Lower Limb Table 20: RCT Study Using Repetitive Transcranial Magnetic Stimulation

Author Year; Country
Research Design
Sample Size



Guzman-Lopez et al. 2014



Level 4

N= 12

Population: 12 healthy individuals- 6 males and 6 females; mean age= 34y;

Treatment: The experiment included four different conditions in two positions: We examined participants lying supine at rest, which was considered the control condition (rest), and while maintaining a steady ankle tonic plantar flexion (pf), dorsiflexion (df) or standing still (ss) of about 30 % of their maximum voluntary contraction (MVC).

Outcome Measures: H-Reflex, EMG

  1. During pf, there was an increase in the facilitation of the H reflex at ISIs 0–20 ms.
  2. During ss, there was inhibition at ISIs 40–60 ms.

Kumru et al. 2013;


PEDro = 8

Randomized sham-controlled trial


Population: N=17 subjects with SCI (13M, 4F); 19-60 yrs old; all AIS D.

Treatment: Patients were randomized to 2 groups: an active repetitive transcranial magnetic stimulation (rTMS) group and a sham group. 3 participants who began in the sham group were crossed over to the active rTMS group after a washout period of more than 3 weeks.

Outcome Measures: Lower Extremity Motor Score (LEMS); 10 Meter Walk Test (10MWT); Timed Up and Go (TUG); Walking Index for Spinal Cord Injury (WISCI); Modified Ashworth Scale (MAS); Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET).

  1. A significant improvement was observed after the last rTMS session in the active group for LEMS, walking speed, and spasticity. Improvement in walking speed was maintained during the follow-up period.
  2. Sham stimulation did not induce any improvement in LEMS, gait assessment, and spasticity after the last session and neither during follow up.
Effect Sizes

Benito et al. 2012


Cohort Study

Level 2

N= 17

Population: 17 individuals- 13 males and 4 females; incomplete SCi; all AIS D; level of injury: C4 – T12; age range= 18 – 60y

Treatment: Patients were randomized to active rTMS or sham stimulation. Three patients from the initial group of 10 randomized to sham stimulation entered the active rTMS group after a 3-week washout period. Therefore, a total of 10 patients completed each study condition. Both groups were homogeneous for age, gender, time since injury, etiology, and ASIA scale. Active rTMS consisted of 15 days of daily sessions of 20 trains of 40 pulses at 20 Hz and an intensity of 90% of resting motor threshold. rTMS was applied with a double cone coil to the leg motor area.

Outcome Measures: Lower extremities motor score (LEMS), Modified Ashworth Scale (MAS), Walking Index for SCI (WISCI II), 10 MWT, Step length and cadence (assessed during 10 MWT), Timed Up and Go (TUG)

  1. There was a significant improvement in LEMS in the active group but not in the sham group.
  2. The active group also showed significant improvements in the MAS, 10MWT, cadence, step length, and TUG, and these improvements were maintained 2 weeks later.
  3. Following sham stimulation, significant improvement was found only for step length and TUG.