Mental Health After SCI

Physical Stimulation Interventions

Author Year
Country
Research Design
PEDro Score
Total Sample Size		 Methods Outcome
Tan et al., (2011)
USA
RCT
PEDro=8
NInitial=105 NFinal=100		 Population: Mean age=52yr; Gender:
males=90, females=15; Level of injury:
paraplegia=66, quadriplegia=37,
unknown=2; Severity of injury:
incomplete=52, complete=42,
Population: Mean age=52yr; Gender:
males=90, females=15; Level of injury:
paraplegia=66, quadriplegia=37,
unknown=2; Severity of injury:
incomplete=52, complete=42,		 1. At baseline, the treatment group had
significantly poorer scores on CESD-SF (p<0.05).
2. There was no significant main effect
of time on CES-D-SF.
3. There were no significant time x
group interactions on CES-D-SF.
Defrin et al., (2007)
Israel
RCT
PEDro=10
N=12		 Population: Mean age=54 yr; Gender:
males=7, females=4.
Intervention: Individuals were
randomly placed into two groups: real or
sham 10 daily motor repetitive
transmagnetic stimulation (rTMS)
treatments (500 trains at 5 Hz for 10s;
total of 5000 pulses at intensity of 115%
of motor threshold) over a 2 wk period,
using figure-of-8 coil over the vertex.
Primary outcome measure was of pain;
while depression was a secondary
outcome measure for the treatment.
Outcome Measures: Beck Depression
Inventory (BDI)		 1. Real and sham TMS groups showed
a significant decrease in BDI values
following the treatment period in
comparison to pretreatment BDI
values (p<0.01).
2. This reduction was maintained by
both groups at follow-up (4.5 wk)
(p<0.01).
3. Only individuals in the rTMS
treatment group exhibited a
decreased level of depression
during follow-up in comparison to
the values at the end of treatment
(p<0.05).
Fregni et al.,(2006)
USA
RCT
PEDro=8
NInitial=17 NFinal=15		 Population: Mean age=35yr; Gender:
males=14, females=3; Level of injury:
paraplegic=8, quadriplegic=9; Severity
of injury: incomplete=6, complete=11;
Mean time post injury=3.5yr;
Depression status=symptoms.
Intervention: Individuals with central
pain were randomized to receive active
transcranial direct current stimulation
(tDCS, treatment; n=11) or sham tDCS
(control, n=6) 20min/d for 5d. Outcomes
were assessed at baseline, 1-5d pre
and post treatment, and 16d follow-up.
Outcome Measures: Beck Depression
Inventory (BDI), Visual Analogue
Scale-Anxiety (VAS-A).		 1. On BDI, there was no significant
effect of time (p=0.82), group
(p=0.43), or time x group interaction
(p=0.94).

Discussion

Three studies evaluated the using of physical stimulation interventions in reducing depressive symptoms post SCI (Defrin et al. 2007; Fregni et al. 2006; Tan et al. 2011). One RCT by Defrin et al. (2007) evaluated the effectiveness of transmagnetic stimulation in reducing pain post-SCI. This study found a significant decrease in depression in individuals treated with transmagnetic stimulation compared to those in the control group at time of follow-up 2-6 weeks post treatment. No significant effects were seen of transcranial electrical stimulation or transcranial direct current stimulation (Fregni et al. 2006; Tan et al. 2011).

Conclusion

There is level 1b evidence (from one randomized controlled trial: Defrin et al. 2007) for the effectiveness of repetitive transmagnetic stimulation in reducing depressive symptoms.

Repetitive transmagnetic stimulation may improve symptoms of depression post SCI.

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