| 저자 |
Sujeong Lee1*, Onyoo Kim1†, Hye-jin Lee1, Bum-suk Lee1, Duk-youn Cho2, Jung-eun Lim2, Jun-min Lee2, Se-guang Yeo2, Ha-yeong Kim1 |
Objective
The aim of this study was to investigate whether intermittent theta-burst stimulation(iTBS), a safe, non-invasive and well-tolerated protocol of excitatory repetitive transcranial magnetic stimulation(rTMS), combined with rehabilitative training can improve upper and lower extremity sensorimotor function in patients with incomplete tetraplegic spinal cord injury(SCI).
Subjects and Methods
In this randomized, single-blind, sham-controlled study, patients with tetraplegia of American Spinal Injury Association(ASIA) Impairment Scale[AIS] B, C, and D were included. A total of thirteen patients were included and devided randomly into the real iTBS and sham iTBS group. Each patient received real or sham iTBS over the hand representation of the primary motor cortex before receiving conventional physical therapy(PT) and occupational therapy(OT). The interventions were scheduled 15 sessions over a 5-week period. The Graded and Redefined Assessment of Strength, Sensibility, and Prehension(GRASSP), grip and pinch strength, the Lower Extremity Motor Score(LEMS), , the Modified Ashworth scalel(MAS), the Spinal Cord Independence Measurement III (SCIM-III), the Berg Balance Scale(BBS), the Trunk Impairment Scale(TIS), and the Beck Depression inventory-II(BDI-II) were compared before and after the stimulation protocols.
Results
Six participants received real iTBS and seven participants received sham iTBS combined with conventional rehabilitation. After 5 weeks of intervention, both groups demonstrated increases in total score of GRASSP-strength, sensibility and quantitative prehension. In addition, the real iTBS group showed improvements in total score of GRASSP-qualitative prehension, SCIM-III, and TIS. The GRASSP-qualitative prehension subscores of lateral key pinch was noted to have been significantly increased in the real iTBS group as evaluated. There was no significant change in the sham iTBS group. There were significant difference between the two groups in GRASSP-qualitative prehension subscore of lateral key pinch and SCIM-III subscore of mobility for moderate distances.
Conclusion
The real iTBS combined with rehabilitative training demonstrated beneficial effects on the lateral key pinch and mobility for moderate distances in patients with incomplete tetraplegic SCI, which were comparable with sham iTBS. These findings suggest that iTBS may be a promising therapeutic tool for upper and lower extremity function in incomplete SCI patients. A larger study is expected in the future. |
