Abstract
Study designRandomized sham-controlled clinical trial.ObjectivesThe objective of this study is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) compared to sham stimulation, on the development of lower limb muscle strength and gait function during rehabilitation of spinal cord injury (SCI).SettingSCI rehabilitation hospital in Viborg, Denmark.MethodsTwenty individuals with SCI were randomized to receive rTMS (REAL, n = 11) or sham stimulation (SHAM, n = 9) and usual care for 4 weeks. rTMS (20 Hz, 1800 pulses per session) or sham stimulation was delivered over leg M1 Monday–Friday before lower limb resistance training or physical therapy. Lower limb maximal muscle strength (MVC) and gait function were assessed pre- and post intervention. Lower extremity motor score (LEMS) was assessed at admission and at discharge.ResultsOne individual dropped out due to seizure. More prominent increases in total leg (effect size (ES): 0.40), knee flexor (ES: 0.29), and knee extensor MVC (ES: 0.34) were observed in REAL compared to SHAM; however, repeated-measures ANOVA revealed no clear main effects for any outcome measure (treatment p > 0.15, treatment × time p > 0.76, time p > 0.23). LEMS improved significantly for REAL at discharge, but not for SHAM, and REAL demonstrated greater improvement in LEMS than SHAM (p < 0.02). Similar improvements in gait performance were observed between groups.ConclusionsHigh-frequency rTMS may increase long-term training-induced recovery of lower limb muscle strength following SCI. The effect on short-term recovery is unclear. Four weeks of rTMS, when delivered in conjunction with resistance training, has no effect on recovery of gait function, indicating a task-specific training effect.
Highlights
Spinal cord injury (SCI) is associated with widespread disability for the individual due to detrimental effects on several body functions
Participants in the present study demonstrated marked increases in iMVCKE (∼28%) and total leg MVC (∼29%) in response to 4 weeks of progressive resistance training (RT) combined with active rTMS
This study is the first to investigate the effects of rTMS as adjunct therapy to RT in individuals with SCI
Summary
Spinal cord injury (SCI) is associated with widespread disability for the individual due to detrimental effects on several body functions. In most individuals sustaining SCI, motor recovery is a priority goal of rehabilitation, as impaired motor function contributes considerably to loss of independence and reduced quality of life (QoL). Mobility limitations have been reported as major factors associated with reduced life satisfaction [1, 2], whereas impairments in mobility (walking-to-wheelchair transition) has been shown to reduce QoL and increase depression scores in SCI [3]. Rehabilitation designated to increase lower limb muscle strength is an important factor for improving mobility and functional independence following SCI.
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