Effect of iTBS and rTMS Combined with Robotic Rehabilitation on Ambulation and Lower Extremity Motor Function in Chronic SCI Patients

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.