Examining the Effects of Theta Burst TMS on Brain Connectivity and Balance Ability in Older Adults With Balance Problems

Inclusion Criteria:

a) Able to provide informed consent b) All ethnic groups c) >65 years of age d) ≥2 non-injury falls or ≥1 injury fall in the past year [17]-[21] e) Absence of dementia/uncontrolled psychiatric disorder h) Able to walk and stand for 5 min continuously independently without assistance (i.e., cane, walker, ankle foot orthotics, electric scooter).

i) Willingness to undergo MRI, participate in the 4-weeks intervention AND in the laboratory studies before, immediately-after, and 3-month after the intervention.

Exclusion Criteria:

1. Inability to provide informed consent.

2. Non-English speaking.

3. Have contraindications to TMS based on TMS Adult Safety Screen (e.g., pregnancy,metal in the brain/skull, neurostimulator, pacemaker, infusion device, medication totreat mental illness)

4. Unintentional weight loss of ≥10 pounds over the past year.

5. Severe uncontrolled hypertension, or uncontrolled diabetes.

6. Poor cognitive status (Montreal Cognitive Assessment (MoCA) score ≥ 26)

7. Untreated depression or Geriatric Depression Scale score on 15 item scale >7

8. History of limb amputation (upper or lower extremity)

9. Planned surgery in the next 3 months.

10. History of chemotherapy or planned chemotherapy in the next 6 months or activemalignancy.

11. Severe osteoporosis, defined by diagnosis of osteoporosis with fracture.

12. Pregnant or have a chance of being pregnant.

13. Chronic inflammatory condition, autoimmune disease or infectious processes such asactive tuberculosis, Human Immunodeficiency Virus, Rheumatoid arthritis, systemiclupus erythematosus, acute or chronic hepatitis B or C.

14. Illicit drug use

15. Use of medications that may increase the risk of falling:

• Sedatives

• Hypnotics

• Anti-cholinergic

• Benzodiazepines

• Anti-depressants

16. Intracranial bleeds visible on their most recent CT or MRI scans.