The combined effects of rTMS and upper extremity robotic therapy for restoring upper extremity function in patients with spinal cord injury: A randomized controlled trial.

Abstract

Context/objective: Non-invasive neuromodulation may be an effective treatment for stimulating motor and functional recovery of the upper extremities after spinal cord injury (SCI). We aimed to investigate the effects of combining repetitive transcranial magnetic stimulation (rTMS) with robotic therapy. We compared upper extremity function in patients who received rTMS and robot therapy to those who received sham rTMS and robot therapy.

Design: Randomized controlled trial.

Setting: Rehabilitation center.

Participants: Thirty patients with SCI were randomized into two groups: an intervention group (IG) receiving rTMS plus robotic therapy and a control group (CG) receiving sham rTMS with robotic therapy.

Interventions: The IG received 15 sessions of combined rTMS and robotic therapy over 5 weeks (3 sessions per week), while the CG received sham rTMS with robotic therapy.

Outcome measures: Functional assessments pre- and post-intervention included the Graded Redefined Assessment of Strength, Sensibility, and Prehension (GRASSP), grip strength, pain levels, the modified Ashworth scale (MAS), and the Korean version of the Spinal Cord Independence Measure III (KSCIM-III).

Results: Both groups showed significant post-treatment improvements in GRASSP domains (Strength, Sensation, Quantitative Prehension), with no significant intergroup differences. Grip strength, pain, and MAS scores improved in both groups without significant differences. In KSCIM-III, the IG showed significant gains in feeding and grooming, while the CG significantly improved in wheelchair-to-toilet/tub transfers.

Conclusions: This study suggests that combining rTMS with upper extremity robotic therapy may have potential benefits for upper extremity function in patients with SCI. However, the addition of rTMS did not demonstrate clear superiority over robotic therapy alone. Further research with larger cohorts and optimized protocols is warranted to clarify its therapeutic value.Trial registration: Clinical Research Information Service, Republic of Korea identifier: KCT0004443.