Transcranial Magnetic Stimulation (TMS) for Upper Limb Dysfunction in Spinal Cord Injury: a Feasibility Study

Feasibility Study to Investigate the Effects of Transcranial Magnetic Stimulation (TMS) Using Theta Burst Stimulation (TBS) to Treat Upper Limb Dysfunction and Spasticity in Patients With Spinal Cord Injury

This study will investigate how repetitive transcranial magnetic stimulation (TMS) using intermittent theta-burst stimulation (iTBS) paradigm affects sensorimotor dysfunction such as pain, spasticity, motor weakness and sensory loss. TMS is technique which allows non-invasive stimulation of the cortex, and can modulate activity of neurons. The purpose of this study will be to assess the feasibility of using TMS with iTBS paradigm to treat sensorimotor dysfunction in people with incomplete spinal cord injury affecting the upper limbs.

Inclusion Criteria:

• Aged 18-70 years old inclusive
• Traumatic and non-traumatic tetraplegic patient following chronic incomplete (AIS C or D) SCI injury (sustained at least three months ago)
• Referred to the Sheffield Spinal Injuries Centre
• Be able to provide written informed consent or verbal consent in the presence of an independent witness
• Spasticity affecting upper limbs with a Modified Ashworth scale (MAS) 2 or above
• Stable medical treatment for at least 1 week before and 1 week after TMS application
• Stable medical condition

Exclusion Criteria:

• Aged less than 18 years old
• Lack the mental capacity to consent
• Ventilated patients with sedation
• Very acute (<3 months) SCI patients
• Implanted electrical devices such as pacemakers, Concomitant neurological conditions, including any history of epilepsy
• Significant joint-related limitation of passive range of movement
• Unable to attend all TMS sessions
• Pregnancy
• Inability to tolerate TBS
• Significant upper limb contractures