ABSTRACT
Objective To investigate the clinical effects of repetitive transcranial magnetic stimulation (rTMS) combined with body-weight-supported treadmill training (BWSTT) on patients with incomplete spinal cord injury (SCI).Methods Four patients with chronic incomplete SCI participated in this study.They were first treated with rTMS and then BWSTT training.They were assessed with clinical measures of function.Two of the four patients were assessed in terms of their H reflex,and using functional magnetic resonance imaging (fMRI) and a balance performance monitor (BPM).Results In two of the four patients,American spinal injury association (ASIA) clinical measures of motor and sensory function improved,as did 10 m walking speed and their sense of effort.In static balance tests,the sway path and sway area of the two patients both decreased.These improvements lasted for 3 weeks after the intervention.The two patients' maximum H reflex amplitude and the H/M amplitude ratio decreased.The fMRI results showed progressive enlargement of the activation volume of the movement-related M1 region after treatment.Conclusion High-frequency rTMS combined with BWSTT may improve motor function,elevate excitability of spinal motor neurons and improve the plasticity of the cerebral cortex in chronic incomplete SCI patients.