Effects of repetitive transcranial magnetic stimulation on recovery in lower limb muscle strength and gait function following spinal cord injury: a randomized controlled trial

Spinal Cord, 2022 · DOI: https://doi.org/10.1038/s41393-021-00703-8 · Published: September 9, 2021

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study investigates whether a non-invasive brain stimulation technique, repetitive transcranial magnetic stimulation (rTMS), can improve lower limb muscle strength and gait function in individuals undergoing rehabilitation for spinal cord injury (SCI). Participants received either rTMS or a sham stimulation along with their usual care for four weeks. The results showed that rTMS may enhance the recovery of lower limb muscle strength following SCI, but it did not have a clear effect on short-term recovery or gait function. Improvements in gait function were similar in both groups, suggesting a task-specific training effect. The study suggests that while rTMS can be a feasible adjunct therapy, its effect on short-term recovery and gait function needs further investigation with longer intervention periods and larger study populations.

Study Duration

4 weeks

Participants

20 individuals with SCI

Evidence Level

Level 1, Randomized sham-controlled clinical trial

Key Findings

1
High-frequency rTMS may increase long-term training-induced recovery of lower limb muscle strength following SCI.
2
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.
3
LEMS improved signiﬁcantly for REAL at discharge, but not for SHAM, and REAL demonstrated greater improvement in LEMS than SHAM (p < 0.02).

Research Summary

The study investigated the effects of rTMS on lower limb muscle strength and gait function in SCI patients. Twenty participants were randomized to receive rTMS or sham stimulation for four weeks, along with usual care including resistance training and physical therapy. Results indicated more prominent increases in total leg, knee flexor, and knee extensor MVC in the rTMS group compared to the sham group, but no clear main effects were found for any outcome measure. LEMS improved significantly in the rTMS group at discharge compared to the sham group. The study concludes that high-frequency rTMS may increase long-term training-induced recovery of lower limb muscle strength following SCI. However, the effect on short-term recovery is unclear, and rTMS had no effect on gait function recovery.

Practical Implications

Adjunct Therapy Potential

rTMS could be considered as an adjunct therapy to resistance training to enhance muscle strength recovery in SCI patients.

Task-Specific Training

When improving gait function is the goal, rTMS should be combined with gait-specific training.

Further Research Needed

Longer intervention periods and larger sample sizes are needed to fully understand the potential of rTMS in SCI rehabilitation.

Study Limitations

1
Underpowered study due to recruitment restrictions and ineligible volunteers.
2
The intervention period may have been too brief to evoke clear RT-induced gains in muscle strength.
3
Lack of control of key training variables such as relative and absolute training intensity.

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