Non-invasive Neuro-orthosis for Quadriplegia

Recruiting at 1 trial location

Overseen By David Friedenberg, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Pacemaker, Seizure disorder, Cancer, others

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

Compensation: Varies

Number of Visits: 7

Duration: 12 weeks

12 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a new wearable device called the NeuroLife EMG-FES Sleeve System, designed for individuals with quadriplegia due to spinal cord injury. The device uses surface electrodes on the forearm to read muscle activity and stimulate muscles, potentially restoring hand and arm functions. Researchers aim to determine its safety and effectiveness and whether muscle signals can indicate recovery progress. The trial suits those who have had a spinal cord injury for over a year and struggle with grasping and manipulating objects. Participants must attend sessions in Columbus, Ohio, three times a week for 12 weeks. As an unphased trial, this study offers a unique opportunity to contribute to groundbreaking research that could enhance quality of life for many.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you have a pacemaker or other implanted devices, you cannot participate in the trial.

What prior data suggests that the NeuroLife EMG-FES Sleeve System is safe for individuals with tetraplegia?

Research has shown that devices like the NeuroLife EMG-FES Sleeve, which use electrical stimulation to assist muscles, are generally safe for people. The NeuroLife system is non-invasive, meaning it doesn't require surgery or implants, often enhancing its safety.

The most common issues with these systems include skin irritation and muscle spasms or tiredness. These effects are usually mild and resolve on their own. The system uses electrodes placed on the forearm's skin, designed for ease of use and comfort.

Overall, studies suggest that the NeuroLife EMG-FES Sleeve System is well-tolerated, with manageable side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

The NeuroLife EMG-FES Sleeve System is unique because it's a non-invasive device that combines electromyography (EMG) and functional electrical stimulation (FES) with up to 160 surface electrodes. Unlike traditional treatments for quadriplegia, which might involve invasive procedures or limited rehabilitation tools, this sleeve offers a closed-loop technology that can both detect muscle activity and stimulate muscles to aid movement. Researchers are excited because it allows participants to practice functional activities with their hand and forearm more effectively, potentially enhancing mobility without surgery or implants.

What evidence suggests that the NeuroLife EMG-FES Sleeve System is effective for tetraplegia?

Research has shown that the NeuroLife EMG-FES Sleeve System, used by participants in this trial, may improve arm and hand function in individuals with long-term paralysis from spinal cord injuries. This system employs EMG to measure muscle activity and FES to stimulate muscles, aiding in movement recovery. Early studies suggest that wearing this sleeve can restore hand and arm function for daily tasks. This non-invasive system, which avoids surgery, uses electrodes on the skin to assist with rehabilitation. Initial findings indicate that the device significantly improves hand grip and control. ^{1 3 6 7 8}

Who Is on the Research Team?

Lauren Wengerd, PhD

Principal Investigator

Ohio State University

David Friedenberg, PhD

Principal Investigator

Battelle Memorial Institute

Peyton Miller, OTD

Principal Investigator

Ohio State University

Are You a Good Fit for This Trial?

This trial is for adults over 22 with chronic tetraplegia from a spinal cord injury, who can't grasp objects but can move their shoulders and elbows. They must be able to attend sessions in person and give informed consent. It's not for those with pacemakers, uncontrolled seizures or conditions that could affect safety or results.

Inclusion Criteria

I can move my shoulder and elbow on my own or with support.

I have had a spinal cord injury in my neck area for over a year.

Able to provide informed consent.

Exclusion Criteria

Comorbid medical condition that, in the opinion of the PI, may impact participant safety or study results

Pregnant or plan to become pregnant (females only)

You have severe and uncontrolled autonomic dysreflexia.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants complete an intensive, task-oriented rehabilitation protocol using the NeuroLife EMG-FES System

12 weeks

3 visits per week (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Assessments at baseline, 4 weeks, 8 weeks, post-intervention, and 4 weeks post-intervention

What Are the Treatments Tested in This Trial?

Interventions

• NeuroLife EMG-FES Sleeve System

Trial Overview

The NeuroLife EMG-FES Sleeve System is being tested on individuals with tetraplegia due to spinal cord injury. This non-invasive device uses electrodes to stimulate muscle activity in the forearm, aiming to restore hand function through rehabilitation therapy three times a week for twelve weeks.

How Is the Trial Designed?

