Identifying and Catalyzing Tipping Points in Post-Stroke Hand Function Recovery: An EEG Monitoring and Closed-Loop TMS Approach

Background Recovery of hand function after stroke is often slow and varies widely between patients. Emerging evidence suggests that rehabilitation may involve “tipping points,” at which neural reorganization accelerates functional gains. In this study, we combined EEG monitoring with closed-loop transcranial magnetic stimulation (TMS) to explore whether such tipping points can be identified and modulated, framed through a quantum-inspired perspective. Methods Sixty stroke patients were enrolled and randomized into a closed-loop TMS group (n = 30) or control group (n = 30). All participants underwent baseline clinical and neurophysiological assessments before an 8-week upper-limb rehabilitation program. In the intervention group, training was supplemented with EEG-triggered closed-loop TMS. Serial EEG recordings, motor evoked potentials (MEP), and TMS-evoked potentials (TEP) were collected alongside clinical scales (FMA-UE, ARAT, grip strength). Assessments were conducted at baseline, Weeks 2, 4, and 6, and at 3-month follow-up. Results Both groups demonstrated gradual improvements, but the closed-loop group showed a marked inflection between Weeks 4–6, with accelerated gains in FMA-UE, ARAT, and grip strength. These functional surges were closely associated with stronger µ-rhythm desynchronization, increased MEP amplitudes, and enhanced TEP N100 responses, reflecting heightened cortical excitability and reorganization. Between-group comparisons confirmed greater improvements in the closed-loop group (all P < 0.05). The recovery trajectory aligns with a quantum-inspired model, where rehabilitation resembles a superposition of neural pathways until a collapse into the optimal route drives rapid functional transition. Conclusions Closed-loop TMS can catalyze tipping points in post-stroke hand recovery. EEG and neurophysiological markers may serve as predictive signals for these critical transitions. A quantum-inspired framework provides a novel lens for interpreting abrupt accelerations in recovery and may guide precision rehabilitation strategies.