Efficacy of combined repetitive transcranial magnetic stimulation and occupational therapy in spinal cord injury patients: a randomized controlled clinical study.

STUDY DESIGN: Randomized controlled trial, clinical trial. OBJECTIVE: Impact evaluation of combined occupational therapy (OT) and transcranial magnetic stimulation (rTMS) on upper limb function in patients with spinal cord injury (SCI). SETTING: National Rehabilitation Center, Seoul, Korea. METHODS: This randomized controlled trial included patients with cervical SCI. One treatment group received OT and rTMS, while the other received OT and sham-rTMS, three times per week for 5 weeks. The primary study outcome (change in upper limb function) was assessed using the graded and redefined assessment of strength, sensibility, and prehension (GRASSP) and hydraulic hand dynamometer. Secondary outcomes included results from the Korean versions of the Spinal Cord Independence Measure III (KSCIM-III), visual analog scale (VAS), modified Ashworth scale (MAS), and Beck Depression Inventory-II. RESULTS: Intervention (IG) and control groups (CG) included 14 and 15 randomly assigned patients, respectively. The IG showed substantial improvements in strength, sensation, and perception when compared to CG. The KSCIM-III results showed greater improvements in IG than in CG. VAS, MAS, and BDI scores increased for pain, spasticity, and depression, respectively, in both groups. Shoulder pain increased significantly in the CG and BDI scores increased significantly in both groups. CONCLUSION: OT and rTMS combination therapy may contribute to upper extremity function improvements and more independence for patients with SCI.