Authors: (including presenting author): :
Hong KY (1), So SYI(2), Liu KLA(2), Chan WKW(3), Lau LC(3), So YW(1), Tseung CHT(1), Cheng KYA(1), Wu MCL(1), Yuen KH(1)
Affiliation: :
(1) Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital (2) Department of Physiotherapy, Tung Wah Eastern Hospital (3) Department of Occupational Therapy, Tung Wah Eastern Hospital
Keyword 2: :
trascranial magnetic stimulation
Keyword 3: :
stroke rehabilitation
Keyword 4: :
motor recovery
Introduction: :
Stroke is a major health threat in Hong Kong and ranks 4th as leading cause of death. Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation technique utilizing magnetic pulses to promote neuroplasticity in stroke survivors. It’s a promising adjunct therapy in stroke rehabilitation, particularly for upper limb (UL) motor recovery.
Objectives: :
To investigate the clinical effectiveness of rTMS on UL functional recovery of subacute post-stroke patients.
Methodology: :
Stroke patients with UL motor deficit were recruited from February 2024 to April 2025. Eligibility was assessed by physicians using contraindication checklist. The “hotspot” on the contra-lesion primary motor cortex (M1) was identified via the motor evoked potential (MEP) from the First Dorsal Interosseous (FDI). 6 inpatient & 4 ambulatory-phase sessions of inhibitory rTMS (1Hz) with suprathreshold intensity to contralesional hotspot were scheduled prior to physical training. Active Range Of Movement (AROM), Handgrip strength, Pinch grip strength and Fugl-Meyer Upper Extremity Scale (FM-UE) were evaluated before and after rTMS. The results were analyzed by Paired t-test and Wilcoxon signed-rank test.
Result & Outcome: :
18 participants were recruited. Mean age was 61.3; 61% were male. 56% paretic side was left; 16.7% received rTPA treatment. Mean time elapsed since stroke was 26.7 days. No major incident was reported, minor incidents included insomnia (1.1%) and muscle spasm (0.56%). For AROM of shoulder, mean flexion improved from 48.6 to 101.9 degrees (p=0.000*); abduction improved from 49.2 to 96.7 degrees (P=0.000*). Elbow mean range AROM improved from 76.1 to 112.8 degrees (p= 0.003*). For AROM of wrist, mean flexion improved from 13.6 to 20.0 degrees (p=0.021*); extension improved from 8.3 to 18.6 degrees (p=0.002*). Mean Hand Grip strength improved from 1.67 to 3.3 kg (p=0.051). Mean Pinch Grip strength improved from 0.6 to 1.7 kg (p=0.019*). Total mean FM-UE improved from 19.3 to 33.0 (p=0.000*). CQI Implementation: Previous rTMS service was too doctor-centred with limited throughput. Since 2024, it’s revolutionized by a Team Approach engaging trained colleagues. EDU APN is site manager and coordinates immediate physical sessions to maximize clinical benefits. Moreover, rTMS is started early during in-patient stay. With all measures, more patients get beneficial outcomes. Conclusion: rTMS restores Upper Limb Movement and ignites Hope of Stroke Patients.
