Table 9 Studies of TBS for Reducing Spasticity

Author Year

Research Design

Total Sample Size

Methods Outcome

Gharooni et al. 2018


RCT Crossover





Population: SCI (n=10): Mean age=46.8±11.9yr; Gender: males=8, females=2; Level of injury: C=10; Mean time since injury=0.95±1.18; AIS scale: B=1, C=4, D=5.

Intervention: Participants were randomized to receive either intermittent transcranial theta-burst stimulation (iTBS) or sham first. A 90 mm circular coil placed on the Cz position of the skull delivered iTBS. Three stimuli at 50 Hz were repeated at 200 millisecond intervals for 2 seconds. An inter-train interval of 8 seconds was repeated 20 times for a total of 600 pulses in 200 seconds. Stimulator output intensity was determined as 80% of the resting membrane threshold as observed by a muscle twitch in the upper limbs during resting state. Sham iTBS consisted of the same protocol with the exception that the coil was turn 90 degrees about its vertical midline axis to ensure no brain stimulation. A 2-week washout period was used in between crossover. Each condition consisted of 10 sessions over 2 weeks. Outcome measures were assessed at baseline and 2 weeks post intervention.     

Outcome Measures: Combined upper-limb modified Ashworth Scale of bilateral elbow and wrist extension and flexion (mAS); Leeds Arm Spasticity Impact Scale (LASIS); Visual Analogue Scale for spasticity (VAS-S).

1.     While there was an observed reduction in mAS, it does not appear to be large enough to improve participants’ perception of spasticity or improvement in function as measured by LASIS and VAS-S.

2.     Intervention effects (adjusted for baseline) include; mAS= -2.67 (CI: -5.17 to -0.17), LASIS=0.16 (CI: -0.18 to 0.48), VAS-S= -1.99 (CI: -21.00 to 17.01).

Nardone et al. 2017


RCT Crossover




Population: SCI (n=10): Mean age=42.8±11.9yr; Gender: males=7, females=3; Level of injury: C=6, T=4; Mean time since injury=8.3±4.5yr; AIS scale: C=4, D=6.

Intervention: Participants were randomly allocated to receive either intermittent theta burst stimulation (iTBS) or sham iTBS first. Interventions were separated by a wash out period of at least 2 months. iTBS was delivered over the scalp site corresponding to the motor cortex area of the dominant leg at an intensity of 80% active motor threshold. Ten bursts (composed of 3 stimuli at 50 Hz) were repeated with a theta frequency of 5 Hz every 10 seconds for a total of 600 stimuli/200 seconds. The same protocol was utilized for the sham iTBS, except that the coil was rotated by 90 degrees so that no current was induced in the brain. Both interventions were administered daily for 10 days each. Outcome measures were assessed at baseline, post intervention, and at 1-week and 4-week follow ups.    

Outcome Measures: Spinal Cord Assessment Tool for Spasticity (SCAT); modified Ashworth Scale (mAS).

1.     Results indicate a significant treatment X time interaction effect for mAS and SCAT (p<0.001 for both).

2.     There was also a significant time effect for mAS and SCAT in the iTBS group (p<0.001 for both). More specifically, there was a decrease in mAS and SCAT followed by a return to baseline.

3.     There were no significant time effects for the sham iTBS group for both mAS and SCAT (p>0.05).