Group I: NeuroLife EMG-FES Sleeve System Experimental Treatment 1 Intervention

The NeuroLife EMG-FES System is a completely non-invasive system (surface electrodes only, no implantable components) worn on the forearm of participants and has up to 160 electrodes that can record electromyography (EMG), or muscle activity, and also electrically stimulate (FES) muscles. Using this combined, closed-loop technology participants will complete a 12-week protocol with a study therapist practicing functional activities using their hand/forearm while wearing the NeuroLife EMG-FES Sleeve System.

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

United States Department of Defense

Collaborator

Trials

940

Recruited

339,000+

Battelle Memorial Institute

Collaborator

Trials

14

Recruited

1,800+

Congressionally Directed Medical Research Programs

Collaborator

Trials

59

Recruited

10,600+

Published Research Related to This Trial

The Nucleus 'FES-22' channel stimulation system was implanted in a 25-year-old paraplegic individual to help partially restore lower limb function, demonstrating its potential for improving mobility in similar patients.

Out of twenty electrodes attached to motor nerves, fifteen successfully produced muscle contractions, indicating effective stimulation and the system's capability to facilitate joint movements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initial results of the nucleus FES-22-implanted system for limb movement in paraplegia. Davis, R., MacFarland, WC., Emmons, SE.[2018]

The novel functional electrical stimulation (FES) system integrated into a powered exoskeleton significantly reduced the motor torques needed for users with paraplegia to perform sit-to-stand transitions, indicating improved efficiency in movement.

All three subjects with spinal cord injury experienced reduced muscle spasticity after using the exoskeleton with FES, and one subject showed enhanced joint movement and further reduced motor torques during over-ground walking, highlighting the potential benefits of FES in rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

FES Coupled With A Powered Exoskeleton For Cooperative Muscle Contribution In Persons With Paraplegia. Murray, SA., Farris, RJ., Golfarb, M., et al.[2020]

The hybrid functional-electrical stimulation (FES) gait system, which includes a computer-controlled orthosis, significantly reduces muscle fatigue and improves movement control compared to traditional FES alone, as shown in a study with four subjects with paraplegia.

By using controllable friction brakes at the hip and knee joints, the system allows for better regulation of limb trajectories and provides necessary support during stance, although further hardware design improvements are needed for practical use outside the lab.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary evaluation of a controlled-brake orthosis for FES-aided gait. Goldfarb, M., Korkowski, K., Harrold, B., et al.[2006]

A second-generation implantable neuroprosthesis was successfully tested in three individuals with C5/C6 spinal cord injuries, showing significant improvements in hand grasp and pinch force over a minimum of 2 years.

The system allowed users to control their hand functions through EMG signals, leading to enhanced performance in daily activities without any system failures, although two of the EMG electrodes required surgical revision.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An implanted upper-extremity neuroprosthesis using myoelectric control. Kilgore, KL., Hoyen, HA., Bryden, AM., et al.[2021]

Functional electrical stimulation (FES) of peripheral mixed nerves can effectively restore motor activity in patients with damaged upper motor neurons, as shown through various neurophysiological and clinical observations.

The therapeutic effects of FES are linked to mechanisms involving spinal reflexes and proprioceptive feedback, suggesting that this method can serve as a valuable orthotic aid for conditions like hemiplegia, paraparesis, and cerebral palsy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional electrical stimulation in control of motor output and movements. Gracanin, F.[2007]

A pilot safety study involving six patients with implantable cardioverter defibrillators (ICDs) showed that long-term neuromuscular electrical stimulation (NMES) of thigh muscles is safe, with no adverse events reported during the treatment.

All patients received a total of over 14 million electrical pulses without any abnormalities in ICD function, suggesting that NMES can be a viable option for improving muscle strength and endurance in patients with chronic heart failure who have ICDs, provided individual risks are assessed beforehand.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term transcutaneous neuromuscular electrical stimulation in patients with bipolar sensing implantable cardioverter defibrillators: a pilot safety study. Crevenna, R., Wolzt, M., Fialka-Moser, V., et al.[2022]

Neuromuscular electrical stimulation (NMES) can effectively increase thigh muscle strength and endurance in heart failure patients, but its use must be carefully monitored due to potential electromagnetic interference (EMI) with implantable cardioverter-defibrillators (ICDs).

In a study of eight patients with ICDs, EMI was detected in three subjects during NMES, particularly when stimulating the neck and thighs, highlighting the need for individualized safety assessments for NMES in patients with ICDs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electromagnetic interference by transcutaneous neuromuscular electrical stimulation in patients with bipolar sensing implantable cardioverter defibrillators: a pilot safety study. Crevenna, R., Stix, G., Pleiner, J., et al.[2022]

Functional Electrical Stimulation (FES) effectively restores controlled muscle contractions and limb function in patients with severe upper motor neuron lesions, particularly benefiting spinal cord injury patients.

