The Effects of rTMS in Rehabilitation Following Spinal Cord Injury

The Effects of Systematic, Repetitive Transcranial Magnetic Stimulation in Rehabilitation After Incomplete Spinal Cord Injury: Neuromuscular Adaptations and Recovery of Lower Limb Muscle Strength

The project will investigate whether repetitive transcranial magnetic stimulation (rTMS) can be used to potentiate/prime spinal cord injured patients' nervous systems for more intense rehabilitation exercise of longer duration - thus leading to greater recovery of motion function. The technique, in which a magnetic coil is positioned above the scalp and forms a magnetic field that activates the desired center of the brain (eg motor cortex), is used in clinical practice for the treatment of a number of disorders. However, although a combination of rTMS and gait training in SCI patients previously has proven beneficial, it is unknown whether additional functional gains can be achieved by combining rTMS and supervised, high-intensity resistance training.

In this project, 30 newly-admitted patients will be recruited and randomized to receive either active rTMS and strength training (n = 15) or sham (imitated) rTMS + strength training, in parallel with standard care. The investigators hypothesize that the active rTMS group will have superior gains in locomotor function and muscle mass, compared to the sham group.

Inclusion Criteria:

• sub-acute (<6 months) incomplete spinal cord injury
• admitted at the SCIWDK for primary rehabilitation

Exclusion Criteria:

• Medical history of multiple central nervous system lesions,
• severe structural,
• inflammatory or degenerative cerebral disorders,
• epilepsy,
• other neurological diseases,
• lower limb peripheral injury,
• or orthopedic injuries that may limit maximal effort contractions