Date of Award


Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Chris M. Gregory

Second Advisor

Kit N. Simpson

Third Advisor

Addie Middleton

Fourth Advisor

James S Zoller


Depression is the leading cause of disability worldwide and the odds of depression are two to three times greater among those with physical disabilities. Accordingly, the prevalence of depression post-central nervous system (CNS) injury, such as post- stroke and spinal cord injury (SCI), is greater than the general population. The impact of depression extends beyond mood and motivation. Depression has been associated with adverse neuroplastic changes, diminished recovery, increased negative medical sequelae, and higher mortality. Unfortunately, depression is not easily treated. Antidepressants and psychotherapy often do not result in symptom remission and recurrent depressive episodes are common. Additionally, individuals post- stroke and SCI are at an increased risk of polypharmacy and adverse events with pharmacotherapy. Exercise has established anti-depressant benefits similar to pharmacological treatments and emerging evidence suggests properly designed programs can augment antidepressant treatments. Non-invasive brain stimulation, such as repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depression in neurologically intact individuals, but its application post-CNS injury is limited. This thesis explores the following topics regarding depression post-CNS injury; (1) time to depression and associated risk factors post-SCI; (2) relationship between self-reported exercise and depression post-SCI; (3) use of rTMS and exercise post-stroke for treatment of depression.


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