Comparison of non-invasive neuromodulation for motor function rehabilitation in incomplete spinal cord injury: a systematic review and network meta-analysis.
- 1Rehabilitation Medicine Department, Shandong Provincial Third Hospital, Shandong University, No.11, Wuyingshan Middle Road, Tianqiao District, Jinan City, Shandong Province, 250031, China.
- 2Rehabilitation Medicine Department, Shandong Provincial Third Hospital, Shandong University, No.11, Wuyingshan Middle Road, Tianqiao District, Jinan City, Shandong Province, 250031, China. [email protected].
Abstract
Background
Spinal cord injury (SCI) disrupts structural and functional connectivity between the brain and spinal cord, resulting in severe motor dysfunction. Various neuromodulation techniques have been applied in SCI rehabilitation and have promoted motor recovery to varying degrees. A Bayesian network meta-analysis was therefore undertaken to compare and rank the relative effects of non-invasive neuromodulation techniques on motor-related outcomes in adults with incomplete SCI.Methods
PubMed, Web of Science, Embase, and The Cochrane Library were searched for randomized controlled trials (RCTs) investigating non-invasive neuromodulation for motor function in patients with incomplete SCI, from database inception to September 13, 2025. Bayesian network meta-analysis was performed using R software. The intervention effects of different non-invasive neuromodulation techniques were compared across motor-related outcomes, including the Lower Extremity Motor Score (LEMS), the 10-Meter Walk Test (10MWT), step length, gait speed, the Modified Ashworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM).Results
Seventeen RCTs involving 523 participants were included. For lower-limb motor strength, 20-Hz repetitive transcranial magnetic stimulation (20 Hz-rTMS) and intermittent theta-burst stimulation (iTBS) both yielded favorable estimates, with iTBS slightly ahead (standardized mean difference [SMD] = 0.87, 95% credible interval [CrI] 0.60 to 1.14) of 20 Hz-rTMS (SMD = 0.83, 95% CrI 0.32 to 1.34). iTBS also conferred the largest gain in gait speed (SMD = 0.52, 95% CrI 0.25 to 0.79), whereas 20 Hz-rTMS produced the greatest reduction in spasticity (mean difference [MD] = - 0.41, 95% CrI - 0.7 to - 0.12). Functional independence on the Spinal Cord Independence Measure (SCIM) improved most with 10-Hz repetitive transcranial magnetic stimulation (10 Hz-rTMS) (SMD = 1.03, 95% CrI 0.03 to 2.03). For motor evoked potential (MEP) latency, transcutaneous spinal cord stimulation (tSCS) (SMD = - 1.21, 95% CrI - 1.94 to - 0.48) and 10 Hz-rTMS (SMD = - 1.22, 95% CrI - 2.08 to - 0.35) showed the strongest shortening, followed by iTBS (SMD = - 0.84, 95% CrI - 1.53 to - 0.14). MEP amplitude increased most under 10 Hz-rTMS (SMD = 1.003, 95% CrI 0.13 to 1.88).Conclusions
iTBS, 20 Hz-rTMS, 10 Hz-rTMS, and tSCS each appear to support motor recovery after incomplete SCI.However, the underlying mechanisms remain unclear. Further investigation is required to elucidate the specific mechanisms and clinical utility of different neuromodulation interventions for SCI.
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BibTeX
@article{han2026comparison,
title = {{Comparison of non-invasive neuromodulation for motor function rehabilitation in incomplete spinal cord injury: a systematic review and network meta-analysis.}},
author = {Yun Han and Junting Han and Haixia Wang and Ying Meng and Jiacai Liang and Xiaona Duan and Muyuan Wang and Yuanyuan Li and Pan Lu and Ziyuan Cao and Chunhua Zhang},
journal = {BMC neurology},
year = {2026},
month = jul,
doi = {10.1186/s12883-026-05178-9},
url = {https://europepmc.org/article/MED/42902225},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparison of non-invasive neuromodulation for motor function rehabilitation in incomplete spinal cord injury: a systematic review and network meta-analysis.
AU - Yun Han
AU - Junting Han
AU - Haixia Wang
AU - Ying Meng
AU - Jiacai Liang
AU - Xiaona Duan
AU - Muyuan Wang
AU - Yuanyuan Li
AU - Pan Lu
AU - Ziyuan Cao
AU - Chunhua Zhang
PY - 2026
DA - 2026/07/01
JO - BMC neurology
DO - 10.1186/s12883-026-05178-9
UR - https://europepmc.org/article/MED/42902225
AB - Background Spinal cord injury (SCI) disrupts structural and functional connectivity between the brain and spinal cord, resulting in severe motor dysfunction. Various neuromodulation techniques have been applied in SCI rehabilitation and have promoted motor recovery to varying degrees. A Bayesian network meta-analysis was therefore undertaken to compare and rank the relative effects of non-invasive neuromodulation techniques on motor-related outcomes in adults with incomplete SCI.Methods PubMed, Web of Science, Embase, and The Cochrane Library were searched for randomized controlled trials (RCTs) investigating non-invasive neuromodulation for motor function in patients with incomplete SCI, from database inception to September 13, 2025. Bayesian network meta-analysis was performed using R software. The intervention effects of different non-invasive neuromodulation techniques were compared across motor-related outcomes, including the Lower Extremity Motor Score (LEMS), the 10-Meter Walk Test (10MWT), step length, gait speed, the Modified Ashworth Scale (MAS), and the Spinal Cord Independence Measure (SCIM).Results Seventeen RCTs involving 523 participants were included. For lower-limb motor strength, 20-Hz repetitive transcranial magnetic stimulation (20 Hz-rTMS) and intermittent theta-burst stimulation (iTBS) both yielded favorable estimates, with iTBS slightly ahead (standardized mean difference [SMD] = 0.87, 95% credible interval [CrI] 0.60 to 1.14) of 20 Hz-rTMS (SMD = 0.83, 95% CrI 0.32 to 1.34). iTBS also conferred the largest gain in gait speed (SMD = 0.52, 95% CrI 0.25 to 0.79), whereas 20 Hz-rTMS produced the greatest reduction in spasticity (mean difference [MD] = - 0.41, 95% CrI - 0.7 to - 0.12). Functional independence on the Spinal Cord Independence Measure (SCIM) improved most with 10-Hz repetitive transcranial magnetic stimulation (10 Hz-rTMS) (SMD = 1.03, 95% CrI 0.03 to 2.03). For motor evoked potential (MEP) latency, transcutaneous spinal cord stimulation (tSCS) (SMD = - 1.21, 95% CrI - 1.94 to - 0.48) and 10 Hz-rTMS (SMD = - 1.22, 95% CrI - 2.08 to - 0.35) showed the strongest shortening, followed by iTBS (SMD = - 0.84, 95% CrI - 1.53 to - 0.14). MEP amplitude increased most under 10 Hz-rTMS (SMD = 1.003, 95% CrI 0.13 to 1.88).Conclusions iTBS, 20 Hz-rTMS, 10 Hz-rTMS, and tSCS each appear to support motor recovery after incomplete SCI.However, the underlying mechanisms remain unclear. Further investigation is required to elucidate the specific mechanisms and clinical utility of different neuromodulation interventions for SCI.
SN - 1471-2377
ER -