and Clyde","OTHER",{"primaryOutcomes":8,"secondaryOutcomes":29,"otherOutcomes":65},[9,13,17,21,25],{"measure":10,"description":11,"timeFrame":12},"Retention","Recruitment and retention","From enrollment till the last assesment at 8 weeks",{"measure":14,"description":15,"timeFrame":16},"Interference","Interference with daily routine","From enrolment till the end of intervention at 4 weeks",{"measure":18,"description":19,"timeFrame":20},"Stimulation","Optimal current stimulation intensity in mA","From the first till the last intervention session at 4 weeks",{"measure":22,"description":23,"timeFrame":24},"Adverse effects","The number of adverse effects","from the first till the last intervention session at 4 weeks",{"measure":26,"description":27,"timeFrame":28},"Feedback","Semi structured interview","From enrolment till the last assesment at 8 weeks",[30,34,38,42,46,49,51,55,58,62],{"measure":31,"description":32,"timeFrame":33},"Hand function","Sensory and motor test Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), range 0-166 (0 no function, 116 all normal)","From the first intervention session till the last assesment at 8 weeks",{"measure":35,"description":36,"timeFrame":37},"Spinal Cord Independence Measure","Spinal Cord Independence Measure (range 0-100, 100 max independence)","From the recruitment till the last assessment at 8 weeks",{"measure":39,"description":40,"timeFrame":41},"Quality of life basic dataset","International Spinal Cord Injury Data Sets Quality of Life Basic Data Set -Data Form","From recruitment till the last assessment at 8 weeks",{"measure":43,"description":44,"timeFrame":45},"Spasticity","Modified Ashworth Scale range 0-4 (0 no increased tone, 4 very rigid)","From the enrolment till the last assesment at 8 weeks",{"measure":47,"description":48,"timeFrame":45},"Dynamometry","Grip force",{"measure":50,"description":50,"timeFrame":45},"International Standard for Neurological Classification of Spinal Cord Injury",{"measure":52,"description":53,"timeFrame":54},"Motor evoked potential","Transcranial magnetic stimulation with EMG measurement of affected muscle response","From the recruitment till the last assesment at 8 weeks",{"measure":56,"description":57,"timeFrame":54},"Somato sensory evoked potential","Measurement of the integrity of the sensory pathways",{"measure":59,"description":60,"timeFrame":61},"Muscle synergy","Measurement of electromyography of muscles or the same arm\u002Fhand","From the recruitment till the last assesments at 8 weeks",{"measure":63,"description":64,"timeFrame":37},"Box and Block test (the number of transferred blocks in 60s, out of 150 blocks)","Manual dexterity",null,{"allocation":67,"interventionModel":68,"interventionModelDescription":69,"primaryPurpose":70,"observationalModel":65,"timePerspective":65,"maskingInfo":71},"RANDOMIZED","PARALLEL","Randomised feasibility study The study design will be a randomised double blinded feasibility study. The investigators will recruit 20 participants, equally split into active and control interventions. The active group will receive upper limb therapy with transcutaneous spinal cord stimulation (tESCS) 1 hour per day, 5 days per week, for 4 weeks, while the control group will receive the same amount of sham therapy with tESCS electrodes placed as in the active group but with only 1 minute of electrical stimulation to achieve blinding.\n\nNote that tESCS has a medical CE mark","TREATMENT",{"masking":72,"maskingDescription":65,"whoMasked":73},"DOUBLE",[74,75],"PARTICIPANT","OUTCOMES_ASSESSOR","Background Spinal Cord Injury affects more than 50,000 people in the UK, with an incidence of 2400 new cases every year. Muscular paralysis and sensory loss carry substantial physiological, psychological, financial, and social costs. Almost 60% of people affected by SCI sustain a high-level injury, that is, injury to spinal levels C2-T1, affecting arms and hands. Restoring hand and arm function is a top priority for people with tetraplegia, where even small improvements of motor function, combined with available assistive devices, may greatly improve independence and quality of life.