Neurostimulation for Respiratory Function After Spinal Cord Injury

This study investigates whether non-invasive brain stimulation (transcranial magnetic stimulation, TMS) combined with spinal cord stimulation can improve breathing function in people with high cervical spinal cord injuries (SCI) — injuries at the neck level that often damage the nerve pathways controlling the diaphragm and respiratory muscles. Many of these patients depend on ventilators to breathe, and even a modest improvement in independent breathing would have a profound impact on quality of life. Participants must be adults aged 18–85 with a spinal cord injury at C1–C5, at least 6 months post-injury, and showing significant respiratory deficits (either on a ventilator or with reduced lung capacity below 80% predicted). They must have a trained caregiver available during sessions. People with active depression, history of seizures, metallic skull implants, cardiac pacemakers, pregnancy, or taking drugs that lower seizure threshold are excluded for safety reasons. Participants will receive neurostimulation sessions and have their lung function and breathing independence assessed throughout the study. This research is significant because respiratory failure is the leading cause of death and hospitalisation in high-level SCI, and even partial restoration of breathing could reduce ventilator dependence.