"Additive Effects of Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation on...

To investigate whether adding repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) to robotic therapy provides additional benefits in upper extremity motor and functional recovery in patients with chronic ischemic stroke.

Randomized, double-blind, sham-controlled clinical trial.

Tertiary rehabilitation center.

Thirty-six patients (N=36) with chronic ischemic stroke and upper extremity impairment were randomly assigned to real rTMS, sham rTMS, real tDCS, or sham tDCS groups.

Participants received 15 sessions of non-invasive brain stimulation (low-frequency rTMS applied to the contralesional primary motor cortex or anodal tDCS applied to the ipsilesional motor cortex), followed by robotic therapy and conventional physiotherapy.

Upper extremity motor and functional outcomes were assessed using the Fugl-Meyer Assessment-Upper Extremity, Barthel Index, Box and Block Test, Stroke Impact Scale, and Modified Ashworth Scale at baseline, post-treatment, and 12-week follow-up.

Both real and sham rTMS groups showed significant improvements in upper extremity motor function that were maintained at 12 weeks (p<0.05). No significant improvements were observed in the real or sham tDCS groups (p>0.05). Although improvements tended to be greater in the real rTMS group, between-group differences were not statistically significant after correction for multiple comparisons (p>0.017). A reduction in finger flexor spasticity was observed only in the real rTMS group (p<0.05).

The addition of rTMS or tDCS to robotic therapy did not result in superior outcomes compared with robotic therapy alone. These findings suggest that robotic therapy may be the primary driver of functional recovery, while the contribution of non-invasive brain stimulation appears limited.