Repetitive Transcranial Magnetic Stimulation with Body Weight-supported Treadmill Training Enhances Independent Walking of Individuals with Chronic Incomplete Spinal Cord Injury: A Pilot Randomized Clinical Trial

• Published in: Brain topography 2024-11, Vol.37 (6), p.1232-1241
• Main Authors: Nogueira, Fernanda, Shirahige, Lívia, Brito, Rodrigo, Lima, Hamably, Victor, João, Sanchez, María Paz, Ilha, Jocemar, Monte-Silva, Katia
• Format: Article
• Language: English
• Subjects: Adult; Biomedical and Life Sciences; Biomedicine; Body weight; Body Weight - physiology; Chronic Disease; Double-Blind Method; Exercise Therapy - methods; Female; Fitness equipment; Functional plasticity; Humans; Magnetic fields; Male; Middle Aged; Neurology; Neuroplasticity; Neurosciences; Original Paper; Pilot Projects; Psychiatry; Quality of Life; Recovery of function; Sensory properties; Spasticity; Spinal cord injuries; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - rehabilitation; Spinal Cord Injuries - therapy; Transcranial magnetic stimulation; Transcranial Magnetic Stimulation - methods; Treatment Outcome; Walking; Walking - physiology
• ISSN: 0896-0267; 1573-6792; 1573-6792
• DOI: 10.1007/s10548-024-01072-0

The purpose of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) combined with body weight-support treadmill training (BWSTT) for improving walking function of individuals with chronic incomplete spinal cord injury (iSCI). A 4-week, double-blinded, randomized, sham-controlled pilot study involved 12 sessions of real (10 Hz, 1800 pulses) or sham rTMS combined with BWSTT (15–20 min, moderate intensity). Walking independence was assessed using the Walking Index for Spinal Cord Injury II (WISCI-II). Lower extremity motor function (lower extremity motor score [LEMS]) and spasticity, sensory function, functional independence (Spinal Cord Injury Measure III [SCIM-III]), and quality of life were also assessed. Walking independence (WISCI-II) after the 6th session was higher in the BWSTT/rTMS real ( n  = 7) (median change (IQR): 3 (1.5 to 3.5)) than in the sham group ( n  = 8) (median change (IQR): 0 (0 to 0.25), but there was no difference between groups after 12th session (BWSTT/rTMS real median change (IQR): 4 (2 to 5); BWSSTT/rTMS sham median change (IQR): 0 (0 to 3.25). Compared to baseline, LEMS and SCIM-III mobility scores were increased after 12 sessions in the BWSTT/rTMS real but not in the sham group. Within- and between-group sensory function, functional independence, and quality of life remained similar. This preliminary result suggests that combining BWSTT with rTMS could lead to earlier gait improvement in patients with chronic iSCI. Significance Adding neuroplasticity-facilitation strategies to conventional rehabilitation can facilitate earlier walking independence and promote long-term functional recovery after chronic iSCI.