Authors: (including presenting author): :
Ip H. Y. J. (1), Chiu W.C. (1), Mak H.C. (1), Cheung H. (1), Chin Y. M. (1) Lam S. K. S. (2), Hung C. Y. (2), Pang K. Y. (2) Wu Y. K. A. (3), Chan W. H. C. (3), Lam K. F. C. (3)
Affiliation: :
(1) Department of Occupational Therapy, PYNEH (2) Department of Neurosurgery, PYNEH (3) Department of Psychiatry, PYNEH
Keyword 1: :
Repetitive Transcranial Magnetic Stimulation
Keyword 2: :
Cognitive training
Keyword 3: :
Acquired brain injury
Introduction: :
Repetitive transcranial magnetic stimulation (rTMS) has been extensively studied globally for various neurological conditions. It is also more commonly applied in public hospital settings in Hong Kong. The participant was a 74-year-old male with a history of a minor ischemic stroke (October 2024) and a subsequent traumatic intracranial haemorrhage (December 2024). He presented with residual mild right-sided weakness, dysphagia, dysarthria, and motor impairments. Occupational therapy assessments at Pamela Youde Nethersole Eastern Hospital (PYNEH) were conducted in March and June 2025.
Objectives: :
This case report evaluates the effectiveness of a novel integrated intervention combining rTMS with concurrent cognitive training for improving cognitive functions in an individual with acquired brain injury (ABI) within a Hong Kong public hospital setting.
Methodology: :
From June to August 2025, the patient received two distinct intervention courses focusing on cognitive functions at PYNEH: 1) A 20-session course of rTMS targeting cognitive networks, paired with concurrent and post-rTMS cognitive training, followed by 2) A second course of 10-session cognitively-focused rTMS administered alongside a separate course of rTMS targeting motor functions. A final course of motor-focused rTMS course was conducted afterwards. A total of 4 courses of rTMS were delivered. The rTMS for cognitive function was applied to the dorsal lateral prefrontal cortex. Each rTMS session consisted of 30 trains of 10 Hz pulse frequency with 90% of the motor threshold. Concurrent cognitive training and post-rTMS cognitive training were also conducted during and immediately after rTMS sessions respectively.
Result & Outcome: :
A retrospective review of clinical notes provided data from three time points: pre-treatment (T1), post-first cognitive rTMS course (T2), and post-treatment (T3). Primary outcome measures for cognitive functions included the Montreal Cognitive Assessment (MoCA-HK), the Rivermead Behavioral Memory Test-3 (RBMT-3), the Symbol Digit Modalities Test (SDMT-written), and the Stroop Color and Word Test. Cognitive outcomes demonstrated notable variation. MoCA-HK improved from 19 (T1) to 24 (T2), then decreased to 20 (T3), resulting in a net 5% improvement from baseline. RBMT-3 General Memory Index improved from 82 (T1; 12th percentile) to 96 (T2; 39th percentile), with a sustained net improvement of 13% with a score of 93 at T3 (32nd percentile). SDMT (written) score showed a minor initial decline from 21 (T1) to 20 (T2), then improved to 23 (T3), yielding a net 10% improvement. Stroop Color-Word Test showed an initial improvement from 38 (T1) to 43 (T2), then followed by a decline to 28 (T3), resulting in a net overall decrease of 26% in color-word test score. The final score remained below the age-matched normative mean (Score 93.98). Subjectively, the patient reported improved cognitive function but estimated a 30% deficit compared to premorbid levels. A slight decline in hand dexterity was noted after the first intervention course.
