Effects of Repetitive Transcranial Magnetic Stimulation Combined With Motor Rehabilitation on Motor and Functional Outcomes in Patients With Ischemic Stroke: A Randomized Sham-Controlled Trial
Ischemic stroke is a leading cause of long-term motor disability, frequently resulting in hemiplegia and limitations in daily activities and quality of life. Motor rehabilitation is a fundamental component of post-stroke care across all stages of recovery; however, functional outcomes may vary, particularly in patients with persistent motor impairment. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that has been used as an adjunct to rehabilitation to modulate cortical excitability and potentially support motor recovery. The purpose of this study is to evaluate the effects of low-frequency rTMS combined with conventional motor rehabilitation compared with sham rTMS combined with conventional motor rehabilitation in patients with first-ever ischemic stroke during the acute, subacute, and chronic stages. Motor function, balance, functional mobility, activities of daily living, and stroke-specific quality of life will be assessed at baseline, after the intervention, and at 3-month and 6-month follow-up.
• Aged 18 to 80 years.
• Diagnosed with a first-ever ischemic stroke, confirmed by neuroimaging.
• Presence of unilateral hemiparesis attributable to the first-ever ischemic stroke.
• Time since stroke onset:
‣ Acute stage: \< 1 month after stroke onset
⁃ Subacute stage: 1 to 6 months after stroke onset
⁃ Chronic stage: \> 6 months after stroke onset
• Moderate neurological impairment, defined as a baseline NIHSS score between 5 and 14.
• Cognitive ability sufficient to understand and follow instructions, indicated by a baseline MMSE score ≥ 20.
• Medically stable and able to participate in a structured motor rehabilitation program.
• Provided written informed consent prior to study enrollment.
• NIHSS and MMSE scores are assessed at baseline only to characterize neurological severity and cognitive status at study entry