# Effects of repetitive transcranial magnetic stimulation on upper extremity motor function in stroke survivors: study protocol of a randomized sham-controlled trial

## TL;DR

This study tests how repetitive transcranial magnetic stimulation affects upper limb motor recovery in stroke patients through a randomized trial.

## Contribution

A novel sham-controlled trial comparing high- and low-frequency rTMS on specific brain regions for stroke rehabilitation.

## Key findings

- Thirty-six stroke patients will be randomized into three groups to assess rTMS effects on upper limb motor function.
- Primary outcomes will include Fugl-Meyer Upper Extremity Motor Function Rating Scale assessments.
- Secondary outcomes like Barthel Index and NIHSS will also be evaluated alongside exploratory fMRI and MEP data.

## Abstract

Stroke is a group of diseases with neurological deficits caused by cerebrovascular lesions. Despite standard treatment, a large number of patients are left with significant upper extremity motor dysfunction. Therefore, improving upper limb motor function and promoting neurological recovery in stroke patients has become a core challenge in the field of neurorehabilitation.

This study will be designed as a randomized, sham controlled clinical trial. Thirty-six patients with upper limb motor dysfunction after stroke will be included, and their Fugl-Meyer Upper Extremity Motor Function Rating Scale (FMA-UE) score will be ≤ 26 points. Subjects will be randomly assigned to the following three groups (n = 12/group): HF-rTMS: Treated with high-frequency (5 Hz) repetitive transcranial magnetic stimulation (rTMS) on the dorsal premotor cortex (PMd) on the contralesional side. Low-frequency group (LF-rTMS): Treated with low-frequency (1 Hz) rTMS on the primary motor cortex (M1) on the contralesional side. Sham control group: The stimulation target and parameter settings will be the same as those of the high-frequency group, but the coil will be placed perpendicular to the scalp plane. The intervention regimen will be rTMS treatment once daily, five times a week for 3 weeks. Outcome measures: Main outcome measures: Upper limb motor function, assessed by FMA-UE. Secondary outcomes: Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS). Exploratory indicators: fMRI data and motor evoked potential (MEP) parameters. All assessment data will be collected before and after the intervention.

This study has been reviewed and approved by the Basic and Clinical Research Ethics Committee of Sichuan Provincial People’s Hospital (Lun Shen (Yan) No. 353–1 of 2025). The results of this research will be disseminated through the network of professionals and the general public, and peer-reviewed scientific papers will be published and presented at relevant conferences.

This trial has been registered with the Chinese Clinical Trials Registry with registration number ChiCTR2500105502.