\n\nTranscutaneous spinal cord stimulation (tESCS) has emerged as a viable neuromodulation approach for facilitating the recovery of motor function in people with SCI. Studies that have applied tESCS at cervical segments combined with activity-based upper limb rehabilitation. Such active-assisted exercises such as gross and fine motor skill training, maximum voluntary contraction training, and unimanual and bimanual task performance have shown significant improvements in upper limb function.\n\nIt is believed that tESCS stimulation activates motor neuronal networks of the spinal cord, including the recruitment of afferent fibres in the posterior root, to elevate spinal network excitability. The underlying hypothesis is that after severe cervical SCI, nonfunctional sensory-motor networks within the cervical spinal cord can be transcutaneously neuromodulated to physiological states that enable and amplify voluntary control of the arm and hand.\n\nA multicentre ONWARD Up-LIFT trial, which included 14 research sites, including QENSIU, has demonstrated functional improvements in people with incomplete chronic tetraplegia. As part of a UK Neuromodulation Network, we were awarded funding to deliver a substantial follow-up study, focusing on chronic complete tetraplegia. The results are showing some neurological recovery but modest functional improvement, indicating that some minimal level of preserved sensory or motor function is required in order to benefit from tESCS. For that reason, the investigators plan to recruit people with incomplete SCI in this study.\n\nRationale In the area of upper limb rehabilitation, the focus has been mainly on people with chronic SCI, likely due to the lack of alternative rehabilitation strategies and the difficulty in applying acute interventions in the clinical setting \\[3-8\\]. However, to date, there have been limited studies reporting the use of tESCS with people with subacute SCI. A randomised controlled trial with 22 complete or incomplete tetraplegic patients (3-12 months post injury, probably recruited from home) compared 8 sessions of tESCS with Armeo robot exercise to 8 sessions of Armeo alone. Both groups achieved comparable functional improvement but Armeo group had a higher change in scores. Our recent search of ClinTrials.gov (search criteria Spinal Cord Injuries, Upper extremity dysfunctions and electrical stimulation) has however, identified no current or future study which includes people with subacute SCI and randomisation.\n\nThere are multiple technologies for people with subacute tSCI, including robotics, functional electrical stimulation, or more recently Brain Computer interface. Then, why do the investigators need yet another rehabilitation technology? There are several features that stand tESCS apart from the other rehabilitation technologies, both when it comes to usability and the mechanism of action. Most notably tSCI facilitates performing functional movements, therefore it can be combined with the existing therapy sessions, rather than requiring extra sessions like e.g. robotic devices or having multiple precisely defined stimulation sites like FES. Setup time is much shorter and the price is lower than robotics. This is of critical importance for the clinical adoption of technology, where lack of time in busy therapists' and patients' schedules is often a major barrier to larger-scale trials that would provide solid scientific evidence.\n\nAn obvious advantage of using tESCS in the subacute rather than in the chronic stage is the potential to supplement natural recovery. In addition, unused muscle has inevitably deconditioned in chronic SCI, therefore weeks of training to optimise muscle health is preferred prior to chronic tESCS intervention, which itself necessitates a large number of sessions. In one research study, the investigators identified requirements for (accompanied) transport and travel time to and from the hospital as the main factors impeding recruitment and increasing dropout rates in chronic patients. These are not issues for patients undergoing primary rehabilitation Finally, while months of tESCS training are required to achieve improvement in people with chronic SCI, it is not known whether this time would be substantially shorter in people undergoing primary rehabilitation post SCI and whether these benefits would be long-lasting.