Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
6149895 | Archives of Physical Medicine and Rehabilitation | 2015 | 36 Pages |
Abstract
A major goal of rehabilitation strategies after spinal cord injury (SCI) is to enhance the recovery of function. One possible avenue to achieve this goal is to strengthen the efficacy of the residual neuronal pathways. Noninvasive repetitive transcranial magnetic stimulation (rTMS) has been used in patients with motor disorders as a tool to modulate activity of corticospinal, cortical, and subcortical pathways to promote functional recovery. This article reviews a series of studies published during the last decade that used rTMS in the acute and chronic stages of paraplegia and tetraplegia in humans with complete and incomplete SCI. In the studies, rTMS has been applied over the arm and leg representations of the primary motor cortex to target 3 main consequences of SCI: sensory and motor function impairments, spasticity, and neuropathic pain. Although some studies demonstrated that consecutive sessions of rTMS improve aspects of particular functions, other studies did not show similar effects. We discuss how rTMS parameters and postinjury reorganization in the corticospinal tract, motor cortical, and spinal cord circuits might be critical factors in understanding the advantages and disadvantages of using rTMS in patients with SCI. The available data highlight the limited information on the use of rTMS after SCI and the need to further understand the pathophysiology of neuronal structures affected by rTMS to maximize the potential beneficial effects of this technique in humans with SCI.
Keywords
rTMSTMSI-waveRMTTBSVASMEPFCRAMTDLPFCAISH-reflexactive motor thresholdSpinal cord injuryresting motor thresholdgamma-aminobutyric acidTheta-burst stimulationRepetitive transcranial magnetic stimulationTranscranial magnetic stimulationcorticospinal tractsRehabilitationflexor carpi radialisHoffman reflexsciMotor cortexprimary motor cortexdorsolateral prefrontal cortexAmerican Spinal Injury Association Impairment Scalevisual analog scaled-waveDirect waveNeuroplasticitymotor-evoked potentialGABA
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Authors
Toshiki PhD, Monica A. PT, PhD,