Non-invasive cerebral and spinal cord stimulation for motor and gait recovery in incomplete spinal cord injury: systematic review and meta-analysis.
Agustin Hernandez-Navarro, Aina Ros-Alsina, Muhammed Yurtseven and 2 others
PMID 40050875WHAT IT FOUND
Pooled non-invasive brain and spinal stimulation improved lower limb strength and gait, but this benefit vanished when broken down by technique. rTMS helped strength more than walking; tDCS effects were small.
Spinal stimulation data was too sparse to conclude anything.
Key findings
01When all non-invasive stimulation techniques were pooled together, there was a large overall effect on lower limb motor strength (LEMS), but this effect size dropped significantly when analyzed by specific technique.
02rTMS showed a large effect on lower limb motor strength but only a small effect on gait velocity, while tDCS showed small effects on both strength and gait.
03Non-invasive spinal cord stimulation (tsDCS and tSCS) could not be meta-analyzed due to a lack of studies; the single tsDCS study showed no improvement, while the single tSCS study showed a significant improvement in walking speed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The number of studies for each specific technique was very low, particularly for spinal cord stimulation (only one study each for tsDCS and tSCS), making the pooled results unreliable for guiding specific treatment choices. Participants had highly variable injury levels, severity (AIS grades A through D), and time since injury, which makes it difficult to know who might benefit. All studies included concurrent rehabilitation therapies, so it is impossible to separate the effect of the stimulation from the effect of the therapy itself. Follow-up periods were short and inconsistent (2 to 8 weeks), so long-term benefits are unknown. Many potentially relevant studies were excluded because their data was incomplete or reported in a way that prevented statistical pooling.
Declared interests
The study was funded by the Ministerio de Ciencia e Innovación. No other conflicts of interest are reported in the provided text.
The easy way to misread this
Do not assume that the large pooled effect for strength applies to every technique. The benefit was driven primarily by rTMS, while tDCS showed only small effects, and spinal stimulation data was too sparse to be conclusive. Furthermore, because all patients received concurrent rehabilitation, you cannot attribute the improvements solely to the stimulation.