Occupational Therapy for Spinal Cord Compression

Overseen By Sarah Detombe, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Western University, Canada

Disqualifiers: Other neurological disorder, Systemic disease, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 4

40 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Occupational therapy rehabilitation, Occupational therapy, Rehabilitation therapy, Physical rehabilitation for Spinal Cord Compression?

Research shows that occupational therapy can help improve daily living activities for people with spinal cord injuries, suggesting it may be beneficial for spinal cord compression as well. It is a key part of rehabilitation, helping patients regain independence and improve their quality of life. ^{1 2 3 4 5}

Is occupational therapy safe for humans?

Research on occupational therapy, including for spinal cord injuries, generally focuses on its effectiveness and implementation rather than specific safety concerns. However, occupational therapy is widely used and considered safe as it involves non-invasive techniques to help improve daily functioning. ^{1 3 6 7 8}

How does occupational therapy differ from other treatments for spinal cord compression?

Occupational therapy for spinal cord compression focuses on helping patients achieve the highest level of independence through creative activities and the use of adapted techniques and equipment. Unlike other treatments, it emphasizes practical skills and may include computer-based technology and prevocational measures to enhance functional abilities. ^{1 3 5 7 9}

What is the purpose of this trial?

The investigators have spent the last decade uncovering unique metabolic and functional abnormalities in the brains of patients with spinal cord compression. Degenerative spinal cord compression represents a unique model of reversible spinal cord injury. In the investigator's previous work, they have demonstrated that cortical reorganization and recruitment is associated with metabolic changes in the brains of patients recovering from spinal cord compression and is correlated with recovery and improved neurological scores. The goal of this study is to combine a rigorous platform of clinical care that includes preoperative evaluation, surgery, and rehabilitation, with state of the art imaging techniques to demonstrate how rehabilitative therapy can increase brain plasticity and recovery of neurological function in patients with spinal cord injury. Neurological function will be carefully evaluated in two groups of patients, those receiving rehabilitation and those not receiving rehabilitation after spine surgery, and will be correlated with the results of advanced imaging.

Eligibility Criteria

This trial is for right-handed individuals with progressive neurological deficits lasting less than 24 months, who are eligible for MRI scans. It's designed to help those recovering from non-traumatic spinal cord injuries like spondylosis and cervical myelopathy.

Inclusion Criteria

My neurological symptoms have worsened in the last 2 years.

Right-handed

Eligible for MRI scanning

Exclusion Criteria

I am not fluent in English.

Being claustrophobic

I have a condition that affects my nervous system.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preoperative Evaluation

Participants undergo preoperative evaluation including advanced imaging techniques

1-2 weeks

Surgery

Participants undergo spine surgery as part of the clinical care platform

1 week

Rehabilitation

Participants receive rehabilitative therapy to increase brain plasticity and recovery of neurological function

6 weeks

Weekly sessions

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments at multiple time points

6 months

Follow-ups at 4 weeks, 6 weeks, and 6 months

Treatment Details

Interventions

• Occupational therapy rehabilitation

Trial Overview The study tests how occupational therapy rehabilitation after spine surgery can improve brain plasticity and recovery of neurological function in patients with spinal cord injury, using advanced imaging techniques to track progress.

Participant Groups

Group I: Rehabilitation Experimental Treatment 1 Intervention

Group II: No rehabilitation Active Control 1 Intervention

Occupational therapy rehabilitation is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Occupational therapy for:

• Spinal cord injury rehabilitation
• Neurological function recovery

Approved in European Union as Occupational therapy for:

• Spinal cord injury rehabilitation
• Neurological function recovery

Approved in Canada as Occupational therapy for:

• Spinal cord injury rehabilitation
• Neurological function recovery

Who Is Running the Clinical Trial?

Western University, Canada

Lead Sponsor

Trials

270

Recruited

62,500+

Findings from Research

In a study of 136 patients with spinal cord injuries, those with incomplete injuries (ASIA-B, ASIA-C) achieved higher levels of independence during early rehabilitation compared to those with complete injuries (ASIA-A), with 45.9% of incomplete cases reaching expected independence levels.

The effectiveness of occupational therapy was significantly influenced by the level of spinal cord injury, as patients with cervical injuries showed a higher likelihood of achieving their rehabilitation goals (33.3-100% success) compared to those with thoracic-lumbar injuries, where no patients reached expected independence levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occupational therapy for patients with spinal cord injury in early rehabilitation. Mingaila, S., Krisciūnas, A.[2018]

A study involving 72 patients with complete cervical tetraplegia showed that occupational therapy significantly improved their ability to perform daily activities, with notable increases in self-care scores after six weeks of therapy.

