Efficacy of QuadroPulse rTMS for improving motor function after spinal cord injury: Three case studies

Context/objective: To examine the effects of repetitive QuadroPulse transcranial magnetic stimulation (rTMSQP) on hand/leg function after spinal cord injury (SCI).Design: Interventional proof-of-concept study.Setting: University laboratory.Participants: Three adult subjects with cervical SCI.Interventions: Repeated trains of magnetic stimuli were applied to the motor cortical hand/leg area. Several exploratory single-day rTMSQP protocols were examined. Ultimately we settled on a protocol using three 5-day trials of (1) rTMSQP only; (2) exercise only (targeting hand or leg function); and (3) rTMSQP combined with exercise.Outcome measures: Hand motor function was assessed by Purdue Pegboard and Complete Minnesota Dexterity tests. Walking function was based on treadmill walking and the Timed Up and Go test. Electromyographic recordings were used for neurophysiological testing of cortical (by single- and double-pulse TMS) and spinal (via tendon taps and electrical nerve stimulation) excitability.Results: Sing...