Non‑invasive cerebral and spinal cord stimulation for motor and gait recovery in incomplete spinal cord injury: systematic review and meta‑analysis

Journal of NeuroEngineering and Rehabilitation, 2025 · DOI: https://doi.org/10.1186/s12984-025-01557-4 · Published: January 15, 2025

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

Spinal cord injury (SCI) can impair a person's ability to walk and control their movements. This review looks at the effectiveness of using non-invasive stimulation techniques on the brain or spinal cord to help people with SCI regain motor function and improve their gait. The review included 12 randomized controlled trials (RCTs) with a total of 341 participants. The analysis showed that non-invasive stimulation had significant positive effects on lower limb motor strength and gait speed in individuals with SCI. Different types of stimulation, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), were analyzed separately. rTMS showed a large effect on motor strength, while tDCS had a small effect on both motor strength and gait speed.

Study Duration

From September 2022 until March 2024 (search period)

Participants

341 participants with incomplete SCI

Evidence Level

Level 1: Systematic review and meta-analysis of RCTs

Key Findings

1
Non-invasive central nervous system stimulation had significant effects on Lower Extremity Motor Scale (LEMS) score and gait speed when all studies were pooled together.
2
Repetitive transcranial magnetic stimulation (rTMS) showed large effect on LEMS, however transcranial direct current stimulation (tDCS) displayed a small effect on motor strength and gait speed.
3
No meta-analysis could be performed for non-invasive spinal cord stimulation due to a lack of studies.

Research Summary

This systematic review and meta-analysis aimed to compare the effect of non-invasive cerebral and spinal cord stimulation on gait recovery and motor strength of lower limbs in subjects with SCI. The review included 12 RCTs with 341 participants. When all studies were pooled together, non-invasive central nervous system stimulation had significant effects on LEMS score and gait speed. Subgroup analyses based on stimulation types and levels revealed a significant reduction in these effects, particularly when categorized by stimulation type (rTMS and tDCS).

Practical Implications

Clinical Practice

Non-invasive brain and spinal cord stimulation techniques, particularly rTMS, can be considered as potential adjunct therapies to improve motor strength and gait function in individuals with incomplete SCI.

Future Research

More randomized controlled trials are needed to evaluate neuromodulation interventions in spinal cord injury, particularly at the spinal cord level, to provide a more comprehensive understanding of their effectiveness.

Standardized Assessment

Future research should prioritize the use of standardized motor, gait, and functional recovery measures, as well as follow-up evaluations, to assess the long-term efficacy of non-invasive stimulation techniques.

Study Limitations

1
Availability, presentation and access to complete information from the studies was uneven.
2
There was a big variability of datasets.
3
Our results are restricted to the short-term effects of the interventions.

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