\n\nAnswering these questions and demonstrating the feasibility of delivering tESCS integrated with standard upper limb therapy would be major steps toward adopting this technology into clinical practice.\n\nThe investigators aim to test the feasibility of delivering tESCS to hospitalised (undergoing primary rehabilitation) tetraplegic patients by combining it with standard upper limb therapy. The investigators hypothesise that tESCS will be straightforward to implement and that it will not significantly burden staff or interrupt the existing patient schedule. The investigators also hypothesise that combining tESCS with conventional upper limb therapy will result in larger functional and neurological improvements than therapy alone.\n\nOver 60% of people sustaining spinal cord injury have tetraplegia, resulting in a high level of disability. tESCS has shown very promising results in people with chronic injuries. Based on results from these studies, the investigators believe that tESCS has the potential to result.in substantial improvement in neurological recovery if delivered in parallel with primary rehabilitation.\n\nThis study will provide the first high quality evidence of the feasibility of incorporating tESCS into clinical practice in the acute care setting. Physical therapy\u002Factivity is an essential co-therapy of tESCS By combining tESCS with standard therapy, the additional burden on therapists will be minimised, increasing the chances of successful clinical translation of the technology.\n\nthe investigators hypothesise that the positive effect of tESCS will be greater in the acute\u002Fsubacute than in the chronic phase and that therefore it would be possible to see significant improvement after only a few weeks of intervention. Improved neurological function should lead to a reduced length of stay and healthcare costs. The results of this study will be the first step towards a larger multicentre trial evaluating the early use of tESCS, a vital step towards wider adoption of tESCS in clinical settings. Such clinical adoption would have the potential to benefit all people with acute tetraplegia.\n\nThe efficient delivery of tESCS and the relative affordability of the device (costing under £10K they are much cheaper than robotic devices) greatly enhance the generalisability of the results for any future clinical trial.\n\nTheoretical Framework It is believed that tESCS stimulation activates motor neuronal networks of the spinal cord, including the recruitment of afferent fibres in the posterior root, to elevate spinal network excitability. The underlying hypothesis is that after severe cervical SCI, nonfunctional sensory-motor networks within the cervical spinal cord can be transcutaneously neuromodulated to physiological states that enable and amplify voluntary control of the arm and hand",[78,84],{"label":79,"type":80,"description":81,"interventionNames":82},"Intervention","EXPERIMENTAL","One hour of transcutaneous electrical stimulation alongside conventional occupational therapy",[83],"Device: Transcutaneous spinal cord stimulation (tESCS) active group",{"label":85,"type":86,"description":87,"interventionNames":88},"Control","SHAM_COMPARATOR","Receiving 1 minute of stimulation alongside the conventional occupational therapy",[89],"Device: Sham transcutaneous spinal cord stimulation (tESCS)",[91,96],{"type":92,"name":93,"description":94,"armGroupLabels":95,"otherNames":65},"DEVICE","Transcutaneous spinal cord stimulation (tESCS) active group","Participants in the active arm will receive 60 min of tESCS alongside the conventional occupation therapy, 20 sessions for 4 weeks, 5 times per week",[79],{"type":92,"name":97,"description":98,"armGroupLabels":99,"otherNames":65},"Sham transcutaneous spinal cord stimulation (tESCS)","The control group will receive only 1 min of tESCS while doing conventional occupational therapy for 60 min. Number of session 20, 4 weeks, 5 times a week",[85],[101,105],{"name":102,"affiliation":103,"role":104},"Aleksandra Vuckovic University O VUCKOVIC, PhD Biomed Eng","School of Engineering, University of Glasgow","STUDY_DIRECTOR",{"name":106,"affiliation":5,"role":107},"Mariel A Purcell, MB CHB BAO","PRINCIPAL_INVESTIGATOR",[109,113],{"name":106,"role":110,"phone":111,"phoneExt":65,"email":112},"CONTACT","+44 