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Updated: Jan 23, 2026

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia
Published on: July 2, 2013
Not all brain regions are created equal for improving bimanual coordination in individuals with chronic stroke
Wan-Wen Liao1, Jill Whitall2, George F Wittenberg3
1Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA.
Objective:
The now standard cortical stimulation approach of inhibiting contralesional primary motor cortex (cM1) disrupts bimanual coordination while facilitating ipsilesional M1 (iM1) fails to enhance paretic arm function, in severely impaired individuals. We propose an alternative target, enhancing contralesional dorsal premotor cortex (cPMd) to improve bimanual coordination and compare its effects to iM1.
Methods:
Fourteen participants with stroke received 5-Hz repetitive transcranial magnetic stimulation (rTMS) on cPMd or iM1 in a repeated cross-over design. Bimanual force/neuromuscular coordination and cortical excitability were assessed. We also examined the relationship of baseline motor function/interhemispheric inhibition (IHI) to participant's responses to each stimulation target.
Results:
We identified two patterns of responses. Participants with more severe impairment and weaker IHI improved bimanual force/neuromuscular coordination, ipsilesional activations and reduced IHI after cPMd-rTMS; whereas, those with milder impairment and stronger IHI improved only after iM1-rTMS.
Conclusions:
Cortical stimulation protocols could be tailored to the types of tasks and to individuals' severity of impairment. Facilitation of cPMd may improve bimanual coordination especially for individuals with limited arm/hand function.
Significance:
Our study is the first to identify cortical stimulation strategies for improving bimanual coordination for individuals with different level of severity of stroke.
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