Paired associative nerve stimulation (PANS) was proposed as a potential nerve rehabilitation treatment strategy. However, few relevant documents are available regarding the strategy, and only a few clinical studies have involved healthy people. To determine the feasibility of the neurorehabilitation treatment and to estimate the effect of PANS on nerve plasticity for individuals with incomplete spinal cord injury (iSCI), a design combining repetitive transcranial magnetic stimulation (rTMS) with trans-spinal electrical stimulation was developed for treating individuals with iSCI in this pilot case study. First, a novel PANS system with multiple stimulation modes was designed and verified with resistors and a metal coil as load. Then, the system was applied to three individuals with iSCI, and five types of paired associative stimulation was performed to confirm the feasibility of the system and determine the most effective treatment strategy. The preliminary result showed that 20-Hz rTMS combined with cathodal trans-spinal direct current stimulation (tsDCS) had the greatest effect on corticospinal excitability. Next, stimulations of 20-Hz rTMS (brain) and sham (spine) as well as sham (brain) and cathode tsDCS (spine) were administered to individuals with iSCI, and the results revealed that paired associative stimulation of brain and spine was more effective than only 20-Hz rTMS brain stimulation or cathodal tsDCS stimulation for corticospinal plasticity.

Original languageEnglish
Article number9478864
Pages (from-to)1341-1349
Number of pages9
JournalIEEE Transactions on Neural Systems and Rehabilitation Engineering
Publication statusPublished - 2021


  • Incomplete spinal cord injury
  • neurorehabilitation
  • paired associative nerve stimulation
  • repetitive transcranial magnetic stimulation
  • trans-spinal electrical stimulation

ASJC Scopus subject areas

  • Internal Medicine
  • Neuroscience(all)
  • Biomedical Engineering
  • Rehabilitation


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