141 201 2536","Margaret.Purcell@ggc.scot.nhs.uk",{"name":114,"role":110,"phone":115,"phoneExt":65,"email":116},"ALEKSANDRA VUCKOVIC, PhD Biomed Eng","+447906441955","aleksandra.vuckovic@glasgow.ac.uk",[118],{"facility":119,"status":65,"city":120,"state":65,"zip":121,"country":122,"countryCode":123,"cosmosGeoPoint":124,"geoPoint":129,"contacts":130},"Queen Elizabeth National Spinal Injuries Unit","Glasgow","G51 4TF","United Kingdom","UK",{"type":125,"coordinates":126},"Point",[127,128],-4.25763,55.86515,{"lat":128,"lon":127},[131,132,135,138],{"name":106,"role":110,"phone":111,"phoneExt":65,"email":112},{"name":133,"role":110,"phone":65,"phoneExt":65,"email":134},"Euan McCaughey, PhD Biomed Eng","euan.mccaughey@nhs.scot",{"name":136,"role":137,"phone":65,"phoneExt":65,"email":65},"Euan O McCaughey, PhD Biomed Eng","SUB_INVESTIGATOR",{"name":139,"role":107,"phone":65,"phoneExt":65,"email":65},"Mariel Purcell, MB CHB BAO",{"type":141,"investigatorFullName":65,"investigatorTitle":65,"investigatorAffiliation":65,"oldNameTitle":65,"oldOrganization":65},"SPONSOR",[143,145],{"name":144,"class":6},"University of Glasgow",{"name":146,"class":6},"The Queen Elizabeth Hospital","100608948",false,"NCT07208188","tESCS for Upper Limb Rehab in Spinal Cord Injury","Transcutaneous Spinal Cord Stimulation for Rehabilitation of Upper Limbs in Early Spinal Cord Injury: Randomised Feasibility Study","SCIRUS","Inclusion Criteria:\n\n* Aged 18 years or over, both sexes.\n* At least 6 weeks post-implant (in participants having a surgery for an implant to stabilise the spine).\n* ISNCSCI upper extremity motor score between 5 and 30 (both arms\u002Fhands)\n* GRASSP-strength score \\>=15 \\& \\\u003C70\n* Medically stable, cognitively intact and able to breathe independently.\n* Attending upper limb therapy sessions at the QENSIU\n* Planned stay longer than the duration of the intervention\n* Able to sit for more than 2 hours a day\n\nExclusion Criteria:\n\n* Unstable cervical spine injury\n* Needing ventilation assistance during daytime\n* Any implanted active metallic device without unconfirmed MRI compatibility (in our previous studies, we safely applied tESCS to participants with MRI-compatible devices\u002Fimplants)\n* Pregnancy and\u002For lactation.\n* Non-injury-related neurological impairment\n* Severe spasticity which have been unstable prior to enrolment\n* Botulinum toxin injections-\n* Clinically significant severe depression\n* Patients who have cardiovascular disease\n* Patients with severe ongoing Autonomic Dysreflexia\n* Skin conditions or allergies that may affect electrode placement.\n* Current infections\n* Patients who have been involved in any other interventional study","ALL","18 Years",{"count":157,"type":158},20,"ESTIMATED","INTERVENTIONAL",[161],"EARLY_PHASE1","Regaining hand and arm function is an important step towards regaining independence following high-level spinal cord injury (tetraplegia). The delivery of small electrical pulses over the skin above the spinal cord, called transcutaneous spinal cord stimulation (tESCS), appears to improve the arm and hand function of people who have had tetraplegia for several years when delivered at the same time as upper limb therapy. However, tESCS has not been tested in people who have a new spinal cord injury. It should be straightforward to deliver tESCS during standard upper limb therapy sessions to inpatients receiving primary rehabilitation. The investigators want to test the practical aspects of delivering this intervention and also to compare recovery between a group of people who only receive upper limb therapy and a group who receive upper limb therapy and tESCS. If successful, tESCS could in the future be used as part of regular therapy following an acute spinal cord injury. Benefits could include faster and better recovery, reduced stay in hospital, and reduced NHS costs.",[164],"Spinal Cord Injuries (SCI)",[166,167,168,169,170],"Tetraplegia","incomplete","subacute","transcutaneous spinal cord stimulation","randmised feasibility study","NOT_YET_RECRUITING","2025-09-26",{"date":174,"type":175},"2025-10-06","ACTUAL",{"date":177,"type":158},"2025-11",{"date":179,"type":158},"2027-12",{"name":5,"class":6},1]