Effects of Transcranial Magnetic Stimulation on Patients of Poststroke Upper Extremity Motor Impairment: A Randomized Controlled Trial

Am J Phys Med Rehabil. 2026 Jan 1;105(1):20-27. doi: 10.1097/PHM.0000000000002792. Epub 2025 Aug 11.

Abstract

Objective: This study compared the effects of continuous theta burst stimulation and low-frequency repetitive transcranial magnetic stimulation on cortical activity modulation and upper limb motor recovery in subacute stroke patients.

Design: A total of 105 subacute stroke patients with unilateral upper limb impairment were randomly divided into the following three groups: continuous theta burst stimulation, low-frequency repetitive transcranial magnetic stimulation, and sham. Main outcomes included upper extremity Fugl-Meyer score and modified Barthel Index scores at baseline, 4 wks (posttreatment), and 12 wks (follow-up). Secondary outcomes evaluated cortical activation via functional near-infrared spectroscopy.

Results: Among 103 recruited participants, 98 completed follow-up. Both continuous theta burst stimulation and low-frequency repetitive transcranial magnetic stimulation groups showed significantly greater upper extremity Fugl-Meyer improvement than the sham group at 4 and 12 wks ( P < 0.05), while modified Barthel Index scores did not differ significantly. Functional near-infrared spectroscopy revealed that active treatments suppressed contralesional primary motor cortex activation, with continuous theta burst stimulation additionally inhibiting premotor and supplementary motor areas.

Conclusions: Continuous theta burst stimulation and low-frequency repetitive transcranial magnetic stimulation effectively enhanced upper limb motor motricity in stroke patients compared to sham stimulation, suggesting their potential as noninvasive neuromodulatory therapies for poststroke rehabilitation.

Keywords: Continuous Theta Burst Stimulation; Functional Near-Infrared Spectroscopy; Poststroke; Repetitive Transcranial Magnetic Stimulation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Motor Cortex / physiopathology
  • Recovery of Function
  • Spectroscopy, Near-Infrared
  • Stroke Rehabilitation* / methods
  • Stroke* / complications
  • Stroke* / physiopathology
  • Transcranial Magnetic Stimulation* / methods
  • Treatment Outcome
  • Upper Extremity* / physiopathology