Repetitive Transcranial Magnetic Stimulation Combined With Bimanual Therapy for Upper Limb Stroke Rehabilitation

Inclusion criteria

• Age 40-80 years;
• First-onset stroke patients;
• Patients diagnosed with cerebral infarction or hemorrhage through CT or MRI;
• Signed informed consent form by the patient and their family;
• Stable physiological parameters;
• Stroke occurred within the last 12 months;
• Patients with unilateral hand function impairment caused by the stroke;
• Upper limb muscle tone (Modified Ashworth Scale, MAS) less than 3 points;
• Able to follow two-step commands.

Exclusion criteria

• A history of epilepsy or family history of epilepsy;
• Presence of suicidal tendencies;
• Currently using medications that lower the seizure threshold;
• Pregnant or planning to become pregnant;
• Co-existing neurological diseases (such as multiple sclerosis, other neurodegenerative diseases, meningitis, brain abscess, or meningioma);
• Subjects with uncontrollable migraines caused by elevated intracranial pressure;
• Subjects taking antidepressants who cannot discontinue the medication;
• Subjects with sleep disorders during rTMS treatment;
• Subjects with cerebellar stroke or brainstem stroke;
• Cerebral ischemic disorders resulting from traumatic brain injury;
• Transient ischemic attacks (TIAs);
• History of bleeding tendency and other conditions affecting upper limb function, such as myasthenia gravis, systemic immune neuropathy, severe epilepsy, endocrine system disorders, wearers of external or internal cardiac pacemakers, individuals with metallic implants or orthopedic devices;
• Co-existing severe heart, liver, kidney dysfunction, or other serious physical illnesses;
• Subjects with impaired consciousness who cannot cooperate with examinations or treatments, such as those with mental disorders, or those with intellectual or cognitive impairments, severe dementia;
• Presence of implanted electronic devices in the body;
• Co-existing severe liver, kidney, or hematological disorders;
• Special vulnerable populations;
• Skin disease (e.g., pressure ulcers, trauma, cellulitis, etc.).