The therapy sessions, conducted by a trained occupational therapist, resulted in significant improvements in specific tasks such as feeding, bathing, dressing, and grooming, indicating the effectiveness of OT in enhancing independence for these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study. Arsh, A., Anwar, Z., Zeb, A., et al.[2023]

Patients with spinal cord injury (SCI) received an average of 52 hours of occupational therapy (OT) during rehabilitation, with significant variations in time spent on different activities based on the type of neurological injury.

The most time-consuming OT activities included strengthening/endurance exercises, activities of daily living (ADLs), and range of motion/stretching, with 77% of therapy occurring in individual sessions, highlighting the importance of personalized treatment approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The SCIRehab project: treatment time spent in SCI rehabilitation. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation. Foy, T., Perritt, G., Thimmaiah, D., et al.[2023]

Occupational therapy (OT) interventions during inpatient spinal cord injury rehabilitation significantly influence functional outcomes, particularly for specific patient subgroups, such as those with motor complete paraplegia and low tetraplegia.

For patients with motor complete paraplegia, focusing on clothing management and hygiene related to toileting was linked to better self-care scores, while for those with low tetraplegia, training in lower body dressing and wheelchair mobility was crucial for improving their functional independence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. Ozelie, R., Gassaway, J., Buchman, E., et al.[2021]

The occupational therapy program for patients with acute spinal cord injuries was designed to provide immediate rehabilitation in the acute care setting, emphasizing early intervention.

Developed collaboratively by experts from Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago, the program includes comprehensive guidelines for evaluation, treatment, orthotic selection, and psychological support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Occupational therapy management of the acute spinal cord-injured patient. Sargant, C., Braun, MA.[2019]

In a study of 29 occupational therapy students, it was found that patient falls are the most frequently unreported safety incidents, with 47.1% of students never reporting them, despite falls being the most commonly reported issue overall (41.1%).

The study highlights a significant under-reporting of safety incidents, particularly in documentation and equipment-related issues, indicating a need for improved reporting practices and measures to enhance patient safety during academic practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Patient safety in the training practices of an undergraduate program in Occupational Therapy]. Peñas-Felizzola, OL., Parra-Esquivel, EI., Gómez-Galindo, AM.[2022]

A quality assurance study was conducted to improve equipment ordering for spinal cord-injured clients, focusing on optimizing functioning while managing costs.

The study involved a follow-up survey of patients from the New England Regional Spinal Cord Injury Center, which identified issues in equipment ordering and led to a plan that enhanced accountability based on client needs and injury levels.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quality assurance in equipment ordering for the spinal cord-injured client. Smith, R.[2019]

In a study of 95 individuals with spinal cord injury (SCI) during inpatient rehabilitation, most participants reported spending significant time in sedentary leisure activities, with little to no engagement in higher intensity physical activities outside of therapy sessions.

However, there was a notable increase in physical activity measured by accelerometers from admission to discharge, particularly in individuals with tetraplegia and those who were ambulatory, indicating that patients can enhance their activity levels during their rehabilitation stay.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation. Zbogar, D., Eng, JJ., Miller, WC., et al.[2018]

Occupational Therapy for spinal cord injured patients has evolved from focusing solely on manual activities to emphasizing the attainment of independence, highlighting the importance of functional levels in patient care.

Creative activities and computer-based technology have been integrated into OT regimens, demonstrating that these approaches can support patients in achieving greater independence and functional outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Between creativity and functional use--development and determination of the status of ergotherapy in rehabilitation of the spinal cord injured patient]. Knauss, R.[2012]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Occupational therapy for patients with spinal cord injury in early rehabilitation. [2018]

2. Pakistan pubmed.ncbi.nlm.nih.gov

Effectiveness of occupational therapy in improving activities of daily living performance in complete cervical tetraplegic patients; A quasi experimental study. [2023]

3. England pubmed.ncbi.nlm.nih.gov

The SCIRehab project: treatment time spent in SCI rehabilitation. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Occupational therapy management of the acute spinal cord-injured patient. [2019]

6. Colombia pubmed.ncbi.nlm.nih.gov

[Patient safety in the training practices of an undergraduate program in Occupational Therapy]. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Quality assurance in equipment ordering for the spinal cord-injured client. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Physical activity outside of structured therapy during inpatient spinal cord injury rehabilitation. [2018]

9. Germany pubmed.ncbi.nlm.nih.gov

[Between creativity and functional use--development and determination of the status of ergotherapy in rehabilitation of the spinal cord injured patient]. [2012]