Temporary Inactivation of Strong Muscle Sensation to Improve Rehabilitation Interventions in SCI

Prior treatment

• Current participation in upper limb rehabilitation therapies
• Current use of illicit drugs, abusing alcohol, or have withdrawn from alcohol in the last 6 months
• Current use of illicit drugs (including heroin, crack/cocaine, marijuana), abusing alcohol or having withdrawn from alcohol in the last 6 months

Other illness

• History of seizures
• First-degree relative with medication-resistant epilepsy
• Other neurological impairment or condition
• History of traumatic brain injury as documented by Rancho Scale Impairment of \<5
• History of brain MRI documented focal cerebral cortex infarct (e.g. hydrocephalus)
• Allergic to lidocaine
• A neuroactive medication that has the potential to lower the seizure threshold
  • Based on documented publications in stroke, this will include bupropion (wellbutrin), psychostimulants and neuroleptics
  • All medications will be reviewed with physician, Dr. Amol Utturkar (DHR)
  • Healthy Controls:
• History of seizures
• First-degree relative with medication-resistant epilepsy
• Allergy to lidocaine
• Other neurological impairment or condition
• A neuroactive medication that has the potential to lower the seizure threshold
• Based on documented publications on stroke, this will include bupropion (wellbutrin), psychostimulants and neuroleptics

Other

• SCI Patients:
• Pacemaker or another implanted device
• Metal in the skull
• Pregnancy
• Pressure ulcers
• Significant lower motor neuron loss at C7 as noted by a nerve conduction velocity \<50 m/s
• Contractures at the elbow
• Severe spasticity as noted by a modified ashworth scale (MAS) \> 4
• Documented, non-sedated post-traumatic amnesia lasting more than 48 hours
• Pregnancy
• Pacemaker or other implanted device
• Metal in the skull
• Pregnancy

• SCI Patients:
• Provision of signed and dated informed consent form
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, aged between 18 and 75 years old
• Have physician diagnosed cervical incomplete spinal cord injury or lesion (iSCI)
• Classified by the American Spinal Cord Association (AIS) impairment scale as AIS C or D
• iSCI occurred at least 18 months ago
• Level of injury or lesion is between C2 and T1
• Bicep strength must be classified as ≥ 3 muscle grade as defined by the medical research council scale
• Tricep strength must be at least an MRC grade of 2 and bet at least 1 muscle grade lower than the bicep
• Both the biceps and triceps will be required to elicit an active motor evoked potential \>200 uV with transcranial magnetic stimulation
• Must maintain current medication regime
• Must present with a weaker side of the body, as indicated by a Upper extremity motor score difference between the left and right side
• UEMS \< 40 (50 max score)
• Must be able to perform reaching movement training task
  • Healthy Controls:
• Provision of signed and dated informed consent form
• Stated willingness to comply with all study procedures and availability for the duration of the study
• Male or female, aged between 18 and 75 years old
• Must be right-handed
• Must be able to perform hand exercises