Low-Frequency Repetitive Transcranial Magnetic Stimulation as an Adjunct to Conventional Rehabilitation for Hand Recovery in Subacute Stroke: A Randomized Pilot Clinical Study

Abstract

Background: Upper-limb weakness and impaired hand function are frequent sequelae of stroke and may substantially limit functional independence. Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) has been proposed as a non-invasive neuromodulatory adjunct to conventional rehabilitation by reducing maladaptive interhemispheric inhibition and facilitating motor recovery.

Objective: This study aimed to evaluate the feasibility and exploratory clinical effect of contralesional LF-rTMS combined with conventional rehabilitation on hand grip strength and hand function in patients with subacute stroke.

Methods: In this randomized pretest–posttest controlled study, 14 of 55 screened patients with first-ever subacute stroke were assigned to LF-rTMS plus conventional rehabilitation (n = 7) or conventional rehabilitation alone (n = 7). LF-rTMS was delivered over the contralesional primary motor cortex at 1 Hz, 90% resting motor threshold, and 1,200 pulses per 20-minute session, five days weekly for two weeks. We assessed grip strength and manual dexterity in both hands before and after treatment using a hand dynamometer and the Box and Block Test, respectively.

Results: Both groups demonstrated improvement trends in paretic-hand outcomes after the intervention period. Paretic-hand grip strength increased by 1.08 ± 1.26 kg in the control group and 2.27 ± 3.74 kg in the LF-rTMS group. Paretic-hand BBT scores increased by 4.14 ± 7.88 blocks/min in the control group and 5.00 ± 8.33 blocks/min in the LF-rTMS group. However, between-group comparisons of change scores did not show statistically significant differences for either grip strength or BBT.

Conclusion: Contralesional LF-rTMS combined with conventional rehabilitation was feasible and associated with within-group improvement trends in paretic-hand grip strength and manual dexterity among patients with subacute stroke. However, this pilot study did not demonstrate superiority over conventional rehabilitation alone. Larger adequately powered studies with longer follow-up are needed to clarify the clinical benefit and durability of LF-rTMS in post-stroke upper-limb rehabilitation.