1000 Section - Dual-Target iTBS: A Circuit-Based Strategy for Motor and Gait Rehabilitation in Stroke and Spinal Cord Injury

We conducted two randomized, single-blinded, sham-controlled trials. 63 patients were assigned to receive iTBS to the affected lower-limb motor cortex (M1) only, both M1 and the contralateral cerebellum (dual-target), or sham stimulation, alongside conventional rehabilitation for 21 days. 30 patients were assigned to receive dual-target iTBS to the central sulcus and the nerve roots of the spinal cord injury segment, or sham stimulation, alongside conventional rehabilitation for 21 days.

Assessments included motor scores (FMA-LE, LEMS), balance (BBS), functional independence (SCIM, MBI), 3D gait analysis, motor-evoked potentials (MEP), and functional near-infrared spectroscopy (fNIRS) for cortical network analysis.

Results: The dual-target iTBS protocol demonstrated synergistic effects in both cohorts. In stroke, the dual-target group showed significantly greater improvements in lower-limb motor function, balance, and gait parameters (step length, swing phase) compared to single-target and sham groups. fNIRS revealed enhanced prefrontal-M1 connectivity and optimized global/local brain network efficiency exclusively with dual-target stimulation. In iSCI, the dual-target group exhibited significantly greater gains in knee muscle strength, motor scores, functional independence, and gait metrics (step length, frequency, ground reaction force) compared to the sham group.

Conclusion: Dual-target iTBS induces robust circuit-specific plasticity by co-activating critical nodes in the cortico-cerebellar or "sensori-cortical-motor" circuits. This strategy significantly improves motor function, gait and functional independence, establishing iTBS as a transformative neuromodulation approach in neurorehabilitation.