Effect of low-frequency repetitive transcranial magnetic stimulation combined with motor imagery training on upper Limb Motor Recovery and Primary Motor Cortex Activation in Stroke Patients

We aimed to investigate the effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with motor imagery training (MIT) on upper limb function recovery and primary motor cortex (M1) activation in patients with stroke. Forty-four patients with stroke were randomly assigned into two groups: experimental (both LF-rTMS combined with MIT, N = 22), and control (LF-rTMS, N = 22) groups. The treatment was performed for 20 min a day, 3 d a week, for 8 weeks. To evaluate upper limb function, the Fugl–Meyer assessment for upper extremity (FMA UE), Wolf motor function test, and action research arm test (ARAT) were conducted. To evaluate M1 activation, motor-evoked potential (MEP) amplitude was evaluated before and after conducting the study. The results indicated that both groups showed significant changes across all evaluation items before and after the intervention. In the prepost and change comparisons, the experimental group demonstrated significantly greater changes in the FMA-UE, WMFT, and ARAT than the control group. Moreover, the combined intervention of LF-rTMS and MIT was effective in improving upper limb function and activating M1 in patients with severe stroke. Therefore, we propose this intervention as a novel clinical intervention method for recovering upper limb function in patients with stroke.