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Effect of iTBS and rTMS Combined with Robotic Rehabilitation on Ambulation and Lower Extremity Motor Function in
Ayse Naz Kalem Ozgen1, Gokhan Yardimci2, Bilge Yilmaz2
1Department of Physical Medicine and Rehabilitation, Etlik City Hospital, Yenimahalle, Ankara, Turkiye.
Objective:
To investigate the effectiveness of intermittent theta-burst stimulation (iTBS) and repetitive transcranial magnetic stimulation (rTMS) combined with robotic rehabilitation on ambulation and lower-extremity motor function in patients with spinal cord injury (SCI).
Design:
This study was a single center, single blind, randomized controlled trial. A total of 30 patients with chronic incomplete SCI were randomly assigned in a 1:1:1 ratio to one of three intervention groups: high-frequency rTMS, iTBS, or sham iTBS. All interventions were administered in combination with robotic rehabilitation. Assessments were performed at baseline, post-treatment, and 4-week follow-up.
Results:
Significant between-group differences were observed at 4 weeks for LEMS, SCIM III, and 10 MWT. Median improvements were 4.0, 5.0, and 0.0 for LEMS (P=.017, q=.050); 3.0, 5.0, and 0.0 for SCIM III (P=.016, q=.050); and 6.6, 5.7, and 0.7 for 10 MWT (P=.005, q=.046) in the rTMS, iTBS, and sham groups, respectively. No significant differences were observed between the active protocols, and no intervention-related adverse events occurred.
Conclusions:
Both rTMS and iTBS combined with robotic rehabilitation were associated with improvements in lower-extremity function, although differences versus sham varied across outcomes. No significant differences were observed between the two active protocols.
