Lower limb rehabilitation in chronic incomplete SCI: a randomized controlled trial protocol comparing combined TMS-tSCS neuromodulation vs. tSCS alone

BackgroundThe prevalence of depressive disorders among adolescents has been increasing in recent years, significantly impairing emotional development and social functioning. Although conventional treatments, including pharmacotherapy and psychotherapy, have demonstrated effectiveness, limitations such as poor adherence and restricted therapeutic settings remain. Virtual reality (VR) technology, which provides immersive and interactive environments, has shown promising potential in the treatment of mental disorders. However, high-quality evidence regarding its effectiveness in adolescents with depressive disorders remains limited.MethodsProtocol version 1.0, January 2026. This study is designed as a single-center, parallel-group randomized controlled trial. A total of 72 adolescents with depressive disorder who meet the eligibility criteria will be recruited and randomly assigned in a 1:1 ratio to either the intervention group or the control group. Participants in the control group will receive usual care, while those in the intervention group will receive additional VR-based intervention for 4 weeks (three sessions per week, approximately 25 min per session). Assessments will be conducted at baseline (T0), post-intervention (T1), and follow-up (T2). The primary outcome is the change in the 24-item Hamilton Depression Rating Scale (HAMD-24) score from T0 to T1. Secondary outcomes include the Hamilton Anxiety Rating Scale-14 (HAMA-14), Children’s Depression Inventory (CDI), Montreal Cognitive Assessment (MoCA), and heart rate variability (HRV) parameters (SDNN, RMSSD, LF, HF, and LF/HF). Data will be analyzed using linear mixed-effects models under the intention-to-treat principle.DiscussionThis study will systematically evaluate the clinical effectiveness of VR-based intervention in adolescents with depressive disorder, as well as its impact on emotional symptoms, cognitive function, and autonomic nervous system activity. The findings are expected to provide evidence-based support for the application of VR technology in adolescent mental health care.Trial registrationhttps://www.chictr.org.cn, ChiCTR2500114846.