{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:48:06Z","timestamp":1791478086449,"version":"4.3.4"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T00:00:00Z","timestamp":1778889600000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272594"],"award-info":[{"award-number":["82272594"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence shows functional electrical stimulation (FES) and intermittent theta\u2010burst stimulation (iTBS) improve motor function in spinal cord injury (SCI). It is unclear whether high\u2010definition cathodal transcranial direct current stimulation (HD C\u2010tDCS) preconditioning could enhance the neuromodulatory aftereffect of iTBS to produce greater improvements in walking function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study examined the synergistic effects of combining HD C\u2010tDCS preconditioning with iTBS and FES therapy on walking ability in individuals with SCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty\u2010four participants with incomplete SCI were randomly assigned to either active or sham HD C\u2010tDCS preconditioning, both followed by identical iTBS and FES interventions. Interventions were delivered once daily, five times weekly for four weeks. Both brain stimulation techniques targeted the primary motor cortex (M1) leg area. The primary outcome was the Lower Extremity Motor Score (LEMS). Secondary outcomes included Fugl\u2010Meyer Assessment of Lower Extremity (FMA\u2010LE), Berg Balance Scale (BBS), Spinal Cord Independence Measure III (SCIM\u2010III), Walking Index for Spinal Cord Injury II (WISCI\u2010II), the root mean square (RMS) values of the rectus femoris and tibialis anterior, step height, knee and ankle range of motion (ROM), and brain functional connectivity via functional near\u2010infrared spectroscopy (fNIRS), evaluated before and after intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Statistically significant differences were observed in all indices between the two groups before and after intervention (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Compared with the control group, the treatment group exhibited a markedly greater improvement in LEMS (MD\u2009=\u20092.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In addition, the treatment group demonstrated notably more pronounced enhancements than the control group in the FMA\u2010LE (MD\u2009=\u20091.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), BBS (MD\u2009=\u20093.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), SCIM\u2010III (MD\u2009=\u20093.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), WISCI\u2010II (MD\u2009=\u20090.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), RMS values of the rectus femoris (MD\u2009=\u200965.19,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and tibialis anterior (MD\u2009=\u20097.20,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), step height (MD\u2009=\u200944.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), as well as changes in knee (MD\u2009=\u200911.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and ankle (MD\u2009=\u20098.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) ROM. Furthermore, fNIRS data revealed that the treatment group exhibited significantly stronger functional connectivity across multiple motor\u2010related cortical networks compared with the control group, including connectivity between the prefrontal cortex (PFC) and M1 (t\u2009=\u20092.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021), the right premotor cortex (rPMC) and M1 (t\u2009=\u20094.99,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and M1 and primary somatosensory cortex (S1) (t\u2009=\u20094.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study shows that HD C\u2010tDCS targeting M1 as a preconditioning intervention before iTBS, combined with FES\u2010assisted walking training, synergistically enhances walking performance and activities of daily living in individuals with SCI. By modulating cortical excitability and promoting motor network reorganization, this sequential multimodal approach enhances neural plasticity and training effects, providing novel mechanistic evidence for mechanistically driven targeted SCI rehabilitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.70932","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T10:51:19Z","timestamp":1778928679000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of High\u2010Definition Cathodal\n                    <scp>tDCS<\/scp>\n                    Preconditioning on Enhancing the Therapeutic Efficacy of\n                    <scp>iTBS<\/scp>\n                    Combined With\n                    <scp>FES<\/scp>\n                    for Improving Walking Function in Patients With Spinal Cord Injury: A Randomized Controlled 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