To enhance patient acceptance and usability, future advancements in electrode technology and the development of 'close-loop' systems for better control and activation are necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical applications of functional electrical stimulation. Kumar, VP., Lau, HK., Liu, J., et al.[2020]

The study presents a system that uses EMG pattern analysis to enable upper-motor-neuron paraplegics to control functional electrical stimulation (FES) for walking with a walker, demonstrating patient-responsive capabilities.

Since its experimental application began in 1982, the system has evolved to include below-lesion EMG control to adjust stimulation levels based on fatigue, enhancing its effectiveness for users.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EMG pattern analysis for patient-responsive control of FES in paraplegics for walker-supported walking. Graupe, D.[2009]

A neuroprosthesis implant significantly improved walking speed, endurance, and overall gait performance in 21 patients with chronic foot drop due to central lesions, with notable improvements measured by various walking tests.

The procedure was safe, with only one case of postoperative bleeding (4%) and no need for surgical revisions, leading to high patient satisfaction (95%) and quality of life improvements (90%).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Foot drop treatment by implantation of a neuroprosthesis (ActiGait®)]. Yao, D., Jakubowitz, E., Ettinger, S., et al.[2018]

Functional Electrical Stimulation (FES) has emerged as a promising treatment for paraplegics, aiming to restore muscle function, prevent atrophy, and improve mobility and quality of life, despite no current treatments being able to fully restore locomotion.

In a clinical application involving two paraplegic patients, an implanted FES neuroprosthesis demonstrated successful outcomes, with both patients reporting satisfaction after the procedure, highlighting the potential of this technology for enhancing rehabilitation in spinal cord injury cases.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Computer added locomotion by implanted electrical stimulation in paraplegic patients (SUAW). von Wild, K., Rabischong, P., Brunelli, G., et al.[2019]

The Networked Neuroprosthesis (NNP) is the first fully implanted modular neuroprosthetic system that can electrically activate paralyzed muscles and record biopotential signals, offering a significant advancement in restoring functionality for individuals with spinal cord injuries.

Bench testing confirmed that the NNP can generate stimulus pulses and accurately record myoelectric, temperature, and accelerometer signals, indicating its potential for various clinical applications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Design and Testing of Stimulation and Myoelectric Recording Modules in an Implanted Distributed Neuroprosthetic System. Makowski, N., Campean, A., Lambrecht, J., et al.[2022]

Long-term use of functional electrical stimulation (FES) with percutaneous intramuscular wire electrodes has been shown to be effective and relatively safe for over 17 years in two participants with paraplegia, allowing them to stand and walk with assistance.

The study found that while localized inflammation and superficial infections were common, they were manageable with treatment, and improvements in electrode design significantly increased their survival rates, indicating a promising approach for rehabilitation in individuals with mobility impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Functional electrical stimulation for walking in paraplegia: 17-year follow-up of 2 cases. Agarwal, S., Kobetic, R., Nandurkar, S., et al.[2019]

This study successfully demonstrated that an EEG-based brain-computer interface (BCI) can control a functional electrical stimulation (FES) system for overground walking in a person with paraplegia due to spinal cord injury, marking a significant step towards restoring voluntary movement.

The participant completed 30 walking tests over 19 weeks with high information transfer rates and no adverse events, suggesting that this noninvasive approach could lead to further research on brain-controlled walking solutions for individuals with spinal cord injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The feasibility of a brain-computer interface functional electrical stimulation system for the restoration of overground walking after paraplegia. King, CE., Wang, PT., McCrimmon, CM., et al.[2018]

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Non-invasive Neuro-orthosis for Quadriplegia

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The overarching goal of this proposal is to investigate the safety, feasibility, and early efficacy of the NeuroLife EMG-FES system on upper extremity outcomes ...

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This study will evaluate our user-friendly, non-invasive NeuroLife system as both an orthosis for returning grasp function during use, and as a rehabilitation ...

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Restoration of upper-extremity function after task-oriented, ...

Two NeuroLife Sleeve systems were used to deliver FES throughout rehab. The EMG-controlled FES system (Fig. 1A) can both sense movement intent ...

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A User-friendly, Non-invasive Neuro-orthosis That Restore...

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The most common risks associated with FES, and thus the. 103. NeuroLife EMG-FES System, include skin irritation, muscle spasms, and muscle fatigue. 104 or ...

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NeuroLife® Technology | Battelle Product Solution

This technology allows us to measure the nerves and muscles of the forearm with high resolution and in real-time.