Neurofeedback to improve spasticity after spinal cord injury
Research type
Research Study
Full title
Exploring the Effects of Neurofeedback on Spasticity and Motor Function in Individuals with subacute and chronic Incomplete Spinal Cord Injury
IRAS ID
288894
Contact name
Aleksandra Vuckovic
Contact email
Sponsor organisation
NHS for Greater Glasgow and Clyde
Clinicaltrials.gov Identifier
Duration of Study in the UK
2 years, 7 months, 29 days
Research summary
Summary of Research
After incomplete spinal cord injury (iSCI), many people still have control over their upper and/or lower limbs, but secondary conditions such as spasticity impair the function they have left. Spasticity includes increased reflex response and muscle tone, and is often painful. In this study we want to test a rehabilitation therapy to reduce spasticity after iSCI and improve participants’ control over their extremities. The study involves recording participants’ brain signals (EEG) and displaying them on a computer, so that they learn to control specific features derived from their brain waves. This is called neurofeedback (NF). Two studies conducted in our group that explored NF effect on central neuropathic pain in iSCI reported as incidental finding a decrease in spasms, muscle tightness and foot drop. The effect of NF is immediate and lasts up to 24 hours. In this study, we will explore systematically the short- and medium-term effect of NF on a larger number of iSCI, to inform a potential randomized clinical trial.Gaining control over one's brain activity requires practice and 80-90% people eventually learn the skill. Each participant will therefore attend five sessions of NF taking no longer than two hours each.
20 participants will be recruited and assigned to either upper or lower limb spasticity groups. This will allow us to determine if the mechanism of NF differs between arms and legs. Participants will be further grouped into sub-acute and chronic groups, depending on the time since injury, to pinpoint at what stage post-injury NF is the most effective. All groups will receive the same number of NF sessions.
The primary outcome measure is the change in spasticity of the hand or leg, as measured by the Modified Ashworth Scale (MAS). Secondary outcomes include use of arm/leg, quality of life, and the relation between functional improvement and EEG changes. Outcomes will be compared before/after each session, and before/after the whole intervention period, both inter- and intra-group.
Summary of Results
Spasticity and rigidity are conditions in which muscles become stiff and tight. Spasticity can make movements jerky or cause sudden muscle spasms, while rigidity makes the muscles feel stiff all the time. They can interfere with walking, movement and many other activities of daily living. Spasticity and rigidity are very frequent in people who had a spinal cord injury (SCI), even if they can walk after the injury.
The study “Neurofeedback to improve spasticity after spinal cord injury” explored whether neurofeedback (NF) training could help people with partial SCI improve control of movement and reduce spasticity. Neurofeedback is a training method that helps participants learn to control their brain activity by showing them in real-time how their brain is working. The study was carried out by researchers at the University of Glasgow, with NHS Greater Glasgow and Clyde acting as study sponsor. Participants were recruited from the Spinal Injuries Unit of the Queen Elizabeth University Hospital, Glasgow. We tested the effect of NF in people with long standing (chronic) SCI and those who recently got injured and were still undergoing rehabilitation at the hospital (in the subacute stage).
The goal of this study was to see if people with partial SCI could improve control of their muscles and reduce stiffness, by teaching them to change brain activity related to spasticity. We tested if participants’ muscle tightness and walking speed and quality changed throughout the study period. Participants kept a diary in which they noted spastic episodes and any other changes related to the intervention. The motivation for the study was that the current spasticity treatment includes medication with unpleasant and even disabling side effects. In a previous NF study which aimed to reduce chronic neuropathic pain in SCI patients, the main study researcher noticed that the intervention also reduced spasticity and improved some aspects of walking. As such, the present study was designed to test specifically those aspects of spasticity and movement control.
Participants took part in 5 NF intervention sessions (1-2 sessions/week for 30 min). During NF, they were looking at a screen that showed them their brain wave patterns related to spasticity, in the form of a bar changing colour and size. These patterns are related to controlling how we move, and the way to change them is through techniques such as relaxing or thinking of happy memories.
A total of 11 participants, (8 chronic and 3 subacute SCI patients) completed the study. 9 of the 11 were able to learn the NF technique to change their brain activity as instructed. In some chronic SCI participants, improvements were seen in spasticity, walking speed and overall quality of walking (symmetry, balance), and in the quality of their sleep. In the subacute group, progress was harder to track, as it overlapped with recovery due to the therapy sessions they received in the clinic.
Three participants experienced some side effects during the training. Two of them mentioned feeling muscle tightness and joint stiffness from sitting for long periods (2 hours including study setup, assessments and debriefing), and two felt tired from looking at the computer screen. In addition, two chronic SCI participants reported side effects specifically related to the NF training. One participant felt tired after the first session and experienced sensations like warmth and tingling in their legs after every session, which lasted for a few days. Another participant reported tingling in their shoulders after the fourth session. These expected side effects were reported in our previous NF studies and have a mild and temporary effect.
In conclusion, NF training improved aspects of movement and daily activities for those who successfully learned the technique. The participant diaries were a useful way to track changes in spasticity and movement noticed between sessions. Future research should focus more on walking in addition to spasticity, and confirm these results on a bigger group of SCI participants.REC name
East of Scotland Research Ethics Service REC 1
REC reference
21/ES/0008
Date of REC Opinion
9 Mar 2021
REC opinion
Further Information Favourable Opinion