Functional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI.
Our randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs.
Patients and methods
Our study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential).
Our study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.