The National Center for Testing Treatments for Chronic Spinal Cord and Traumatic Brain Injury (NCTT)

Developed with Georgene Hergenroeder, R.N., M.H.A, and Pramod Dash, Ph.D., The National Center for Testing Treatments for Chronic Spinal Cord and Traumatic Brain Injury (NCTT) is a multicenter research network that aims to develop treatments to improve the neurological and motor functions of persons living with spinal cord injuries (SCI) and traumatic brain injuries (TBI) and to reduce the premature mortality rates associated with these conditions. As a national network, the NCTT will collaborate with established patient support and advocacy groups as well as other medical institutions.

The Center’s approach toward developing treatments involves multiple concurrent initiatives. The NCTT obtains detailed medical histories, performs examinations and functional tests, and reviews available imaging studies from eligible patients. Potential subjects’ blood samples are also banked and analyzed so that DNA is available to evaluate how patients’ responses to injury as well as treatment are related to their genetic background. Every patient is specifically and thoroughly classified by type and severity of injury, medical issues (e.g., depression, neuropathic pain, recurrent infections, skin breakdown), and current level of neurological function. In combination, the aforementioned steps enable the NCTT to classify subjects’ research interests and injury characteristics in order to offer them appropriate, desirable research opportunities.

Among the upcoming NCTT research programs is a project that aims to investigate the positive impact of Transcranial Magnetic Stimulation on persons with TBI and SCI. After suffering trauma to the brain or spinal cord, these patients may have impaired motor and/or sensory function, ranging from weakness and weakened coordination and balance to paralysis. Neuromotor abnormalities have been found in more than 30% of severe TBI subjects two years post injury; moreover, 59% of persons with SCI are tetraplegic and 41%, paraplegic. Compounding the motor dysfunction are issues of chronic pain, which is present in over 50% of both TBI and SCI cases. Currently, treatment options for impaired motor function and pain are limited and those that do exist offer variable, suboptimal effectiveness.

Evidence suggests that repetitive Transcranial Magnetic Stimulation (rTMS) may be a promising treatment to improve motor function and reduce central neuropathic pain. rTMS is a noninvasive neuro-stimulatory technique in which a coil positioned near the brain generates an electromagnetic field that crosses the skull and induces brain currents. rTMS is well tolerated and relatively safe, and has been tested in multiple conditions including neuropsychiatric, neuromotor, and neuropathic pain. Studies in chronic stroke utilizing rTMS combined with occupational therapy have shown upper extremity motor improvement and reduction in spasticity. However, only a few studies have been performed in subjects with post-acute SCI or TBI; furthermore, the effects of multiple time courses of rTMS on both motor function and chronic pain have never been evaluated. Via the utilization of rTMS, this study will evaluate the effect of rTMS on motor function and central neuropathic pain in people with SCI or TBI. We hypothesize rTMS will produce improvements in in hand function and promote an analgesic effect in SCI and TBI subjects with loss of hand function and/or neuropathic pain below the level of injury.

While these aforementioned research and therapeutic endeavors augment those on-going at other acute intervention networks, NCTT is vastly more cost-effective because enough patients can be enrolled in a few centers and on-call teams are unnecessary. Patients can enroll in more than one trial, separated by time. Thus, NCTT can systematically and simultaneously test viable treatments such as Transcranial Magnetic Stimulation or the use of stem cells.

Alongside these NCTT initiatives are other on-going projects such as “HOPES,” a multicenter, randomized clinical trial investigating the effect of HypOthermia for Patients requiring Evacuation of Subdural Hematoma. Traumatic brain injury (TBI) resulting in subdural hematoma (severe bleeding in the brain) occurs in over 40,000 Americans annually with up to 70% of these injuries resulting in death or severe disability. Hypothermia (extreme cooling) has been proposed as a novel therapy to reduce the effects of this injury. HOPES is a prospective, controlled, multi-center trial that aims to test whether treating TBI patients with hypothermia prior to surgical evacuation of a subdural hematoma improves their long-term prognosis. This trial seeks to confirm that early induction and maintenance of therapeutic hypothermia in patients with TBI undergoing hematoma evacuation will see improved global neurologic outcomes as measured by Glasgow Outcome Scale (GOSE) at six months.

If you are interested in participating in the NCTT or have any questions about the enrollment process, please call us at (713) 486-7771 or email,